Alessandro Gennaro

LOOKING AT THE PSYCHOTHERAPY PROCESS AS AN INTERSUBJECTIVE DYNAMIC OF MEANING-MAKING: A CASE STUDY WITH DISCOURSE FLOW ANALYSIS

This work presents a dialogic model of psychotherapy (the Two-Stage Semiotic Model, TSSM) with discourse flow analysis (DFA) and a low-inferential method of analysis based on it. TSSM claims that in good-outcome psychotherapy, the patients system of meanings follows a U-shaped trend: First, it decreases, and then the dialog promotes new meanings. DFA represents a sessions dialog as a “discourse network” made by the associations for temporal adjacency between contents; then it studies the networks dynamic properties. DFA has been applied to the textual corpus obtained from the verbatim transcript of a 15-session psychotherapy course. Findings are consistent with the hypotheses.

The Unbearable Dynamicity of Psychological Processes: Highlights of the Psychodynamic Theories

The term dynamic generally refers to the psychology grounded on and informed by psychoanalysis—even if dynamic perspectives do not necessarily coincide with it. It is well known that in Freudian theory, the dynamic level of analysis is that focused on conflicts and their role in shaping psychological facts. Yet contemporary psychoanalytically oriented psychology gives a broader meaning to the label, and consequently dynamic psychology is the psychology concerning the affective source (motivation, instinct, intra-psychic, and/or interpersonal conflicts) shaping (inter)subjectivity. Thus, in contemporary psychology the term psychodynamic can be seen as a synecdoche where the whole—the psychoanalytically oriented psychology—is referred to by means of the part—the dynamic level of analysis as conceptualized by Freud. Here we assume this broad definition. Therefore, henceforth the term psychodynamic will be used as being synonymous with psychoanalytically oriented psychological theory.

Analyzing psychotherapy process as intersubjective sensemaking: An approach based on discourse analysis and neural networks

Abstract The authors propose a method for analyzing the psychotherapy process: discourse flow analysis (DFA). DFA is a technique representing the verbal interaction between therapist and patient as a discourse network, aimed at measuring the therapist–patient discourse ability to generate new meanings through time. DFA assumes that the main function of psychotherapy is to produce semiotic novelty. DFA is applied to the verbatim transcript of the psychotherapy. It defines the main meanings active within the therapeutic discourse by means of the combined use of text analysis and statistical techniques. Subsequently, it represents the dynamic interconnections among these meanings in terms of a “discursive network.” The dynamic and structural indexes of the discursive network have been shown to provide a valid representation of the patient–therapist communicative flow as well as an estimation of its clinical quality. Finally, a neural network is designed specifically to identify patterns of functioning of the discursive network and to verify the clinical validity of these patterns in terms of their association with specific phases of the psychotherapy process. An application of the DFA to a case of psychotherapy is provided to illustrate the method and the kinds of results it produces.

Automated method of content analysis: A device for psychotherapy process research

Abstract The work presents a computer-aided method of content analysis applicable to verbatim transcripts of psychotherapy: the Automated Co-occurrence Analysis for Semantic Mapping (ACASM). ACASM is able to perform a context-sensitive strategy of analysis aimed at mapping the meanings of the text through a trans-theoretical procedure. The paper is devoted to the presentation of the method and testing its validity. To the latter end we have compared ACASM and independent blind human coders on two tasks of content analysis: (a) estimating the semantic similarity between two utterances; (b) the semantic classification of a set of utterances. Results highlight that: (a) ACASMs estimates of semantic similarity are consistent with the corresponding estimates provided by coders; (b) coders’ agreement and coder-ACASM agreement on the task of semantic classification have the same magnitude. Results lead to the conclusion that the content analysis produced by ACASM is indistinguishable from that performed by human coders.

Grasping the Dynamic Nature of Intersubjectivity

The acknowledgement of the dynamicity of psychological phenomena ®has been progressively gaining acceptance in various branches of psychology. In some of these areas (first of all the neurosciences, psycholinguistic, but also cognitive psychology, and social psychology) the theory has greatly benefited from the adoption of conceptual models and methods of investigation provided by the Dynamic Systems theory (inter alia, Salvatore, Tebaldi, & Poti, 2008). However, in other fields of psychology, authors refer to the dynamic systems in metaphorical terms, using it as a striking image to describe the irreversibility and intrinsic creativity/autonomy of the psychological phenomena under investigation. As a result of this rhetorical strategy, in various areas related to the study of intersubjectivity (work psychology, clinical, and psychodynamic psychology as well as cultural psychology and at least partially developmental psychology) there is an evident gap between the conceptualisation of the phenomena as dynamic and the empirical investigation of it as a “static” process (Lauro-Grotto, Salvatore, Gennaro, & Gelo, 2009—Chapter 1 in this book).

Psychopathology as Social Construction: The Case of Anorexia Nervosa

Changes to definitions and theories of psychopathology result less from scientific advances and more from changes in social and cultural values. Herein, the historical and contemporary diversity in definitions and theories of anorexia nervosa is used to illustrate this point. First, we offer a discussion of diachronic diversity (diversity over time) and synchronic diversity (diversity at a given point in time) in conceptions and theories of psychopathology in general. Second, we elaborate a social constructionist perspective on psychopathology in general. Third, to illustrate this perspective, we provide a diachronic and synchronic analysis of definitions and theories of anorexia nervosa. Fourth, we discuss the implications of this analysis for clinical practice. We conclude that whatever view eventually prevails will depend not on which one is better at rooting out some hidden truth about anorexia nervosa but, rather, on which one is viewed as more compatible with evolving social and cultural standards, views, and norms regarding health and illness in general and self-starvation in particular.

An automated method of content analysis for psychotherapy research: A further validation

Abstract Objective: The aim of the study is to validate the ability of ACASM (Automated Co-occurrence Analysis for Semantic Mapping) to provide a representation of the content of the therapeutic exchange that is useful for clinical analysis. Method: We compared the clinical case analyses of a good outcome psychodynamic therapy performed by a group of clinicians (n = 5) based on the verbatim transcripts (transcript-based analysis) with the clinical case analyses performed by another group of clinicians (n = 5) based on the ACASM representation of the same sessions (ACASM-based analysis). Comparison concerned two levels: the descriptive level and the interpretative level of the clinical case analysis. Results: Findings showed that, inconsistently with our hypothesis, ACASM-based descriptions of the case obtained worse evaluations than transcript-based descriptions of the case (on all 3 criteria adopted). On the contrary, consistently with our hypothesis, ACASM is undistinguishable from the verbatim transcripts as regards the case interpretation (on 2 out of 3 criteria adopted). Conclusions: ACASM provides a description of the case that, though different from the one provided by the transcripts, enables clinicians to elaborate clinical interpretations of the case which approximate those produced by clinicians working directly on verbatim transcripts.

Deconstructive and Constructive Dynamics in the Clinical Process: A Step Further in the Validation of the Two-Stage Semiotic Model

The two-stage semiotic model (TSSM) suggests that the basic dynamics of a psychotherapy process could be described in terms of alternation of two different processes aimed respectively at constraining patients’ meanings regulating experience and action (deconstructive process) and at supporting the elaboration of innovative meanings (constructive process). The present case study tests the specificity of each of these processes in terms of clinically relevant features detected at interpersonal, intrapsychical, and clinical levels. A 76-session good-outcome psychodynamic treatment was studied. The results enable constructive and deconstructive sessions to be differentiated in terms of interaction modalities and the patients modalities of thinking. This is consistent with the TSSM hypothesis that the constructive and deconstructive sessions are composed of qualitatively different clinical processes.

Clinical Mutual Attunement and the Development of Therapeutic Process: A Preliminary Study

Despite the identification of many factors that play a central role in the development of the psychotherapy process, there is still a lack of evidence about the basic relational mechanisms that pave the way to its working. In this pilot study, we focus on nonverbal microprocessual attunement as the basic mechanism grounding the displacing of discrete factors in shaping the clinical process. Two single sessions of two short-term psychodynamic treatments, selected respectively from a good- and a poor-outcome treatment, have been coded in terms of patient and therapist speech rate, coordination in ruptures, resolution of the therapeutic alliance, and patients displayed thinking processes. Two dynamic structural equation models focusing on clinical attunement as a factor able to activate the interplay of the assessed clinical dimensions have been theoretically designed and tested in both cases. The driven theoretical structural equation models fit the data, suggesting a different role of nonverbal attunement as a moderating factor. The obtained results are consistent with the hypothesis claiming that a good-outcome psychotherapy session is characterized by a mechanism of clinical attunement that enforces the therapist–patient relationship and promotes the integration of formal thinking processes that affect emotional and cognitive domains.

Dynamic Mapping of the Structures of Content in Clinical Settings (DMSC). A new coding system for analysing the patient's narratives

OBJECTIVES The paper presents a method of content analysis framed within a semiotic and contextual model of the psychotherapy process as a situated dynamics of sensemaking: the Dynamic Mapping of the Structures of Content in Clinical Settings (DMSC). DESIGN DMSC is a system of content analysis focused on a generalized level of meaning, concerning basic aspects of the patients narrative (e.g., if the narrative concerns herself or other than herself). METHOD The paper presents the result of the application of DMSC to an intensive single-case analysis (Katja). The method has been applied by judges to the transcripts of sessions and is aimed at identifying patterns of combinations (defined: Patterns of content) of the categories characterizing the patients narratives (pattern analysis approach) as well as at mapping the transition among these patterns (sequential analysis approach). RESULTS These results provide evidence of its construct validity. In accordance with the theoretical model grounding the method, we have found that: (a) DMSC provides a meaningful representation of the patients narratives in terms of Patterns of content; (b) the probability of transition among the Patterns of content have proved to be significantly associated with the clinical quality of the sessions. CONCLUSION The DMSC has to be considered an attempt paving the way for further investigations aimed at developing a deeper understanding of the role played by the dynamics of sensemaking in the psychotherapy process.