Dialogical research on psychotherapy. Eugenie Georgaca & Evrinomy Avdi Aristotle University of Thessaloniki, Greece

Transcription

1 Dialogical research on psychotherapy Eugenie Georgaca & Evrinomy Avdi Aristotle University of Thessaloniki, Greece

2 Workshop structure Introduction to qualitative psychotherapy research and dialogical theory Trends and principles of dialogical psychotherapy research Levels and tools of data analysis Analysis Participants conducting analysis in small groups Discussion / conclusions

3 Our research in context Process - outcome psychotherapy research Quantitative process-outcome psychotherapy research Criticisms: Simplistic assumptions Responsiveness Therapist-researcher gap Practice-based evidence The case for qualitative process research

4 Our research in context Language-based qualitative research Open ended and discovery oriented Detailed descriptions Naturalistic Idiographic in depth analysis of single cases Exploring variability and contradiction complexity of therapeutic encounter Bridging macro-level (theory) and micro-level (linguistic/ discursive practices)

5 Our research in context Language-based qualitative research Explore interaction and sequences of meaning making Explore therapist effects Enhance therapist creativity Enhance therapist reflexivity Language-based qualitative research Examining in detail how therapy gets done in practice Examining the formation and negotiation of client subjectivity

6 Dialogical theory Centrality of dialogue in human life To live means to participate in dialogue: to ask questions, to heed, to respond, to agree and so forth. In this dialogue a person participates wholly and throughout his whole life: with his eyes, lips, hands, soul, with his whole body and deeds (Bakhtin, 1984)

7 Dialogical theory Dialogical theory key assumptions (Linell, 2011) Relational view of human subjectivity Interactionism Contextualism Co-construction Dialogical vs. monological accounts Alterity - Commonality vs difference Dynamism

8 Dialogical theory and psychotherapy The potential of dialogue talking, listening, jointly creating meaning to heal. Dialogue as key metaphor in psychotherapy literature: Focus on the dialogical constitution of the self Focus on the process of dialogue

9 Dialogical accounts of selfhood The self as a polyphonic novel (e.g. Hermans, 2003, 2004) Spatially structured and embodied Populated by voices of others Decentralised and open Historically and culturally contextualised Characteristics of the self: Multiplicity Organisation Self-reflection

10 Dialogical accounts of therapy Therapy as a process of dialogue Therapist responsiveness Listening, responsive understanding Therapist comprehensive embodied presence Therapist inviting explorations/ new meanings Orientation towards generating dialogue

11 Trends in dialogical psychotherapy research Hubert Hermans et al Personal Positioning Repertoire Miguel Goncalves et al Innovative Moments Paul Lysaker et al Narrative in schizophrenia

12 Trends in dialogical psychotherapy research Mikael Leiman Dialogical Sequence Analysis Mikael Leiman, William Stiles et al Voices Reformulation of the Assimilation Model

13 Trends in dialogical psychotherapy research Joao Salgado & Carla Cunha Positioning Microanalysis Jaako Seikkula, Aarno Laitila & Peter Rober Dialogical Investigations of Happenings of Change

14 Trends in dialogical psychotherapy research Macro-analytic approaches vs Micro-analytic approaches

15 Principles of dialogical analysis of psychotherapy Psychotherapy as a semiotic process Focus on language Analysing psychotherapy sessions The dialogical character of the self Mapping dialogical positions / macro-level / based on content Analysing enactment of positions / micro-level / based on form & function

16 Principles of dialogical analysis of psychotherapy The dialogue between client and therapist Interactional construction of meaning Levels of analysis of therapist s position: The therapist as a real, interactional addressee of the client s talk The therapist as an addressee, a counter-position of the client s position The therapist as an institutional role Analysing the therapist s interventions

17 Principles of dialogical analysis of psychotherapy Culture, the self and psychotherapy Historical and cultural determinants of the self and subjectivity The role of dominant discourses Psychotherapeutic discourse / psychotherapy as institution

18 Introduction to the psychotherapy material Menninger Clinic, U.S.A Menninger Psychotherapy Research Project: examining psychoanalytic psychotherapy of clients diagnosed with borderline personality disorder expressive vs. supportive treatment therapeutic alliance / client collaboration 3 long-term psychotherapies 17 sessions each Horwitz, L., Gabbard, G., Allen, J. C., Frieswyk, S. H., Colson, D.B., Newson, G. E., Coyn. L. (1996). Borderline Personality Disorder: Tailoring the psychotherapy to the patient. Washington DC: American Psychiatric Press.

19 Introduction to the psychotherapy material Ms Green woman, late 20s, divorced drug and alcohol abuse, problems with impulse control, self-damaging behaviour several previous hospitalisations Therapy: 2 years and 4 months (207 sessions) first in-patient, then day program 17 sessions, randomly selected, throughout therapy

20 Introduction to the psychotherapy material Particularities of specific therapy: Psychodynamic framework Therapist very active in interpreting Client fairly unreflective / tendency to act out

21 Study design How are therapies selected? Purposefully selected Randomly selected - from archive or from new cases Practical and ethical considerations / patient agreement / participation in specific project

22 Study design How is material selected for analysis? Randomly selected sessions Significant moments paradigm Specific ideas focusing the analysis

23 Transcription Transcription formats: Table Text Stanza Transcription conventions Audio/video recordings

24 Organisation of material Initial reading Segmenting sessions into long meaning units: Topic discussed Relational episode Second reading Refining text segmentation Highlighting key parts of the text Brainstorming on text Research diary

25 Levels of analysis Examining client s talk Describing client s internal dynamics of dialogical self positions and their shifts in time Examining client-therapist interaction Describing how dialogical positions are constructed and negotiated

26 Levels of analysis Level 1: Mapping dialogical positions Level 2: Sequential analysis of dialogical positions and patterns Level 3: Micro-analysis of interaction

27 Levels of analysis Moving from macro-analysis to micro-analysis Collaborative research

28 Analytical tools Dialogical position: agent (who / by whom) recipient/other (to whom) referential object (about what) Dialogical pattern Voice

29 Analytical tools At the level of interaction: Speaker listener Within the text: Subject of the utterance other/recipient & referential object in the utterance At the level of the intersection between the interaction and the text: Subject position addressee

30 Analytical tools At the level of interaction / act of narrating / enunciation: Speaker / narrator / subject of enunciation Listener / interlocutor

31 Analytical tools At the level of text / narrative / utterance: Subject of the utterance Other / recipient Referential object

32 Analytical tools Describing the subject of the utterance: who is the agent/protagonist of the action described who is the other/recipient of the action described what is being said/described (content) what is the action about (referential object) whose words are being used, whose voice is expressed what kind of agent / I position is being articulated acting, feeling, thinking I factual/descriptive/experiencing I vs reflective I when is the action described taking place (past, present, future)

33 Analytical tools By addressing these issues we can: identify dialogical positions map dialogical patterns detect shifts in positions and patterns This corresponds to level 1 and part of level 2 of our analysis

34 Analytical tools At the level of the intersection between the interaction and the text: Subject position addressee

35 Analytical tools Deducing subject position: Speaker s authorial stance Content of talk Form of talk Rhetorical/interactional features and functions Discourses employed

36 Analytical tools Authorial stance Drawing from: Positioning theory Footing Discourse analysis

37 Analytical tools Authorial stance Authorship Responsibility Distance from dialogical positions Layers of reflexive positions Evaluative comments Attributions of statements to others Rhetorical disclaimers Identification with dialogical positions Reflexive positions Enacting positions

38 Analytical tools Addressee Therapist positioned In line with the client s dialogical pattern In line with the therapist s institutional role Alliance through reflexive positioning

39 Analytical tools Action orientation Function and rhetorical organization of talk Features of interaction Drawing upon: Discourse analysis Conversation analysis Dialogical Investigation of Happenings of Change

40 Analytical tools Context Institution of psychotherapy Broader sociocultural discourses Drawing upon: Discourse analysis

41 Analytical tools By addressing these issues we can: Understand the mutual relation between intrapersonal and interpersonal aspects of the self Explore the processes through which the self is articulated Explore the active construction and co-construction of the self This is done through micro-analysis This corresponds to parts of level 2 and to level 3 of our analysis

42 Analytical concepts Agency Self-reflection Observing positions, meta-positions, reflexive positions