Child Attachment and Psychological Therapies Research Unit, Anna Freud Centre, London, UK.
School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Infant Ment Health J. 2023 Sep;44(5):691-704. doi: 10.1002/imhj.22073. Epub 2023 Jun 21.
This paper describes a method for investigating clinical process, Layered Analysis, which combines therapist countertransference reports and multi-faceted microanalytic research approaches. Findings from the application of Layered Analysis to video-recorded micro-events of rupture and repair in four psychoanalytic parent-infant psychotherapy sessions are presented. Layered analysis showed that countertransference and observation are complementary perspectives, which enable concomitant study of interactive events, conscious internal experiences, as well as nonconscious and unconscious elements of therapeutic interaction. Interactional rupture and repair were found to constitute co-constructed micro-events that occurred fleetingly and often implicitly, and differed in the structure, coherence and flow of interactions and in the relationship between verbal and nonverbal communication. Furthermore, interactional ruptures were found to sometimes 'get into' the therapist and transiently disrupt their self-organization, such that the therapist became a locus of disruption for the patient(s), actively contributing to the rupture, which thus became embedded in the therapeutic system. Interactive repair was found to be most often initiated by the therapist and to be underpinned by the therapist re-establishing self-regulation, through metabolizing embodied and verbal aspects of the rupture. Studying such processes can enhance our understanding of clinical process, inform therapist training and clinical supervision, and contribute to clinical outcomes.
本文描述了一种临床过程研究方法——分层分析，它结合了治疗师反移情报告和多方面的微观分析研究方法。本文呈现了将分层分析应用于四个精神分析性母婴心理治疗会议中破裂和修复的微观事件的视频记录的研究结果。分层分析表明，反移情和观察是互补的视角，能够同时研究互动事件、有意识的内在体验以及治疗互动的无意识和潜意识元素。研究发现，互动破裂和修复构成了共同构建的微观事件，这些事件瞬息即逝且常常是隐含的，在互动的结构、连贯性和流畅性以及言语和非言语交流之间的关系上存在差异。此外，研究发现，互动破裂有时会“进入”治疗师，暂时破坏他们的自我组织，从而使治疗师成为患者的破坏源，积极促成破裂，从而使破裂嵌入治疗系统中。研究发现，互动修复大多由治疗师发起，并由治疗师通过新陈代谢破裂的身体和言语方面来重新建立自我调节来支撑。研究这些过程可以增进我们对临床过程的理解，为治疗师培训和临床监督提供信息，并有助于临床结果。
