PRIVATE THEORIES AND PSYCHOTHERAPEUTIC TECHNIQUE

Abstract

That if real success is to attend the effort to bring a man to a definite position, one must first of all take pains to find him where he is and begin there. This is the secret of the art of helping others (Kierkegaard [1848] 1962, p. 27)

The aim of this study is to explore the importance, to the therapeutic process, of the relation between the patient's and the therapist's problem formulations and private theories of pathogenesis and cure. Four cases of young adults in psychoanalytic psychotherapy were compared, two with unequivocally positive and two with more ambiguous outcome at termination. The patients and therapists were interviewed about their private theories initially and at termination of therapy, and a qualitative comparison was made between the cases. In the two more successful cases the therapists had early in therapy perceived obstacles for the therapeutic work in the patients' ways of thinking, feeling, and relating, and made interpretative interventions focusing on these. This was not observed in the less successful cases. In the more successful cases the patient's and the therapist's private theories were more similar at termination than initially, whereas the opposite development was found in the less successful cases. One hypotheses generated is that the therapeutic process can be facilitated by a therapist listening to the patient's private theories, making interpretative interventions focusing on obstacles to the therapeutic work, including contradictions between their private theories, and monitoring the patient's reactions to these interventions.

Notes

This project is conducted at the Institute of Psychotherapy, Stockholm County Council, and the Psychotherapy Section, Department of Clinical Neuroscience, Karolinska Institute. The project is supported by a grant from the Bank of Sweden, Tercentenary Foundation. The project has been approved by Karolinska Institute's ethical committee and all participants have given informed consent.

Cut‐off for GSI is computed with the formula given by Jacobson and Revenstorf (1988) and based on the non‐clinical samples of women and men, respectively, 20–25 years old, in the Swedish standardization of SCL‐90 (Fridell et al. 2002). The change needed on GSI is based on the reliability coefficient (0.90) recommended by Hansen and Lambert (1996) and the standard deviation for the patient population's pre‐treatment ratings.

Cut‐off for GAF is defined theoretically, as GAF>70 represents the spectrum of clinical normality. The change needed on GAF is based on the reliability coefficient (0.65) given by Michels et al. (1996) and the standard deviation for the patient population's pre‐treatment ratings.

Cut‐off for DRS – the mean of the patient's representations of mother, father, and self – is defined theoretically, as DRS = 6 is the threshold value for neurotic personality structure. The change needed on mean DRS is based on the reliability coefficient (0.71) of the Swedish standardization (Hjälmdahl et al. 2001) and the standard deviation for the patient population's pre‐treatment ratings.

GSI = Global Symptom Index of the SCL‐90.

GAF = Global Assessment of Functioning.

DRS = Differentiation‐Relatedness Scale. M = Mother, F = Father, S = Self, T = Therapist.

*Clinically significant change.