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Dominance and Nurturance in the Narratives Told by Clients in Psychotherapy
Psychotherapy Research
Abstract
The personal narrative or relationship episode has recently been described by Luborsky, Barber, and Diguer (1992) as a "basic data unit in psychotherapy sessions" (p. 287). To determine if the interpersonal content of these narratives is related to psychotherapy outcome, we documented all relationship episodes (i.e., accounts of specific events involving the self and others) from two early, two middle, and two late sessions of each of 20 cases of short-term, dynamically oriented psychotherapy (N = 495 episodes) and coded all interpersonal acts of self and other on Kiesler's (1985) Acts Version of the Interpersonal Circle. Results revealed a significant relation between therapy outcome and the location on the interpersonal circumplex of clients' portrayal of self but not others' acts. Specifically, the most successful clients tended to fall primarily in the friendly-submissive portions of the circumplex on the basis of their portrayal of self acts, while the least successful clients fell on the hostile half of the circumplex.
... The absence of a significant relationship between IIP total and outcome in patients with eating disorders is in accordance with the findings of Constatino and colleagues [26], while other studies have found that IIP-total is associated with treatment outcome [6,24,25]. With regard to the finding that higher levels of interpersonal problems of the Cold type significantly predicted poorer treatment outcome for the patients (p = 0.003), previous research, investigating a broad spectrum of mental disorders treated with different therapeutic methods, has indicated that interpersonal problems in the quadrant Hostile-Dominant negatively affects treatment outcome [6,[12][13][14][15][16][17][49][50][51]. Of these, only one study exclusively deals with the effect of group therapy [14], and another study specifically investigates eating disorders [6]. ...
Background
Interpersonal problems are thought to play an essential role in the development and maintenance of eating disorders. The aim of the current study was to investigate whether a specific interpersonal profile could be identified in a group of patients diagnosed with Bulimia Nervosa, Binge Eating Disorder, or Eating Disorders Not Otherwise Specified, and to explore if specific types of interpersonal problems were systematically related to treatment outcome in this group of patients.
Methods
The participants were 159 patients who received systemic/narrative outpatient group psychotherapy. Interpersonal problems were measured at baseline, and eating disorder symptoms were measured pre- and post treatment. Data were analysed with the Structural Summary Method, a particular method for the analysis of the Inventory of Interpersonal Problems, and hierarchical regression analysis was conducted.
Results
The patients demonstrated a generally Non-assertive and Friendly-submissive interpersonal style. No significant association between the overall level of interpersonal problems and treatment outcome was identified. However, the results showed a correlation between being cold and hostile and poor treatment outcome, while being domineering showed a trend approaching significance in predicting better treatment outcome.
Conclusion
The results indicate that patients with eating disorders show a specific interpersonal profile, and suggest that particular types of interpersonal problems are associated with treatment outcome.
... Downloaded by [b-on: Biblioteca do conhecimento online UMinho] at 04:12 08 June 2016 Luborsky and colleagues (1992) argued that in successful psychotherapy, changes in the responses of other and of the self are more common than changes in wishes. Thus, a successful transformation of the CCRT present at the beginning of therapy is achieved by a decrease in negative responses and an increase in positive responses (of other and of self; Crits-Christoph & Luborsky, 1998;McMullen & Conway, 1997). Several studies (e.g., Bressi et al., 2000;Cierpka et al., 1998) further suggested that these indicators are associated with symptomatic improvement. ...
Psychotherapy research suggests that therapeutic change is associated with the emergence and development of innovative moments (IMs)—that is, exceptions to the problematic self-narrative that brought the client to therapy. This study compares two recovered cases of major depression, according to symptom measures, that presented contrasting profiles of evolution of IMs: one typical of successful therapy (Barbara), and another typical of unsuccessful therapy (Claudia). The core conflictual relationship theme (CCRT) was used to study narrative change independently of the innovative moments coding system (IMCS). The results suggest a high congruence between the IMCS and the CCRT profiles. Although Barbara presented changes in the IMCS and the CCRT in a similar way, Claudia's self-narratives (IMs and CCRT), despite symptom change, did not change. The results are discussed, considering the importance of narrative changes in recovery from depression and the maintenance of therapeutic gains.
... In selecting die particular instances diat informed die present study, I relied on my previous knowledge of die content and themes discussed by each woman during her course of psychodierapy. This knowledge was attained dirough hundreds of hours of listening to die audiotapes of sessions and working widi a large, transcribed set of metaphors of self and odier actions (see McMullen & Conway, 1994) and of narratives of interpersonal episodes (see McMullen & Conway, 1997). ...
Variations in how we describe, explain, and treat "depression" and in who is labeled "depressed" attest to the significance of the social-historical contexts in which our understandings and practices are based. A prevalent, modern-day (Western) conception of "depression" is as a gendered (primarily female), devalued condition characterized by a discourse of the deficient self. In an effort to learn more about the particular forms of this discourse, the metaphors used by 10 depressed women (aged 28–62 yrs) to talk to their psychotherapists about their "selves" in relation to their perceived difficulties were studied. Two broad cultural imperatives were constructed from these metaphors: (1) Don't be too mothering and (2) Don't be too child-like. At the core of these 2 imperatives were messages about the importance of autonomy, for both oneself and others. This valuing of autonomy can be clearly located at the heart of 20th-century Western ideals. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Applications of the agency-eommunion framework have not subsided in recent years. The two constructs have played central roles in recent work on interpersonal behavior measurement (Moskowitz & Zuroff, 2004), interpersonal measurement techniques (Pincus, Gurtman, & Ruiz, 1998), narrative interpretation (McAdams, Hoffman, Mansfield, & Day, 1996), social psychology (Abel & Wojiscke, 2007; Judd, James-Hawkins, Yzerbyt, & Kashima, 2005 ), and interpersonal psychotherapy (Kiesler & Auerbach, 2003; McMullen & Conway, 1997). Most recently, Len Horowitz and colleagues (2006) have reworked several ingredients of the earlier theoretical positions on agency and communion. ...
In this chapter, we are concerned with chronic individual differences in self-presentation. We argue that such dispositions constitute strong and pervasive aspects of personality. People differ in the degree to which they are attuned to self-presentation demands, are motivated to self-present, and in the nature of the image they tend to present. Both the process and individual differences literatures are immense. For booklength treatments, see Schlenker (1980), Rosenfeld, Giacalone, and Riordan (1995), or M. R. Leary (1995). Because our mandate here is to reframe rather than exhaust the literature, our coverage is necessarily selective. Our reframing is guided by an audience distinction (public vs. private) and a content distinction (agentic vs. communal image). As detailed below, an agentic image involves "getting ahead" whereas a communal image involves "getting along" (Bakan, 1966; Hogan, 1983). Our generic two-level framework is previewed in Figure 19.1. Throughout the chapter, we argue that the resulting four subtypes of self-presentation must be treated separately. As noted already, our emphasis is on individual differences in self-presentation rather than the psychological processes maintaining these differences. However, the process literature has begun to fertilize the individual-differences literatures. Therefore, a brief review of the former is in order. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... The potential for interpersonal classification is only beginning to be explored, and indeed, recent research points to an important practical application-for predicting response to psychotherapy. In this regard, a number of studies (Davies-Osterkamp, Straws, & Schmitz, 1996;Gurtman, 1996;Horowitz et al., 1988;Horowitz, Rosenberg, & Bartholomew, 1993;McMullen & Conway, 1997;cf. Maling, Gurtman, & Howard, 1995) have now either shown or suggested that individuals classified in the fiiendly/submissive quadrant are more likely to profit born psychodynamic therapy than are those in other quadrants. ...
Forty years ago, the Kaiser Research group pioneered an approach to interpersonal assessment based on a structural model of personality, the interpersonal circle. With renewed interest in circular models, issues about the measurement, analysis, and application of these kinds of individual data reemerge. This article is an introduction to and revision of the basic principles of circular profile analysis. Using the recent circumplex of interpersonal problems, we define the model and its data, explain the structural summary, and discuss the descriptive and possible clinical significance of profile indices. Future researchers should seek to expand understanding of how circular profile variables relate to clinical assessment and treatment, and also apply the analytic methods to test key aspects of interpersonal theory.
... Olen rajannut tarkastelun ulkopuolelle tutkimukset , joissa tarinoita on analysoitu määrällisten frekvenssimatriisien muodossa (Luborsky ym. 1992; McMullen & Conway 1997; Crits-Christoph ym. 1999; Semerari ym. ...
Psychotherapy has been shown to be an effective treatment for depression, but not enough is known about the subjective meanings of therapy for human life. This study focuses on experiences of the effects of psychotherapy, thoughts about changes in depression and meanings of the therapy in the inner narratives of persons who sought psychotherapy for their depression. The study was based on interviews of 14 persons, who took part in the Helsinki Psychotherapy Study (HPS). Half of them took part in short-term solution-focused therapy and half in long-term psychodynamic psychotherapy. The sample included both women and men. Part of them had recovered from their depression by the end of therapy (BDI<10), part had not. Therapy was experienced to have effects on one s immediate feelings, thoughts and social actions. Some barriers were also connected to the therapy and the HPS research frame. The relief of depression was explained by enhanced understanding and perspective changes. Also the therapeutic alliance and factors not connected to therapy were seen to have influence on the experienced changes. The resumption of depression was regarded as the consequence of ill-fitting therapy or therapist, incompleteness of the therapy or other reasons not connected to the therapy itself. With the narrative analysis three interpretations were constructed concerning how the persons had sought for therapy, what was the image they had about themselves and their problems and what were their expectations for the therapy. The interpretations were summed up to the life historical, situational and moral inner narrative. Through the psychotherapy some inner narratives came true. In these cases psychotherapy reinforced the original inner narrative. In other cases psychotherapy did not meet the inner narrative of the person, neither had the narrative changed. For some persons the inner narrative got new forms during the therapy: the analyses showed that psychotherapy had reconstructed the persons conceptions about themselves and their problems, which led to changes in the expectations concerning the therapy. Key words: psychotherapy, depression, inner narrative, qualitative research, analysis of narrative, narrative analysis Psykoterapia on osoitettu vaikuttavaksi hoitomuodoksi masennuksen hoidossa, mutta terapian subjektiivisista merkityksistä ihmisten elämässä tiedetään varsin vähän. Tässä tutkimuksessa selvitettiin masennuksen vuoksi psykoterapiaan hakeutuneiden ihmisten kokemuksia psykoterapian vaikutuksista, heidän käsityksiään masennuksensa muutoksista ja terapian merkityksiä osana ihmisten sisäisiä tarinoita . Tutkimus perustui 14 Helsingin Psykoterapiaprojektiin osallistuneen henkilön haastatteluihin. Puolet heistä oli osallistunut lyhyeen voimavarasuuntautuneeseen terapiaan ja puolet pitkään psykodynaamiseen psykoterapiaan. Otoksessa oli sekä naisia että miehiä, ja osa oli toipunut terapian päättymiseen mennessä oireista (BDI<10), osa ei. Terapialla koettiin olleen vaikutuksia niin ihmisten välittömiin kokemuksiin, ajatteluun kuin sosiaaliseen toimintaankin. Terapiaan ja tutkimusasetelmaan koettiin liittyneen myös joitakin haittoja. Masennuksen muutoksia selitettiin lisääntyneellä ymmärryksellä ja näkökulmien muuttumisella. Myös terapiasuhteella ja erilaisilla terapian ulkopuolisilla tekijöillä koettiin olleen merkitystä masennuksen lievittymiseen. Masennuksen jatkuessa syyt liitettiin joko vääränlaiseen terapiaan tai terapeuttiin, terapian keskeneräisyyteen tai terapian ulkopuolisiin tekijöihin. Narratiivisen analyysin avulla tuotettiin kolme erilaista tulkintaa siitä, miten ihmiset olivat hakeutuneet terapiaan, millainen käsitys heillä oli itsestään ja ongelmistaan sekä millaisia odotuksia heillä oli terapian suhteen. Nämä tulkinnat tiivistettiin elämänhistorialliseen, situationaaliseen ja moraaliseen sisäiseen tarinaan. Psyko-terapian myötä osa ihmisten sisäisistä tarinoista toteutui, jolloin psykoterapian todettiin vahvistaneen olemassa olevaa sisäistä tarinaa. Joskus taas psykoterapia ei ollut kohdannut sisäistä tarinaa, eikä ihmisen itsestään kertoma tarina ollut muuttunut. Joidenkin ihmisten sisäiset tarinat saivat terapian kautta uudenlaisia muotoja. Psykoterapian todettiin tällöin muokanneen ihmisen käsityksiä itsestään ja ongelmistaan uudenlaisiksi, jolloin myös terapiaan liittyvät odotukset muuttuivat. Avainsanat: psykoterapia, masennus, sisäinen tarina, laadullinen tutkimus, kertomusten analyysi, narratiivinen analyysi
... However, these systems have rarely been applied to the coding of narratives drawn from therapy sessions. One exception is the recent study by McMullen and Conway (1997), who reported on the reliability of the identification of eight categories of interpersonal behavior, drawn from Kiesler's (1985) Interpersonal Circle. The narratives for this study were derived from 20 patients in short-term dynamic psychotherapy. ...
We present an analysis of the reliability and base rates of the interpersonal contents of narratives told by patients in psychotherapy. Trained judges rated two samples, including 60 opiate-dependent patients in cognitive or psychodynamic therapy and 72 depressed patients in cognitive or interpersonal therapy. Using a comprehensive system based upon a circumplex model and involving 104 separate categories, we found that most categories of interpersonal behavior could be rated reliably. Potential problem categories were identified and strategies for increasing reliability are discussed. In particular, categories related to the concept of the introject (what the self does to the self) had low reliability. An analysis of the base rates of interpersonal themes revealed that issues related to autonomy/ assertion were most prevalent, although some differences between the two samples were evident. The implications of the results for research on narratives and models of psychotherapy are discussed.
في مجلدهما الكلاسيكي "فهم الطرح: طريقة ثيمة العلاقة الصراعية الجوهرية" ، قدم لوبورسكي وبول كريتس كريستوف أول إثبات ملموس لملاحظات فرويد حول الطرح. باستخدام طريقة ثيمة العلاقة الصراعية الجوهرية التي ابتكرها ليستر لوبورسكي والتي نالت استحسانا كبيرا ، أوضحا كيفية قياس الأنماط المتكررة في العلاقة المركزية للمرضى بشكل ثابت وكيفية استكشاف مثل هذه الأنماط في العلاج النفسي الدينامي والعلاجات الكلامية الأخرى. ولا تزال طريقة ثيمة العلاقة الصراعية الجوهرية الأداة المفضلة للباحثين والأطباء على حد سواء.
وقد تمت مراجعة وتحديث جميع فصول هذا المجلد ، وستة جديدة تمامًا. في الجزء الأول ، ويقدم المؤلفون مسحًا لأساسيات طريقة ثيمة العلاقة الصراعية الجوهرية ، بما في ذلك تاريخها ، والتسجيل ، والفئات المعيارية ، والإجراءات التوضيحية التفصيلية لتسجيل طريقة ثيمة العلاقة الصراعية الجوهرية لسرد المرضى.
وقد تم وصف نموذج حكايات العلاقة ، وهو أسلوب جديد متعدد الاستخدامات للحصول على السرد عند الطلب "أيا كان وقت حكيه" ، وفي الفصل السابع يتعمق المؤلفون في الجوانب المتعددة لـطريقة ثيمة العلاقة الصراعية الجوهرية في الجزء الثاني ، حيث يستكشفون تسعة اتجاهات للعثور على معاني لمقياس طريقة ثيمة العلاقة الصراعية الجوهرية . ويتضمن هذا القسم أيضًا دراسة موسعة حديثًا عن موازاة طريقة ثيمة العلاقة الصراعية الجوهرية في روايات اليقظة والحلم. وهناك أيضًا استكشافان جديدان لاتساق طريقة ثيمة العلاقة الصراعية الجوهرية عبر الوقت - من سن 3 إلى 5 سنوات ، ومن قبل العلاج النفسي إلى أثناء العلاج النفسي.
وفي الجزء الثالث ، يتحول الكتاب إلى المزيد من التطبيقات السريرية لطريقة طريقة ثيمة العلاقة الصراعية الجوهرية ، بما في ذلك الاستخدامات اليومية لطريقة ثيمة العلاقة الصراعية الجوهرية في الممارسة العملية. في الخلاصة التكاملية للكتاب ، يفكر المؤلفون في تقارب العديد من نتائج طريقة ثيمة العلاقة الصراعية الجوهرية مع ملاحظات فرويد حول الطرح ومجموعة من الوصفات للتطور الصحي المستمر لطريقة ثيمة العلاقة الصراعية الجوهرية.
This paper offers a critical review of narrative approaches to therapy, in terms of theory, practice and research. It proposes that narrative approaches currently lack a theory that explains adequately how the reworking of narratives brings about changes and how a client's various narratives are integrated. Research approaches to the study of narrative in therapy are at an early stage. A review of current research into narrative approaches to therapy is presented, and suggestions are offered for further research.
In recent years, anger has been conceptualized as an interpersonal script. To investigate the different varieties of this script, 109 stories of angry experiences told by clients to their therapists were drawn from audiotapes of psychotherapy sessions. Phrases representing 5 features of a script (i.e., antecedents, beliefs and evaluations, self's expression of anger, behavioral reactions of others, and the consequences) were extracted from each story, coded, and subjected to cluster analysis. Five clusters were identified: (1) Direct expression and receptive response, (2) Tit for tat, (3) Other tries to come through for self, (4) No direct expression, and (5) Hostile confrontation over unmet expectations. Our results confirm what can be extrapolated from the literature as common scripts and draw attention to other less commonly described ones. The importance of understanding anger scripts as a dynamic interplay between self and other is emphasized.
Narratives about interactions with other people constitute a significant part of patient talk during psychotherapy sessions. This article reviews our research on interpersonal narratives as a basic unit of analysis in psychotherapy research. Studies on the reliability of locating such narratives are reviewed, followed by a presentation of studies on the frequency and determinants of narratives. Narratives can also be used to examine the patient-therapist relationship, and a series of studies has suggested that while there is some degree of similarity of themes between outside of therapy relationships and the relationship with the therapist, not all patients evidence this "transference" effect. Therapists' ability to formulate and accurately interpret the relationship themes that are apparent in narratives has been found to be associated with outcome, retention, and the development of the therapeutic alliance over the course of treatment. The implications of these findings for research and practice are discussed.
The purpose of the current investigation was to explore the predictors of the frequency and completeness of interpersonal narratives in psychotherapy. Narratives were extracted from 548 sessions of 72 patients who received either cognitive (CT) or interpersonal therapy (IPT) for depression. Consistent individual differences in narrative frequency, length, completeness, and number of therapist words per narrative were found. IPT sessions contained significantly more narratives than CT sessions, and CT sessions contained a higher proportion of therapist words per narrative. The alliance was positively related to the number of patient words per narrative, and patients with more involved interpersonal styles elicited more therapist words per narrative. Expectations about the causes of depression and helpfulness of focusing on interpersonal issues in therapy influenced narrative frequency and completeness more in CT than in IPT.
Based on the recent discussion on evidence-based psychotherapy, the last 5 volumes of the international journal Psychotherapy Research were bibliometrically analyzed. The analysis demonstrates the variety and complexity of recent psychotherapy research by investigating articles from Psychotherapy Research, which serves as the official organ of the Society for Psychotherapy Research. North American and European contributions were compared with respect to the hypotheses, research tradition, methodological approaches, leading representatives (frequently cited authors of the journal), and the reception of the international state of research. Regardless of the current dominance of empirically supported treatments, the editors of Psychotherapy Research strategically compiled a wide variety of current research approaches without restricting the publications to randomized controlled studies that evaluated care systems. This approach has proven successful in view of the impact of the journal within the scientific community and among the flagship journals of the field.
The way in which patients behave toward others is considered to be a correlate of mental health and thus of successful psychotherapy. Until now, research regarding the extent to which this assumption is justified has produced contradictory findings. On the basis of 2 definitions of normal interpersonal behavior (Benjamin, 1993; Crits-Christoph, Demorest, Muenz, & Baranackie, 1994), the authors studied 10 patients undergoing psychoanalytic therapy to determine whether changes in their descriptions of interpersonal relationships were associated with a decrease in self-reported symptoms and interpersonal problems during the first 2 years of treatment. Using a hierarchical linear model, the authors identified moderate to high correlations in the expected direction: The patients' affiliative behavior toward their objects as well as the average valence and variability of their affective experience increased when therapy was successful. In contrast, patients' descriptions of their objects' behavior did not change in a systematic manner.
Beliefs about what may be expected in interpersonal relationships, whether conceptualized as transference, script, or object relations paradigm, are key elements in several theories of psychopathology. Yet methods of studying such beliefs are still rare. To be practice-relevant methods must stay close to the give and take of psychotherapy, as does Luborsky’s CCRT method. Data are presented on reliability of the first step of the CCRT method, reduction of transcripts to key excerpts, "relationship episodes" (REs), where transference-like beliefs may especially be revealed. RE location requires "intuitive" judgments for which no unequivocal decision formulae exist.
Examined the efficacy of a method for studying figurative expressions generated by clients in psychotherapy. All client-generated figurative expressions relating to interpersonal actions from 21 cases of psychotherapy were selected and coded according to The 1982 Interpersonal Circle: Acts Version developed by D. J. Kiesler (unpublished manuscript). Analyses were performed on 471 audiotaped psychotherapy sessions for which 2 coders applied measures of therapy outcome and of dominance and nurturance. Results reveal a fairly clear and theoretically consistent relationship between therapy outcome and the location on the interpersonal circumplex of clients' figurative expressions of self actions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)