Temporal organization of discursive voices and their association with outcomes in a case of psychotherapy
DOI:
https://doi.org/10.21615/cesp.7585Palavras-chave:
discursive voices, change in psychotherapy, case study, vector auto-regression, entropy, borderline personality disorder, dialogical self theoryResumo
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.
Downloads
Referências
Avdi, E. (2012). Exploring the contribution of subject positioning to studying therapy as a dialogical enterprise. International Journal for Dialogical Science, 6, 61-79.
Avdi, E., & Georgaca, E. (2009). Narrative and discursive approaches to the analysis of subjectivity in psychotherapy. Social and Personality Psychology Compass, 3, 654-670. https://doi.org/10.1111/j.1751-9004.2009.00196.x
Badalamenti, A. F., & Langs, R. J. (1992). The progression of the entropy of a five dimensional psychotherapeutic system. Systems Research, 9(3), 3–28. https://doi.org/10.1002/sres.3850090301
Barani, F. (2019). Dynamics of self-dialogue in the aftermath of trauma: A “fictional dissociation”. Theory & Psychology, 29(3), 377-395. https://doi.org/10.1177/0959354319842949
de Felice, G., Giuliani, A., Pincus, D., Scozzari, A., Berardi, V., Kratzer, L., Aichhorn, W., Schöller, H., Viol, K., & Schiepek, G. (2022). Stability and flexibility in psychotherapy process predict outcome. Acta Psychologica, 227, 103604. https://doi.org/10.1016/j.actpsy.2022.103604
Dimaggio, G. (2012). Dialogically oriented therapies and the role of poor metacognition in personality disorders. In H. J. M. Hermans & T. Gieser (Eds.) Handbook of dialogical self theory (356-373). Cambridge University Press. https://doi.org/10.1017/CBO9781139030434.025
Falkenström, F., Solomonov, N., & Rubel, J. A. (2022). How to model and interpret cross-lagged effects in psychotherapy mechanisms of change research: A comparison of multilevel and structural equation models. Journal of Consulting and Clinical Psychology, 90(5), 446–458. https://doi.org/10.1037/ccp0000727
Fischer-Kern, M., Schuster, P., Kapusta, N. D., Tmej, A., Buchheim, A., Rentrop, M., Buchheim, P., Hörz, S., Doering, S., Taubner, S., & Fonagy, P. (2010). The relationship between personality organization, reflective functioning, and psychiatric classification in borderline personality disorder. Psychoanalytic Psychology, 27, 395-409. https://doi.org/10.1037/a0020862
Fischer-Kern, M., Doering, S., Taubner, S., Hörz, S., Zimmermann, J., Rentrop, M., Schuster, P., Buchheim, P., & Buchheim, A. (2015). Transference-focused psychotherapy for borderline personality disorder: Change in reflective function. The British Journal of Psychiatry, 207, 173-174. https://doi.org/10.1192/bjp.bp.113.143842
Frances, T. (2024). A dialogical narrative approach to transitions and change in young women’s lives after domestic abuse in childhood: considerations for counselling and psychotherapy. British Journal of Guidance & Counselling, 52(1), 19–35. https://doi.org/10.1080/03069885.2023.2292747
Friese, S. (2020). ATLAS.ti 8 Windows - User Manual - updated for program version 8.4. Scientific Software Development GmbH, Berlin. All rights reserved. Document version: 784.20200630. http://downloads.atlasti.com/docs/manual/atlasti_v8_manual_en.pdf
Georgaca, E. (2003). Exploring signs and voices in the therapeutic space. Theory & Psychology, 13, 541-560. https://doi.org/10.1177/09593543030134005
Georgaca, E., & Avdi, E. (2019). Developing a dialogical approach to analysing psychotherapy. In Konopka, A., Hermans, H. J., & Gonçalves, M. M. (Eds.). Handbook of Dialogical Self Theory and Psychotherapy (pp. 153-169). Routledge.
Gkantona, G. (2023). My Inner World: Analyzing the Client’s Self-Dialogicality with the Method of Internal Multi-Actor Performance. Journal of Constructivist Psychology, 36(3), 401–419. https://doi.org/10.1080/10720537.2022.2100534
Gonçalves, M. M., & Ribeiro, A. P. (2012). Therapeutic change, innovative moments and the reconceptualization of the self: A dialogical account. International Journal for Dialogical Science, 6, 81-98.
Guastello, S. J. (2016). Entropy. In S. Guastello & R. Gregson (Eds.) Nonlinear dynamical systems analysis for the behavioral sciences using real data (pp. 213-230). Taylor & Francis.
Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford publications.
Hermans, H. J. (2008). How to perform research on the basis of dialogical self theory? Introduction to the special issue. Journal of constructivist Psychology, 21, 185-199. https://doi.org/10.1080/10720530802070684
Hermans, H. J. (2003). The construction and reconstruction of a dialogical self. Journal of Constructivist Psychology, 16, 89-130. https://doi.org/10.1080/10720530390117902
Hermans, H. J. (2004). The dialogical self: Between exchange and power. In Hermans, H. J., & Dimaggio, G. (Edits.), The dialogical self in psychotherapy (pp. 29-44). Routledge.
Hermans, H. J. (2014). Self as a society of I‐positions: A dialogical approach to counselling. The Journal of Humanistic Counseling, 53, 134-159. https://doi.org/10.1002/j.2161-1939.2014.00054.x
Hermans, H. J., & Dimaggio, G. (2007). Self, identity, and globalization in times of uncertainty: A dialogical analysis. Review of general psychology, 11(1), 31-61. https://doi.org/10.1037/1089-2680.11.1.31
Hermans, H., & Hermans-Konopka, A. (2010). Dialogical self theory: Positioning and counter-positioning in a globalizing society. Cambridge University Press.
Hill, C. E., Knox, S., Thompson, B. J., Williams, E. N., Hess, S. A., & Ladany, N. (2005). Consensual qualitative research: An update. Journal of Counseling Psychology, 52, 196-205. https://doi.org/10.1037/0022-0167.52.2.196
Hill, C. E., Thompson, B. J., & Williams, E. N. (1997). A guide to conducting consensual qualitative research. The Counseling Psychologist, 25, 517-572. https://doi.org/10.1177/0011000097254001
Imperiale, M. N., Lieb, R., & Meinlschmidt, G. (2023). Treatment-associated network dynamics in patients with globus sensations: a proof-of-concept study. Scientific Reports, 13(1), 15615. https://doi.org/10.1038/s41598-023-42186-y
Kay, E., Gillespie, A., & Cooper, M. (2023). From Conflict and Suppression to Reflection: Longitudinal Analysis of Multivoicedness in Clients Experiencing Depression. Journal of Constructivist Psychology, 37(3), 239-258, https://doi.org/10.1080/10720537.2023.2175752
Kivity, Y., Levy, K. N., Kelly, K. M., & Clarkin, J. F. (2021). In-session reflective functioning in psychotherapies for borderline personality disorder: The emotion regulatory role of reflective functioning. Journal of Consulting and Clinical Psychology, 89(9), 751–761. https://doi.org/10.1037/ccp0000674
Kockler, T. D., Tschacher, W., Santangelo, P. S., Limberger, M. F., & Ebner-Priemer, U. W. (2017). Specificity of emotion sequences in borderline personality disorder compared to posttraumatic stress disorder, bulimia nervosa, and healthy controls: an e-diary study. Borderline personality disorder and emotion dysregulation, 4, 1-8. https://doi.org/10.1186/s40479-017-0077-1
Konopka, A., Hermans, H. J., & Gonçalves, M. M. (2018). The dialogical self as a landscape of mind populated by a society of I-positions. In A. Konopka, H. J. Hermans, & M. M. Gonçalves (Eds), Handbook of dialogical self theory and psychotherapy (pp. 9-23). Routledge.
Lambert, M. J., Hansen, N. B., Umpress, V., Lunnen, K., Okiishi,J., & Burlingame, G. M. (1996). Administration and scoring manual for the OQ-45.2 (Outcome. Questionnaire). Stevenson, MD: American Professional Credentialing Services LLC.
Lamey, A., Hollenstein, T., Lewis, M. D., & Granic, I. (2004). GridWare (Version 1.1). [Computer software]. http://statespacegrids.org
Leiman, M. (2012). Dialogical sequence analysis in studying psychotherapeutic discourse. International Journal for Dialogical Science, 6, 123-147.
Levy, K. N., Meehan, K. B., Kelly, K. M., Reynoso, J. S., Weber, M., Clarkin, J. F., & Kernberg, O. F. (2006). Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder. Journal of consulting and clinical psychology, 74, 1027-1040. https://doi.org/10.1037/0022-006X.74.6.1027
Lopes-de-Oliveira, M. C. S., Branco, A. U., & Freire, S. F. D. C. (2020). Self, context and development. In M. C. S. Lopes-de-Oliveira, A. U. Branco, & S. F. Freire, (Eds.). Psychology as a dialogical science: Self and culture mutual development. Springer International Publishing.
Lüdemann, J., Rabung, S., & Andreas, S. (2021). Systematic review on mentalization as key factor in psychotherapy. International journal of environmental research and public health, 18(17), 9161. https://doi.org/10.3390/ijerph18179161
Lyra, M. C. D. P. (2011). Contributions for Modeling the Psychotherapeutic Process of Change. Integrative Psychological and Behavioral Science, 45(3), 347–354. https://doi.org/10.1007/s12124-011-9178-3
Martínez, C., & Tomicic, A. (2018). From Dissociation to Dialogical Reorganization of Subjectitvity in Psychotherapy. In Konopka, A., Hermans, H. J., & Gonçalves, M. M. (Eds.). Handbook of Dialogical Self Theory and Psychotherapy: Bridging Psychotherapeutic and Cultural Traditions (pp. 170-185). Routledge.
Martínez, C., Tomicic, A., & Medina, L. (2012). Dialogic discourse analysis of psychotherapeutic dialogue: Microanalysis of relevant psychotherapy episodes. International Journal for Dialogical Science, 6, 99-121.
Martínez, C., Tomicic, A., Medina, L., & Krause, M. (2014). A microanalytical look at mutual regulation in psychotherapeutic dialogue: Dialogic Discourse Analysis (DDA) in episodes of rupture of the alliance. Research in Psychotherapy: Psychopathology, Process and Outcome, 17(2), 73 - 93. https://doi.org/10.4081/ripppo.2014.153
Maillard, P., Dimaggio, G., de Roten, Y., Berthoud, L., Despland, J.-N., & Kramer, U. (2017). Metacognition as a predictor of change in the treatment for borderline personality disorder: A preliminary pilot study. Journal of Psychotherapy Integration, 27, 445–459. https://doi.org/10.1037/int0000090
Mellado, A., Martínez, C., Tomicic, A., & Krause, M. (2022a). Dynamic patterns in the voices of a patient diagnosed with borderline personality disorder, and the therapist throughout long-term psychotherapy. Journal of Constructivist Psychology, 1-24. https://doi.org/10.1080/10720537.2022.2082606
Mellado, A., Guastello, S. J., Martínez, C., Tomicic, A., & Krause, M. (2022b). Self‐organization in dialogical patterns of a patient with borderline personality disorder and their therapist: A case study from nonlinear dynamics perspective. Counselling and Psychotherapy Research, 23(2), 577-591. https://doi.org/10.1002/capr.12527
McKenzie, K., & Murray, G. (2013). Psychotherapy as entropy management. Medical Hypotheses, 81(2), 156-158. https://doi.org/10.1016/j.mehy.2013.05.023
Montesano, A., Oliveira, J. T., & Gonçalves, M. M. (2017). How do self-narratives change during psychotherapy? A review of innovative moments research. Journal of Systemic Therapies, 36, 81-96. https://doi.org/10.1521/jsyt.2017.36.3.81
O’Driscoll, C., Epskamp, S., Fried, E. I., Saunders, R., Cardoso, A., Stott, J., Wheatley, J., Cirkovic, M., Naqvi, S. A., Buckman, J. E. J., & Pilling, S. (2022). Transdiagnostic symptom dynamics during psychotherapy. Scientific Reports, 12(1), 10881. https://doi.org/10.1038/s41598-022-14901-8
Olthof, M., Hasselman, F., & Lichtwarck-Aschoff, A. (2020). Complexity in psychological self-ratings: Implications for research and practice. BMC medicine, 18(1), 1-16. https://doi.org/10.1186/s12916-020-01727-2
Osatuke, K., & Stiles, W. B. (2006). Problematic internal voices in clients with borderline features: An elaboration of the assimilation model. Journal of constructivist psychology, 19, 287-319. https://doi.org/10.1080/10720530600691699
Pincus, D., & Guastello, S. J. (2005). Nonlinear Dynamics and Interpersonal Correlates of Verbal Turn-Taking Patterns in a Group Therapy Session. Small Group Research, 36(6), 635–677. https://doi.org/10.1177/1046496405280864
Pincus, D., Ortega, D. L., & Metten, A. M. (2016). Orbital decomposition for multiple time-series comparisons. In S. J. Guastello, & R. A. Gregson (Eds.). Nonlinear dynamical systems analysis for the behavioral sciences using real data (pp. 531-552). CRC Press.
Posit team. (2022). RStudio: Integrated Development Environment for R. Posit Software, PBC. URL http://www.posit.co/
Ramseyer, F., Kupper, Z., Caspar, F., Znoj, H., & Tschacher, W. (2014). Time-series panel analysis (TSPA): multivariate modeling of temporal associations in psychotherapy process. Journal of consulting and clinical psychology, 82(5), 828-838. https://doi.org/10.1037/a0037168
Rapp, P. E., Cellucci, C. J., Gilpin, A. M., Jiménez-Montaño, M. A., & Korslund, K. E. (2011). Communication patterns in a psychotherapy following traumatic brain injury: A quantitative case study based on symbolic dynamics. BMC Psychiatry, 11(1). https://doi.org/10.1186/1471-244x-11-119
Raudenbush, S. W., Bryk, A. S., Cheong, Y. F., Congdon, R. T., & du Toit, M. (2011). HLM 7: Hierarchical linear and nonlinear modeling. Scientific Software International.
Ribeiro, A. P., & Gonçalves, M. M. (2011). Maintenance and transformation of problematic self-narratives: a semiotic-dialogical approach. Integrative Psychological and Behavioral Science. https://doi.org/10.1007/s12124-010-9149-0
Reisch, T., Ebner‐Priemer, U. W., Tschacher, W., Bohus, M., & Linehan, M. M. (2008). Sequences of emotions in patients with borderline personality disorder. Acta Psychiatrica Scandinavica, 118(1), 42-48. https://doi.org/10.1111/j.1600-0447.2008.01222.x
Salvatore, S., & Tschacher, W. (2012). Time dependency of psychotherapeutic exchanges: the contribution of the theory of dynamic systems in analyzing process. Frontiers in Psychology, 3, 253. https://doi.org/10.3389/fpsyg.2012.00253
Sidis, A. E., Bøe, T. D., Karlsson, B. E., Lidbom, P. A., Moore, A. R., Pickard, J., & Deane, F. P. (2023). In defence of loose ends: Psychotherapy process research in the real world. New Ideas in Psychology, 69, 101011. https://doi.org/10.1016/j.newideapsych.2023.101011
Schiepek, G., Schöller, H., de Felice, G., Steffensen, S. V., Bloch, M. S., Fartacek, C., Aichhorn, W., & Viol, K. (2020). Convergent Validation of Methods for the Identification of Psychotherapeutic Phase Transitions in Time Series of Empirical and Model Systems. Frontiers in Psychology, 11. 1970. https://doi.org/10.3389/fpsyg.2020.01970
Shannon, C. E. (1948). A mathematical theory of communication. The Bell System Technical Journal, 27, 379-423. https://doi.org/10.1002/j.1538-7305.1948.tb01338.x
Shannon, C. E., & Weaver, W. (1949). The mathematical theory of communication. University of Illinois Press.
Taubner, S., Kessler, H., Buchheim, A., Kächele, H., & Staun, L. (2011). The role of mentalization in the psychoanalytic treatment of chronic depression. Psychiatry: Interpersonal & Biological Processes, 74, 49-57. https://doi.org/10.1521/psyc.2011.74.1.49
Tomicic, A., Martínez, C., Pérez, J. C., Hollenstein, T., Angulo, S., Gerstmann, A., ... & Krause, M. (2015). Discourse-voice regulatory strategies in the psychotherapeutic interaction: Aa state-space dynamics analysis. Frontiers in Psychology, 6, 378. https://doi.org/10.3389/fpsyg.2015.00378
Tschacher, W., Scheier, C., & Grawe, K. (1998). Order and pattern formation in psychotherapy. Nonlinear Dynamics, Psychology, and Life Sciences, 2, 195-215.
Viou, M., & Georgaca, E. (2023). “Their voice becomes my voice”: Understanding the development of the dialogical self through the internalization of voices in group psychotherapy. Theory & Psychology, 33(4), 577–596. https://doi.org/10.1177/09593543231176254
von Bergen, A., & De La Parra, G. (2002). OQ-45.2 Cuestionario para evaluación de resultados y evolución en psicoterapia: Adaptación, validación e indicaciones para su aplicación e interpretación. Revista de Terapia Psicológica, 20, 161 - 176.
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2024 Augusto Mellado, Claudio Martínez
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Revista CES Psicología ISSN 2011 3080
Facultad de Psicología, Universidad CES Primera edición 2008. Última actualización Mayo 29 de 2024. Todos los derechos reservados. Hecho el depósito legal que exige la ley.
Se autoriza la reproducción total o parcial de los artículos citando la fuente y el autor. This publication may be reproduced by mentioning the source and the authors.
| Métricas do artigo | |
|---|---|
| Vistas abstratas | |
| Visualizações da cozinha | |
| Visualizações de PDF | |
| Visualizações em HTML | |
| Outras visualizações | |
