Dynamic patterns in voices and the personal positions of a patient diagnosed with Borderline Personality Disorder (BPD) and the therapist in different contexts of long-term psychotherapy, and the association with the change process
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2021
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Abstract
Change in subjectivity of the patients is a key aspect for achieving significant outcomes in psychotherapy. The dialogical self theory considers that the subjectivity is formed of subjective positions, and voices defining a dynamic, non-unitary, and multivoiced self, as well as proposing methods to recognise them. Change occurs in the interaction between patient and therapist, which has the characteristics of a non-linear dynamical system. A case study was designed consisting of two consecutive sub-studies. Study 1 identified dynamic patterns in the personal positions, and voices of a patient diagnosed with Borderline Personality Disorder (BPD) and the therapist in change episodes of long-term psychotherapy, and study 2 described the trajectory of the dynamic patterns throughout psychotherapy, and their association with the patient´s outcomes. The procedure was carried out in successful psychotherapy (OQ45-2) and used the Change Episodes Model to track change episodes in the patient, and the Model of Analysis of Discursive Positioning in Psychotherapy (MAPP) to identify personal positions, and voices in the patient and therapist. Through the State Space Grid (SSG) were identified dynamic patterns both in change episodes and in each of the psychotherapy sessions, selecting those most representative to describe the trajectory of the patient's subjective change. Different patterns were found both in change episodes, and along the course of the psychotherapy, describing a progress toward pattern formation including voices of the therapist’s proposer position and patient´s reflective position. The results suggest that aspects of subjective change are non-linear and emergently consolidating throughout the therapeutic process. The theoretical and clinical relevance of distinguishing a trajectory that begins in monological subjective patterns, related to psychological suffering, and advances to dialogical subjective patterns associated to the patient's positive outcomes, is discussed.
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Tesis (Doctor en Psicoterapia)--Pontificia Universidad Católica de Chile, 2021