Self‐organisation in dialogical patterns of a patient with borderline personality disorder and their therapist: A case study from nonlinear dynamics perspective

Abstract

Objective The purpose of this study was to identify self‐organised dynamics in sessions with dialogical patterns (i.e. reflective interactions of self‐states associated with psychological change) within long‐term psychotherapy. One of the hallmarks of self‐organisation is the presence of an Inverse Power Law (IPL) in the frequency distribution of relevant events, which reflect better adaptation to internal and environmental changes, produced by psychotherapy. Methods A case study of successful psychotherapy (44 weekly sessions) with a patient diagnosed with borderline personality disorder (BPD) and the therapist was conducted. The expressions of the subjectivity (i.e. voices) in the patient and therapist were identified through the Model of Analysis of Discursive Positioning in Psychotherapy (MAPP). State Space Grids (SSG) identified sessions that presented dialogical patterns acting as attractors (8 sessions) and those with non‐dialogical patterns acting as attractors (12 sessions). Finally, Orbital Decomposition (ORBDE) produced statistics of self‐organisation in both groups of sessions and the degree of fit to an IPL. Results Both groups of sessions presented an acceptable fit to the IPL distributions (R2 = .853 and .938), and statistics placed them in different self‐organised regions. Conclusions Although dialogical patterns are an emergent property of therapy, their structure is similar to sessions of other types, in that dynamic processes occur in them that can be empowered in patients to consolidate psychological change. The nonlinear and emergent character of these self‐organised processes and their clinical implications for activating the patients' psychological resources are discussed.

Una aproximación dialógica a la supervisión de la psicoterapia de personalidades disfuncionales

“…Un desarrollo reciente de esta línea teórica sugiere que abordar clínicamente tanto las voces internas de los pacientes como las de los terapeutas, así como sus influencias mutuas, contribuye significativamente al resultado del tratamiento (Hacohen et al, 2019). Dentro de las investigaciones en psicoterapias dialógicas, son especialmente reseñables las del grupo chileno (Mellado et al, 2022a(Mellado et al, , 2022b(Mellado et al, , 2023. Resulta especialmente reseñable un artículo sobre la utilización conjunta del análisis de secuencias dialógicas y el modelo de asimilación (Stiles et al, 2006), sin duda de gran interés pero que excede los propósitos del presente artículo.…”