Guidelines for reflective practice in psychotherapy: A reflection on the benefits of combining moment-by-moment and phase-by-phase mapping in clinical decision making.

Abstract

This article intends to highlight the importance of reflective practice, explore the benefits of integrating moment-by-moment and phase-by-phase guiding principles while thinking through and intervening in our cases, and offer psychotherapists of any persuasion guidelines for a reflective practice based on this integration. Reflective practice includes both careful observation of patient's responses, and the use of such data to consider choices that might lead to greater attunement and more successful therapy. The integration of moment-by-moment and phase-by-phase maps, by allowing coordination between a more micro and a more macro level, similar to the idea of figure and ground, favors therapists' responsiveness, the tracking of progress and/or stuckness in psychotherapy cases-in-progress, and integrative clinical decision-making. The guidelines offered combine addressing the match between the therapist's strategic objectives and the patient's evolving capacities, and observing at each moment, in each therapeutic phase, whether and how the patient is able to make use of the resources that the therapist offers.

Analysing phase progression in Susan's case

“…This Phase 4 promotion seems to reflect a solution‐focus orientation on the part of the therapist, favouring change and focus on resources from very early in the process. From a PCM perspective, this focus on change early in the process can be risky and favour impasses and misattunements in the therapeutic process, and we expect more complex patients to resent this early focus (Conceição, ; Ferreira, Basseches et al, ). Susan, however, does not seem to have resented this Phase 4 promotion early on, but her major gain seems to have been awareness of herself and her experience (Phase 2 gains).…”

“…This study intended to highlight the potential usefulness of adding a phase‐by‐phase perspective to the equally important moment‐by‐moment one when studying therapeutic processes and also when reflecting on our cases in progress (Ferreira, Basseches et al, ).…”

“…The temporal sequencing component of the PCM suggests that, even if the patient needs to develop competencies from more advanced phases, the therapeutic gains are more solid when the competencies of the previous phases are sufficiently grounded. It is important, therefore, to articulate the therapist's promotion of general strategies with the patient's capacity to assimilate those interventions and to ask two questions: (a) what is the therapist predominantly promoting at each session and (b) is he/she contemplating whether the patient is already capable of receiving and processing it (Ferreira, Basseches, & Vasco, ). These considerations inform the therapist whether the patient needs to proceed to the work of subsequent phases or whether he/she needs to consolidate the work of the current phase or even of a previous one (Conceição, , ).…”

“…To clarify how therapists and patients coconstruct syntheses and move forward along the process, the DAPP suggests that we look at what therapeutic resources are being used and ask three questions: (a) what resources is the therapist offering the patient; (b) how is the patient receiving and using these resources; and (c) how is the therapist responding to the way the patient is receiving and using these resources and is the therapist able to adapt his/her offerings to the patient's capacity to use them (Basseches & Mascolo, ; Ferreira, Basseches et al, ).…”

Tracking and understanding phase progression in Lisa's case

“…In this realm and in accordance to the responsiveness principle of Stiles, Honos‐Webb, and Surko (), it is important to integrate the therapist's promotion of general strategies with the patient's assimilation capacities of those interventions. It is useful to ask two questions: (a) What is the therapist predominantly promoting at each session in terms of general strategies and (b) is he/she contemplating whether the patient is adequately capable of receiving and processing it (Ferreira, Basseches, & Vasco, ). These considerations inform the therapist whether the patient needs to proceed to the work of subsequent phases or whether he/she needs to consolidate the work of the current phase or even of a previous one (Conceição, , ).…”