Distributed changes in psychotherapy – Towards a critique of a therapist- and sessions-centred conceptualisation of therapeutic change processes
DOI:
https://doi.org/10.7146/pl.v45i1.146582Keywords:
psychotherapy, change, client agency, client reflexivity, context, critiqueAbstract
The paper identifies and criticises a tendency to view the practice of psychotherapy as revolving around therapist intervention during sessions. We first show how this thinking manifests itself on a meta-theoretical level, encompassing a sharp divide between a medical and a contextual explanation of client change. This divide offers a convenient handle on the complexity inherent in the endeavour to explain change processes in therapy, yet it also hides what the two meta-theories have in common. We argue that this
common ground centres around a foundational belief that the therapist produces change through the manipulation of underlying mechanisms of change. As a result, little attention is given to notions of client-agency and reflexivity together with the broader physical and temporal contexts across which they occur. In the paper’s second half, we draw on Dreier and Mackrill’s work to outline a different understanding of therapy-related change as a client-driven and cross-contextual process. We then extend this perspective by presenting a qualitative case study that examined how a client reconsiders her troubles during therapy, pointing to the fact that a) shifts in her stances occur in relation to different contextual influences, and b) that the particular configuration of these contextual influences lets her explore ways of creating meaning and coherence. In conclusion, these findings support the importance of including the client’s cross-contextual reconsiderations in conceptualisations of therapy-related change.
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