Exploring alliance strains in psychodynamic child psychotherapy
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Tarih
2022
Yazarlar
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Yayıncı
İstanbul Bilgi Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Terapötik ittifaktaki gerilim ya da kırılma, terapist ve hasta arasında terapi görevleri ve hedefleri üzerindeki anlaşmazlık ve / veya duygusal bağda gerilim şeklinde kendisini gösterir. Çalışmalar, doğru bir şekilde ele alındığı takdirde bu kırılmaların terapötik değişim açısından faydalı olabileceğini göstermiştir. Erişkin psikoterapisinde farklı hasta grupları için ittifakta kırılma ve onarım süreçleri incelenmesine rağmen, çocuk psikoterapisinde kırılma ve onarım süreçlerinin dinamikleri hakkında çok az şey bilinmektedir. Bu çalışma, hastaların tedavi öncesi özelliklerini göz önünde bulundurarak, çocuk psikoterapisinde ittifakta kırılmaların nasıl oluştuğunu ve çözüldüğünü araştırmayı amaçlamıştır. Hem terapistlerden hem de hastalardan elde edilen Çocuklar İçin Terapötik İttifak Ölçeği formlarına dayalı olarak, çok düzeyli doğrusal modelleme ile düşük ittifaka sahip, 24 çocuğa ait 43 seans belirlenmiştir. Bu seanslar, seans içi kırılmaları tespit etmek için gözleme dayalı bir ölçek olan Terapötik İttifakta Kırılma ve Çözülmeleri Derecelendirme Sistemi ile kodlanmıştır. İçe yönelim belirtileri olan çocuklarda, dışa yönelim davranış sorunları olan çocuklara göre kırılmaların daha az sıklıkta olduğu ve çözümleme stratejilerinin daha etkin kullanıldığı yönünde bir eğilim olduğu gözlenmiştir. Ayrıca, bu çalışmada farklı problem tiplerine sahip çocuklarda, bazı kırılma tiplerinin daha baskın olduğu görülmüştür. Erkeklerde kızlara göre daha sık ve etkili kırılmaların olduğu bir eğilim gözlemlenmiştir. Problem tipine ve cinsiyete göre gözlemlenen farklı eğilimler, küçük örneklem büyüklüğü nedeniyle istatistiksel olarak desteklenememiştir. Son olarak yaş değişkeni, kırılma skoru ile anlamlı ve olumsuz bir şekilde ilişkili bulunmuştur. Mevcut çalışma, psikodinamik çocuk psikoterapisinde terapötik ittifak süreç araştırmaları literatürüne, seans içi kırılma ve çözülmeleri araştırarak katkıda bulunmaktadır.
Strain or rupture in the therapeutic alliance is manifested by disagreement on therapy tasks and goals, as well as tension in affective bond between psychotherapist and patient. Studies have shown that, if ruptures are dealt with properly, they can be beneficial in terms of therapeutic change. In adult psychotherapy, rupture and resolution processes had been studied for different patient groups; however, little is known about the dynamics of the phenomenon for child psychotherapy. This study aimed to explore how strains occur and operate in the child psychotherapy while considering pretreatment characteristics of the patients. By using multilevel linear modeling low alliance sessions were determined based on Therapeutic Alliance Scale for Children (TASC) forms, obtained from both therapists and patients. After determining sessions with alliance strains, 43 sessions of 24 children were coded with an observer-based measure, 3RS (Rupture Resolution Rating System), to detect within session ruptures. It was observed that there is a trend towards rupture markers being less frequent, and resolution strategies being more effectively used for children with internalizing symptoms, compared to children with externalizing behavior problems. Additionally, predominant rupture markers were detected for children with different problem types. For gender, a trend towards more frequent and influential ruptures were observed for boys, compared to girls. These trends in frequency and impact of the rupture markers and resolution strategies could not be statistically supported, due to small sample size. Also, age was found significantly and negatively correlated with rupture significance. The current study contributes to our knowledge of therapeutic alliance, as a process, in psychodynamic child psychotherapy, by providing micro-analytic investigation of alliance strains and resolutions.
Strain or rupture in the therapeutic alliance is manifested by disagreement on therapy tasks and goals, as well as tension in affective bond between psychotherapist and patient. Studies have shown that, if ruptures are dealt with properly, they can be beneficial in terms of therapeutic change. In adult psychotherapy, rupture and resolution processes had been studied for different patient groups; however, little is known about the dynamics of the phenomenon for child psychotherapy. This study aimed to explore how strains occur and operate in the child psychotherapy while considering pretreatment characteristics of the patients. By using multilevel linear modeling low alliance sessions were determined based on Therapeutic Alliance Scale for Children (TASC) forms, obtained from both therapists and patients. After determining sessions with alliance strains, 43 sessions of 24 children were coded with an observer-based measure, 3RS (Rupture Resolution Rating System), to detect within session ruptures. It was observed that there is a trend towards rupture markers being less frequent, and resolution strategies being more effectively used for children with internalizing symptoms, compared to children with externalizing behavior problems. Additionally, predominant rupture markers were detected for children with different problem types. For gender, a trend towards more frequent and influential ruptures were observed for boys, compared to girls. These trends in frequency and impact of the rupture markers and resolution strategies could not be statistically supported, due to small sample size. Also, age was found significantly and negatively correlated with rupture significance. The current study contributes to our knowledge of therapeutic alliance, as a process, in psychodynamic child psychotherapy, by providing micro-analytic investigation of alliance strains and resolutions.
Açıklama
Lisansüstü Programlar Enstitüsü, Klinik Psikoloji Ana Bilim Dalı
Anahtar Kelimeler
Psikoloji, Psychology
