Process in Psychotherapy as Decreasing Asymmetry between Patient and Therapist: Evidence from the Verbal Interaction

Winefield, Helen R.; Bassett, Darryl; Chandler, Margaret; Proske, Inara

doi:10.1176/appi.psychotherapy.1987.41.1.117

Cited by 6 publications

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“…This result is consistent with the quantitative results of McDaniel, et al [75] who found correlations between rate of improvement and an estimate of the number of patient utterances. The result seen here is also consistent with the Winefield, et al [76] quantitative characterization of a psychodynamically oriented psychotherapy which showed decreasing asymmetry in patient/therapist verbal behavior during the course of treatment. This decrease in asymmetry was evidenced by increased therapist speech activity.…”

Section: Resultssupporting

confidence: 92%

Communication patterns in a psychotherapy following traumatic brain injury: A quantitative case study based on symbolic dynamics

Rapp

Cellucci²,

Gilpin

et al. 2011

BMC Psychiatry

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BackgroundThe role of psychotherapy in the treatment of traumatic brain injury is receiving increased attention. The evaluation of psychotherapy with these patients has been conducted largely in the absence of quantitative data concerning the therapy itself. Quantitative methods for characterizing the sequence-sensitive structure of patient-therapist communication are now being developed with the objective of improving the effectiveness of psychotherapy following traumatic brain injury.MethodsThe content of three therapy session transcripts (sessions were separated by four months) obtained from a patient with a history of several motor vehicle accidents who was receiving dialectical behavior therapy was scored and analyzed using methods derived from the mathematical theory of symbolic dynamics.ResultsThe analysis of symbol frequencies was largely uninformative. When repeated triples were examined a marked pattern of change in content was observed over the three sessions. The context free grammar complexity and the Lempel-Ziv complexity were calculated for each therapy session. For both measures, the rate of complexity generation, expressed as bits per minute, increased longitudinally during the course of therapy. The between-session increases in complexity generation rates are consistent with calculations of mutual information. Taken together these results indicate that there was a quantifiable increase in the variability of patient-therapist verbal behavior during the course of therapy. Comparison of complexity values against values obtained from equiprobable random surrogates established the presence of a nonrandom structure in patient-therapist dialog (P = .002).ConclusionsWhile recognizing that only limited conclusions can be based on a case history, it can be noted that these quantitative observations are consistent with qualitative clinical observations of increases in the flexibility of discourse during therapy. These procedures can be of particular value in the examination of therapies following traumatic brain injury because, in some presentations, these therapies are complicated by deficits that result in subtle distortions of language that produce significant post-injury social impairment. Independently of the mathematical analysis applied to the investigation of therapy-generated symbol sequences, our experience suggests that the procedures presented here are of value in training therapists.

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Section: Resultssupporting

confidence: 92%

Communication patterns in a psychotherapy following traumatic brain injury: A quantitative case study based on symbolic dynamics

Rapp

Cellucci²,

Gilpin

et al. 2011

BMC Psychiatry

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“…The therapist's speech showed decreasing presumptuousness as the patient's speech became less dominated by informativeness. These changes were interpreted as evidence of decreasing asymmetry in status between the therapist and patient (Winefield et al 1987).…”

Section: Resultsmentioning

confidence: 99%

“…The therapist was conscious of exercising his skills through the medium of language and spoke in a more considered manner than the patient; for example, the discrepancies between grammatical form and pragmatic intent were greater in his speech than in hers (Winefield et al 1987). His comments about the course of treatment (see later in this article) indicated that selfmonitoring of speech was an important component of his therapeutic activity.…”

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confidence: 99%

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Tag questions and powerfulness: Quantitative and qualitative analyses of a course of psychotherapy

Winefield

Chandler²,

Bassett³

1989

Lang. Soc.

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A complete course of psychotherapy provided extensive information about natural speech patterns of a male psychiatrist and a female patient. Contrary to assertions of the deferential function of tag questions, the patient's use of this form increased as she gained in self-confidence and improved her psychological adjustment. Qualitative analysis of the type, antecedents, and consequences of tag questions in sessions at the beginning and end of the therapy shows how the patient's use of the form reflects her growing independence. Quantitative and qualitative analyses of verbal interaction offer complementary benefits, and a two-stage research method is advocated. (Psychotherapeutic discourse, tag questions, pragmatics, sociolinguistics, psychotherapy process)

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“…These synchronies may afford each person access to the other's experience and mode of knowing, which ultimately allows for the incorporation of new relational structure in each subsystem. This idea is influenced by existing research into mutual speech patterns and vocal rhythms, nonverbal behavior, and endogenous biological rhythms in mother-infant and therapeutic interactions (Beebe, Jaffee, Feldstein, Mays, 6 Alson, 1985;Beebe, Stern, 6 Jaffe, 1979;Davis 6 Hadiks, 1994;Kraemer, 1992;Matarazzo 6 Wiens, 1977;Pendick, 1993;Winefield, Bassett, Chandler, 6 Proske, 1987). Further research might investigate the endogenous mechanics of empathic resonance and internalization of new object relational patterns and expectations.…”

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confidence: 99%

Reflections on the therapeutic system as seen from the science of chaos and complexity: Implications for research and treatment.

Perna

The Psychological Meaning of Chaos: Translating Theory Into Practice.

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Implications for Research and Treatmentvolution is chaos with feedback" (Joseph Ford, quoted in Gleick, 1987, p. 314). This simple formula serves as a starting point, an "initial condition," for the ideas explored in this chapter. In chapter 5, I introduced the idea that maximum entropy chaos precedes a phase transition in a complex system. I equated this with the phenomenon of psychological regression as a precedent for developmental leaps. Chaos implies maximum probability. Contextual feedback is what determines which trajectory a chaotic system follows. Thus, in a psychotherapy relationship, if some aspect of the patient system is de-structured so that many possibilities exist for self-evolution, the feedback within the therapeutic environment can select the ultimate developmental path on which the patient embarks. Just how this selectivity occurs and why it sometimes does not are persistent questions in psychotherapy theory and research. Systems theory offers a unique perspective from which to view psychotherapeutic change processes. This chapter focuses on the specific areas of symbolic communication, therapeutic connectedness, symbiosis, and empathic attunement.I begin with the assumption that the therapeutic relationship is a complex system that emerges from the complex systems of the patient and the therapist in interaction with one another. An assumption derived from infant development research is that both therapist and patient demonstrate self as well as mutual regulatory functions within the therapeutic relationship. The relationship then

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Process in Psychotherapy as Decreasing Asymmetry between Patient and Therapist: Evidence from the Verbal Interaction

Cited by 6 publications

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Communication patterns in a psychotherapy following traumatic brain injury: A quantitative case study based on symbolic dynamics

Communication patterns in a psychotherapy following traumatic brain injury: A quantitative case study based on symbolic dynamics

Tag questions and powerfulness: Quantitative and qualitative analyses of a course of psychotherapy

Reflections on the therapeutic system as seen from the science of chaos and complexity: Implications for research and treatment.

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