Publicação
Ambivalence Resolution in Psychotherapy
| Resumo: | The present dissertation explores the process of ambivalence resolution in psychotherapy through a narrative-dialogical lens. Ambivalence is herein defined as the conflictual relationship between two opposed positions: one expressed in a narrative novelty (i.e., distinct from the problematic pattern: an innovative moment (IM)) and another one representing the problematic pattern which impelled the client to therapy. Ambivalence markers (AMs) are moments during the therapeutic conversation which entail the production of an IM that is immediately followed by a return to the problematic pattern. A variety of studies have been demonstrating that AMs are more frequent in unchanged than in recovered cases, revealing ambivalence´s potential to hinder the process of psychotherapeutic change, if left unresolved. Nonetheless, ambivalence resolution was not yet empirically and systematically studied in the tradition of process research in psychotherapy. The present work consists of a series of three studies in which ambivalence resolution was systematically studied through the development of a coding system (the ambivalence resolution coding system, ARCS) which was used to analyze all the sessions of a variety of clinical cases. The ARCS allows the identification of two processes of ambivalence resolution throughout the therapeutic process: dominance and negotiation. In dominance, the innovative position controls the problematic position through a harsh imposition of its power, thus inhibiting the problematic´s position supremacy; negotiation entails the communication and engagement in joint action between both positions of the self. The first study consisted of an intensive case study of an emotion-focused therapy (EFT) recovered major-depression case with the ARCS. A central aim of this study was to test the ARCS´s viability before coding a larger sample. Simultaneously, it was possible to describe the ambivalence resolution process in this single case. Results revealed that, as treatment progressed, dominance tended to decrease and negotiation was increasingly more frequent. These results were replicated in the second study with a sample of 22 major depression cases from different therapeutic approaches (EFT, narrative therapy and cognitive-behavioral therapy). A generalized linear modelling analysis revealed that while in recovered cases dominance decreased across sessions, in unchanged cases dominance was relatively high during the course of the whole treatment. Also, in recovered cases negotiation increased throughout the therapeutic process, which did not happen for unchanged cases. These tendencies did not significantly differ between therapeutic models. In general, we conclude that in order to resolve ambivalence, negotiation between positions of the self seems to be a necessary condition. In the third study, a sample of 5 cases of grief therapy was analyzed with the ARCS. The central aim of this study was to understand if the results achieved with samples of major depression were similar in a distinct problematic. A previous exploration of the resolutions led to the distinction of a further ambivalence resolution category – escalation. Escalation is defined as the process of the innovative position struggling to control the problematic position whereas the dominance process implies the actual dominance of the innovative position. Results revealed distinct tendencies between recovered and unchanged cases: escalation decreased and dominance increased in recovered cases and opposite tendencies were observed in unchanged cases. Negotiation decreased in unchanged cases from the beginning until the end of treatment while in recovered cases it was increasingly frequent until the middle sessions of treatment and decreased again until the final sessions. In general, we conclude that the processes of dominance and negotiation probably have complementary necessary roles in the progressive resolution of ambivalence while the escalation process seems to be more associated with the unsuccessful resolution of ambivalence. |
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| Autores principais: | Braga, Cátia Sofia Macedo |
| Assunto: | Ciências Sociais::Psicologia |
| Ano: | 2017 |
| País: | Portugal |
| Tipo de documento: | tese de doutoramento |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Universidade do Minho |
| Idioma: | inglês |
| Origem: | RepositóriUM - Universidade do Minho |
| Resumo: | The present dissertation explores the process of ambivalence resolution in psychotherapy through a narrative-dialogical lens. Ambivalence is herein defined as the conflictual relationship between two opposed positions: one expressed in a narrative novelty (i.e., distinct from the problematic pattern: an innovative moment (IM)) and another one representing the problematic pattern which impelled the client to therapy. Ambivalence markers (AMs) are moments during the therapeutic conversation which entail the production of an IM that is immediately followed by a return to the problematic pattern. A variety of studies have been demonstrating that AMs are more frequent in unchanged than in recovered cases, revealing ambivalence´s potential to hinder the process of psychotherapeutic change, if left unresolved. Nonetheless, ambivalence resolution was not yet empirically and systematically studied in the tradition of process research in psychotherapy. The present work consists of a series of three studies in which ambivalence resolution was systematically studied through the development of a coding system (the ambivalence resolution coding system, ARCS) which was used to analyze all the sessions of a variety of clinical cases. The ARCS allows the identification of two processes of ambivalence resolution throughout the therapeutic process: dominance and negotiation. In dominance, the innovative position controls the problematic position through a harsh imposition of its power, thus inhibiting the problematic´s position supremacy; negotiation entails the communication and engagement in joint action between both positions of the self. The first study consisted of an intensive case study of an emotion-focused therapy (EFT) recovered major-depression case with the ARCS. A central aim of this study was to test the ARCS´s viability before coding a larger sample. Simultaneously, it was possible to describe the ambivalence resolution process in this single case. Results revealed that, as treatment progressed, dominance tended to decrease and negotiation was increasingly more frequent. These results were replicated in the second study with a sample of 22 major depression cases from different therapeutic approaches (EFT, narrative therapy and cognitive-behavioral therapy). A generalized linear modelling analysis revealed that while in recovered cases dominance decreased across sessions, in unchanged cases dominance was relatively high during the course of the whole treatment. Also, in recovered cases negotiation increased throughout the therapeutic process, which did not happen for unchanged cases. These tendencies did not significantly differ between therapeutic models. In general, we conclude that in order to resolve ambivalence, negotiation between positions of the self seems to be a necessary condition. In the third study, a sample of 5 cases of grief therapy was analyzed with the ARCS. The central aim of this study was to understand if the results achieved with samples of major depression were similar in a distinct problematic. A previous exploration of the resolutions led to the distinction of a further ambivalence resolution category – escalation. Escalation is defined as the process of the innovative position struggling to control the problematic position whereas the dominance process implies the actual dominance of the innovative position. Results revealed distinct tendencies between recovered and unchanged cases: escalation decreased and dominance increased in recovered cases and opposite tendencies were observed in unchanged cases. Negotiation decreased in unchanged cases from the beginning until the end of treatment while in recovered cases it was increasingly frequent until the middle sessions of treatment and decreased again until the final sessions. In general, we conclude that the processes of dominance and negotiation probably have complementary necessary roles in the progressive resolution of ambivalence while the escalation process seems to be more associated with the unsuccessful resolution of ambivalence. |
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