Terapirelaterede forandringers flertydighed - mod en kritik af en terapeut- og sessionscentreret forståelse af den psykoterapeutiske praksis
Nøgleord:
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.
Referencer
Aagaard, J. (2018). Striving for experiential resonance: Critique, postcritique and phenomenology. Qualitative Studies, 5(1), 29-38. https://doi.org/10.7146/qs.v5i1.105460
Blumer, H. (1954). What is Wrong with Social Theory? American Sociological Review, 19(1), 3-10. https://doi.org/10.2307/2088165
Bohart, A.C. & Tallman, K. (1996). The active client: Therapy as self-help. Journal of Humanistic Psychology, 36(3), 7-30. https://doi.org/10.1177/00221678960363002
Bohart, A.C. (2000). The client is the most important common factor: Clients’ selfhealing capacities and psychotherapy. Journal of Psychotherapy Integration, 10(2), 127-149. https://doi.org/10.1023/A:1009444132104
Bohart, A.C. & Tallman, K. (2010). Clients: The neglected common factor in psychotherapy. I B.L. Duncan, S.D. Miller, B.E. Wampold & M.A. Hubble, The heart and soul of change: Delivering what works in therapy (s. 83-111). American Psychological Association.
https://doi.org/10.1037/12075-003
Butler, S.F. & Strupp, H.H. (1986). Specific and nonspecific factors in psychotherapy: A problematic paradigm for psychotherapy research. Psychotherapy: Theory, Research, Practice, Training, 23(1), 30-40. https://doi.org/10.1037/h0085590
Charmaz, K. (2003). Grounded theory: Objectivist and constructivist methods. I N.K. Denzin & Y.S. Lincoln, Strategies for qualitative inquiry (2. red. udgave), (s. 249- 291). Sage.
Cuijpers, P., Reijnders, M. & Huibers, M.J.H. (2018). The Role of Common Factors in Psychotherapy Outcomes. Annu Rev Clin Psychol, 7. maj 2019, 15(1), 207-231. https://doi.org/10.1146/annurev-clinpsy-050718-095424
Dreier, O. (1998). Client perspectives and uses of psychotherapy. European Journal of Psychotherapy & Counselling, 1, 295-310. https://doi.org/10.1080/13642539808402315
Dreier, O. (2000). Psychotherapy in clients’ trajectories across contexts. I C. Mattingly & L. Garro, Narratives and the cultural construction of illness and healing (s. 237-258). University of California Press. https://doi.org/10.1525/california/9780520218246.003.0010
Dreier, O. (2008). Psychotherapy in Everyday Life. Cambridge University Press. https://doi.org/10.1017/CBO9780511619519
Dreier, O. (2011). Intervention, evidence-based research and everyday life. I P. Stenner, Theoretical Psychology: Global Transformations and Challenges (s. 260-269). Captus Press Inc.
Dreier, O. (2015). Interventions in everyday lives. European Journal of Counselling and Psychotherapy, 17(2), 114-128. https://doi.org/10.1080/13642537.2015.1027781
Dreier, O. (2019). Generalizations in situated practices. I C. Højholt & E. Schraube, Subjectivity and Knowledge: Generalizations in the Psychological Study of Everyday Life (s. 177-193). Springer Nature. https://doi.org/10.1007/978-3-030-29977-4_10
Dreier, O. (2020). Critical psychology – subjects in situated social practices. I M. Fleer, F. González Rey & P. Jones, Cultural-historical and critical psychology: Common ground, divergences and further pathways (s. 11-26). Springer Nature. https://doi.org/10.1007/978-981-15-2209-3_2
Duncan, B.L. & Miller, S.D. (2000). The client’s theory of change: Consulting the client in the integrative process. Journal of Psychotherapy Integration, 10(2), 169-187. https://doi.org/10.1023/A:1009448200244
Elkins, D.N. (2009). The medical model in psychotherapy: Its limitations and failures. Journal of Humanistic Psychology, 49(1), 66-84. https://doi.org/10.1177/0022167807307901
Flyvbjerg, B. (2006). Five Misunderstandings About Case-Study Research. Qualitative Inquiry, 12(2), 219-245. https://doi.org/10.1177/1077800405284363
Gantt, E.E. & Williams, R.N. (2016). Explanation versus understanding in psychology: A human science approach. I C.T. Fishcer, L. Laubscher & R. Brooke, The qualitative vision for psychology: An invitation to a human science approach (s. 31-48). Duquesne University Press.
Geertz, C. (1973). The Interpretation of Cultures. Basic Books.
Gordon, R. (2012). Where oh where are the clients? The use of client factors in counselling psychology. Counselling Psychology Review, 27(4), 8-17. https://doi.org/10.53841/bpscpr.2012.27.4.8
Hougaard, E. (2021). Psykoterapiforskning gennem 100 år – hvor langt er vi nået? Psyke & Logos, 21(42), 12-38. https://doi.org/10.7146/pl.v42i1.128765
Jørgensen, C.R. (2004). Active Ingredients in Individual Psychotherapy: Searching for Common Factors. Psychoanalytic Psychology, 21(4), 516-540. https://doi.org/10.1037/0736-9735.21.4.516
Jørgensen, C.R. (2018). Den psykoterapeutiske holdning. Hans Reitzels Forlag.
Kazdin, A.E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3, 1-27. https://doi.org/10.1146/annurev.clinpsy.3.022806.091432
Kazdin, A.E. (2009). Understanding how and why psychotherapy leads to change. Psychotherapy Research, 19, 418-428. https://doi.org/10.1080/10503300802448899
Kvale, S. & Brinkmann, S. (2015). Interview – det kvalitative forskningsinterview som håndværk (3. udgave). Hans Reitzels Forlag.
Lambert, M.J. & Barley, D.E. (2002). Research summary on the therapeutic relationship and psychotherapy outcome. I J.C. Norcross, Psychotherapy relationships that work: Therapist contributions and responsiveness to patients (s. 17-32). Oxford University Press.
Levitt, H.M., Pomerville, A. & Surace, F.I. (2016). A qualitative meta-analysis examining clients’ experience of psychotherapy: A new agenda. Psychological Bulletin, 142, 801-830. https://doi.org/10.1037/bul0000057
Mackrill, T. (2008a). Exploring psychotherapy clients’ independent strategies for change while in therapy. British Journal of Guidance & Counselling, 36(4), 441-453. https://doi.org/10.1080/03069880802343837
Mackrill, T. (2008b). Pre-treatment change in psychotherapy with adult children of problem drinkers: The significance of leaving home. Counselling & Psychotherapy Research, 8, 160-165. https://doi.org/10.1080/14733140802193341
Mackrill, T. (2009a). A Cross-Contextual Construction of Clients’ Therapeutic Practice, Journal of Constructivist Psychology, 22(4), 283-305. https://doi.org/10.1080/10720530903113839
Mackrill, T. (2009b). Constructing client agency in psychotherapy research. Journal of Humanistic Psychology, 49(2), 193-206. https://doi.org/10.1177/0022167808319726
Mackrill, T. (2011). The case of “Jane and Joe”: A diary-based, cross-contextual case study. Pragmatic Case Studies in Psychotherapy, 7(1), 187-229. https://doi.org/10.14713/pcsp.v7i1.1078
Mahrer, A.R. (2000). Philosophy of science and the foundations of psychotherapy. American Psychologist, 55(10), 1117-1125. https://doi.org/10.1037/0003-066X.55.10.111
McLeod, J. (2011). Systematic case study research: A practice-oriented introduction to building evidence base for counselling and psychotherapy. Counselling and Psychotherapy Research, 11(1), 1-10. https://doi.org/10.1080/14733145.2011.54895
McLeod, J. (2016). Everyday life, manifesto-writing and the texture of human agency. European Journal of Psychotherapy & Counselling, 18(4), 415-423. https://doi.org/10.1080/13642537.2016.1260621
Mulder, R., Murray, G. & Rucklidge, J. (2017). Common versus specific factors in psychotherapy: Opening the black box. The Lancet Psychiatry, 4(12), 953-962. https://doi.org/10.1016/S2215-0366(17)30100-1
Oddli H.W., Stänicke, E., Halvorsen, M.S. & Lindstad, T.G. (2022). Causality in psychotherapy research: Towards evidential pluralism. Psychother Res, november 2023, 33(8), 1004-1018. https://doi.org/10.1080/10503307.2022.2161433
Valsiner, J. & Brinkmann, S. (2016). Beyond the “Variables”: Developing Metalanguage for Psychology. I S. Klempe & R. Smith, Centrality of History for Theory Construction in Psychology. (s. 75-90). Springer. https://doi.org/10.1007/978-3-319-42760-7_4
Wampold, B.E. (2007). Psychotherapy: The humanistic (and effective) treatment. American Psychologist, 62(8), 857-873.
https://doi.org/10.1037/0003-066X.62.8.857
Wampold, B.E. & Budge, S.L. (2012). The 2011 Leona Tyler Award Address: The relationship— And its relationship to the common and specific factors of psychotherapy. The Counseling Psychologist, 40(4), 601-623. https://doi.org/10.1177/0011000011432709
Wampold, B.E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270-277. https://doi.org/10.1002/wps.20238
Wampold, B.E. & Imel, Z.E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work (2. red. udgave). Routledge/Taylor & Francis Group. https://doi.org/10.4324/9780203582015
Wampold, B.E., Baldwin, S.A., Holtforth, M. g. & Imel, Z.E. (2017). What characterizes effective therapists? I L.G. Castonguay & C.E. Hill, How and why are some therapists better than others?: Understanding therapist effects (s. 37-53). American Psychological Association. https://doi.org/10.1037/0000034-003
Downloads
Publiceret
Citation/Eksport
Nummer
Sektion
Licens
Ophavsret er tidsskriftets og forfatternes. Det er gældende praksis, at artikler publiceret i Psyke & Logos, som efterfølgende oversættes til andet sprog, af forfatteren frit kan publiceres i internationale tidsskrifter, dog således at det ved reference fremgår, at den oversatte artikel har et forlæg i en dansksproget version i Psyke & Logos. Artikler kan frit deles og linkes til på forsknings- og undervisningsnetværk (så som Blackboard). Link foretrækkes, fordi det giver oplysning om brug af tidsskriftets artikler.
