Augusto Mellado

Introduction: This umbrella review identified systematic and non-systematic reviews of quantitative and qualitative empirical studies on interventions aimed at promoting humanization in Primary Health Care (PHC). The objective of this umbrella review was to synthesize and compare the available evidence on interventions aimed at promoting humanization in PHC. It addressed two questions: (1) What are the main definitions and dimensions of humanization in healthcare identified in the existing body of research? and (2) Which interventions promote humanization in PHC, and what outcomes have they demonstrated? Methods: The reviews were selected following PRISMA guidelines and eligibility criteria based on the PICOS strategy (population, interventions, comparators, outcomes, and study design). Records were identified in Web of Science (WoS), Scopus, and PubMed. Results: Twenty-five systematic and non-systematic reviews were included. The evidence shows consistent convergence in defining humanization in PHC as person-centered and relational care grounded in open communication, empathy, respect, and patient participation in decision-making. The most frequently studied interventions include person-centered communication styles, shared decision-making, reorganization of care processes (e.g., welcoming practices, continuity, and coordination), and organizational strategies targeting access and equity. These interventions are robustly associated with improvements in experiential outcomes, such as satisfaction, trust, participation, reduced decisional conflict, and strengthened therapeutic relationships, while effects on final clinical outcomes are more variable and context-dependent. Community-based, intercultural, and digital interventions were also identified, extending humanization toward social determinants, continuity of care, and reduced access barriers. Discussion: Findings showed that humanization in PHC aligns with classic Person-Centered Care frameworks, where patients' values, preferences, and life contexts guide clinical decisions. Relational micro-practices emerge as central quality mechanisms, yet their impact depends on enabling organizational conditions, including time, continuity, coordination, and institutional support. Overall, humanization appears as a system-level property rather than an isolated technique, requiring integrated, context-sensitive, and equity-oriented interventions to achieve sustained and meaningful effects.

Investigation in sexual abuse in children resorting to semiotic analysis is scarce. In this study semiotic transformation processes of four girls aged 7 to 12, attending Treatment Centers for abused children in Santiago, Chile, are examined. Analysis of excerpts from therapy sessions was undertaken tracing meaning trajectories of psychological elaboration around sexual abuse drawing on the methodological approach of the Trajectory Equifinality Model (TEM). Girls dialogical exchanges with therapist were followed, as girls meaning making in semiotic fields was displayed in psychotherapeutic dialogues. Two meaning complexes were analized: to talk about abuse, displayed semiotically as Talk- Not Talk and Remember-Not Remember . Three psychological dynamics are highlighted: psychological distancing, ambivalence and tension. They appear as girls intensely inquire about themselves, trying to look for new perspectives for their lives. Difficult issues appeared around these notions, mostly self concept and relational difficulties. Issues of trust, shame, blame and denial are dealt with. Finally, therapeutical implications are discussed.

Psychotherapy, as a cultural activity, faces the challenge of adapting to historical changes and emerging issues. In this article, a multilevel approach to psychotherapeutic intervention that encompasses the individual, relational, and contextual dimensions is proposed. The approach is based on an historical-cultural theoretical framework that integrates constructivist, systemic, and semiotic components to broaden perspectives for psychotherapy. The primary purpose is to integrate concepts derived from cultural psychology to structure ideas related to the theoretical understanding of intervention. A conceptual elaboration is presented to address the extension of the mind into the social and cultural contexts in continuous exchange between the self and others, as an essential vital process. First, the central concepts of semiosis, development, temporality, and dialogicality are presented as theoretical principles that guide this approach. The article elaborates on the cultural semiotic model as a framework to guide therapists’ understanding of the issues prompting individuals to seek psychological consultation and change, proposing therapeutic aims, conceptual tools for intervention, and strategies for building the therapeutic relationship. The relevance of this theoretical proposal for psychotherapy, as cultural mediation cuts across individual, relational, and contextual levels, is discussed.

Voices are the expression of subjective states of patients and therapists in their discourse during psychotherapy. Some voices can be monological, potentially becoming rigid and limiting the experience, and others dialogical, allowing for greater flexibility and reflexivity. The interaction of voices may be disorganized or organized throughout the psychotherapy. A secondary analysis is presented of a case study of a patient diagnosed with Borderline Personality Disorder (BPD). In this 44-session successful psychotherapy (OQ-45.2), different voices were identified using the Discourse Positioning Analysis Model in Psychotherapy (MAPP), and entropy levels (Hs) were assessed in the interaction of these voices using the State Space Grid (SSG) technique. The objective of this study was to describe the temporal association between the interaction of the patient and therapist's reflective voices, their level of organization (entropy), and the patient's outcomes in psychotherapy. To achieve this objective, an idiographic analysis based on vector auto regression (VAR) was conducted. The results suggest a good fit of the model for one-session delays (lag 1). There was temporal stability (autoregression) [p < .01] and a positive trend [p < .00] of the patient's outcomes, and a positive cross-regression between the degree of organization of voices (t-1) and patient outcomes (t) [p < .01]. A temporal dynamic is suggested in which greater organization of patient-therapist voice interactions influences the quality of the patient's outcomes. No significant association could be established between outcomes and reflective voices despite their positive synchronous correlation (lag 0). Studies at the nomothetic level are needed to test an extension of this model.

La humanización en salud en Chile enfrenta múltiples desafíos que impactan tanto la calidad de la atención como la experiencia del paciente y de los trabajadores sanitarios, desde lo individual, familiar, comunitario, territorial y organizacional. Este concepto, que busca colocar al paciente en el centro del proceso de atención y considerar sus necesidades emocionales y psicológicas, además de las biológicas, por lo que se requiere una transformación profunda en la manera en que se presta la atención sanitaria en sus distintos niveles de atención y prevención. Uno de los principales desafíos es la sobrecarga del sistema de salud. La alta demanda y los recursos limitados a menudo conducen a un enfoque mecanicista y fragmentado, donde la atención se centra en aspectos técnicos y clínicos en lugar de en el bienestar integral del paciente. Esto puede resultar en una falta de tiempo para establecer relaciones interpersonales significativas entre profesionales de la salud y pacientes, afectando la calidad de la comunicación y el nivel de empatía. Presentando de este modo grandes desafíos, como la formación profesional sanitarios humanizados, de medición e indicadores y como se aborda la investigación con una mirada humanizada, la relevancia de la participación activa de pacientes y comunidades, el desarrollo de la humanización en salud pública y atención primaria, la Integración de medicinas complementarias y saberes ancestrales, la humanización del final de la vida y las tecnologías al servicio de la persona humana. Abordar estos desafíos es crucial para mejorar la calidad de la atención y la experiencia del paciente.

Introduction: This systematic review identified qualitative and mixed-methods empirical studies on psychotherapy from dialogical and narrative approaches, aiming to address the following questions: (1) How are subjectivity and intersubjectivity qualitatively understood in dialogical and/or narrative psychotherapies studied using dialogical and narrative approaches? (2) How do therapeutic changes occur, including their facilitators and barriers? (3) What psychotherapeutic resources are available for psychotherapists in these types of studies?Method: The articles were selected according to the Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the eligibility criteria proposed by the PICOS strategy (participants, interventions, comparators, outcomes, and study design) from 163 records identified in the Web of Science Core Collection databases.Results: The systematic review process allowed the selection of 16 articles. The results provided insights into the understanding of subjectivity, intersubjectivity, change in psychotherapy, its facilitators, and barriers from these perspectives. It also offered some therapeutic interventions that can be implemented in psychotherapies, integrating dialogical and/or narrative aspects.Discussion: The centrality of dialogical exploration of patient/client resources, therapists as interlocutors fostering client agency, polyphony serving as scaffolding for change, and interconnection with the sociocultural environment are discussed. The integration of this latter topic has been a challenge for these types of studies, considering the active construction of shared meanings. The dialogical and narrative approaches focus psychotherapy on transforming meanings through dialogue and re-authoring stories, evolving within cultural and historical contexts. Thus, this study highlights the relevance of these perspectives in contemporary psychotherapy, emphasizing dialogue in co-creation within an intersubjective framework.

Individuals psychologically process their experiences while involved in dialogue in daily situations. In psychotherapeutic sessions, we can appreciate the ongoing process of constructing meaning when focusing on a microgenetic level during the exchange of child and therapist. We examine an excerpt from a therapeutic process with a sexually abused child from a socio-genetic perspective, with a focus on the display of semiotic fields, meaning growth and balancing tension and as a mean to deal with the painful consequences. Self-regulatory mechanisms are displayed in dialogical chains, providing insight into processing strategies to cope with a traumatic experience. Ambivalence and tension are essential to elaborate new meanings as well as a therapist willing to accompany the child.