Parent development in clinical child neurological assessment process: Encounters with the assimilation model

Therapist interventions and client ambivalence in two cases of narrative therapy for depression

AIM

We understand ambivalence as a cycle of opposing expressions by two internal voices. The emergence of a suppressed voice produces an innovative moment (IM), challenging the dominant voice, which represents the client's problematic self-narrative. The emergence of the IM is opposed by the dominant voice, leading to a return to the problematic self-narrative. This study analyzed therapist and client responses to each other in episodes of ambivalence.

METHOD

The therapeutic collaboration coding system (TCCS) assesses whether and how the therapeutic dyad is working within the therapeutic zone of proximal development (TZPD) by examining client responses to therapist interventions. We applied the TCCS to episodes in which a good- and a poor-outcome client in narrative therapy expressed ambivalence.

RESULTS

In both the good- and poor-outcome cases, the therapist responded to the emergence of ambivalence similarly, balancing challenging and supporting. The good-outcome case responded at the developmental level proposed by the therapist when challenged, while the poor-outcome case lagged behind the level proposed.

DISCUSSION

This supports the theoretical explanation that the therapist did not match client's developmental level in the poor-outcome case, working beyond the client's current TZPD and contributing to the maintenance of ambivalence.

Achieving an empathic stance: dialogical sequence analysis of a change episode

Abstract This study examined a client's therapeutic progress within one session of an 18-session child neurological assessment. The analysis focused on a parent-psychologist dialogue in one session of the assessment process. Dialogical sequence analysis (DSA; Leiman, 2004, 2012) was used as a micro-analytic method to examine the developing discourse. The analysis traced the mother's developing of a reflective stance toward herself and her problematic ways of interacting with her daughter, who was the client. During the dialogue, the mother began to recognize her own contribution in maintaining the problematic pattern. Her gradual acknowledgment of the child's perspective and her growing sense of the child's otherness were mediated by an observer position (third-person view) toward the problematic pattern, which allowed a flexible exchange between the perspectives of self and the other. The results demonstrate the parallel development of intrapersonal and interpersonal empathy shown previously to characterize the transition from stage 3 (problem statement/clarification) to stage 4 (understanding/insight) in the assimilation of problematic experiences sequence (Brinegar, Salvi, Stiles, & Greenberg, 2006).