Publicação
Narrative change in constructivist grief therapy : the innovative moments model
| Resumo: | This dissertation explores the process of narrative change in constructivist grief therapy through the lens of the Innovative Moments Model. According to this model – grounded in the narrative perspective of human change – clients reformulate the problematic narratives brought to therapy by investing in the elaboration of Innovative Moments (IMs), pictured as alternative experiences in their lives that fall outside the domain of the problematic self-narrative. Associated with this investment in self-narrative transformation throughout therapy, this dissertation also explores how problematic selfnarratives can be maintained by the elaboration of return to the problem markers (RPMs), instigating a movement of ambivalence between the new self-narrative (IMs) and the old one (RPMs). In order to understand how complicated grief clients invested in the maintenance or transformation of their problematic self-narratives (or problematic stories of loss) throughout therapy and which narrative processes could be associated with change and ambivalence, a set of studies were conducted and presented in this dissertation. The first study presented an intensive analysis of a good outcome case of constructivist grief therapy with a bereaved mother, using the “Innovative Moments Coding System” (IMCS). Results showed that the emergence and expansion of IMs were associated with a gradual transformation of the problematic self-narrative into a more healthful story of loss, demonstrating the feasibility of analyzing narrative change with the IMCS in this form of therapy. The second study investigated the processes of change (through IMs) and ambivalence (through RPMs) in two cases of constructivist grief psychotherapy. The research strategy involved three steps: 1) tracking IMs with the IMCS, 2) exploring the themes expressed therein (or protonarratives) through grounded theory analysis and 3) analyzing the emergence of RPMs with the “Return to the Problem Coding System” (RPCS), which is an empirical system that tracks every time an IM is attenuated by a RPM. Results showed that both cases presented a high percentage of RPMs, and that the evolution of IMs and RPMs over sessions was significantly correlated, being mainly organized around the themes “Integration” (new integration of loss centered on the construction of a new symbolic relationship with the deceased) and “Proactivity” (search for moments of well-being). Considering these results, we hypothesized that the stability of ambivalence in grief therapy may represent a form of self-protection from the anxiety of changing (and releasing the intense pain towards a more adaptive experience of loss) as a disconnection from the deceased. The third study aimed to further understand how IMs depicted the movement of selfnarrative transformation in constructivist grief therapy. The emergence of IMs was analyzed using the IMCS among a sample of six cases of constructivist grief therapy. The association between IMs development and the severity of grief symptomatology was also analyzed. Grief symptomatology was assessed using the “Inventory of Complicated Grief” (ICG). A thematic analysis was performed to explore the evolution of IMs through elaboration of the themes “Integration” and “Proactivity”, identified as relevant processes in loss adaptation in the previous study. A generalized linear model analysis (GLM) showed a different rate of IMs production over time between cases with different clinical outcomes. More specifically, cases with greater improvement changed the probability of having IMs with a higher rate over time than cases with less improvement. Results also showed that the themes “Integration” and “Proactivity” had a high prevalence in this sample, highlighting the relevance of these narrative processes in grief therapy. In general, we conclude that the results of this study reinforce IMs’ relevance in studying narrative change among cases with distinct clinical progressions. The fourth and last study aimed to further analyze the process of ambivalence in constructivist grief therapy. The six cases previously analyzed with the IMCS in the third study were now analyzed with the RPCS. The association between RPMs and the severity of grief symptomatology was also examined, considering the ICG scores. The results showed that RPMs emerged in all cases. The application of a GLM analysis showed that the probability of these RPMs decreased over time in cases with greater symptomatic improvement, while the opposite occurred in cases with less improvement. These results suggest an association between symptom improvement and the reduction of ambivalence, supporting previously reported findings. |
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| Autores principais: | Alves, Daniela Rodrigues |
| Ano: | 2013 |
| 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: | This dissertation explores the process of narrative change in constructivist grief therapy through the lens of the Innovative Moments Model. According to this model – grounded in the narrative perspective of human change – clients reformulate the problematic narratives brought to therapy by investing in the elaboration of Innovative Moments (IMs), pictured as alternative experiences in their lives that fall outside the domain of the problematic self-narrative. Associated with this investment in self-narrative transformation throughout therapy, this dissertation also explores how problematic selfnarratives can be maintained by the elaboration of return to the problem markers (RPMs), instigating a movement of ambivalence between the new self-narrative (IMs) and the old one (RPMs). In order to understand how complicated grief clients invested in the maintenance or transformation of their problematic self-narratives (or problematic stories of loss) throughout therapy and which narrative processes could be associated with change and ambivalence, a set of studies were conducted and presented in this dissertation. The first study presented an intensive analysis of a good outcome case of constructivist grief therapy with a bereaved mother, using the “Innovative Moments Coding System” (IMCS). Results showed that the emergence and expansion of IMs were associated with a gradual transformation of the problematic self-narrative into a more healthful story of loss, demonstrating the feasibility of analyzing narrative change with the IMCS in this form of therapy. The second study investigated the processes of change (through IMs) and ambivalence (through RPMs) in two cases of constructivist grief psychotherapy. The research strategy involved three steps: 1) tracking IMs with the IMCS, 2) exploring the themes expressed therein (or protonarratives) through grounded theory analysis and 3) analyzing the emergence of RPMs with the “Return to the Problem Coding System” (RPCS), which is an empirical system that tracks every time an IM is attenuated by a RPM. Results showed that both cases presented a high percentage of RPMs, and that the evolution of IMs and RPMs over sessions was significantly correlated, being mainly organized around the themes “Integration” (new integration of loss centered on the construction of a new symbolic relationship with the deceased) and “Proactivity” (search for moments of well-being). Considering these results, we hypothesized that the stability of ambivalence in grief therapy may represent a form of self-protection from the anxiety of changing (and releasing the intense pain towards a more adaptive experience of loss) as a disconnection from the deceased. The third study aimed to further understand how IMs depicted the movement of selfnarrative transformation in constructivist grief therapy. The emergence of IMs was analyzed using the IMCS among a sample of six cases of constructivist grief therapy. The association between IMs development and the severity of grief symptomatology was also analyzed. Grief symptomatology was assessed using the “Inventory of Complicated Grief” (ICG). A thematic analysis was performed to explore the evolution of IMs through elaboration of the themes “Integration” and “Proactivity”, identified as relevant processes in loss adaptation in the previous study. A generalized linear model analysis (GLM) showed a different rate of IMs production over time between cases with different clinical outcomes. More specifically, cases with greater improvement changed the probability of having IMs with a higher rate over time than cases with less improvement. Results also showed that the themes “Integration” and “Proactivity” had a high prevalence in this sample, highlighting the relevance of these narrative processes in grief therapy. In general, we conclude that the results of this study reinforce IMs’ relevance in studying narrative change among cases with distinct clinical progressions. The fourth and last study aimed to further analyze the process of ambivalence in constructivist grief therapy. The six cases previously analyzed with the IMCS in the third study were now analyzed with the RPCS. The association between RPMs and the severity of grief symptomatology was also examined, considering the ICG scores. The results showed that RPMs emerged in all cases. The application of a GLM analysis showed that the probability of these RPMs decreased over time in cases with greater symptomatic improvement, while the opposite occurred in cases with less improvement. These results suggest an association between symptom improvement and the reduction of ambivalence, supporting previously reported findings. |
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