Facial-affective communication and verbal relational offers during ruptures and resolution strategies: A single case study

Comunicación facial-afectiva y ofertas relacionales verbales durante rupturas y estrategias de resolución: Un estudio sistemático de caso único

Autores/as

  • Carolina Altimir Colao Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP), Universidad de Las Américas
  • Nelson Valdés-Sánchez Psychology Department, Universidad Santo Tomás, Chile. Millennium Institute for Research on Depression and Personality (MIDAP), Chile.Center for Research in Psychotherapy (CIPsi), Chile.

Palabras clave:

Ruptures, Resolutions, Facial-Affective Communication, Relational Offers, Psychotherapeutic Process, Therapeutic Alliance

Resumen

La investigación sobre la relación terapéutica ha subrayado su papel central en el proceso de cambio terapéutico, indicando la relevancia de determinar los elementos y mecanismos específicos que intervienen en su configuración (Knobloch-Fedders, Elkin, & Kiesler, 2014). La investigación sobre las rupturas de la relación terapéutica ha aportado a la comprensión del proceso de negociación interpersonal que interviene en la interacción paciente-terapeuta. Aunque estudios anteriores han contribuido a la caracterización objetiva y exhaustiva de las rupturas, se necesitan más investigaciones para especificar los marcadores que permiten comprender el modo como los patrones de regulación afectiva entre paciente y terapeuta están involucrados y contribuyen a la generación de estos eventos y a los intentos de reparación. El objetivo de este estudio es caracterizar el comportamiento facial-afectivo de paciente y terapeuta asociado a las ofertas relacionales (OR) verbales durante los eventos de ruptura (R) y de estrategia de resolución (ER) en una terapia psicodinámica breve. El comportamiento afectivo facial se determinó usando el Facial Action Coding System (FACS), las ORs se derivaron del análisis del contenido de las transcripciones de sesiones, y las R y ER se determinaron usando el 3RS. Se realizaron análisis anidados para establecer asociaciones entre las variables. Los resultados indican la presencia de pautas regulatorias faciales-verbales entre paciente y terapeuta características de las rupturas y estrategias de resolución; y señalan el valor de combinar múltiples enfoques para permitir el acceso a indicadores observables de los procesos regulatorios diádicos que contribuyen a comprender y atender las oscilaciones de la relación terapéutica.

Abstract

Research on the therapeutic relationship has underscored its central role for the therapeutic change process, indicating the relevance of determining the specific elements and mechanisms involved in its configuration (Knobloch-Fedders, Elkin, & Kiesler, 2014). Research on ruptures of the therapeutic relationship has yielded particular contributions to better understanding the interpersonal negotiation process involved in the patient-therapist interaction. Although previous studies have contributed to the objective characterization and the exhaustive description of ruptures, more research is needed to further specify markers that allow a better understanding about how patterns of affective regulation between patient and therapist are involved and contribute to the emergence of these events and the attempts at reparation. The aim of this study is to characterize patient’s and therapist’s facial-affective behavior associated to verbal relational offers (RO) during rupture (R) and resolution strategy (RS) events in a brief psychodynamic therapy. Facial-affective behavior was determined using the Facial Action Coding System (FACS), ROs were derived from the content analysis of session transcripts, and R and RS were determined using the 3RS. Nested analyses were carried to establish associations between variables. Results indicate characteristic patient-therapist facial-verbal regulatory patterns for both rupture and resolution strategy events. These findings underscore the value of combining multiple approaches to allow an access to observable indicators of dyadic affect regulatory processes that can contribute to better understand and be attentive to the oscillations of the therapeutic relationship.

Descargas

Los datos de descargas todavía no están disponibles.

Biografía del autor/a

Carolina Altimir Colao, Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP), Universidad de Las Américas

Doctora en Psicoterapia. Investigadora Adjunta Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP), Profesora Titular de la Escuela de Psicología de la Universidad de Las Américas, Profesora Asistente Adjunta Pontificia Universidad Católica de Chile. Directora de Psicoterapia y Cambio - Red Latinoamericana de Investigación en Psicoterapia, Sub-directora Centro de Investigación en Psicoterapia (CIPsi). Miembro de la Society for Psychotherapy Research (SPR).

Nelson Valdés-Sánchez, Psychology Department, Universidad Santo Tomás, Chile. Millennium Institute for Research on Depression and Personality (MIDAP), Chile.Center for Research in Psychotherapy (CIPsi), Chile.

Doctor en Psicoterapia. Docente Escuela de Psicología, Universidad Santo Tomás (UST), Sede Santiago, Chile. Investigador Adjunto Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP). Investigador Centro de Investigacion en Psicoterapia (CIPsi). Miembro de la Sociedad Cientifica de Psicología (SCP) y de la Society for Psychotherapy Research (SPR).

Citas

Altimir, C., &. Jiménez, J.P. (2020). Walking the middle ground between hermeneutics and science: A research proposal on psychoanalytic process. The International Journal of Psychoanalysis, 101(3), 496-522 https://doi.org/10.1080/00207578.2020.1726711

Altimir, C., Krause, M., de la Parra, G., Dagnino, P., Tomicic, A., Valdés, N., … Vilches, O. (2010). Clients', therapists', and observers' agreement on the amount, temporal location, and content of psychotherapeutic change and its relation to outcome. Psychotherapy Research, 20, 4, 472 - 487. https://doi.org/10.1080/10503301003705871

Anstadt, T., Merten, J., Ullrich, B., & Krause, R. (1997). Affective dyadic behavior, core conflictual relationship themes, and success of treatment. Psychotherapy Research, 7, 397-417. https://doi.org/10.1080/10503309712331332103

Aron, L. (1996). A meeting of minds: Mutuality in psychoanalysis. Hillsdale, NJ: Analytic Press.

Bänninger-Huber, E. (1992). Prototypical affective microsequences in psychotherapeutic interaction. Psychotherapy Research, 2, 291-306. https://doi.org/10.1080/10503309212331333044

Bänninger-Huber, E., & Widmer, C. (1999). Affective relationship patterns and psychotherapeutic change. Psychotherapy Research, 9, 74-87. https://doi.org/10.1080/10503309912331332601

Barros, P., Altimir, C., & Pérez, J.C. (2016). Patients’ facial-affective regulation during episodes of rupture of the therapeutic alliance / Regulación afectivo-facial de pacientes durante episodios de ruptura de la alianza terapéutica. Estudios de Psicología, 37, 2-3, 580-603. https://doi.org/10.1080/02109395.2016.1204781

Benecke, C., & Krause, R. (2005). Facial affective relationship offers of patients with panic disorder. Psychotherapy Research, 15, 178-187. https://doi.org/10.1080/10503300512331335048

Benecke, C., Peham, D., & Bänninger-Huber, E. (2005). Nonverbal relationship regulation in psychotherapy. Psychotherapy Research, 15, 81-90. https://doi.org/10.1080/10503300512331327065

Castonguay, L.G., Goldfried, M.R., Wiser, S., Raue, P.J., & Hayes, A.M. (1996). Predicting the effect of cognitive therapy for depression: A study of unique and common factors. Journal of Consulting and Clinical Psychology, 64, 497-504. https://doi.org/10.1037/0022-006X.64.3.497

Coutinho, J., Ribeiro, E., Fernandes, C., Sousa, I., & Safran, J. D. (2014). The development of the therapeutic alliance and the emergence of alliance ruptures. Anales de Psicología, 30(3), 985–994. http://dx.doi.org/10.6018/analesps.30.3.168911

Coutinho, J., Ribeiro, E., Hill, C., & Safran, J. D. (2011). Therapists’ and clients’ experiences of alliance ruptures: A qualitative study. Psychotherapy Research, 21(5), 525–540. http://dx.doi.org/10.1080/10503307.2011.587469

de la Parra, G., von Bergen, A., & del Río, M. (2002). Primeros hallazgos de la aplicación de un instrumento que mide resultados psicoterapéuticos en una muestra de pacientes y de población general. Revista Chilena de Neuropsiquiatría, 40, 201-209. http://dx.doi.org/10.4067/S0717-92272002000300003

Dreher, M., Mengele., U., Krause, R., & Kämmerer, A. (2001). Affective indicators of the psychotherapeutic process: An empirical case study. Psychotherapy Research, 11, 99-117. https://doi.org/10.1080/713663855

Ekman, P. (1979). About brows: Emotional and conversational signals. In M von Cranach, K. Foppa, W. Lepenies and D. Ploog (Eds.) (pp. 169-249). Human Ethology. Cambridge, UK: Cambridge University Press.

Ekman, P., & Friesen, W. V. (1978). Facial action coding system: A technique for the measurement of facial movement. Palo Alto, California: Consulting Psychologists Press.

Ekman, P., & Friesen, W. V. (1982). Felt, false, and miserable smiles. Journal of Nonverbal Behavior, 6(4), 238-252. https://doi.org/0191-5886/82/1400-0238

Eubanks, C. F., Muran, J. C., & Safran, J. D. (2015). Rupture Resolution Rating System (3RS): Manual. Technical Report.

Fleiss, J. L., Levin, B., & Cho Paik, M. (1981). Statistical Methods for Rates and Proportions. (3rd. ed). New York: John Wiley & Sons.

Fonagy, P., & G. Moran, (1993). Selecting Single Case Research Designs for Clinicians. In E. N. Miller, L. Luborsky, J. P. Barber, and J. P. Docherty (Eds.). Psychodynamic Treatment Research: A Handbook for Clinical Practice (pp. 62–95). New York: Basic Books.

Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48, 9–16. https://doi.org/10.1037/a0022186

Kächele, H. (2020). From case study to single case research: The specimen case Amalia X. In M. Leuzinger-Bohleber, M. Solms, & S. E. Arnold (Eds.). Outcome research and the future of psychoanalysis. Clinicians and researchers in dialogue. (pp. 68-88). New York: Routledge.

Knobloch-Fedders, L. M., Elkin, I., & Kiesler, D.J. (2015). Looking Back, looking Forward: A historical reflection on psychotherapy process research. Psychotherapy Research 25(4), 383–395. https://doi.org/10.1080/10503307.2014.906764

Krause, M., Altimir, C., Pérez, C., & de la Parra, G. (2014). Generic Change Indicators in therapeutic processes with different outcomes. Psychotherapy Research, 25(5), 533-545. https://doi.org/10.1080/10503307.2014.935516.

Krause, M., de la Parra, G., Arístegui, R., Dagnino, P., Tomicic, A., Valdés, N., … Ramírez, M.L. (2007). The evolution of therapeutic change studied through generis change indicators. Psychotherapy Research, 17, 673-689. https://doi.org/10.1080/10503300601158814

Krause, R., & Merten, J. (1999). Affects, Regulation of Relationship, Transference and Countertransference. International Forum of Psychoanalysis, 8, 103-114. https://doi.org/10.1080/080370699436429

Lambert, M. J., Hansen, N. B., Umpress, V., Lunnen, K., Okiishi, J., & Burlingame, G. M. (1996). Administration and scoring manual for the OQ-45.2. Wilmington, DE: American Professional Credentialing Services.

Merten, J. (1997). Facial-affective behavior, mutual gaze, and emotional experience. Journal of Nonverbal Behavior, 21(3), 179-201. https://doi.org/10.1023/A:1024969514170

Merten, J. (2005). Facial microbehavior and the emotional quality of the therapeutic relationship. Psychotherapy Research, 15, 325-333. https://doi.org/10.1080/10503300500091272

Mitchell, S.A. (1988). Relational concepts in psychoanalysis. Cambridge, MA: Harvard University Press.

Norcross, J. C. (2011). Psychotherapy relationships that work: Evidence based responsiveness (2nd ed.). New York: Oxford University Press. https://doi.org/10.1093/acprof:oSo/9780199737208.001.0001

Piper, W.E., Azim, H.F.A., Joyce, A.S., & McCallum, M. (1991). Transference interpretations, therapeutic alliance, and outcome in short term individual psychotherapy. Archives of General Psychiatry, 48, 946-953. http://doi.org/10.1001/archpsyc.1991.01810340078010

Rasting, M., & Beutel, M. (2005). Dyadic affective interactive patterns in the intake interview as a predictor of outcome. Psychotherapy Research, 15(3), 188-198. https://doi.org/10.1080/10503300512331335039

Raudenbush, S. W., Bryk, A. S., Cheong, Y., Congdon, R., & du Toit, M. (2004). HLM6: Linear and non-linear modeling. Chicago: Scientific Software International.

Rozmarin, E., Muran, J. C., Safran, J., Gorman, B., Nagy, J., & Winston, A. (2008). Subjective and intersubjective analyses of the therapeutic alliance in a brief relational therapy. American Journal of Psychotherapy, 62(3), 313-328.

Safran, J. D. (2003). The relational turn, the therapeutic alliance, and psychotherapy research: Strange bedfellows or postmodern marriage? Contemporary Psychoanalysis, 39, 449-475. https://doi.org/10.1080/00107530.2003.10747215

Safran, J. D., & Kraus, J. (2014). Alliance ruptures, impasses, and enactments: A relational perspective. Psychotherapy, 51, 381–387. https://doi.org/10.1037/a0036815

Safran, J. D., & Muran, J, Ch. (2000). Negotiating the therapeutic alliance. A relational treatment guide. New York: The Guilford Press.

Safran, J. D., & Muran, J. Ch. (2006). Has the concept of the therapeutic alliance outlived its usefulness? Psychotherapy: Theory, Research, Practice, Training, 43, 286-291. https://doi.org/10.1037/0033-3204.43.3.286

Safran, J. D., Muran, J. C., Samstag, L. W., & Winston, A. (2005). Evaluating alliance-focused intervention for potential treatment failures: A feasibility study and descriptive analysis. Psychotherapy: Theory, Research, Practice, Training, 42(4), 512–531. https://doi.org/10.1037/0033-3204.42.4.512

Sayette, M. A., Cohn, J. F., Wertz, J. M., Perrott, M. A., & Parrott, D. J. (2001). A psychometric evaluation of the Facial Action Coding System for assessing spontaneous expression. Journal of Nonverbal Behavior, 25(3), 167 - 185. https://doi.org/10.1023/A:1010671109788

Publicado

2020-10-08

Número

Sección

Investigación con Adultos