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 patient's 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.     

Affect Attunement and Maternal Attachment: A Pilot Study

The notion that individual differences in mothers' representations of their own early childhood attachment relationships impede or facilitate the recognition of an infant's experiences and needs was investigated. Women were classified as secure, dismissing, of preoccupied in relation to attachment on the basis of the Adult Attachment Interview (George, Kaplan, & Main, 1985) and then videotaped in a laboratory setting with their 10- to 13-month-old babies. Maternal attunement behaviors and fantasies about the babies during the attunement moment were recorded and examined in light of individual differences in maternal attachment. The findings reveal that securely attached mothers are more attuned to their babies than are those mothers who are insecurely attached. Secure mothers attune to a range of infant affect, whereas insecure mothers attune to particular affects and not to others. Specifically, dismissing mothers tended not to attune to negative affect, whereas preoccupied mothers randomly attuned to both positive and negative affect states. Qualitative analyses suggest that insecure mothers misattune to infant affects that threaten their internalized attitudes toward attachment. The findings support the hypothesis that the nature of a mother's internal affective experience powerfully influences the affects she acknowledges and attunes to in her child.     

Interaction Testing as a Measure of Therapeutic Change in Groups

Two therapy groups were followed by means of repeated interaction testing over the course of their therapeutic lifetime. The consensus Rorschach, analyzed as if it were the product of a single individual, indicated marked differences in the progress of the two groups with evidence of growth, expansion in the case of one group and a therapeutic stalemate in the case of the second group. Independent clinical evaluation of therapeutic progress by the therapists of both groups were in complete agreement with the consensus Rorschach psychograms. The possibility that non-conformist members may contribute to poor therapeutic progress is considered.     

The Embodied Attunement of Therapists and a Couple within Dialogical Psychotherapy: An Introduction to the Relational Mind Research Project

In dialogical practice, therapists seek to respond to the utterances of clients by including in their own response what the client said. No research so far exists on how, in dialogs, therapists and clients attune themselves to each other with their entire bodies. The research program The Relational Mind is the first to look at dialog in terms of both the outer and the inner dialogs of participants (clients and therapists), observed in parallel with autonomic nervous system (ANS) measurements. In the ANS, the response occurs immediately, even before conscious thought, making it possible to follow how participants in a multiactor dialog synchronize their reactions and attune themselves to each other. The couple therapy case presented in this article demonstrates how attunement is often not a simple “all at the same time” phenomenon, but rather a complex, dyadic or triadic phenomenon which changes over time. In the case presented, there was strong synchrony between one therapist and one client in terms of their arousal level throughout the therapy session. It was also observed that high stress could occur when someone else was talking about something related to the participant, or if that person mirrored the participant's words. Overall, it seems that in evaluating the rhythmic attunement between therapists and clients it is not enough to look at single variables; instead, integrated information from several channels is needed when one is seeking to make sense of the embodiment.     

The Added Value of Studying Embodied Responses in Couple Therapy Research: A Case Study

This article reports on the added value of embodied responses identified through sympathetic nervous system (SNS) activity in couple therapy research. It focuses on moments of change and the timing of therapeutic interventions or therapeutic moves in a couple therapy session. The data for this single‐case study comprise couple therapy process videotapes recorded in a multi‐camera setting, and measurements of participants’ SNS activity. The voluntary participants were a marital couple in their late thirties and two middle‐aged male psychotherapists. The division into topic segments showed how the key issue of seeking help, which was found to comprise three separate components, was repeatedly dealt with in the session. SNS activity showed different degrees of synchronization between the couple, between the therapists, and between the couple and therapists during the dialogue pertaining to these three components. The issue of timing emerged as a complex, even ambivalent, phenomenon. Arousal in the therapists was in line with their therapeutic activity, whereas in the clients it was more anticipatory. The approach used here rendered visible some of the intensity that therapeutic dialogue can generate when dealing with issues of relationship change in the couple context and showed how this intensity can be dialogically regulated in the therapeutic system.     

Reflective Adaptation of a Technology Artifact: A Case Study of Classroom Change

This case study examines the changes that took place in a 5th-grade mathematics classroom in Hong Kong when an American-made technological artifact was introduced. Using classroom observation, videotaping, and daily interviews with the teacher and students, the study documents the changes that occurred in the classroom and the factors shaping those changes. Using the artifact prompted the teacher to make changes by altering the content, the sequence of instruction, and the social arrangements for class participation. In addition, the class engaged in extensive discussions about the social implications of solving complex mathematics problems. Most of these changes, however, were made after the attempts to maintain routine instruction broke down. The study suggests that new technologies that are not compatible with the existing practice may lead to intense and sometimes profound reflections about which aspects of the individuals, their environment, and the new artifact to adapt into a new classroom structure. A significant challenge is how to support participants' role shifting and their subsequent psychological changes when new technology is introduced.     

Testing the Effectiveness of Family Therapeutic Assessment: A Case Study Using a Time-Series Design

This study reports normative data for the Peebles Rorschach content scoring system. Group Rorschach protocols from undergraduates were scored and reliably classified by quadrant. Frequencies were obtained by sex and by quadrant. Social desirability was demonstrated to vary across quadrants. The validity of quadrant classification was suggested by self-reports and MMPI scales. MMPI profile code predictions were made by experts for each quadrant and compared with obtained mean profile codes. The scoring system was evaluated and theoretical origins were discussed.     

社会转型与民间信仰变迁——泉州个案研究

泉州是我国民间信仰最为繁盛发达的地区之一,也是改革开放后经济社会急剧转型的地区之一。转型社会的几个典型特征——城市化进程加快、人口流动性加大、经济快速提升以及现代社团组织制度初步确立,给泉州民间信仰以深刻影响。泉州民间信仰因之表现出从传统时代民众的公共性事务,向当代信徒的私人性事务过渡的趋势。     

生成与动力:具身认知研究中的互动观

从方法论上讲,认知研究中的个体主义把研究的焦点放在个体身上,倾向于从个体内部寻求对社会行为的解释。与个体主义取向不同的是,具身认知中的互动观更注重人际和社会互动对于理解他人的重要作用。心理学中的生态学方法最早关注了环境与有机体之间的互动对知觉产生的影响。生成认知在此基础上更进一步,认为互动不仅发生在有机体与环境之间,而且表现为主体与主体的交互影响,两个主体间的交互不是两个笛卡尔式心灵的对话,交互的主体是身体,是一种"肉身间性"的过程。具身认知研究中的互动观强调身心一体论,反对身心二元论,在方法论上表现出反还原论的特色。     

Learning to Graph Linear Functions: A Case Study of Conceptual Change

This case study shows how a student's strategies and associated conceptions emerged and changed over the course of a 6-session tutoring curriculum designed to develop conceptual knowledge of linear functions. Using microgenetic and sequential analyses, we identify the student's strategies and conceptions and describe how these changed. We show how the student did not erase his original conception or replace it with a conception supported by instruction, but instead refined his initial strategies and conceptions.     

Parent-Child Interaction Therapy and ADHD: A Case Study With a Hearing Child of a Deaf Father and a Hearing Mother

Parent-Child Interaction Therapy (PCIT) has demonstrated promising evidence in its implementation with deaf and hard-of-hearing (DHH) families. This case study presents the implementation of PCIT with a hearing mother, a deaf father, and their 7-year-old hearing son with Attention-Deficit/Hyperactivity Disorder (ADHD) and oppositional behaviors, using the assistance of certified interpreters. Results documented improvement in child behavior, parenting skills and stress, and parent-child communication. Notably, paternal ratings showed greater improvement across these outcomes than maternal ratings. Overall, PCIT continues to demonstrate its effectiveness as a treatment option for DHH families with children with challenging behaviors. The limitations and implications are discussed.     

Dyadically Expanded States of Consciousness and Therapeutic Change in the Interaction Between Analyst and Adult Patient

This paper presents a discussion of the mutual regulation model and the dyadic expansion of consciousness model as a way to better understand the interaction between the analysand and analyst and the process of therapeutic change. We argue that by examining matching, mismatching, and in particular reparation of therapeutic exchanges at the micro-level as well as the macro-level of the therapeutic exchange, including whole sessions or even over multiple sessions provides insight in the establishment of the therapeutic relationship and the formation of Dyadic States of Consciousness. Clinical examples are presented.     

Falling in Love as a Therapeutic Moment-Therapy as a Moment of Falling in Love

The author compares falling in love in ordinary life with falling in love in therapy. This way, he offers a wider understanding of these phenomena, regarding in particular to transferring processes. The result is a model, inside the frame of reference of Gestalt Therapy, to work through the positive sources of falling in love process-in ordinary life and in therapy. Among other things, he means by that: (1) an understanding of the links between one's original family and partner's choice and (2) a new perspective of the alternatives of behavior the person has now (in the resolution phase of falling in love), in comparison with his/her experience in his/her original family.     

A Case Study: A Discussion of Depression,Ambivalence, Attachment,and Culture Portrayed in the Therapeutic Environment

ABSTRACT

This paper uses object relations theory to conceptualize and manage the complexities of a home-based case that was followed for a period of six months. It discusses maternal depression in relation to the caregiver role, self-harm, and self-determination. The client's ambivalence issues are addressed, with particular emphasis on transference and countertransference issues in the relationship and the use of transitional space and objects. Also discussed is the effect of maternal depression and ambivalence on mother-infant attachment, with the introduction of interaction-guidance as a treatment modality. An examination of cultural differences and the concomitant ethical implications that arose in the treatment process is provided. Finally, therapeutic implications and reflexivity are addressed.     

A Business Model for Managing System Change Through Strategic Financing and Performance Indicators: A Case Study

This article describes how a system of care operated by a county government agency used a fiscal crisis as the opportunity to reform its children's system. A cross-system response to the crisis is outlined that includes a system of care framework coupled with a business model, inter-departmental collaboration and leadership, the use of strategic reinvestment strategies, and a quality improvement system that focuses on key indicators. Implementation of the system change is described with a specific focus on cross-system entry points, financing strategies that re-allocate funds from deep-end programs to community-based services, and management oversight through the use of performance indicators to monitor and support effectiveness. This article examines the results of the system change, including the diversion of youth from system penetration, the reduction in residential treatment bed days, the re-allocation of these savings to community-based services, and the outcomes of children who were diverted from residential care and served in the community. The article offers a number of recommendations for other communities contemplating system change.     

The Contributing Factors of Change in a Therapeutic Process

The clients’ and therapists’ perceptions about the degree to which each of four common factors in therapy—extra-therapeutic factors; model/techniques; therapeutic alliance; and hope/expectancy—contribute to change in the therapeutic process were investigated in this study. In addition, the perceptions about the percentage of change attributed to clients and therapists were also explored. Results revealed that the therapists and clients have different perceptions on what factors contribute the most to change and that clients and therapists believe that the client contributes the most to change in a therapeutic process.M. L. Thomas, MSW, is a doctoral student in Marriage and Family Therapy at Florida State University.     

Social Change Movements and the Struggle Over Meaning-Making: A Case Study of Domestic Violence Narratives

Social movement theorists have emphasized the important role of meaning-making for social change movements (e.g., D. A. Snow and R. D. Benford, 1992, In: A. D. Morris & C. M. Mueller (Eds.) Frontiers in social movement theory. Yale University Press, New Haven, CT, pp 133-155; C. M. Mueller, 1992, In: A. D. Morris & C. M. Mueller (Eds.) Frontiers in social movement theory. Yale University Press, New Haven, CT, pp 3-26). Using the domestic violence movement as a case study, this study undertakes a close analysis of advocates' narratives about the phenomenon of domestic violence. This analysis sheds light on the current status of the movement as a social change movement attempting to promote alternative understandings of domestic violence as a social, rather than individual, problem. Study findings provide some evidence that the domestic violence movement has become increasingly de-politicized by documenting a range of narratives that convey an apolitical, degendered, individual-level analysis of domestic violence.