Mentalization adherence, therapeutic alliance, and rupture repair: A comparative study of two single-cases of psychodynamic child therapy
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Tarih
2022
Yazarlar
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Yayıncı
İstanbul Bilgi Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Zihinselleştirme, davranışları altta yatan zihinsel durumlar açısından anlamlandırma yeteneğidir ve bu kapasitenin arttırılması terapötik değişim için önemlidir. Terapötik ittifak, danışan ve terapist arasındaki işbirlikçi ve duygusal yönleri içeren ilişkiyi ifade eder. Ampirik araştırmalar bu kavramların çocuk terapisindeki rolünü vurgulamış olsa da aralarındaki ilişkileri araştıran daha önce yapılmış hiçbir çalışma yoktur. Bu çalışma, zihinselleştirme uyumu ile terapötik ittifak arasındaki ilişkileri incelemektedir ve iki değişken arasında çift yönlü bir ilişki olduğu hipotezi öne sürülmüştür. Bu çalışmanın bir diğer amacı çocuk terapisinde ihmal edilen bir araştırma alanı olan kırılma onarım süreçlerini araştırmaktır. İttifak kırılmaları terapötik ilişkideki zorlukları ifade eder ve daha etkili terapi süreçleri için bu kırılmaların çözülmesine vurgu yapılmaktadır. Bu araştırmada ampirik vaka çalışması yaklaşımı uygulanarak iki psikodinamik çocuk terapisi vakası seçildi. Bir vaka, terapi sonunda problemli davranışlarda ve işlevsellikte anlamlı bir değişim gösterirken, diğer vaka klinik olarak anlamlı bir değişim göstermedi. Örneklem okul çağında ve içe yönelim problemleri yaşayan iki kız çocuğundan oluşuyordu. Danışanların terapi başlangıcındaki özellikleri, vakaların tarihçeleri ve tedavi sürecinin detayları ile ilgili bilgilere yer verildi. Çocukların tüm terapi seansları Therapy Process Observational Coding System-Alliance Scale (TPOCS-A), Rupture Resolution Rating System (3RS), ve MBT-C Adherence Scale (MBT-CAS) ile kodlandı. Zaman serisi analizleri ve Granger Nedensellik testleri, anlamlı değişim gösteren vakada, zihinselleştirme uyumu ve terapötik ittifakın iki yönlü olarak birbirini yordadığını ortaya koydu. Ancak klinik olarak anlamlı değişim göstermeyen vakada değişkenler arasında bu ilişki bulunamadı. Terapötik ilişkinin derinlemesine anlaşılmasını sağlamak için, vakalar arasında ittifak kırılma ve onarım süreçleri karşılaştırıldı. Sonuçlar, anlamlı değişim gösteren vakada ittifaktaki kırılmaların daha iyi çözümlendiğini gösterdi. Terapistlerin müdahaleleri ile ittifak arasındaki ilişkiyi daha iyi anlamak için seanslar klinik olarak analiz edildi. Bulgularımız, terapistin zihinselleştirme uyumunun terapötik ilişki ile yakından ilişkili olduğunu ve çocuk psikoterapisinde ittifak kırılmalarını çözmenin önemini vurgulamaktadır. Anahtar Kelimeler: zihinselleştirme, terapötik ittifak, kırılma onarım, psikodinamik çocuk terapisi, süreç araştırması
Mentalization is the ability to make sense of behavior in terms of underlying mental states and enhancing this capacity is important for therapeutic change. Therapeutic alliance refers to the relationship between the patient and the therapist which involves collaborative and emotional aspects. Although the role of these constructs in psychodynamic child therapy has been highlighted by empirical research no prior study has investigated the associations between them. This study examines the relations between mentalization adherence and therapeutic alliance, and it was hypothesized that adherence and alliance will have a bidirectional relationship. Another purpose of this study is to explore rupture repair processes which is a neglected area of research in child therapy. Alliance ruptures are difficulties in the therapeutic relationship resolving them is emphasized for more effective therapy processes. An empirical single-case approach was taken, and two psychodynamic child therapy cases were selected. One case showed significant improvement at the end of treatment whereas the other case did not show clinically significant change. The sample consisted of two school-aged girls with internalizing difficulties. Baseline characteristics of the patients, descriptions of the treatments and background information are presented. All psychotherapy sessions were coded with Therapy Process Observational Coding System-Alliance Scale (TPOCS-A), Rupture Resolution Rating System (3RS), and MBT-C Adherence Scale (MBT-CAS). Time series analyses were conducted, and Granger Causality tests revealed that mentalization adherence and therapeutic alliance bidirectionally predicted each other in the case with improved outcome. However, this relationship was not found in the case with no clinically significant improvement. To provide a deeper understanding of the therapeutic relationship, alliance ruptures and resolutions were compared descriptively between the cases. The results showed that in the case with good outcome ruptures had a higher overall resolution. To further comprehend the relationship between therapists' interventions and the alliance clinical analyses of the sessions were used. Our exploratory findings indicate that therapist's mentalization adherence is closely related to the therapeutic relationship and highlight the importance of resolving alliance ruptures in child psychotherapy. Keywords: mentalization, therapeutic alliance, rupture repair, psychodynamic child therapy, process research
Mentalization is the ability to make sense of behavior in terms of underlying mental states and enhancing this capacity is important for therapeutic change. Therapeutic alliance refers to the relationship between the patient and the therapist which involves collaborative and emotional aspects. Although the role of these constructs in psychodynamic child therapy has been highlighted by empirical research no prior study has investigated the associations between them. This study examines the relations between mentalization adherence and therapeutic alliance, and it was hypothesized that adherence and alliance will have a bidirectional relationship. Another purpose of this study is to explore rupture repair processes which is a neglected area of research in child therapy. Alliance ruptures are difficulties in the therapeutic relationship resolving them is emphasized for more effective therapy processes. An empirical single-case approach was taken, and two psychodynamic child therapy cases were selected. One case showed significant improvement at the end of treatment whereas the other case did not show clinically significant change. The sample consisted of two school-aged girls with internalizing difficulties. Baseline characteristics of the patients, descriptions of the treatments and background information are presented. All psychotherapy sessions were coded with Therapy Process Observational Coding System-Alliance Scale (TPOCS-A), Rupture Resolution Rating System (3RS), and MBT-C Adherence Scale (MBT-CAS). Time series analyses were conducted, and Granger Causality tests revealed that mentalization adherence and therapeutic alliance bidirectionally predicted each other in the case with improved outcome. However, this relationship was not found in the case with no clinically significant improvement. To provide a deeper understanding of the therapeutic relationship, alliance ruptures and resolutions were compared descriptively between the cases. The results showed that in the case with good outcome ruptures had a higher overall resolution. To further comprehend the relationship between therapists' interventions and the alliance clinical analyses of the sessions were used. Our exploratory findings indicate that therapist's mentalization adherence is closely related to the therapeutic relationship and highlight the importance of resolving alliance ruptures in child psychotherapy. Keywords: mentalization, therapeutic alliance, rupture repair, psychodynamic child therapy, process research
Açıklama
Lisansüstü Programlar Enstitüsü, Klinik Psikoloji Ana Bilim Dalı
Anahtar Kelimeler
Psikoloji, Psychology
