The Therapeutic Collaboration in Dropout Cases of Narrative Therapy: An Exploratory Study

Abstract

<jats:p>With this study, we aimed to describe the interaction within the therapeutic dyads involved in dropout cases of narrative therapy, once the quality of interaction in therapy appears to constitute a critical factor in clients’ decisions regarding its discontinuation. Seven dropout cases of narrative therapy, which were conducted by the same therapist, were analyzed using the Therapeutic Collaboration Coding System. The coding procedure required two trained and independent judges along with an auditing process. Overall, the findings demonstrated that independent of the clients’ responses, the therapist tended to increase the challenging interventions and decrease the supporting interventions over time. In turn, the clients oscillated between having experiences of safety and experiences of intolerable risk. The results will be discussed in terms of their theoretical and empirical relevance in relation to clinical implications. &#x0D; </jats:p>

Therapeutic Collaboration in Career Construction Counseling: Case Studies of an Integrative Model

“…The six cases studied were considered successful cases because they presented at least one statistically reliable change in one of the five outcome measures. This pattern that starts with supporting problem interventions in the initial phase and evolves to more challenge interventions in subsequent phases is in line with the pattern found in psychotherapy (e.g., Pinto et al, 2018;Rodrigues, 2018). Counseling in general seems to be characterized by a more supportive phase in the beginning of the intervention to provide a safe environment where clients can work on their problematic self-narratives and evolves progressively to more challenging phases where counselors and clients work collaboratively in clients' potential developmental level to foster change.…”

“…Regarding clients' responses, they follow a similar pattern in all cases. The major proportion of responses are validations by safety throughout all the intervention, a pattern also found in other studies that use TCCS (Ribeiro et al, 2014(Ribeiro et al, , 2016a(Ribeiro et al, , 2018Taveira et al, 2017;Pinto et al, 2018).…”

“…The internal consistency of the study was 0.92 for counselors' interventions and 0.93 for clients' responses (Ribeiro et al, 2013). The TCCS reliability has consistently shown good results with different therapeutic approaches and outcomes: narrative therapy (Ribeiro et al, 2014;Ferreira et al, 2015;Pinto et al, 2018); constructivist therapy (Ribeiro et al, 2018); cognitivebehavioral therapy (Pires, 2016;Stiles et al, 2016;Rodrigues, 2018); emotion focused therapy (Ribeiro et al, 2016a); client centered therapy (Ribeiro et al, 2014); good and poor outcome and dropout cases (Ribeiro et al, 2014(Ribeiro et al, , 2016aFerreira et al, 2015;Pires, 2016;Stiles et al, 2016;Pinto et al, 2018;Rodrigues, 2018). Taveira et al (2017) were also successful in applying the TCCS for the first time to a single case of CCC.…”

Responsiveness and therapeutic collaboration in narrative therapy.

“…A general contribution of a comparative case study in narrative therapy (Ferreira et al, 2015) supporting the TCM is that, compared with a poor outcome, the therapist of a good outcome case (both completer cases) seems to have been appropriately responsive to clients by adjusting the therapist's interventions to the client's previous immediate responses and being able to maintain or quickly return to work within the client's TZPD. In contrast, in narrative poor outcome dropouts, we have found a pattern of therapist's insistence on interventions that exceeded clients' TZPD, and this behavior increased in predropout sessions (e.g., A. P. Pinto et al, 2018). In addition, the same narrative case studies support the notion that, in different phases of therapy, responsive therapists may consider the use of different strategies (e.g., supporting or challenging clients' perspective) based on specific clients' experiences and progress.…”

¿Cómo funciona la terapia narrativa? Una revisión de la investigación de procesos y procesos-resultados

“…Finalmente, los procesos de colaboración fueron analizados en siete casos (6 mujeres, entre 19 y 43 años) de abandono de TN para depresión tratados por el mismo terapeuta (Pinto, Sousa, Pinheiro, Freitas y Ribeiro, 2018). En general, el terapeuta tendió a exhibir una alta proporción de desafío de la voz problemática en todos los casos, la que tendió a aumentar progresivamente a lo largo de las sesiones.…”