The use of the "Once-Upon-A-Time…" Test in treatment outcome assessment

• Autor(a) principal: Pires, Rute
• Data de Publicação: 2005
• Outros Autores: Fagulha, Teresa
• Idioma: eng
• Título da fonte: Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
• Texto Completo: http://hdl.handle.net/10451/4189
• topic: "Once-Upon-A-Time..." Test; Treatment outcome assessment; Psychotherapeutic process

In an era in which the advent of managed health care is questioning the value of traditional psychological assessment, we discuss the role of the "Once-upon-a-time…" Test in treatment outcome assessment. The "Once upon a time..." Test (Fagulha, 1992, 1997) is a storytelling projective technique whose purpose is to describe the way children deal with the emotions of anxiety and pleasure. In psychodynamic theories, these emotions have an important adaptive function for psychological development (Freud, 1926/1978; Klein, 1932/1969). The “Once upon a time..." Test task is to complete seven stories which are presented as pictures in a cartoon format. Each story depicts common situations in the life of any child that evoke emotions of anxiety and of pleasure. Five cards refer to anxiety provoking situations and two refer to pleasurable experiences. For each card there are nine scenes that represent different possible ways of dealing with the emotional experience evoked by the card. These scenes are grouped into three categories of three scenes each – the Anxiety category (A), the Fantasy category (F) and the Reality category (R). The child is asked to complete the story drawn on the card by selecting and then placing three of these nine scenes in sequence. The categories of the scenes chosen by the child and the sequences organized with these scenes reflect the way children deal with their emotions, anxiety and pleasure, in a transitional space (Winnicott, 1971/1975) between fantasy and reality. After selecting and placing the scenes in sequence, the child tells the story that he/she has just invented. Although the majority of the studies done on the "Once upon a time..." Test have been centered on the analysis of the chosen scenes, according to their category (Anxiety, Fantasy and Reality) and their placement in sequence (in the first, second or third position), a complementary coding system was developed afterwards. This system involves the study of the arranged sequences based on the nine scenes available for each card, and not only the three categories (Pires & Fagulha, 2001). According to this system, the arranged sequences based on the nine scenes available for each card correspond to four different possible ways of facing anxiety and confronting with it. There is a strategy that represents the non-recognition of the painful emotion – Denial –, and three strategies that involve the recognition of this disturbing affect, corresponding to two distinct ways of coping with it – Operational Adaptive Strategy and Emotional Equilibration Strategy – and to one other that proves to be inefficient in dealing with it – Impossibility. The studies done with both coding systems have come to the same conclusion: the patterns of answers reflect differences in ages. As children mature they are able to master anxiety in a more active and efficient manner. In the coding system category of the scenes chosen and their position in the sequence, this developmental achievement is seen through a tendency to respond to anxious situations by choosing scenes that show either anxiety or reality in the first position of the sequence. There is also a progressive decrease in choice of anxiety scenes for story endings corresponding to an increase in the choice of reality or fantasy scenes. As children mature, fantasy scenes in first position of the sequence are less chosen because they reflect the denial of the distress reflected in the card (Fagulha, 1992, 1997, 2000) Regarding the complementary coding system sequences of scenes, the higher degree of emotional stability allows children to deal with anxious situations through adaptive strategies, such us Operational Adaptive Strategy and Emotional Equilibration Strategy. Denial of the anxiety and Impossibility to deal with it are strategies less used by mature children (Pires & Fagulha, 2001) In view of these empirical data is our aim to analyze and discuss a child pattern of answers to the "Once upon a time..." Test at two different moments of her psychotherapeutic process, at treatment initiation and then again to make a decision about treatment termination. We expect to give an account of the "Once upon a time..." Test potentialities to the objective evaluation of the results of child psychotherapy.