“Awkward to ask”: An investigation of inner dialogues helps explain psychotherapy termination
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| Year of publication | 2016 |
| Type | Appeared in Conference without Proceedings |
| MU Faculty or unit | |
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| Description | Case description: A 23-year old female student presenting with depressive symptoms entered therapy with a 33-year old female therapist who had 8 years of experience in psychodynamic approach. The client completed questionnaires on outcome, therapeutic alliance, and important aspects of therapy. Furthermore, three sessions (out of planned 20) were followed by an Interpersonal Process Recall interview, during which both participants talked about their thoughts and experiencing (i.e., “inner dialogues”) during self-selected important moments of the particular session. Client’s autonomy and authenticity emerged as important topics of these interviews. Treatment goals: Reduction in depressive symptoms (lack of interest in previously enjoyable activities, avoiding social contact, exhaustion, absence of desire to live) was the main goal. The client wanted to become less dependent on opinions of other people, feel less self-conscious regarding her weight and attain higher self-esteem. Course of the treatment: There was a possible alliance rupture identified at the 14th session, which was not discussed during the following session. On a request made by the client, the therapy ended after the 18th session, prior to the 20th session it was scheduled for. Evaluation: The client markedly improved on all outcome measures at the conclusion of the therapy (e.g., Clinical Outcome Routine Evaluation – Outcome Measure). During the treatment, the therapeutic alliance between participants was relatively stable as measured by Working Alliance Inventory and Session Rating Scale. Conclusion: An analysis of therapist’s and client’s inner dialogues explained alliance ruptures and premature conclusion of the therapy: the therapist wanted the client to be more authentic at sessions. Although she was wary of pushing the client too much towards openness and authenticity, the client felt that in many respects the therapist was not close enough for her to share intimate details of her life. |
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