João Salgado

A dynamic look at narrative change in psychotherapy: A case study tracking innovative moments and protonarratives using state space grids

Abstract This study aims to further the understanding of how innovative moments (IMs), which are exceptions to a clients problematic self-narrative in the therapy dialogue, progress to the construction of a new self-narrative, leading to successful psychotherapy. The authors’ research strategy involved tracking IMs, and the themes expressed therein (or protonarratives), and analysing the dynamic relation between IMs and protonarratives within and across sessions using state space grids in a good-outcome case of constructivist psychotherapy. The concept of protonarrative helped explain how IMs transform a problematic self-narrative into a new, more flexible, self-narrative. The increased flexibility of the new self-narrative was manifested as an increase in the diversity of IM types and of protonarratives. Results suggest that new self-narratives may develop through the elaboration of protonarratives present in IMs, yielding an organizing framework that is more flexible than the problematic self-narrative.

Narrative Therapy vs. Cognitive-Behavioral Therapy for moderate depression: Empirical evidence from a controlled clinical trial

Abstract Background: Systematic studies of the efficacy of Narrative Therapy (NT) for depression are sparse. Objective: To evaluate the efficacy of individual NT for moderate depression in adults compared to Cognitive-Behavioral Therapy (CBT). Method: Sixty-three depressed clients were assigned to either NT or CBT. The Beck Depression Inventory-II (BDI-II) and Outcome Questionnaire-45.2 (OQ-45.2) were used as outcome measures. Results: We found a significant symptomatic reduction in both treatments. Group differences favoring CBT were found on the BDI-II, but not on the OQ-45.2. Conclusions: Pre- to post-treatment effect sizes for completers in both groups were superior to benchmarked waiting-list control groups.

Dialogism and the psyche: Bakhtin and contemporary psychology

The authors argue that dialogical philosophy, and particularly the work of the Bakhtin circle, offers psychology a way to conceptualize and study human experience such that the notion of psyche is preserved and enriched. The authors first introduce the work of the Bakhtin circle and then briefly outline some of the most influential theories of self and psyche. The implications of dialogism for theories of the self are then discussed, focusing on six basic principles of dialogical thought – namely, the principles of relationality, dynamism, semiotic mediation, alterity, dialogicality, and contextuality. Together, these principles imply a notion of psyche that is neither an isolated homunculus nor a disembodied discourse, but is, rather, a temporally unique, agentive enactment that is sustained within, rather than against, the tensions between individual and social, material and psychological, multiple and unified, stable and dynamic. The authors also discuss what this dialogical conception of psyche implies for research, arguing first that dynamic relations, rather than static entities, are the proper unit of psychological study and, second, that a dialogical research epistemology must conceive of truth as a multi-voiced event, rather than as a singular representation of fact. Finally, the authors introduce this special issue and outline the other contributions.

Setbacks in the process of assimilation of problematic experiences in two cases of emotion-focused therapy for depression.

Abstract Objective: Research on the assimilation model has suggested that psychological change takes place in a sequence of stages punctuated by setbacks, that is, by transient reversals in the developmental course. This study analyzed such setbacks in one good outcome case and one poor outcome case of Emotion-focused therapy (EFT) for depression. Method: Intensive analyses of five transcribed sessions from each case identified 26 setbacks in the good outcome case and 27 in the poor outcome case. The reason for each setback was classified into one of four categories: balance strategy, exceeding the therapeutic zone of proximal development either induced by the therapist (ZPD-T) or induced by the client (ZPD-C), or spontaneous switches. Results: In the good outcome case the most frequent reasons for setbacks were balance strategy and spontaneous switches, whereas in the poor outcome case the most frequent reason for setbacks was ZPD-T. Conclusions: As in previously studied therapies, setbacks in EFT, usually represent productive work on relatively less advanced strands of the clients major problems. Results point to the importance of the therapist attending to the limits of the clients therapeutic ZPD.

Therapeutic collaboration and the assimilation of problematic experiences in emotion-focused therapy for depression: Comparison of two cases

Abstract Objective: The Assimilation model argues that therapists should work responsively within the client’s therapeutic zone of proximal development (TZPD). This study analyzed the association between the collaborative processes assessed by the Therapeutic Collaboration Coding System (TCCS) and advances in assimilation, as assessed by the Assimilation of Problematic Experiences Scale (APES). Method: Sessions 1, 4, 8, 12, and 16 of two contrasting cases, Julia and Afonso (pseudonyms), drawn from a clinical trial of 16-sessions emotion-focused therapy (EFT) for depression, were coded according to the APES and the TCCS. Julia met criteria for reliable and clinically significant improvement, whereas Afonso did not. Results: As expected, Julia advanced farther along the APES than did Afonso. Both therapists worked mainly within their client’s TZPD. However, Julia’s therapist used a balance of supporting and challenging interventions, whereas Afonso’s therapist used mainly supporting interventions. Setbacks were common in both cases. Conclusions: This study supports the theoretical expectation that EFT therapists work mainly within their client’s TZPD. Therapeutic exchanges involving challenging interventions may foster client change if they occur in an overall climate of safety.

From Bakhtinian theory to a dialogical psychology

The analysis of the different articles in this special issue gives a rather promising but complex image of a dialogical approach to psychology. Mikael Leiman proposed utterances as the object of study for psychotherapy research, semiotic mediation as the explanatory principle, and semiotic position as the unit of analysis. Frank Richardson cautioned us about how dialogical proposals can become entrapped by the extreme decentering tendency of social constructionism. James Cresswell, in his turn, claimed that Bakhtins work is precisely a way of avoiding the unbalanced account of personal vacuity and freedom found in many constructionist accounts: it is precisely because we are bound to social ties that we become ethically involved with others and, indeed, with ourselves. Michèle Grossen and Anne Salazar Orvig claimed that otherness and the institutional, transpersonal dimensions are also present in every dialogical act, something that tends to be overlooked. Moore et al., following this suggestion, pointed to the multiplicity of institutional social frames, adding to the potential tension between the different available ways of interpreting self and context. Following these various contributions, the authors argue that a dialogical conception implies a relational self in constant dialogical and ethical involvement with society. They further argue that to respect the complexity of the whole in each lived situation, we need different, and more conversational, research strategies. In a final synthesis, centrifugal and centripetal movements of the self are conceived as mutually dependent in a fundamentally temporal conception of psychological becoming.

Being Human: Experiencing and Communicating

Haye’s article Living being and speaking being highlights a confusion that the traditional cognitive science has been making between cognition and representation, reducing semantics (meaning) to the syntax (computation with symbols). This traditional view cannot fully grasp the dependence of meaning on the relational context, opening space for the need to take into account the Bakhtinian notions of responsivity and addressivity to an other as defining features of the communicational social act. Socialized signs are conceived here as central tools to our relation to the world and to the others. We pursue some of the implications of this radical dialogical commitment specifying their implications to an ontological level of human beings: relationships are the ground for the depiction of human beings and otherness as a necessary complementarity of our own existence.

Listening to India, Listening to Ourselves: The Place of Self in Culture

Nandita Chaudhary’s book Listening to Culture: Constructing Reality from Everyday Talk offers us the possibility of embarking on a journey through the complex and multifaceted reality of human life in India. It turns out to be a truly enriching piece of work in the realm of cultural psychology studies. The author follows several streams of thought, trying to create a delicate balance between the arguments of postmodernism and socioconstructivism, while retaining the aim of creating a scientific approach of personhood. Indeed, all this work embraces the challenge of making an empirical analysis of the person that follows the basic premise of cultural psychology: bringing to the foreground subjectivity and culture as two bounded and intertwined poles. Most of all, through several tales, personal stories and accounts of national events, we get the feeling of contact with the human life that takes place in that part of the globe. Psychology, in its dualistic approach of separating personhood and culture, has been dominated by categories clearly rooted in (some) Western cultures. Underneath this state of affairs lies a kind of belief in

Does assimilation of problematic experiences predict a decrease in symptom intensity

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. Method Participants 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. Results The assimilation progress was shown to be a better predictor of decreases in symptom intensity than the reverse. Conclusion The results supported the assimilation models suggestion that assimilation progress promotes decreases in symptom intensity in the treatment of clients with major depressive disorder.

Changes in symptom intensity and emotion valence during the process of assimilation of a problematic experience: A quantitative study of a good outcome case of cognitive-behavioral therapy

Abstract The assimilation model describes the change process in psychotherapy. In this study we analyzed the relation of assimilation with changes in symptom intensity, measured session by session, and changes in emotional valence, measured for each emotional episode, in the case of a 33-year-old woman treated for depression with cognitive-behavioral therapy. Results showed the theoretically expected negative relation between assimilation of the clients main concerns and symptom intensity, and the relation between assimilation levels and emotional valence corresponded closely to the assimilation models theoretical feelings curve. The results show how emotions work as markers of the clients current assimilation level, which could help the therapist adjust the intervention, moment by moment, to the clients needs.