Therapist interventions and client ambivalence in two cases of narrative therapy for depression

Ribeiro, António P.; Braga, Cátia; Stiles, William B.; Teixeira, Poliane; Gonçalves, Miguel M.; Ribeiro, Eugénia

doi:10.1080/10503307.2016.1197439

Cited by 20 publications

(18 citation statements)

References 38 publications

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“…Although the clients might have wished to decrease their experience of suffering and might have wanted to change with the help of the therapist, it is possible that they were blocked in the process of collaboration if they were anticipating change as having undesirable implications in their self-meanings or narrative structure. This would be consistent with studies that focused on impasses and blocks of change (Feixas et al, 2013;Ferreira et al, 2015;Gabalda & Stiles, 2009;Ribeiro et al, 2014Ribeiro et al, , 2016aRibeiro et al, , 2016bStiles, Gabalda, & Ribeiro, 2016), which suggest that self-conflicts regarding the experience of change may be involved in an increasing non-collaborative interaction and, subsequently, in dropout cases of therapy.…”

Section: Discussionsupporting

confidence: 86%

“…Considering all the cases that the therapist was responsible for, including the cases selected for this study, the therapist attended a total of 34 cases of narrative therapy, from which 26.47% were successful completers, 38.26% were unsuccessful completers, 5.88% were successful dropouts, and 29.41% were unsuccessful dropouts. Despite the different outcomes, previous case studies using the TCCS (e.g., Ferreira, Pinto, Ribeiro, Pereira, & Pinheiro, 2015;Ribeiro et al, 2014Ribeiro et al, , 2016a consistently demonstrate that this therapist tended to intervene according to challenging strategies since the beginning of the therapy.…”

Section: Methods Participantsmentioning

confidence: 85%

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The Therapeutic Collaboration in Dropout Cases of Narrative Therapy: An Exploratory Study

Pinto

Sousa

Pinheiro

et al. 2018

rdp

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With this study, we aimed to describe the interaction within the therapeutic dyads involved in dropout cases of narrative therapy, once the quality of interaction in therapy appears to constitute a critical factor in clients’ decisions regarding its discontinuation. Seven dropout cases of narrative therapy, which were conducted by the same therapist, were analyzed using the Therapeutic Collaboration Coding System. The coding procedure required two trained and independent judges along with an auditing process. Overall, the findings demonstrated that independent of the clients’ responses, the therapist tended to increase the challenging interventions and decrease the supporting interventions over time. In turn, the clients oscillated between having experiences of safety and experiences of intolerable risk. The results will be discussed in terms of their theoretical and empirical relevance in relation to clinical implications.

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Section: Discussionsupporting

confidence: 86%

Section: Methods Participantsmentioning

confidence: 85%

The Therapeutic Collaboration in Dropout Cases of Narrative Therapy: An Exploratory Study

Pinto

Sousa

Pinheiro

et al. 2018

rdp

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“…A series of intensive case studies of assimilation progress in different therapeutic models has shown that good outcome clients, as assessed by standard symptom intensity measures, progress toward high APES levels across their sessions (e.g., Brinegar, Salvi, & Stiles, 2008;Caro Gabalda, 2011;Caro Gabalda, Stiles, & Pérez Ruiz, 2016;Gray & Stiles, 2011;Honos-Webb, Stiles, & Greenberg, 2003;Knobloch, Endres, Stiles, & Silberschatz, 2001;Mendes et al, 2016;Osatuke et al, 2007;Ribeiro, Braga et al, 2016a;Ribeiro, Cunha et al, 2016b). For example, in a study of one good outcome client, Basto et al (2016) found a strong negative correlation across 16 sessions of CBT between APES level and symptom intensity.…”

Section: Relation Of Assimilation To Therapy Outcomementioning

confidence: 99%

Does assimilation of problematic experiences predict a decrease in symptom intensity?

Basto

Stiles

Rijo

et al. 2017

Clin Psychology and Psychoth

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The assimilation model describes therapeutic change as an integration of experiences that had previously been problematic, distressing, avoided, or warded off. This study assessed whether assimilation was associated with treatment outcome in a sample of psychotherapeutic treatments for depression. Further, it assessed the direction of the association—whether increasing assimilation predicted decreases in symptom intensity or decreasing symptom intensity predicted increases in assimilation.MethodParticipants were 22 clients with mild to moderate depression drawn from a clinical trial comparing cognitive behavioral therapy with emotion‐focused therapy. The direction of prediction between assimilation progress and changes in self‐reported symptom intensity was assessed.ResultsThe assimilation progress was shown to be a better predictor of decreases in symptom intensity than the reverse.ConclusionThe results supported the assimilation model's suggestion that assimilation progress promotes decreases in symptom intensity in the treatment of clients with major depressive disorder.

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“…Despite the difference in conceptualizations, both empathy and challenge are observable in the actual interaction across different psychotherapy approaches ( Bänninger-Huber and Widmer, 1999 ; Voutilainen et al, 2010 ; Ribeiro et al, 2013 ; Weiste and Peräkylä, 2014 ) and both have positive association with therapeutic outcome ( Orlinsky and Howard, 1986 ; Keijsers et al, 2000 ; Elliot et al, 2011 ). Although empathy and challenge can be seen as diverging orientations, in reality they often co-exist ( Bänninger-Huber and Widmer, 1999 ; Voutilainen et al, 2010 ; Ribeiro et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

Empathy, Challenge, and Psychophysiological Activation in Therapist–Client Interaction

et al. 2018

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Two central dimensions in psychotherapeutic work are a therapist’s empathy with clients and challenging their judgments. We investigated how they influence psychophysiological responses in the participants. Data were from psychodynamic therapy sessions, 24 sessions from 5 dyads, from which 694 therapist’s interventions were coded. Heart rate and electrodermal activity (EDA) of the participants were used to index emotional arousal. Facial muscle activity (electromyography) was used to index positive and negative emotional facial expressions. Electrophysiological data were analyzed in two time frames: (a) during the therapists’ interventions and (b) across the whole psychotherapy session. Both empathy and challenge had an effect on psychophysiological responses in the participants. Therapists’ empathy decreased clients’ and increased their own EDA across the session. Therapists’ challenge increased their own EDA in response to the interventions, but not across the sessions. Clients, on the other hand, did not respond to challenges during interventions, but challenges tended to increase EDA across a session. Furthermore, there was an interaction effect between empathy and challenge. Heart rate decreased and positive facial expressions increased in sessions where empathy and challenge were coupled, i.e., the amount of both empathy and challenge was either high or low. This suggests that these two variables work together. The results highlight the therapeutic functions and interrelation of empathy and challenge, and in line with the dyadic system theory by Beebe and Lachmann (2002), the systemic linkage between interactional expression and individual regulation of emotion.

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Therapist interventions and client ambivalence in two cases of narrative therapy for depression

Abstract: This supports the theoretical explanation that the therapist did not match client's developmental level in the poor-outcome case, working beyond the client's current TZPD and contributing to the maintenance of ambivalence.

Cited by 20 publications

References 38 publications

The Therapeutic Collaboration in Dropout Cases of Narrative Therapy: An Exploratory Study

The Therapeutic Collaboration in Dropout Cases of Narrative Therapy: An Exploratory Study

Does assimilation of problematic experiences predict a decrease in symptom intensity?

Empathy, Challenge, and Psychophysiological Activation in Therapist–Client Interaction

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