A Case Study Investigating Whether the Process of Resolving Interpersonal Problems in Couple Therapy Is Isomorphic to the Process of Resolving Problems in Individual Therapy

Abstract

The assimilation model of therapeutic change describes the self as comprised of multiple internal voices (mental states), and tracks the development of understanding and joint action between those voices in successful psychotherapies. This model has been constructed from studies of individual therapy, and has generally focused on intrapersonal change. The emotion-focused, couple therapy case presented here involving Sarah and Mark was studied using an iterative, team-based approach to theory-building case-study research to (1) assess whether the process of resolving interpersonal problems in couple therapy is isomorphic to the process of assimilation in individual therapy and, if possible, and to (2) extend the model's ability to describe the process of resolving interpersonal problems. Observations supported the hypothesis that intra-and interpersonal problems resolve in ways that are isomorphic to one another: The patterns of perception, emotion, communication, and action observed during the process of resolving interpersonal problems were consistent with those observed in intrapersonal problem resolution in previous assimilation model research. As the couple developed mutual understandings and increasingly engaged in cooperative action, previously excluded aspects of one another's experience came to be increasingly included (i.e., valued and influential) in each partners' meaning-and decision-making. This parallels the increasing inclusion of previously avoided experience observed in successful individual treatments. Case observations are presented, and clinical and research implications are discussed.

Terapia de Casal e Estratégias de Resolução de Conflito: Uma Revisão Sistemática

“…As perspectivas teóricas dos estudos foram predominantemente comportamentais e cognitivo-comportamentais (Baucom, Baucom, & Christensen, 2015;Baucom, Sevier, Eldridge, Doss, & Christensen, 2011;Bélanger, Laporte, Sabourin, & Wright, 2015;Kirby & Baucom, 2007a;2007b;Li, Lin, Nelson, & Eckstein, 2008;Sevier, Eldridge, Jones, Doss, & Christensen, 2008) em detrimento das abordagens sistêmicas, teoria do apego e teoria psicodinâmica (Conradi, Jonge, Neeleman, Simons, & Sytema, 2011;Makinen, & Johnson, 2006;Schielke et al, 2011;Tilden, Hoffart, Sexton, Finset, & Gude, 2011;Zuccarini, Johnson, Dalgleish, & Makinen, 2013). Esse resultado pode estar associado ao fato de as primeiras abordagens estarem mais pró-ximas dos pressupostos positivistas, quantitativos em ciência, que podem ser comparados à utilização de protocolos e manuais.…”

“…Foram identificadas distintas variáveis associadas à resolução dos conflitos conjugais durante o processo terapêutico, descritas como: problemas de apego (Makinen, & Johnson, 2006), dificuldade crônica de regulação emocional (Kirby, & Baucom, 2007b), técnica específica de resolução de problemas (Li et al, 2008), manejo de estratégias em terapia de casal e em terapia individual (Schielke et al, 2011), função do apego ao parceiro nos resultados do tratamento (Conradi et al, 2011), relação entre processos comuns e processos específicos (Tilden et al, 2011), satisfação conjugal e autoavaliação de habilidades de resolução de problemas (Bélanger et al, 2015). Essa diversidade de abordagens e variáveis ilustra a complexidade do fenômeno e a necessidade de aprimorar cada vez mais as pesquisas sobre a conjugalidade, a fim de construir um corpus de conhecimento mais consistente sobre a temática (Costa et al, 2016).…”

“…No mesmo sentido, a capacidade de ser empático, de perdoar e de ser otimista, associa-se ao clima conjugal, que poderá ser de maior positividade ou negatividade dependendo de fatores individuais e diádicos (Costa et al, 2016). Essa compreensão vai ao encontro da ideia de que, na terapia de casal, as mudanças relacionais e intrapessoais estão associadas (Schielke et al, 2011).…”

Editor's Introduction: Combining Pragmatic Case Studies Within a Single Case Experimental Design

“…It is exemplified in the work of William Stiles and associates, who have published some of their research in PCSP (Stiles, 2009;Gray & Stiles, 2011;Schielke et al, 2011). Stiles et al employ theory-building case studies to develop an "assimilation" theory of therapy, which views treatment progress as a function of the degree to which difficult, disturbing, and conflicting experiences are properly acknowledged, worked through, and connected to constructive action while being fully incorporated and integrated into the patient's internal experiencing.…”

A Key Role for Case Studies: Theory Building

“… assimilation theory studied in an emotion-focused couple therapy case with a couple enduring long-standing emotional injury and conflict within their relationship (Schielke, Stiles, et al, 2011); and  assimilation theory investigated in a cognitive-behavioral therapy case with a client with general anxiety disorder (Gray & Stiles, 2011).…”