Terapirelaterede forandringers flertydighed - mod en kritik af en terapeut- og sessionscentreret forståelse af den psykoterapeutiske praksis
DOI:
https://doi.org/10.7146/pl.v45i1.146582Nøgleord:
psykoterapi, forandring, klientrefleksivitet, kontekst, kritik, klientagensResumé
Artiklen identificerer og problematiserer den terapeut- og sessionscentrerede tænkning, der florerer inden for psykoterapifeltet. I artiklens første del viser vi, hvordan denne tænkning aktuelt kommer til udtryk på et metateoretisk niveau, hvor en medicinsk og en kontekstuel forklaring af klientforandringer ofte stilles over for hinanden i en todeling af feltet. Mens todelingen har en kompleksitetsreducerende fordel, skjuler den samtidig væsentlige ligheder mellem de to forklaringer. Disse ligheder kan sammenfattes i en grundlæggende overbevisning, nemlig at terapeuten som en del af terapien skaber klientens forandring gennem manipulationen af underliggende virkningsmekanismer. Som en konsekvens af denne overbevisning negligeres klientagens og -refleksivitet sammen med forandringers bredere kontekstualitet. I artiklens anden del skitserer vi på baggrund af Dreier og Mackrills arbejde et alternativt perspektiv, der fremstiller terapirelaterede forandringer som klientdrevne og tværkontekstuelle processer. Vi præsenterer efterfølgende et kvalitativt casestudie, der undersøgte, hvordan en klient under sit terapiforløb løbende genovervejer sine udfordringer og problemer. Vi peger på, a) at skift i klientens forholdemåder forekommer på et flertydigt grund lag, og b) at denne flertydighed efterlader lommer eller rum, der lader klienten afsøge mening, betydninger og sammenhænge i evaluerende relationer mellem forskellige kontekstuelle indflydelser. Tilsammen underbygger fundene, at klientens genovervejelser, som de udspiller sig sideløbende med sessionerne og i deres forbindelser til klientens øvrige liv, bør stå centralt i en konceptualisering af terapirelaterede forandringer.
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