Change in Psychotherapy: A Dialogical Analysis Single-Case Study of a Patient with Bulimia Nervosa

Abstract

Starting from the critical review of various motivational frameworks of change that have been applied to the study of eating disorders, the present paper provides an alternative conceptualization of the change in psychotherapy presenting a single-case study. We analyzed six psychotherapeutic conversations with a bulimic patient and found out narratives “for” and “against” change. We read them in terms of tension between dominance and exchange in I-positions, as described by Hermans. These results indicate that the dialogical analysis of clinical discourse may be a useful method to investigate change from the beginning to the end of therapy.

Becoming ex‐obese: narrations about identity changes before and after the experience of the bariatric surgery

“…The exchange is made up of questions and answers, agreements and disagreements; the same principles that the conversational analysis identified to examine the speech among the participants have been applied to the analysis of the dialogue between voices within the self (Linell , Salvini et al . ).…”

Storytelling as a Therapeutic Tool for Family Support in Bulimia Nervosa

“…Resistance to change derives from the slavery of repeating, which traps the dialogical self. The tension between change (liberty of reborn) and resistance to change (self-determination to repetition) can be also represented as voices discussing and contrasting in the context of a personal arena, in the dynamic of a dialog between parts [37].…”

“…As Marquez stated [35,36], change vs. non-change is something like an inner dialog between voices, but not only "inner" since external components appear (family, partner, friends, etc.). As stated by Salvini et al [37], the dialog between voices implies that when one party speaks, the other party is required to be silent. This way, it is common that a dominant discourse emerges (interactional dominance), the dialog being asymmetrical.…”

“…Based on the study of Hermans et al [42], Salvini et al [37] considered the trend toward discursive change during the therapeutic process according to the following four dimensions: (a) interactional dominance, (b) topic dominance, (c) amount of talk, and (d) strategic movements. In a process of scientific ST, it is relevant to analyze linguistic variations probably linked to a transition from a dysfunctional narrative to a new more coherent one.…”

“…At the beginning the amount of talk and strategic Storytelling as a Therapeutic Tool for Family Support in Bulimia Nervosa DOI: http://dx.doi.org/10.5772/intechopen.86195 movements might be summarized as a scarce of true dialog with different attempts to impose one over others. Each member seems to search for a top position in the group, thus polarizing and dominating the other voices [37]. As the sessions go on, a more reciprocal interaction is favored.…”