The Self Between Cacophony and Monologue: A Conceptualization and Empirical Examination of Dialogical Complexity

Theory of dialogical self distinguishes between cacophonous, monological, and dialogical structure of the self. So far these structures have not been examined within systematic quantitative studies. Focusing on this issue, we conceptualized the three structures as degrees on a dimension of dialogical complexity. To assess dialogical complexity, we proposed a numerical index derived from the personal position repertoire and examined it empirically. We compared the index of dialogical complexity with indices of cognitive complexity (derived from the repertory grid technique), integrative complexity, and presence of dialogical relationships in narratives (both derived from the thematic apperception test). In our sample of a total of 60 nonclinical respondents, the index of dialogical complexity was not correlated with cognitive complexity. It was weakly negatively but significantly correlated with integrative complexity. Respondents who yielded a higher score of dialogical relationships in narratives formed the dialogical structure of the self according to the dialogical complexity index. Respondents who yielded less dialogical relationships in narratives obtained a wider range of dialogical complexity scores that indicated more cacophonous or monological structures. We conclude that the relationships with integrative complexity and with presence of dialogical relationships in narratives support the original conceptualization of dialogical complexity. However, due to limitations of the study, the results are not decisive, and further examination of dialogical complexity including clinical samples is needed.     

Micro‐analysis of a therapist‐generated metaphor referring to the position of a parentified child in the family

The purpose of this exploratory study is to develop a deeper understanding of the way in which the metaphorical language of therapists evolves in dialogue with a client over the course of a therapeutic session. We first briefly report on a study in which we categorized the metaphors used by therapists in twelve therapy sessions with a role‐played client. Then we focus on an intensive micro‐analysis of one particular metaphor that was introduced in the session by one particular therapist in the categorization study: the metaphor of a fireman in the family. Our analysis allowed us a detailed look at some of the ways in which metaphorical language opens dialogical space in the session to talk about the position of parentification of the client and about the price she has to pay for this position in terms of preoccupying worries and loneliness. Furthermore our analysis revealed the delicate dialogical nature of the therapeutic process in which, in talk, the therapist takes the client's experiencing into account all the time.     

the use of narratives to contextualize the experiences and needs of unemployed,underemployed, and displaced workers

The author examined the role of narratives used by unemployed, underemployed, and displaced workers seeking job training assistance through a government‐funded One‐Stop Career Center. Interviews with employees of a One‐Stop Career Center provided insight on client rate of disclosure of personal narratives and how client narratives are used to facilitate the job search process. Specifically, data from the interviews suggest that narratives give career center employees insight on job seekers' background, barriers, and reemployment mind‐set. Furthermore, the act of listening was seen as legitimizing job seekers' experiences. Implications of the findings are discussed.     

The effects of therapist-client age similarity on pretherapy expectations

The present study investigated the effects of similarity between psychotherapist age and client age on client's preference for a therapist, willingness to disclose, expected therapeutic climate, and perceptions of therapist competence. Similarity theory provided a rationale for the hypothesis that prospective clients would perceive a psychotherapist similar in age more favorably than a therapist dissimilar in age. Support for the hypothesis was obtained on the dimensions of client preference, willingness to disclose, and therapist competence. Also, consistent with previous research, high experienced therapists were viewed more favorably than low experienced therapists.This research is based on a doctoral dissertation submitted by Kathleen M. Tall under the direction of Michael J. Ross to Saint Louis University.     

A Negotiation Approach to Intake and Treatment Choice

Treatment choice is the decision process whereby the psychotherapeutic methods and the psychotherapist are determined when psychotherapy is recommended for a specific client. In this article the problem of treatment choice is situated within an integrative view of psychotherapy. A review of the literature confirms the usefulness of the following concepts for treatment choice: client preferences, client control of the situation of choice, and the mutual acceptability of differing views of therapists and clients. These research findings reveal the importance of four elements in the psychotherapeutic intake strategy: exploration of the client's perspective, informing the client, negotiation as a process of confrontation between the client's and the clinician's perspective, and the client's ultimate choice between alternative treatment proposals.     

Spontaneous Moments and the Domain of Non-Verbal Communication

Abstract

This paper investigates the impact of non-verbal interactions and spontaneous encounters on the therapeutic process and on a client's structural and behavioral patterns. The following case vignette concerns a client who presents with a pattern of non-verbal relational schemas based on his early traumatic experiences. The non-verbal and verbal role reenactments that unfold between client and therapist will be examined from an intersubjective, dialogical and self psychological perspective. Finally, the paper will explore how important therapeutic shifts may occur by attending to and working through these non-verbal aspects of the treatment, leading to new relational structures.     

Clinical relationships with forensic clients: A three-dimensional model

This paper considers the clinical relationship with clients in mandatory treatment. In several countries, clients found guilty of committing a sexual or violent offense (often resulting in a jail sentence) are obliged by law to meet a psychotherapist. This mandatory treatment occurs both during the time in jail and in the community. The clinical relationship with these clients is a complex process involving the therapist, the client, and the courts. In this paper we describe some common factors that can facilitate or hinder the therapist's work in this situation.     

Carl Rogers's Life and Work: An Assessment on the 100th Anniversary of His Birth

This article summarizes the life and work of America's most influential counselor and psychotherapist, Carl Rogers. He developed the client‐centered, person‐centered approach; popularized the term client; pioneered the recording of counseling cases; conducted landmark research on counseling and psychotherapy; and was a leader in the humanistic psychology movement, and more. Later, he applied the person‐centered approach to resolving intergroup and international conflict. Work on the client‐centered approach continues, and current research validates many of Rogers's earlier contributions.     

From scapegoating to thinking and finding a home: delivering therapeutic work in schools

This paper discusses how the child psychotherapist's core skills can be usefully applied in a school setting. It outlines some of the important policy changes that have necessitated a move towards delivering therapeutic work in community settings such as schools. It is argued that the role of the child psychotherapist in schools has much in common with the role played by the psychotherapist in a therapeutic community. The paper suggests that therapy in schools is in many ways less simple than therapy in clinic settings, and in particular it is often unclear who exactly the client is and at what level to intervene when a referral is made. The referred patient is not necessarily the ‘problem’, so that the child psychotherapist must be prepared to tackle issues in the system to ensure that splitting and projection are reduced, and systems around children can become more containing. Clinical vignettes and one main clinical illustration are used to try to illustrate these points.     

The manifestation of transference during early psychotherapy sessions: Exploring an alternate data source for therapist narratives in transference research

Introduction: Previous transference studies have compared in‐session client narratives about significant others to in‐session client narratives about the therapist, limiting data to the information that clients are willing to share with the therapist. Method: The first three sessions of 30 therapies with high‐functioning individuals were examined using the Core Conflictual Relationship Theme (CCRT) method. Client narratives about others were drawn from the psychotherapy sessions and client narratives about the therapist were drawn from a Participant Critical Event (PCE) interview conducted after the third session of therapy. Results: Factor analyses of the CCRT components indicated several relational patterns: a complementary pattern of relating characterised by a devaluation of the therapist and idealisation of others; a concordant relational transfer where clients feel bad with both the therapist and others; and as clients experience control issues with significant others, they wish to adopt a submissive stance toward the therapist. The results suggest that the source of therapist narratives may influence the results of transference research.     

Ways to Bolster Resilience in Traumatized Clients: Implications for Psychotherapists

This study aims to further theoretical and clinical discussions regarding the therapy of psychosis from a dialogical perspective and to contribute to the contemporary research literature that works toward developing methods for studying the dialogical processes in therapy. Three videotaped sessions of a therapy with a heterosexual couple, in which both partners had psychotic experiences, were analyzed using the Dialogical Investigations of Happenings of Change, a method developed with an aim to capture the dialogical qualities of multiactor conversations. The analysis illustrated shifts in the dialogical characteristics of the conversation through the sessions and associated shifts in the clients’ positioning, toward increased agency, as well as enrichment of the narratives regarding their difficulties. The gradual development toward more dialogical conversations, evidenced mainly in increased sharing of dominance and therapist responsiveness and participation, seemed to facilitate the joint construction of new words and meanings, the expression of strong feelings, the narration of difficult experiences, and increased agency. The findings support the view that a client's sense of agency, which can be particularly impoverished in psychosis, can be reconstructed in the context of dialogue, in which clients have a central place in telling their story.     

Encounters with Boundary Challenges: A Preliminary Model of Experienced Psychotherapists’ Working Strategies

Five experienced clinical psychologists were interviewed about their strategies for maintaining boundaries in psychotherapy. The interviews were subjected to qualitative analysis using grounded theory techniques to develop a preliminary model of boundary maintenance. The central principle exhibited by the interviewees was maintaining a therapeutic relationship to facilitate client self care. Overall, the central principle was comprised of three main working strategies: (1) maintaining client boundaries to ensure a clear focus on client needs; (2) maintaining psychotherapist boundaries to protect effective practice; and (3) maintaining psychotherapy boundaries to facilitate client reflection, awareness, and assumption of responsibility. Each strategy included two or three distinct meaning categories, explicated in the paper. Implications for clinical work and future research are discussed.     

Dialogue and power: a critical analysis of power in dialogical therapy

This article explores the relationship between dialogue and power in the practice of dialogue-oriented, "not-knowing" forms of therapy. It is argued that power of a dynamic and reversible kind infuses much ordinary social dialogue, and that the joint processes of power and resistance work together to render an interaction dialogical. In contrast, in dialogical therapy, overt exercises of power threaten the interaction's dialogical status, and power is deferred and denied by the therapist through not-knowing practices. A case study of Harlene Anderson's (1997) is used to illustrate that it is precisely power's presence that informs the practices of not knowing and uncertainty that characterize dialogical therapies. It is suggested that the not-knowing therapist withholds aspects of his or her voice as a condition for dialogicity. Instead, special speaking arrangements are required, in which the therapist's not-knowing is continuously communicated to the client, for the therapeutic conversation to remain dialogical. Without these speaking arrangements, I argue that therapy moves toward monologue. Therapists inherit powerful speaking positions from the institutional and sociocultural context, and the rejection of power within therapy serves only to conceal this aspect of power, which nevertheless pervades the therapeutic relationship. Finally, it is suggested that power is a "common factor"--shared by all therapies--and that our status as "inheritors" of power needs to be included in our understanding of the therapeutic process. This expanded view of therapy requires the re-theorization of dialogue, such that it includes, rather than excludes, considerations of power.     

Topic-focused analysis in a case of integrative psychotherapy with a father fearing his own anger

Even though evidence-based knowledge is considered the foundation of clinical practice, many clinicians question the clinical relevance of published research. Clinicians increasingly define themselves as having an integrative stance, in contrast to the tendency for most research to be based on clearly defined psychotherapies. Qualitative single case studies make it possible to generate knowledge about what actually occurs in integrative therapy. Topic change process analysis (TCPA) is used in the analysis of brief integrative therapy conducted by a very experienced psychotherapist drawing on a complex variety of therapeutic approaches. The client was a man in his late thirties, worrying about his strong anger, particularly related to one of his children. Analysis of topic areas, topic shifts, response patterns within topics and changes in perspective made it possible to identify key processes and key patterns of the therapy which resulted in a very positive outcome for the client. Implications of these findings for practice, and future research, are discussed.     

Birth—From Metaphor to Reality in Jewish Literature and Psychoanalysis: Discussion of Lewis Aron’s Paper “With you I’m Born Again”

In his innovative paper, Lewis Aron discusses narratives of his own “metaphorical birth” as a psychoanalyst, through the years of working with his first analysand and by way of his encounters with four different supervisors. Aron suggests varied psychoanalytic perspectives and dialogical readings of the essence of birth in mutual relations and of its presence in the analytic dyad.     

Medicalized Psychiatry and the Talking Cure: A Hermeneutic Intervention

The dominance of the medical-model in American psychiatry over the last 30 years has resulted in the subsequent decline of the ??talking cure??. In this paper, we identify a number of problems associated with medicalized psychiatry, focusing primarily on how it conceptualizes the self as a de-contextualized set of symptoms. Drawing on the tradition of hermeneutic phenomenology, we argue that medicalized psychiatry invariably overlooks the fact that our identities, and the meanings and values that matter to us, are created and constituted by our dialogical relations with others. While acknowledging the importance of medical and pharmaceutical interventions, we suggest that it is only by means of the dialogical interplay of the talking cure that the client can both recognize unhealthy and self-defeating ways of being and be opened up to the possibility of new meanings and self-interpretations.     

Portable Digital Devices: Meeting Challenges to Psychotherapeutic Privacy

Portable digital devices, such as smartphones, tablets, and netbooks, now permeate our society. These devices allow substantial efficiencies in access to and communication of information by mental health professionals. They also bring with them risks to psychotherapist–client privacy. This article reviews these threats and offers suggestions as to their mitigation.     

Dominance and Dialogue in Couple Therapy for Psychological Intimate Partner Violence

Although there is controversy concerning indications for conjoint therapy in Intimate Partner Violence (IPV), both research and practice have come to recognize that it has some important benefits. This study analyzes issues of dominance and dialogue in a conjoint therapy for psychological IPV within a naturalistic setting, in which the spouses sought couple therapy on a voluntary basis. The method used to analyze the therapy was Dialogical Investigations of Happenings of Change (DIHC). Results on dominance indicated that the male client showed more quantitative dominance, whereas semantic dominance was more present in the female client, and therapists used more interactional dominance. Results on dialogue analysis showed that dialogical dialogue might help to construct a new-shared meaning of the issue of violence. In the Discussion section some research and clinical implications of the results are derived.