School of Psychology, University of Minho, Braga, Portugal.
Department of Mathematics and Applications, University of Minho, Braga, Portugal.
Clin Psychol Psychother. 2018 May;25(3):369-377. doi: 10.1002/cpp.2169. Epub 2018 Jan 7.
Ambivalence in the process of psychotherapeutic change should be addressed and resolved if we are to avoid psychotherapeutic failure and promote sustained change. In this context, ambivalence can be defined as the cyclical conflictual relation between two opposed positions of the self: one expressed as an innovation, and a subsequent one expressed in a trivialization or rejection of the innovation (problematic position). This conflict may be resolved in two different ways: (a) the dominance of the innovative position and the consequent inhibition of the problematic one and (b) the negotiation between the innovative and the problematic positions. In this study, we sought to study the evolution of the dominance and the negotiation processes in recovered and unchanged cases; to analyse if different therapeutic models produce different results on the evolution of the dominance and negotiation processes, and finally, to study if these processes are predictive of ambivalence resolution. The complete sessions of 22 clinical cases of depression (6 cognitive-behavioural therapy, 10 narrative therapy, and 6 emotion-focused therapy cases) were independently coded for innovative moments, ambivalence, and ambivalence resolution. Results revealed that recovered cases had a progressively higher proportion of negotiation along treatment, whereas in unchanged cases, negotiation was virtually absent throughout treatment. Both dominance and negotiation were significant predictors of ambivalence reduction, however, negotiation had a higher impact than dominance. Overall, these results did not significantly differ for the 3 therapeutic models. The theoretical implications of these findings are discussed, and theoretical derived suggestions for clinicians are presented.
如果我们要避免心理治疗失败并促进持续的变化，就应该解决和处理心理治疗变化过程中的矛盾心理。在这种情况下，矛盾心理可以被定义为自我的两个对立立场之间的周期性冲突关系：一个立场表现为创新，而随后的一个立场则表现为对创新的轻视或拒绝（有问题的立场）。这种冲突可以通过两种不同的方式解决：（a）创新立场的主导地位和随后对有问题立场的抑制，以及（b）创新立场和有问题立场之间的协商。在这项研究中，我们试图研究恢复和未改变的病例中主导地位和协商过程的演变；分析不同的治疗模式是否会对主导地位和协商过程的演变产生不同的结果，最后，研究这些过程是否可以预测矛盾心理的解决。对 22 例抑郁症的完整治疗过程（6 例认知行为疗法、10 例叙事疗法和 6 例情绪聚焦疗法）进行了独立编码，以评估创新时刻、矛盾心理和矛盾心理的解决。结果表明，恢复的病例在治疗过程中协商的比例逐渐增加，而未改变的病例在整个治疗过程中协商几乎不存在。主导地位和协商都是矛盾心理减少的显著预测因素，然而，协商的影响比主导地位更大。总的来说，这三种治疗模式的结果没有显著差异。讨论了这些发现的理论意义，并为临床医生提出了理论推导的建议。
