Patterns of change: tracking the therapeutic focus

INTRODUCTION: Brief dynamic psychotherapy has been increasingly important in the actual clinical practice. For its brevity, focalization must be accomplished. The work on focus consolidates the material, abbreviates psychotherapy, and is considered to be a change mechanism. Operationalized Psychodynamic Diagnosis OPD-2 proposes a concept of focus as the specific problem areas that are significant for patient's psychodynamics, in terms of relational pattern, inner conflicts, and structural vulnerabilities. The study on foci becomes a research and clinical imperative, where change on foci must be considered. AIMS & METHODS: This study aimed to (1) identify foci in change episodes and (2) establish the relationship between them during the process. A multiple single-subject design was used, considering the analysis of 13 outpatient psychotherapies done as treatment as usual (average of 18 sessions each process). OPD-2and Level of Presence of Foci were used to identify foci worked by therapist and patient during change episodes, already codified in a previous research usign the list of Generic Change Indicators. RESULTS & DISCUSSION: 208 change episodes were analysed. Conflict focus relates inversely with structural focus at the initial phase, and the latter appears to increase during the process. Some focus relates to different levels of patients change. Results are discussed in their clinical relevance. (AU)

Análisis de los estilos lingüísticos de paciente y terapeuta durante la conversación terapéutica en episodios de cambio, utilizando el buscador lingüístico y contador de palabras (LIWC) / Analysis of linguistic style in patient and therapist during therapeutic conversation in change episodes using the linguistic in-quiry and word count (LIWC)

El interés creciente en el desarrollo del proceso psicoterapéutico ha llevado a los investigadores a centrarse en el estudio de la interacción verbal y no-verbal de la interacción paciente-terapeuta, considerando la noción de lenguaje performativo como lenguaje que no solo es un simple reflejo de la realidad sino también constitución de la misma. Asumimos que durante la conversación terapéutica ambos, paciente y terapeuta, están “haciendo algo” mientras “dicen algo” (Reyes et al., 2008; Searle, 1980, 2002). En consecuencia, la conversación entre paciente y terapeuta puede sentar una nueva realidad en la que se construye el cambio psicológico del paciente. Asimismo las tres últimas décadas ofrecen argumentos como para concluir que la salud física y mental se correlaciona con el tipo de palabras utilizadas durante la conversación (Chung & Pennebaker, 2007; Graybeal, Sexton, & Pennebaker, 2002; Niederhoffer & Pennebaker, 2002; Stirman & Pennebaker, 2001; Slatcher, Vazire, & Pennebaker, 2008), las cuales reflejan la manera en que los procesos psicológicos de los sujetos están estructurados. Este artículo incluye los resultados de la utilización del Linguistic Inquiry and Word Count (LIWC, Pennebaker, Booth, & Francis, 2001) para el análisis de la conversación terapéutica entre paciente y terapeuta, basado en ciertas categorías lingüísticas y psicológicas, durante episodios de cambio.

The growing interest in knowing what happens during the psychotherapeutic process has made researchers focus on the study of verbal and non-verbal patient-therapist interaction, considering a notion of performative language, in which the languageis not only understood as a simple reflection of reality, but as constitutive of it. We assumed that during the therapeutic conversation, both patient and therapist, are also “doing something” while they are “saying something” (Reyes et al., 2008; Searle,1980, 2002). Consequently, the conversation between patient and therapist can set a new reality on which the patient’s psychological change is built. There is also support in the last three decades to conclude that the physical and mental health is correlatedwith the type of words used during the conversation (Chung & Pennebaker, 2007; Graybeal, Sexton & Pennebaker, 2002; Niederhoffer & Pennebaker, 2002; Stirman & Pennebaker, 2001; Slatcher, Vazire & Pennebaker, 2008), which is a reflection of theway their psychological processes are structured. This article includes the results ofusing the Linguistic Inquiry and Word Count (LIWC, Pennebaker, Booth & Francis, 2001) for the analysis of the therapeutic conversation between patient and therapist during change episodes, based on certain linguistic and psychological categories.