The Mutual Regulation Processes During the Psychodynamic Psychotherapy of Depression: An Observational Study of Communicative Acts in the Construction of the Early Therapeutic Alliance = Los Procesos de Regulación Mutua Durante la Psicoterapia Psicodinámica de la Depresión: Un Estudio Observacional de los Actos Comunicativos en la Construcción de la Alianza Terapéutica Temprana

Author

Del Giacco, Luca

Director

Anguera Argilaga, María Teresa

Salcuni, Silvia

Tutor

Anguera Argilaga, María Teresa

Date of defense

2021-09-20

Pages

409 p.



Department/Institute

Universitat de Barcelona. Departament de Psicologia Social i Psicologia Quantitativa

Abstract

Therapeutic conversation represents a continuous and dynamic activity of meaning construction turn by turn, based on a two-way interpretative process between therapist and patient. In particular, verbal structures and intents, vocal characteristics, and speech interruptions are indivisible and fundamental elements of therapeutic discourse; they convey psychological and emotional processes that transform the internal organization of individuals into more complex structures, fostering change. During this activity, verbal and non-verbal components interact with each other, forming a non-linear communication field that expresses the therapeutic process and the clinical function of the therapeutic relationship and fosters the development and regulation of factors such as the therapeutic alliance. This relational dimension, influenced by communicative coordination processes underlying the mutual regulation between participants, is predictive of change, especially in the early stages of psychotherapy. During the therapeutic interaction, patients experience alliance construction by manifesting different verbal and non-verbal behaviors whereby they express their psychological processes and symptoms. In particular, depressed patients present verbal, vocal, and interruption behaviors that are an expression of their symptomatology and impact on communicative exchanges with the therapist, hindering the development and maintenance of the therapeutic alliance and change. In literature, the predominance of verbal communication over the above-stated components resulted in a fragmented communicative field with distinct theories and measurement tools, which prevented the understanding of therapist-patient dynamics and their role in the construction of the early therapeutic alliance at the process level. Studies analyzing the dynamics between communication (as a single and interacting communicative field) and relational aspects in the therapist-patient interplay are absent, especially in the Italian context and in brief focal psychotherapy with depressed patients. Therefore, this doctoral thesis as a collection of two publications aims to identify the verbal, vocal, and interruption behaviors emerging turn by turn between the therapist and depressed patient within psychodynamic psychotherapy and investigate those communicative modes of each participant that foster the alliance construction by the other during mutual regulation processes. A particular case of indirect observational methodology was implemented; as a mixed method in itself, it was able to provide a fuller picture of the therapeutic interaction by supporting it with objective measures. Thirty audio recordings and transcripts of brief focal psychotherapy sessions with ten depressed patients treated by the same therapist (8,327 speaking turns) were considered. The observational design selected to guide and organize the investigation was nomothetic/follow-up/multidimensional, given its greater wealth of information and complexity among low-intensity evaluation designs. Study 1, focused on identifying communicative behaviors through a theory that unify the communicative field, resulted in the construction of an ad hoc indirect observation instrument of the therapeutic conversation based on the performative function of the Speech Act Theory. This classification system showed high intra-and inter-observer reliability and made it possible to describe the participants’ communicative modes trend. Study 2 aimed to investigate the communicative modes of the therapist and depressed patients that, according to the literature, foster the mutual construction of the early therapeutic alliance: asking, exploring, elaborating, and interrupting cooperatively for the former; affirming, exploring, expressing emotions, and interrupting cooperatively for the latter. The study showed the presence of sequential patterns and significant relationships between the selected communicative behaviors and this relational dimension during the mutual regulation processes. All this allows increasing knowledge about these dynamics, providing professionals with useful information to improve the treatment effectiveness and to advance in the application of the mixed-methods approach in the field of psychotherapy research.


Durante la psicoterapia psicodinámica, los componentes verbales (estructuras e intenciones) y no verbales (voz e interrupciones) interactúan entre sí, transmitiendo procesos psicológicos y emocionales y formando un campo comunicativo no lineal en la base de la alianza terapéutica. Esta dimensión relacional predice el cambio, influenciada por los intercambios paciente-terapeuta desde las etapas iniciales del encuentro. Los pacientes deprimidos presentan comunicación verbal y no verbal específica y muestran dificultades para desarrollar y mantener la alianza terapéutica. Esta tesis doctoral tiene como objetivo identificar las conductas verbales, vocales y de interrupción que emergen turno tras turno entre el terapeuta y el paciente deprimido dentro de la psicoterapia psicodinámica e investigar aquellos modos comunicativos de cada participante que fomentan la construcción de la alianza durante la regulación mutua. Se aplicó un caso particular de metodología observacional indirecta como método mixto en sí mismo y se consideraron 30 grabaciones de audio y transcripciones de sesiones de psicoterapia con diez pacientes deprimidos tratados por la misma terapeuta (8,327 turnos de habla). El diseño observacional fue nomotético, de seguimiento y multidimensional. El estudio 1, centrado en la identificación de las conductas comunicativas a través de una teoría unificadora del campo comunicativo, produjo un instrumento de observación indirecta ad hoc de la conversación terapéutica basado en la función performativa de la Teoría de los Actos del Habla. Este sistema de clasificación mostró una alta fiabilidad intra e inter-observador y permitió describir la tendencia de los modos comunicativos de los participantes. El estudio 2 investigó los modos comunicativos del terapeuta y de los pacientes deprimidos que, según la literatura, fomentan la construcción mutua de la alianza terapéutica temprana: preguntar, explorar, elaborar e interrumpir cooperativamente para el primero; afirmar, explorar, expresar emociones e interrumpir cooperativamente para el segundo. Se detectaron patrones secuenciales y relaciones significativas entre las conductas comunicativas seleccionadas y la dimensión relacional durante los procesos de regulación mutua. Todo ello permite aumentar el conocimiento de estas dinámicas, proporcionando a los profesionales información útil para mejorar la eficacia del tratamiento y avanzar en la aplicación del enfoque de mixed methods en el campo de la investigación en psicoterapia.

Keywords

Psicopatologia; Psicopatología; Pathological psychology; Depressió psíquica; Depresión mental; Mental depression; Psicoteràpia; Psicoterapia; Psychotherapy; Comunicació oral; Comunicación oral; Oral communication; Llenguatge corporal; Lenguaje corporal; Body language; Terapèutica; Terapéutica; Therapeutics

Subjects

616.89 - Psiquiatria. Psicopatologia

Knowledge Area

Ciències de la Salut

Note

Tesi realitzada conjuntament amb la Università degli Studi di Padova (Itàlia)

Documents

LUCA DEL GIACCO_PhD_THESIS.pdf

4.132Mb

 

Rights

L'accés als continguts d'aquesta tesi queda condicionat a l'acceptació de les condicions d'ús establertes per la següent llicència Creative Commons: http://creativecommons.org/licenses/by-nc-sa/4.0/

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