Ambivalence in grief therapy: The interplay between change and self-stability

Abstract

This article explores the role of ambivalence in grief therapy within a narrative framework. From this perspective, change starts with the occurrence of innovative moments, which can be nullified by reaffirmation of the problematic self-narrative as a sign of ambivalence. This study analyzed ambivalence in six complicated grief cases using the "Return to the Problem Coding System." Markers of ambivalence emerged in all cases, with a decreasing profile in cases with greater symptomatic improvement, suggesting an association between clinical change and ambivalence evolution in therapy. Addressing ambivalence may bring to light important aspects of client's self-reconstruction after a major loss.

Three narrative-based coding systems: Innovative moments, ambivalence and ambivalence resolution

“…To illustrate the three coding systems throughout this paper, we will use clinical vignettes from a complicated grief case of a 63-year-old woman (that we will further refer to as "Laura", a fictional name) who lost her 30-year-old daughter to cancer two years before starting therapy (this case was included in a grief sample presented in Alves et al, 2014 andAlves et al, 2016). After her daughter's death, Laura showed a significant incapacity to reconnect with her world (e.g., playing with her grandchildren, working at her family store, driving her car) and to find meaning to the death of her "young and generous" daughter.…”

Ambivalence Predicts Symptomatology in Cognitive-Behavioral and Narrative Therapies: An Exploratory Study

“…While former studies analyzed the relationship between AMs and pre-post change (Gonçalves et al., 2011b; Ribeiro et al., 2014, 2015; Alves et al., 2015), this study examined the predictive effect of AMs on symptomatic change in the subsequent session. Ribeiro et al.…”

“…Studies that tracked AMs along treatment revealed that in unchanged cases AMs’ frequency is higher – keeping stable or even increasing as the psychotherapeutic process evolves – while for recovered cases the frequency of AMs is generally lower and decreases as treatment progresses (Gonçalves et al., 2011b; Ribeiro et al., 2014, 2015; Alves et al., 2015). Overall, these results suggest that (1) ambivalence – as measured by AMs – is a frequent process both in unchanged and recovered cases; and (2) its persistence along treatment is associated with therapeutic failure.…”

“…These studies used various samples with different clinical problems and distinct therapeutic models. Yet, most of these models shared a predominantly constructivist or phenomenological approach such as narrative therapy (Ribeiro et al., 2015), meaning reconstruction approach to grief (Alves et al., 2015), and emotion-focused therapy (Ribeiro et al., 2014). Thus, the present study firstly aims at contrasting ambivalence between a sample of narrative therapy and a sample of cognitive-behavioral therapy.…”

“…Thus, the present study firstly aims at contrasting ambivalence between a sample of narrative therapy and a sample of cognitive-behavioral therapy. Also, studies with AMs (Gonçalves et al., 2011b; Ribeiro et al., 2014, 2015; Alves et al., 2015) have suggested that persistent ambivalence is in some way related to unsuccessful outcomes. However, the precise relationship between AMs and clients’ symptomatology remains unclear as all previous studies associated AMs with pre-post change.…”