No abstract

Objective: The aim of this case report is to demonstrate the feasibility of a systemic procedure (synergetic process management) including modeling of the idiographic psychological system and continuous high-frequency monitoring of change dynamics in a case of dissociative identity disorder. The psychotherapy was realized in a day treatment center with a female client diagnosed with borderline personality disorder (BPD) and dissociative identity disorder.Methods: A three hour long co-creative session at the beginning of the treatment period allowed for modeling the systemic network of the client's dynamics of cognitions, emotions, and behavior. The components (variables) of this idiographic system model (ISM) were used to create items for an individualized process questionnaire for the client. The questionnaire was administered daily through an internet-based monitoring tool (Synergetic Navigation System, SNS), to capture the client's individual change process continuously throughout the therapy and after-care period. The resulting time series were reflected by therapist and client in therapeutic feedback sessions.Results: For the client it was important to see how the personality states dominating her daily life were represented by her idiographic system model and how the transitions between each state could be explained and understood by the activating and inhibiting relations between the cognitive-emotional components of that system. Continuous monitoring of her cognitions, emotions, and behavior via SNS allowed for identification of important triggers, dynamic patterns, and psychological mechanisms behind seemingly erratic state fluctuations. These insights enabled a change in management of the dynamics and an intensified trauma-focused therapy.Conclusion: By making use of the systemic case formulation technique and subsequent daily online monitoring, client and therapist continuously refer to detailed visualizations of the mental and behavioral network and its dynamics (e.g., order transitions). Effects on self-related information processing, on identity development, and toward a more pronounced autonomy in life (instead of feeling helpless against the chaoticity of state dynamics) were evident in the presented case and documented by the monitoring system.

Objective: Current approaches of routine outcome monitoring (session-by-session measures) expect that trajectories of change should move on a standard track. Patients moving out of standard tracks are assumed to be at risk of deterioration. From a nonlinear dynamic systems perspective, there is not any assumption regarding a supposed standard track a patient should follow. Individual trajectories should be more complex than averaged tracks, highly individual, and characterised by pattern transitions. Method: We tested if high-frequency (daily) trajectories of change are moving on standard tracks, if there are different complexity levels of high-versus low-frequency time series, if 'not on track' dynamics will be correlated with poor outcome and if complexity peaks representing the critical instabilities of a process will be correlated with the outcome. The patients included in the data analysis (N = 88) used the Therapy Process Questionnaire (TPQ) for daily self-assessments and the ICD-10based Symptom Rating (ISR) for outcome evaluation. Results: High-frequency trajectories are not running on standard tracks and are not necessarily correlated with poor outcome. Locally increased complexity may be associated with good outcome. Conclusion: It may be useful to move beyond the concept of standard tracks and expected treatment outcomes. Routine feedback procedures should use the information that is given by the nonlinear dynamics of multiple change criteria. K E Y W O R D S dynamic complexity, nonlinear dynamic systems, on track versus. not on track, processoutcome research, psychotherapy feedback This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Theoretical models of psychotherapy not only try to predict outcome but also intend to explain patterns of change. Studies showed that psychotherapeutic change processes are characterized by nonlinearity, complexity, and discontinuous transitions. By this, theoretical models of psychotherapy should be able to reproduce these dynamic features. Using time series derived from daily measures through internet-based real-time monitoring as empirical reference, we earlier presented a model of psychotherapy which includes five state variables and four trait variables. In mathematical terms, the traits modulate the shape of the functions which define the nonlinear interactions between the variables (states) of the model. The functions are integrated into five coupled nonlinear difference equations. In the present paper, we model how traits (dispositions or competencies of a person) can continuously be altered by new experiences and states (cognition, emotion, behavior). Adding equations that link states to traits, this model not only describes how therapeutic interventions modulate short-term change and fluctuations of psychological states, but also how these can influence traits. Speaking in terms of Synergetics (theory of self-organization in complex systems), the states correspond to the order parameters and the traits to the control parameters of the system. In terms of psychology, trait dynamics is driven by the states—i.e., by the concrete experiences of a client—and creates a process of personality development at a slower time scale than that of the state dynamics (separation of time scales between control and order parameter dynamics).