Associations between the Rorschach Ego Impairment Index and Measures on Intrapsychic and Interpersonal Functioning

The Rorschach Ego Impairment Index-2 (EII-2) has shown considerable validity as a measure of personality disturbance. However, few studies have been conducted on the associations between the EII-2 and measures related to ego strength and interpersonal capacities in mood and anxiety disorder patients. This study examined the strength of associations between the EII-2 and its subcomponents with measures of psychological suitability for psychotherapy, personality functioning, and interpersonal problems. A total of 315 outpatients with mood or anxiety disorders were assessed with the Rorschach Comprehensive System (RCS), comprising the EII-2, the Suitability for Psychotherapy Scale (SPS), the I…

Soft Prosody and Embodied Attunement in Therapeutic Interaction: A Multimethod Case Study of a Moment of Change

This study focused on a moment of weeping in one psychotherapy case. The overall aim was toexplore the role of “soft prosody” in psychotherapy interaction—that is, the participants’ use ofpauses, a lower volume, slower rhythms, and softer intonation than in the surrounding speech. Amixed-method, micro-analytic perspective was applied to investigate (a) social interaction, includ-ing its verbal and nonverbal elements; (2) the participants’ bodily responses, including autonomicnervous system (ANS) measurements; and (3) the participants’ thoughts and feelings during thetherapy session, as reported in subsequent individual interviews. Soft prosody was observed to be animportant conversational t…

The process and content of advice giving in support of reflective practice in management consulting

Although consulting has been defined as an ‘advice‐giving activity’ there has not been much research on advice practices in management consulting. In particular, there is a lack of evidence on how advice might assist in supporting another central issue in management work, namely reflective practice. This article approaches consulting from a discursive perspective and views reflective practice at the level of language use. The authors use data on naturally occurring talk during a single Organization Development (OD) consulting process and discursive methodology to examine these conversations, and offer empirical evidence on how advising can support reflective managerial practice. Examples of…

Dysregulated Motherhood: Exploring the Risk Features in a Mother’s Caregiving Representations

In the case of a mother with dysregulating attachment experiences and current enrolment in a parent-infant psychotherapy process, we explored which insecure, hostile/helpless, and prementalizing risk features were similar in her attachment and caregiving representations; which risk features were specific to her caregiving representations; and how these theory-defined features overlapped in detecting caregiving risks. Risk features in the attachment representations were assessed from the adult attachment interview and risk features in the caregiving representations from written psychotherapy notes. We found similar insecure (preoccupied and disorganized), prementalizing and hostile/helpless …

Aikuisten turvapaikanhakija- ja pakolaisasiakkaiden terapeuttisissa keskusteluissa kuvaamat hyödylliset muutokset

Tutkimuksessa tarkastellaan sitä, kuinka kuusi aikuista turvapaikanhakija- ja pakolaisasiakasta kuvaavat kokemiaan hyödyllisiä muutoksia luonnollisissa terapeuttisissa keskusteluissa. Asiakkaiden keskustelukäynnit kriisikeskuksen työntekijöiden luona videotallennettiin. Tutkimuksen kohteena olivat asiakkaiden esittämät ja tulkkien suomeksi välittämät ilmaukset. Tutkimusmenetelmänä käytettiin aineistolähtöistä laadullista sisällönanalyysia. Analyysissä syntyi neljä hyödyllisen muutoksen kategoriaa. Hyödyllisen muutoksen kategorioita ovat helpottuneempi olotila, uusien ongelmiin ja elämään liittyvien hallintakeinojen omaksuminen, itseymmärryksen ja voimaantumisen tunteen lisääntyminen ja rake…

Agency displays in stories of drunk driving: Subjectivity, authorship, and reflectivity

This study examined 30 stories of drunk driving (DD) recounted by repeat offenders in the early phase of a court-mandated counseling program. The focus of analysis was on displays of agency in the narrators’ portrayal of themselves as protagonists in the stories. The expressions of subjectivity, authorship, and reflectivity were considered as constructors of agency positions. In the analysis of the videotaped and transcribed stories, five story types of agency were found. They displayed the narrator-protagonists’ agency positions as either unconcerned, weak, egotistical, akratic, or disowned. The quality of telling is viewed as expressing the narrators’ problematic agency positions, readine…

Concensus Rorschach interaction patterns of families with an asthmatic child

This paper reports a study of interaction in families with a child suffering from bronchial asthma. Eighteen families, subdivided into two groups according to the severity of the child's illness, were given the Consensus Rorschach following Willi's procedure. Quantitative assessments of family members on cognitive-affective functioning and social interaction were obtained. Factor analysis of quantitative scores revealed diversified interactional strategies among family member groups. Families as wholes varied as to patterns of cross-generational alliances and/or domination of different family members and could be clustered into four interactional pattern groups. There was no correlation bet…

Men­ta­li­saa­tio­teo­rian näkö­kul­ma nar­sis­min proble­ma­tiik­kaan ja sijoit­ta­mis­koh­tee­na ole­mi­seen

Alliance Formations in Couple Therapy: A Multimodal and Multimethod Study

AbstractThe authors sought to study underlying processes of alliance formation, a multimethod and multimodal research procedure was developed and applied to a 6-minute episode from one couple thera...

Discourse in Psychotherapy: Using Words to Create Therapeutic Practice

Applying a discursive perspective, the first sessions of nine individual psychotherapies were analyzed. Six topical themes and three different forms of discourse were found. The colloquial discourse, consisting of mundane words and expressions, was the one used most by the interlocutors. The medical discourse, the use of professional terminologies from psychiatry and clinical psychology, was the one used the least and only when dealing with the presenting problem. The therapeutic discourse was used mostly by therapists. It introduced expressions by which the clients’ mind and issues related to the therapy as a treatment could be discussed. The clients and therapists used talk that served th…

Conversations on contexts and meanings: On understanding therapeutic change from a contextual viewpoint

Recent developments within family therapy theory, often referred to as the Post-Milan Movement, have once again stressed the therapeutic encounter'squality of conversation. When therapy is looked upon as conversation, attention is not only paid to the fact that most of what happens in a session is talking. Rather, a more fundamental stance towardshuman life as basically meaning- making is taken. This is one of the essential premises of the contextualist approach to the social sciences. When applied to human problems this approach claims that “symptoms” evolve when (1) a person gives meaning to and performs a social act within a context inappropriate to the socially shared meaning of that ac…

Inviting Participation in Organizational Change Through Ownership Talk

This article takes the practitioner’s view toward and focuses on participation through talk within multiparty settings of one process consulting case. From the perspective of discursive psychology, the authors ask what happens in interaction when the consultant is working to put into practice the ideal of active client participation in organizational change. They argue that participation is established when psychological ownership of the process is displayed through talk in interaction. This happens when what the authors call “ownership talk” is used: A person is sharing his or her views, interests, and experiences related to the change process.The authors provide detailed observations and …

Sensitivity in topic development and meaning making in a process consultation contract meeting

PurposeThe purpose of this paper is to explore the discursive practices used when the agenda for a consultation process was negotiated in a contract meeting. The paper illustrates the role of sensitivity in meaning making practices, that is, how displays of sensitivity were intertwined with topic development.Design/methodology/approachThe paper offers an in‐depth analysis of naturally occurring conversation in a meeting between a consultant and two client managers. The audio‐recorded data is analyzed by utilizing methodology introduced and developed in the traditions of Ethnomethodology and Conversation Analysis (CA).FindingsThe authors show how both the consultant and the clients displayed…

Displaying agency problems at the outset of psychotherapy

In order to present him- or herself at the outset of psychotherapy as a credible client, the person needs to, on one hand, formulate a sense of lost agency in accounts of his/her life situation, and on the other, to present him- or herself as willing and able to take part in conversational self-exploration. In this study, we looked in detail at how one person, seeking psychotherapy, constructed accounts that served this double function. We sought to develop the usefulness of the concept of agency as an integrative theoretical construct of core processes in therapy and introduced a model of five aspects of agentic vs. non-agentic presentation, developed and applied in an earlier study on cli…

Constructions of Nonagency in the Clients’ Initial Problem Formulations at the Outset of Psychotherapy

This multiple case study investigated how clients construct nonagentic positions when formulating their problems in the beginning of their first psychotherapy session. The initial problem formulations of nine clients entering psychotherapy were analyzed with a detailed model drawing on discursive methodology, the 10 Discursive Tools model (10DT). We found ten problem formulation categories, each one distinguished by the tool from the 10DT model primarily used to construct nonagency. All clients gave several problem formulations from different categories and constructed nonagentic positions with a variety of discursive tools. When the resulting problem formulation categories were read in com…

Cognitive Deficits in Patients with First-Episode Psychosis as Identified by Exner’s Schizophrenia Index in Finland and Spain

The co-occurrence of nonsuicidal and suicidal self-injurious acts in adult women: A pilot study of similarities and differences

Nonsuicidal self-injury (NSSI) and suicidal self-injury (SSI) co-occur in adults. The purpose of the current study was to examine differences and similarities in NSSI and SSI in adult women with respect to (1) methods used and lethality of methods, (2) intent and impulsivity of act, (3) precipitating events, and (4) consequences. The data consist of variables pertaining to 46 self-injurious acts committed by 16 Finnish female participants and recorded using Suicide Attempt Self-Injury Interviews (SASII). The data were analyzed using variables weighted by the number of acts. This study found several differences as well as similarities between the acts of SSI and those of NSSI: (a) the respec…

How paradoxical is ‘paradoxical’ outcome? : Different pathways and implications

The present special issue includes single and multiple case studies which report on the phenomenon of ‘paradoxical’ outcomes in psychotherapy, operationalized as discordant outcome assessments within the same case. In an attempt to find ground for my published response, I endeavored to juxtaposition the cases from the different studies, and by doing that gain an overview of the contributions and arguments. As a result of that exercise, I suggest three different types of paradoxical outcome with different pathways and implications. Discussing the concept of ‘illusory mental health’ as a possible explanation for paradoxical outcome, I suggest that self-ratings within a nonclinical range, give…

Narrative Transformations and Externalizing Talk in a Reflecting Team Consultation

This article reports on a therapeutic consultation session following the reflecting team working format. A stanza form of transcription of the original video recording is used to present the narrative constructions of the consultation process, and the transformation of these constructions. This method of transcription and analysis seeks to convey to the reader the dynamics of tellings and reformulations of the client's problem story as they emerged in the conversational exchanges between consultant and client, and between the members of the reflecting team. The creation and use of an externalized fictive agent in the conversation is shown. This externalizing talk served to afford new agent…

Effects of training on attitudes of psychiatric personnel towards patients who self-injure

Background Improving attitudes of personnel towards self-injurious patients leads to better working alliance and contributes to better patient outcomes. Previous research into the improvement of these attitudes has recorded the need for specific training in evidence-based assessment and treatment of self-injurious patients. Aim The current study describes the attitudes towards self-injurious patients among psychiatric personnel. The study also evaluates the effect of a structured clinical training program on psychiatric personnel's attitudes towards patients who self-injure. It further examines whether age, education, frequency of self-injurious patients contact, and work experience of the …

Dialogical Management of Morality in Domestic Violence Counselling

Moral issues have rarely been an explicit topic when family violence has been discussed in psychological literature. This article contributes to this topic through a detailed analysis of the transcripts of a counselling session on domestic violence, with special emphasis placed on how complex issues of morality are dialogically managed by the participants. It is shown that the morality of counselling is not explicit, but is constructed by various cautious and indirect conversational devices. In the analysed conversation it was possible for the counsellor to ‘prescribe’ a normative morality only if this was done indirectly and discreetly. The function of these various delicate discursive te…

Rorschach Characteristics and Comparison of First-Episode Psychotic Patients in Finland and Spain

Identifier avec précision les troubles schizophréniques a toujours été un problème complexe et controversé. Les caractéristiques psychologiques de la schizophrénie ont donné lieu à un volume considérable de travaux et de débats. Ces dernières années sont apparus un nombre croissant d'articles portant sur les différences et similitudes des manifestations de la psychose selon les cultures, partant de l'idée que les caractéristiques de personnalité nationales pourraient contribuer aux tableaux psychopathologiques. Le but premier de cette étude est de mieux comprendre les troubles psychotiques par l'investigation de la structure de personnalité et du fonctionnement de patients faisant un premi…

Semantic polarities and psychopathologies in the family: permitted and forbidden stories

The researcher in the field : some notes on qualitative research in mental health

In this published response to five studies in the present special issue, all representing qualitative research in the field of mental health, this research is approached as cultural and social practice. The five studies are looked upon as informative examples of research activity in mental health, and it is asked how that particular field is conceptualised as a form of human activity, how the authors position themselves in relation to the field, why they ask the questions they seek to answer and how epistemic queries concerning knowing and not-knowing manifest themselves and are addressed in the studies. The paper seeks to contribute to the debate on the uses of qualitative methodology in m…

Placement of responsibility and moral reasoning in couple therapy

Within the past two decades there has been a growing awareness of the importance of moral and ethical judgements in family and couple therapy. In this article we provide a detailed analysis of placements of responsibility related to blame in one couple therapy session. We suggest that it is important to study therapeutic interaction in situ, when searching for an understanding of moral reasoning in couple therapy and an ethical evaluation of the practice. A detailed analysis of discursive tools used by clients and therapists makes it possible to look at moral reasoning in action as it unfolds within the flow of therapeutic conversation. The findings are discussed in relation to two discours…

Aikuisten turvapaikanhakijoiden ja pakolaisten mielenterveyden ja psyykkisten ongelmien erityispiirteet

Loss of self-control as excuse in group-therapy conversations for intimately violent men.

This article examines the constructions of loss of self-control by male perpetrators of intimate violence in therapy-group conversations. It looks at discursive strategies used by therapists and clients in therapy-group negotiations concerning the issue of self-control. The data are part of a larger corpus of videotaped and transcribed recordings of treatment groups for male perpetrators and consists of four treatment group processes. The analysis concentrates on episodes of self-control talk where a participant referred to loss of self-control when accounting for his violent behavior. The loss of self-control was found to be a fundamental constituent of excuses and was used to account for …

Narrative process modes as a bridging concept for the theory, research and clinical practice of systemic therapy

This article is concerned with the relationships which hold between the clinical practice and the theory of family therapy; and between these and academic research. These relationships are seen as tenuous and thin because, in the first place, there is a lack of rigorous theoretical underpinning; and second, the research methods employed do not fit in with current family therapy practice, and with the theory that underlies this practice. The role of the concept of narrative process modes is proposed as a bridging and mediating one. The external, internal and reflective narrative process modes are seen as relevant from the point of view of family therapy process research, and the clinical pra…

Constructing Nonagency at the Beginning of Psychotherapy : The 10DT model

This study examined how nine clients discursively constructed non-agency in their first session of individual psychotherapy. With open reading and linguistic analysis of the transcribed first sessions, combined with theory-based considerations, we created a model of discursive means for ascribing agentic and non-agentic positions, the 10 Discursive Tools model (10DT). There was large variability in how the tools functioned to create the impression of problematic agency, and the clients could not be classified according to their tool use patterns. The study shows the potential of the 10DT model for the detailed examination of presentations of “not-being-able” produced by psychotherapy client…

12‐month follow‐up of first‐episode psychosis in Finland and Spain—differential significance of social adjustment‐related variables

Objective:  This study explored 12‐month outcome and its associations to social adjustment‐related variables in patients with first‐episode non‐affective psychosis in Finland and Spain.Methods:  Fo...

Discordances in Ascriptions of Agency and Reflectivity in the First Psychotherapy Session

We analyzed the first sessions of nine long-term individual psychotherapies with a model of ten discursive tools of agency ascription and studied discursive discordances, sequences of two talk turns in which the therapeutic dyad was misaligned in terms of how they ascribed agency to the client. We also studied how the clients’ agency self-ascriptions in the turn immediately following the discordances changed from the first turn. Classifying these discordance sequences, eight different types of sequences were found. One, in which the clients’ reflective agency constructions were missed by the therapists, was subjected to a detailed analysis. peerReviewed

Duration of untreated psychosis and its correlates in first-episode psychosis in Finland and Spain

Kalla O, Aaltonen J, Wahlstrom J, Lehtinen V, Garcia Cabeza I, Gonzalez de Chavez M. Duration of untreated psychosis and its correlates in first-episode psychosis in Finland and Spain. Acta Psychiatr Scand 2002: 106: 265–275. © Blackwell Munksgaard 2002. Objective: To examine the association of duration of untreated psychosis (DUP) with early course characteristics in first-episode psychosis in Finland and Spain. Method: Eighty-six patients from Finland (49) and Spain (37) were evaluated on various early course characteristics. Results: The mean value of DUP was 4.0 months (median 2 months) for the Finnish patients and 9.9 months (median 2 months) for the Spanish ones. In both groups, long …

Constructing the Moral Order of a Relationship in Couples Therapy

Although couples therapy is rightly seen as one modality of the psychotherapies, many salient aspects of the process are not revealed by psychological theory. These have to do with how, in therapeutic conversations, the couple relationship is presented and performed as a social institution with a particular social and moral order. The moral order of a relationship includes more or less articulated and shared understandings of what is valued and what is not, what are the loyalties, duties, and responsibilities expected from the partners, and the grounds for evaluating actions. It also includes expectations concerning how value, concern, and respect are communicated. In this case study, based…

Self-descriptions of socially phobic persons in short-term group psychotherapy

This paper explores how socially phobic persons exhibit their self-images through self-descriptions expressed in a naturalistic group therapy context. The data, which is analysed qualitatively, consists of videotaped therapy sessions, transcribed verbatim, from two groups of individuals (n = 17, mainly women) attending short cognitive–constructive psychotherapy. Seven categories of self-descriptions are found. Three categories –‘self as miserable,’ ‘self as insufficient’ and ‘self as transparent’ – relate to experiential self-images. Four categories – ‘self as adjusting and pleasing others,’ ‘self as demanding toward self,’ ‘self as outsider, different, isolated’ and ‘self as hiding and con…

Assimilation, reflexivity, and therapist responsiveness in group psychotherapy for social phobia: A case study.

Objective: This case study examined reflexivity and the assimilation of problematic experiences, especially its progress within and between the Assimilation of Problematic Experiences Scale (APES) Stages 2–3, in group psychotherapy for social phobia. Method: The data consisted of all of one client's turns expressing the two voices of her main problematic experience in 12 sessions, and all replies by the therapist in direct connection to them. The client's utterances were rated on the APES. Results: A detailed analysis of 13 conversational passages revealed that progress in assimilation happened only when the client took a reflexive stance towards her inner experience or outer actions. There…

Constructions of Agency in Accounts of Drunk Driving at the Outset of Semi-Mandatory Counseling

Convicted drunk drivers, in accounts of their offenses, rarely display qualities of agency that would contribute to a favorable outcome in counseling. Instead, the discursive and rhetorical aim of the accounts is often to evade responsibility and ownership of the offending behavior. Such disclaim of personal agency can be achieved in various ways in the narration of drunk driving (DD) incidences. This study examined how five aspects of agentic presentation (reflexivity, historicity, intentionality, causal attribution, and relationality) were present in or missing from such accounts. It was found that a tentative model of (non)agentic display based on those five aspects could differentiate b…

Stimulated Recall Interview Coding System SRI-CS : Käsikirja 1.0