Integrative Cognitive Model of Therapeutic Accompaniment

Conceptual and Theoretical Bases.

Autor:Mg. Dante O Tolosa

Título: Magister (U. de Valencia)–Lic. en Psicología. Especialista en Terapia Cognitiva

Maimonides University–Mar del Plata. Academic Director of the Program

Therapeutic Accompaniment Training. UNSE–PECUNSE.

Institutional Dependency: President of the Association of Cognitive Therapists

NOA. San Miguel de Tucumán Argentina.

Thematic axis: Therapeutic Accompaniment – Cognitive-Behavioral Psychotherapy.

Severe Mental Disorders.

Correo Electrónico:dantetolosa@[Link]

The conceptual foundations of the cognitive-behavioral model of function will be presented.

of Therapeutic Accompaniment. The theoretical framework will be deepened.

appealing to integration from the paradigm of evidence-based science.
Conceptually, it will be understood that the AT function will be limited to peripheral areas.
of dysfunctional meaning constructions, rather in the manifestations
cognitive, emotional, and behavioral. From the behavioral model, the interventions of
They will be tested focused on observable and learned behaviors that cause some
degree of discomfort in the person.

Summary

Behavioral function of Therapeutic Accompaniment - the conceptual foundations of

A cognitive model will be presented. It will deepen the theoretical framework, appealing to the
integration from the paradigm of evidence-based science. Conceptually, it is understood
that the AT function will be limited in outlying areas dysfunctional constructs meaning, rather
cognitive, emotional and behavioral manifestations. From the behavioral model, AT

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interventions will focus on observable behaviors and learned that cause some degree of
discomfort in the person.

Since the early years when it was implemented in Argentina, the operational definition
The Therapeutic Accompanist (AT) was adjusting according to the new strategies
what was applied or acquired in the development of their work. The first definition of the
que se tiene noticias es la de Eduardo Kalina (Goyeneche y Piccinini, 2013), quien en la
In the 60s, the term "Qualified Friend" was used to refer to the health agent who worked in.

conventional treatments that failed or were insufficient. These terms came to

to designate an alternative strategy that was applied when classical internationalization and the
medication did not reach the proposed therapeutic purposes.

At a later moment, the term—still in use—of Accompaniment

Therapeutic (AT) refers to a specialized clinical resource that operates from a
psychotherapeutic approach embedded in a professional team, from an experience
intersubjective, where its function is generated in the transitional space of the bond. In this
meeting, of the accompanied and the companion, emphasis is placed on containment of the
patient and offering himself as a reference, while also presenting the companion as a
otro, un testigo–soporte que apuntalay suplementa, como un prójimo cercano favorecedor
of the individual's resilient process.

Based on an analysis of the bibliography on AT in Argentina (Tolosa, 2013), we

they extracted some data that are useful for this work:

has a theoretical psychoanalytic framework of reference, the remaining 15% is

distributed in psychosocial and integrative approaches.

A common factor is the presence of a treatment director or supervisor.

3. The term companion is used as a therapeutic property in itself.

In this way, the need arose (Tolosa, 2015) to give the initial kick-off.
in the generation of a specialized bibliography in AT; which was also
according to the current scientific paradigm, influenced by cognitive models and

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integrative, recognized by the international scientific community as
program developers for treatment with empirical verification for various
mental disorders, especially for those that are more serious and that
they may require the assistance of therapeutic accompaniment.

In this regard, and in search of a new adjustment in the dynamism of the

conceptual and clinical practice, from the cognitive–integrative model is given
relevancia de la funciónAuxiliar Terapéutico(AXT) al desempeño de este agente
of health, which revalues and specifies even more its function as a means to
achieve an end within the framework of a treatment plan (Tolosa, 2015).

Now then, two questions to answer would be the following: 1. Why is it

{"denominacognitivo":"cognitive denomination?","integrativo":"What is referred to as integrative?"}

In relation to the first question, it must be said that, in general terms,

se concibe que el cambio que sebusca con todo plan terapéutico ocurra en los
cognitive processes, which are understood as mechanisms
representational involved in the disturbance and in the generation of
alternatives in the processing system of lived experiences.

According to Judith Beck (2000), the central postulate of the cognitive model assumes that

psychological disturbances would have a common factor of a distortion of

thought, which would influence the mood and behavior of people.
Thus, a realistic assessment and a modification of thinking would produce a

responsible for the continuous improvement of the patient.

One aspect that brings it closer to other models is its object of study, the being.

human as a significant builder of their reality. In this sense, Keegan

(2007:75) affiliate company:

Cognitive models, beyond their differences

epistemological or theoretical, perceive man as a builder

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 of meanings. From birth, the human being must
learning to understand reality if it aspires to survive. The greatest
part of cognitive resources - the mental resources with which
what we manage to understand the reality–they are not innate, but
they are built [...]. This is a task [that we carry out] throughout
of life.

Aaron Beck was the one who named cognitive psychotherapy as the body of
knowledge that I was developing, while Albert Ellis, whom
he is also considered one of the pioneers of this model, named
rational therapy on theoretical gesture.

Beck, Rush, Shaw, and Emery (1983) called it a schema for patterns.
relatively stable cognitives that form the basis of regularity of the
interpretations of reality. For them, people use these schemas.
to locate, code, differentiate and assign meanings to the world in which
They live. This arises the assumption of the attributional capacity of individuals, which
it aims to control the psychological systems that remain in a
permanent feedback.

Based on the information processing metaphor, for this model,

individuals carry out a series of operations through these schemes that
they allow them to select, organize, and categorize stimuli; which makes it
they should be accessible and endowed with meaning. At the same time,

lead individuals to action.

Likewise, the schemes are a continuum that ranges from the active to the inactive.
from modifiable to unmodifiable. Depending on the valence, the schemes that
The hypervalent ones are always active, while the latent ones are activated.
in particular situations.

As adaptive mechanisms of the individual, they take shape through the

relationships that people establish with the environment and the determinants

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genetic. From an evolutionary perspective, they first acquire a strong nuance of adaptation
in trying to ensure that the person survives psychologically and physically, however, the
psychological disturbance appears when they stop fulfilling their function, to
to activate automatically, rigidly, and maladaptively.

The authors argue that the contents of the schemas are the beliefs.
shaped by the relationship between the schemas and reality. Beliefs are
everything that is believed in, are internal operations of the schemes that
allow to make sense of the world and that are built and generalized through
experience. There are different types of beliefs:

a) nuclear (those that form the self of the individual, which are difficult to
change, which give a sense of identity and shape the idiosyncrasy), b)
peripherals (related to more secondary aspects, they are easier to
change and have less relevance than the nuclear ones).

Within this architecture of the cognitive model, Beck (in Beck, Rush, Shaw and
Emery 1983) coined the term automatic thoughts to those thoughts that
they appear in the flow of normal thought and condition its direction or
course. By being assigned absolute certainty, they are not questioned and determine the
conduct and affection. Described as brief and telegraphic, they can be verbal or
appear in the form of images, and they impose themselves automatically. They are

fleeting, conscious, and can be understood as the expression or manifestation

clinic of beliefs. A distinctive feature of these thoughts is

The more nuclear they are, the less recognition they have.

Within the framework of this structure of cognitive processes, the AT will work on
level of automatic thoughts, with emphasis on peripheral beliefs,
but fundamentally in the emotional and behavioral consequences of
these underlying processes. Instead, it will be the therapist who methodically explores
y sistemáticamente en los territorios que hacen a la identidad de la persona. En el
The following graph No. 1 represents that process:

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 In response to the second question, Tolosa (2015) considers that the AT
It frames in an integrative perspective because the approach is conceived.
therapeutic must be based on general principles, where the organization of
the intervention designs do not fit into a hermetic theoretical body, but rather
they are based on hypotheses that address the set of generic variables that
they make up the demand and can be adapted specifically to each
patient (Fernández Alvarez, 2003).

In a study conducted by Carreras and Tolosa (2014) on the AT,

The sample consisted of 106 subjects, when analyzing the therapeutic framework (Psychoanalytic,

Cognitive-Integrative, Behavioral or Systemic) with which the assistants felt

statistical significance. Significant values were more associated with the

patient demand and the therapeutic framework that the theoretical framework that it

sustained.

From this cognitive-integrative model, it is understood that the relationship that

establishes between the AT and the patient is configured within the framework of empiricism

collaborative, which implies a bond that both members consolidate as part

of a team that works together in the search for planned change
The components of this empiricism are expressed in attitudes of

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equality, of teamwork, of sharing responsibility for change, of
unconditional positive regard and absence of value judgments (Beck,
2010).

In the Figure No. presented below, the general scheme can be seen.
that shows how the cognitive-integrative model of AT is composed. There it
you will be able to observe the scenario of virtuous feedback that involves the contribution of

each theoretical model. THERAPEUTIC TASKS

Model
Cognitive

Training in
Social Skills

Social Learning Theory

Behavioral Model

Ecological Neuropsychology

THERAPEUTIC TARES

Thus, from this perspective, any intervention that is carried out must begin
with consideration of the basic processes of the person. That is to say, if one
pretend that a patient modifies a behavior pattern, that they develop a
better perceived self-efficacy, that learns a particular skill and performs it

appropriate neuropsychological ones that allow him to support the other areas
functional. Similarly, when thinking of this model as a system, a change
produced in any of the functional areas will influence in some way the
remaining. Thus, for example, the generation of a new social skill
(training in social skills) in a patient is associated with practice
behavioral, which enhances the cognitive reframing of the experience of exclusion
vivid (cognitive model), influencing, in turn, a better perceived self-efficacy
(social learning theory).

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 Likewise, neurofunctionality (Mias and Krawchik, 2002–Ardila, 2001) provides
the substrate, initially, and then it feeds back positively. It
showed (Iragorri, Rosas, Hernández, and Orozco-Cabal, 2009) that psychotherapy
produce changes in neuronal metabolic rates, at the neurochemical level (in
especially the levels of serotonin), and stimulation of neuronal plasticity. Of
in the same way, as psychotherapy is a process comparable to chronic exposure
a un estímulo controlado, parte de sus efectos sobre el comportamiento pueden
explain themselves through a learning process, which finds its substrate in the
molecular mechanisms of memory and learning.

Finally, this system of the cognitive-integrative conceptual model of the

The function of the AT is framed within two permanent processes: a) The
psychoeducation, which is present at various stages of the therapeutic plan,
improving knowledge about the disease and resources to cope with it and b)
the therapeutic tasks, where the AT plays a major role in the execution
of the activities planned in the therapeutic device.

In conclusion, the Integrative Cognitive Model holds that the function of the AT
it will be governed by general principles of intervention, in accordance with a device
therapeutic that seeks to generate changes in the cognitive processes of the person
that is attended. Likewise, the therapist has an active role alongside the AT in this
process of the designed therapeutic device, where its effectiveness
It will depend on the communicative quality and coordination that exists among them.

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 Bibliography:

Bibliography:
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Iragorri, A, Rosas l, Hernández, G, Orozco-Cabal, G. (2009) Neurobiological Effects of the

Psychotherapy. Med. Journal 17 (1): 75-80.
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Therapeutic Companions: Update

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Mias CD, Krawchik R (2002). Fundamentals of the application of cognitive models

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Tolosa, D (2013) Bibliometric Analysis of the literature on the role of the Companion
Therapeutic in Argentina. Internal distribution material. UNSE–PECUNSE:

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Tolosa, D (2015) From Accompaniment to Therapeutic Assistant. Conceptual bases,
theoretical and clinical aspects of a cognitive-integrative model. Akadia Publishing. Buenos Aires.

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