Volume 27, Issue 2
DOI: 10.24205/03276716.2018.1065
Therapist's subjective experience during significant segments of psychotherapy
Abstract
The aim of this study is to reconstruct and understand, through a collaborative process between researcher and clinician, the therapist's subjective experience of a single case during significant episodes of therapy. This case study draws on a combination of two methodological approaches that we believe are relevant for practice oriented research. On the one hand, it links research and practice through the collaboration between a clinician and a researcher, in a mutual interest to reconstruct the clinician's points of view during the moment-to-moment process of therapy, which takes place in a naturalistic setting. On the other hand, it incorporates the events paradigm as an approach for the selection of relevant session events (change, stuck, rupture and resolution) that contextualize the clinician´s experience to be explored. A 70 year old female patient with major depression and her 32 year old female therapist agreed to participate in this study. All of the 21 sessions of the therapy were videotaped and transcribed. Expert raters observed therapy sessions and identified change and stuck episodes (according to the Generic Change Indicators model of change), as well as ruptures of the alliance and resolution strategies (based on the Rupture Resolution Rating System), resulting in a total of 43 significant events. After therapy termination, the therapist participated in six sessions of a retrospective interview with the researcher, in which she observed all of the therapy episodes as they appeared chronologically along the therapy, recalling her experience during those events. A Grounded Theory based qualitative analysis was applied to the interviews. Results show that the therapist's report about her experience during significant episodes of therapy can be described with reference to herself, the patient and the relationship; at the same time, each can be described along the cognitive, affective, behavioral, roles expectations, disposition towards therapy and interventions dimensions. Specifically, change episodes are characterized by contents referred primarily to the patient, while stuck episodes refer primarily to the therapist and the relationship. Rupture episodes were characterized by contents associated to the affective state of the therapist and that of the patient, as well as to the therapist´s assessment of the therapy during the observation of the episodes. Resolution strategy episodes were characterized by a reference to contents associated to the relationship, specifically the bond, and the therapist's expectations about herself. In general our study shows that what the therapist experiences has an influence on the selection and implementation of strategies and techniques used during the psychotherapeutic process. This study highlights the compatibility of research models used to assess change, with the therapist's clinical experience. In this sense, our findings could help to bridge the historical gap between clinical practice and research. Furthermore, our results illustrate the possibility of using this type of practice oriented research for monitoring and supervising psychotherapeutic processes and as tool for therapist training.
Keywords
Practice oriented research, subjective experience, therapist perspective, therapy process, significant episodes