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Withdrawal ruptures in adolescents with borderline personality disorder psychotherapy are marked by increased speech pauses-can minimal responses be automatically detected? PLoS One 2023; 18:e0280329. [PMID: 36649265 PMCID: PMC9844899 DOI: 10.1371/journal.pone.0280329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 12/27/2022] [Indexed: 01/18/2023] Open
Abstract
Alliance ruptures of the withdrawal type are prevalent in adolescents with borderline personality disorder (BPD). Longer speech pauses are negatively perceived by these patients. Safran and Muran's rupture model is promising but its application is very work intensive. This workload makes research costly and limits clinical usage. We hypothesised that pauses can be used to automatically detect one of the markers of the rupture model i.e. the minimal response marker. Additionally, the association of withdrawal ruptures with pauses was investigated. A total of 516 ruptures occurring in 242 psychotherapy sessions collected in 22 psychotherapies of adolescent patients with BPD and subthreshold BPD were investigated. Trained observers detected ruptures based on video and audio recordings. In contrast, pauses were automatically marked in the audio-recordings of the psychotherapy sessions and automatic speaker diarisation was used to determine the speaker-switching patterns in which the pauses occur. A random forest classifier detected time frames in which ruptures with the minimal response marker occurred based on the quantity of pauses. Performance was very good with an area under the ROC curve of 0.89. Pauses which were both preceded and followed by therapist speech were the most important predictors for minimal response ruptures. Research costs can be reduced by using machine learning techniques instead of manual rating for rupture detection. In combination with other video and audio derived features like movement analysis or automatic facial emotion detection, more complete rupture detection might be possible in the future. These innovative machine learning techniques help to narrow down the mechanisms of change of psychotherapy, here specifically of the therapeutic alliance. They might also be used to technologically augment psychotherapy training and supervision.
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Soma CS, Wampold BE, Flemotomos N, Peri R, Narayanan S, Atkins DC, Imel ZE. The Silent Treatment? Changes in patient emotional expression after silence. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | - Raghuveer Peri
- University of Southern California Los Angeles California USA
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Bengoechea C, Molinero C, Velasco C, López-Ibor B. Análisis del uso y funciones del silencio en la comunicación de los profesionales sanitarios en una unidad de oncología pediátrica. PSICOONCOLOGIA 2021. [DOI: 10.5209/psic.74538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Existen diferentes tipos de silencio, con múltiples funciones, y cada uno puede provocar efectos diversos en la comunicación. En el ámbito sanitario una comunicación eficaz es fundamental para lograr que los pacientes comprendan lo que les sucede y se expresen con claridad y confianza ante los profesionales sanitarios. El silencio juega un papel clave en esta comunicación. Objetivo: Desarrollar un instrumento para conocer la importancia que tiene el silencio para los profesionales sanitarios y analizar de qué manera emplean el silencio en su comunicación con los pacientes. Métodos: En el estudio han participado 43 profesionales del ámbito de la Oncología Pediátrica. Este estudio propone una clasificación de los tipos de silencio en la comunicación sanitaria. Resultados: El silencio es heterogéneo y cumple diferentes funciones. Se comprueba que los profesionales sanitarios emplean distintos tipos de silencio, siendo los Silencios Neutros los más utilizados, a continuación, los Silencios Productivos y los menos empleados los Silencios Obstructivos. Aquel que más se usa es el que favorece la atención, el acompañamiento, la reflexión y la expresión, mientras que el silencio de poder y el de desconexión son los menos empleados. Conclusión: El instrumento de evaluación propuesto (Q-SPS) ha presentado buenos niveles de consistencia interna para esta muestra permitiendo establecer un perfil comparativo entre el uso del silencio por parte de los distintos profesionales del ámbito de la salud por lo que podría valorarse una investigación más exhaustiva con mayor volumen de participantes.
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Knol ASL, Koole T, Desmet M, Vanheule S, Huiskes M. How Speakers Orient to the Notable Absence of Talk: A Conversation Analytic Perspective on Silence in Psychodynamic Therapy. Front Psychol 2020; 11:584927. [PMID: 33364999 PMCID: PMC7750524 DOI: 10.3389/fpsyg.2020.584927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022] Open
Abstract
Silence has gained a prominent role in the field of psychotherapy because of its potential to facilitate a plethora of therapeutically beneficial processes within patients’ inner dynamics. This study examined the phenomenon from a conversation analytical perspective in order to investigate how silence emerges as an interactional accomplishment and how it attains interactional meaning by the speakers’ adjacent turns. We restricted our attention to one particular sequential context in which a patient’s turn comes to a point of possible completion and receives a continuer by the therapist upon which a substantial silence follows. The data collection consisted of 74 instances of such post-continuer silences. The analysis revealed that silence (1) can retroactively become part of a topic closure sequence, (2) can become shaped as an intra-topic silence, and (3) can be explicitly characterized as an activity in itself that is relevant for the therapy in process. Only in this last case, the absence of talk is actually treated as disruptive to the ongoing talk. Although silence is often seen as a therapeutic instrument that can be implemented intentionally and purposefully, our analysis demonstrated how it is co-constructed by speakers and indexically obtains meaning by adjacent turns of talk. In the ensuing turns, silence indeed shows to facilitate access to the patient’s subjective experience at unconscious levels.
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Affiliation(s)
- A S L Knol
- Center for Language and Cognition Groningen, University of Groningen, Groningen, Netherlands.,Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Tom Koole
- Center for Language and Cognition Groningen, University of Groningen, Groningen, Netherlands.,Health Communication Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Stijn Vanheule
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Mike Huiskes
- Center for Language and Cognition Groningen, University of Groningen, Groningen, Netherlands
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Acheson R, Verdenhalven N, Avdi E, Midgley N. Exploring silence in short-term psychoanalytic psychotherapy with adolescents with depression. JOURNAL OF CHILD PSYCHOTHERAPY 2020. [DOI: 10.1080/0075417x.2020.1830297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | | | - Evrinomy Avdi
- Anna Freud National Centre for Children and Families, Aristotle University of Thessaloniki, Greece & ChAPTRe, London, UK
| | - Nick Midgley
- UCL and the Anna Freud National Centre for Children and Families, London, UK
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Kykyri VL, Karvonen A, Wahlström J, Kaartinen J, Penttonen M, Seikkula J. Soft Prosody and Embodied Attunement in Therapeutic Interaction: A Multimethod Case Study of a Moment of Change. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2016. [DOI: 10.1080/10720537.2016.1183538] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
| | - Anu Karvonen
- Department of Psychology, University of Jyvaskyla, Jyvaskyla, Finland
| | - Jarl Wahlström
- Department of Psychology, University of Jyvaskyla, Jyvaskyla, Finland
| | - Jukka Kaartinen
- Department of Psychology, University of Jyvaskyla, Jyvaskyla, Finland
| | - Markku Penttonen
- Department of Psychology, University of Jyvaskyla, Jyvaskyla, Finland
| | - Jaakko Seikkula
- Department of Psychology, University of Jyvaskyla, Jyvaskyla, Finland
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Daniel SIF, Folke S, Lunn S, Gondan M, Poulsen S. Mind the gap: In-session silences are associated with client attachment insecurity, therapeutic alliance, and treatment outcome. Psychother Res 2016; 28:203-216. [PMID: 27148916 DOI: 10.1080/10503307.2016.1177673] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE The association between in-session silences and client attachment, therapeutic alliance, and treatment outcome was investigated in two treatments for bulimia nervosa. METHOD 69 women and one man were randomized to two years of psychoanalytic psychotherapy (PPT) or 20 sessions of cognitive behavioral therapy (CBT). Client attachment was assessed using the Adult Attachment Interview. Early, middle and late sessions (N = 175) were evaluated with the Vanderbilt Therapeutic Alliance Scales, and quality of in-session silences was coded with the Pausing Inventory Categorization System (PICS). Multilevel Poisson and linear regression analyses were performed. RESULTS Coders identified 6236 pauses, which were more frequent in PPT than in CBT. Higher pausing frequency and higher relative frequency of obstructive pauses were associated with client insecure attachment as well as with poorer treatment alliance, and accounted for part of the relation between client attachment and therapeutic alliance. Good outcome clients had higher relative frequency of productive pauses, especially in mid-treatment, and lower relative frequency of obstructive pauses, especially in late treatment. CONCLUSION The study further validates the PICS. Findings indicate that therapists may be able to use in-session silences as an indicator of client attachment insecurity and as a prognostic sign of eventual treatment outcome.
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Affiliation(s)
- Sarah I F Daniel
- a Department of Psychology , University of Copenhagen , Copenhagen K , Denmark
| | - Sofie Folke
- a Department of Psychology , University of Copenhagen , Copenhagen K , Denmark
| | - Susanne Lunn
- a Department of Psychology , University of Copenhagen , Copenhagen K , Denmark
| | - Matthias Gondan
- a Department of Psychology , University of Copenhagen , Copenhagen K , Denmark
| | - Stig Poulsen
- a Department of Psychology , University of Copenhagen , Copenhagen K , Denmark
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Levitt HM. Interpretation-Driven Guidelines for Designing and Evaluating Grounded Theory Research: A Constructivist-Social Justice Approach. Psychother Res 2015. [DOI: 10.1007/978-3-7091-1382-0_22] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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Hooghe A, Neimeyer RA, Rober P. The complexity of couple communication in bereavement: an illustrative case study. DEATH STUDIES 2011; 35:905-924. [PMID: 24501858 DOI: 10.1080/07481187.2011.553335] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Sharing grief experiences, or "storying"grief can be a key resource in adapting to loss, one that can contribute to stronger bonds and relational intimacy within the family. In this article, the authors conceptualize communication between grieving family members in terms of 3 "D" processes, emphasizing the extent to which such communication is dialectic, dialogic, and dynamic in nature. They illustrate the complexity of sharing about a mutual loss, focused on these 3 features, by referring to a case study of a couple coping with the death of a child in the context of a newly formed family. Rather than unilaterally advocating the promotion of open communication, the authors suggest that therapists working with bereaved families first discuss the complexities of communication with the family members, specifically those concerning talking and keeping silent, and explore the different meanings associated with sharing grief experiences with each other.
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Affiliation(s)
- An Hooghe
- Institute for Family and Sexuality Studies, University of Leuven, Leuven, Belgium.
| | - Robert A Neimeyer
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Peter Rober
- Institute for Family and Sexuality Studies, University of Leuven, Leuven, Belgium
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Stringer JV, Levitt HM, Berman JS, Mathews SS. A study of silent disengagement and distressing emotion in psychotherapy. Psychother Res 2010; 20:495-510. [PMID: 20552533 DOI: 10.1080/10503301003754515] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Daniel SIF. Adult attachment insecurity and narrative processes in psychotherapy: an exploratory study. Clin Psychol Psychother 2010; 18:498-511. [PMID: 21110406 DOI: 10.1002/cpp.704] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Different types of client attachment insecurity may affect the psychotherapeutic process in distinct ways. This exploratory study compared the in-session discourse of clients with dismissing and preoccupied attachment states of mind on Adult Attachment Interviews conducted prior to therapy in the context of a randomized clinical trial of psychoanalytic and cognitive-behavioural psychotherapy for bulimia nervosa. In a subsample of six sessions from each of eight therapy dyads, preoccupied clients were found to talk more and have longer speaking turns than dismissing clients, who in turn generated more pauses. Using the Narrative Processes Coding System, preoccupied clients were found to show more narrative initiative; whereas, differences in terms of narrative process modes were not as clearly interpretable. Contrary to expectations, the two insecure states of mind were equally different in the relationship-focused psychoanalytic therapy and in the symptom-focused cognitive-behavioural therapy. Suggestions for further investigations of the in-session discourse of clients with different attachment states of mind are given.
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Affiliation(s)
- Sarah I F Daniel
- The University Clinic, Department of Psychology, University of Copenhagen, Denmark.
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Levitt HM, Williams DC. Facilitating client change: Principles based upon the experience of eminent psychotherapists. Psychother Res 2010; 20:337-52. [DOI: 10.1080/10503300903476708] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Pascual-Leone A, Greenberg LS, Pascual-Leone J. Developments in task analysis: New methods to study change. Psychother Res 2009; 19:527-42. [DOI: 10.1080/10503300902897797] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Mergenthaler E. Resonating minds: a school-independent theoretical conception and its empirical application to psychotherapeutic processes. Psychother Res 2009; 18:109-26. [PMID: 18815969 DOI: 10.1080/10503300701883741] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The resonating minds theory will be introduced as a means to describe psychotherapeutic processes and change. It builds on the mind-brain interface with psychotherapeutic interventions causing change in the brain, an altered brain causes changes in the emotional, cognitive, and behavioral regulation, and this again will change the types of subsequent therapeutic interventions. For the empirical assessment of this theory the therapeutic cycles model will be used. It is based on computer assisted analysis of verbatim transcripts using emotional tone, abstraction and narrative style as language measures. Sample applications and studies are shortly presented in order to provide evidence for the applicability and face validity of this approach.
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Clients’ Experiences of Disengaged Moments in Psychotherapy: A Grounded Theory Analysis. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2008. [DOI: 10.1007/s10879-008-9087-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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