Θεραπευτική σχέση και μακρόχρονη ομαδική συστημική ψυχοθεραπεία: μια ποιοτική προσέγγιση

Manuscript (English)
Δημοσιευμένα: Jun 7, 2021
DOI: https://doi.org/10.12681/psy_hps.26889
Λέξεις-κλειδιά:
θεραπευτική σχέση ποιοτική έρευνα προσέγγιση συστημικής ψυχοθεραπείας SANE
Tsabika Bafiti
«Λόγω Ψυχής»-Ινστιτούτο Εκπαίδευσης και Έρευνας στη Συστημική Ψυχοθεραπέια
https://orcid.org/0000-0002-6282-027X
Περίληψη

Η σύγχρονη βιβλιογραφία έχει επισημάνει τη θεραπευτική σχέση ως έναν από τους σημαντικότερους μηχανισμούς ψυχοθεραπευτικής αλλαγής. Οι έρευνες έχουν αναδείξει κάποια χαρακτηριστικά του θεραπευτή, όπως η ενσυναίσθηση, η αποδοχή και η αυθεντικότητα, αλλά και του θεραπευόμενου, όπως η ποιότητα των διαπροσωπικών του σχέσεων και οι προσδοκίες του, τα οποία συμβάλλουν στη θεραπευτική συμμαχία. Ελάχιστα δεδομένα υπάρχουν για τη σημασία της θεραπευτικής σχέσης στη μακρόχρονη ομαδική συστημική ψυχοθεραπεία. Διενεργήθηκαν 10 ημιδομημένες συνεντεύξεις με θεραπευόμενους, οι οποίοι είχαν ολοκληρώσει  μακρόχρονη ομαδική ψυχοθεραπεία με την προσέγγιση SANE – System Attachment Narrative Encephalon®, ένα εμπλουτισμένο μοντέλο συστημικής θεραπείας. Οι συμμετέχοντες είχαν τη δυνατότητα να μιλήσουν για την προσωπική τους θεραπευτική  εμπειρία στην ομάδα 2 με 8 χρόνια μετά την ολοκλήρωσή της. Τα δεδομένα αναλύθηκαν με τη μέθοδο της Ερμηνευτικής Φαινομενολογικής Ανάλυσης. Προέκυψαν τρία βασικά θέματα και έξι υποθέματα που αφορούσαν τη θεραπευτική σχέση. Τα βασικά θέματα ήταν: 1) ο ρόλος του θεραπευτή, με υποθέματα 1.α) ο θεραπευτής ως πηγή ασφάλειας, 1.β) ο θεραπευτής ως γονεϊκό πρότυπο, 2) η λειτουργία του θεραπευτή,  με υποθέματα: 2.α) η έκφραση του συναισθήματος του θεραπευτή, 2.β) η μετάβαση του θεραπευόμενου από την εξάρτηση στην αυτονομία και 3) ιδιότητες του θεραπευτή, με υποθέματα 3.α) η προσωπικότητα του θεραπευτή, 3.β) η επάρκεια του θεραπευτή στον επαγγελματικό του ρόλο. Η μελέτη αποσκοπεί να συνεισφέρει στο ερευνητικό πεδίο της διεργασίας της μακρόχρονης ομαδικής ψυχοθεραπείας, αξιοποιώντας την εμπειρία των θεραπευόμενων για να διαφωτιστούν  οι παράμετροι της θεραπευτικής σχέσης που εκείνοι θεώρησαν πιο σημαντικές και βοηθητικές.

Λεπτομέρειες άρθρου
  • Ενότητα
  • ΕΙΔΙΚΟ ΑΦΙΕΡΩΜΑ
Creative Commons License

Αυτή η εργασία είναι αδειοδοτημένη υπό το Creative Commons Attribution-ShareAlike 4.0 International License.

Το περιοδικό ΨΥΧΟΛΟΓΙΑ έχει υιοθετήσει μία πολιτική Platinum open-access. Τα έξοδα υποβολής, επεξεργασίας ή δημοσίευσης των εργασιών καλύπτονται από την Ελληνική Ψυχολογική Εταιρεία. Τα πνευματικά δικαιώματα των δημοσιευμένων εργασιών προστατεύονται από την άδεια 'Creative Commons Attribution-ShareAlike 4.0 International'. Οι Συγγραφείς διατηρούν τα Πνευματικά Δικαιώματα και χορηγούν στο περιοδικό το δικαίωμα της πρώτης δημοσίευσης. Η άδεια αυτή επιτρέπει σε τρίτους, να χρησιμοποιούν την εργασία σε οποιαδήποτε μορφή, με την προϋπόθεση της διατήρησης των διατυπώσεων που προβλέπονται στην άδεια σχετικά με την αναφορά στον αρχικό δημιουργό και την αρχική δημοσίευση στο περιοδικό ΨΥΧΟΛΟΓΙΑ. Επιπλέον, κάθε διανομή της εργασίας οφείλει να γίνεται με τους ίδιους όρους διανομής, δηλαδή με την ίδια άδεια Creative Commons.

Λήψεις
Τα δεδομένα λήψης δεν είναι ακόμη διαθέσιμα.
Αναφορές
Ackerman, S. J., &Hilsenroth, M. J. (2003). A review of therapist characteristics and techniques positively impacting the therapeutic alliance. Clinical Psychology Review 23, 1-33.https://doi.org/10.1016/S0272-7358(02)00146-0
Androutsopoulou, A., Bafiti, T., & Kalarritis, G. (forthcoming). ‘From mind to culture’: Developing a Treatment Plan Manual for the enriched systemic psychotherapy perspective SANE-System Attachment Narrative Encephalon®. In M. Mariotti, G. Saba, & P. Stratton (Eds.), Handbook of systemic approaches to psychotherapy manuals: Integrating research, practice, and training. (EFTA Series, 6th volume). Springer.
Androutsopoulou, A., Bafiti, T., & Kalarritis, G. (2014). The enriched systemic perspective SANE - System Attachment Narrative Encephalon ®: Selected training guidelines for clinical practice. Human Systems. The Journal of Therapy, Consultation and Training, 25 (2), 161 - 176.
Asay, T.P. and Lambert, M.J. (1999). The empirical case for the common factors in therapy: quantitative findings. In M.A. Hubble, B.L. Duncan and S.D. Miller (eds.) The Heart and Soul of Change: What Works in Therapy (pp. 33–56). American Psychological Association. https://doi.org/10.1037/11132-001
Bachelor, A. (1995). Clients' perception of the therapeutic alliance: A qualitative analysis. Journal of Counseling Psychology, 42, 323-337. https://doi.org/10.1037/0022-0167.42.3.323
Bachelor, A. & Horvath, A. (1999). The therapeutic relationship. In M.A. Hubble, B.L. Duncan, & S.P. Miller (Εds), The heart and soul of change. What works in therapy (pp. 133-178). American Psychological Association.
Bafiti, T., Viou, M., Moschakis, Ch., & Nikolaou, N. (2019, September). “Looking back in therapy”: An interpretative phenomenological analysis of clients’ experiences of systemic group therapy, years after completion”. [Paper Presengtation]. 10th Conference of the European Family Therapy Association, “Visible and Invisible: Bordering Change in Systemic Family Therapy”, Napoli.
Bafiti, T., Viou, M. & Tarasis, P. (2018). Stepping up the ladder in safety: An Interpretative Phenomenological Analysis of how LGB clients experience their therapists’ sexual orientation. The European Journal of Counselling Psychology, 7, 211-223. https://doi.org/10.5964/ejcop.v7i1.139
Barber, J. P., Luborsky, L., Crits-Christoph, P., Thase, M. E., Weiss, R., Frank, A., Onken, L., & Gallop, R. (1999). Therapeutic alliance as a predictor of outcome in treatment of cocaine dependence. PsychotherapyResearch, 9, 54–73. https://doi.org/10.1093/ptr/9.1.54
Βασιλείου, Α.Γ. (1987). Ο άνθρωπος ως σύστημα: Μια παρουσίαση για τον παιδοψυχίατρο. Στο Ι. Τσιάντης, Σ. Μανωλόπουλος, (Επιμ.), Σύγχρονα θέματα παιδοψυχιατρικής (259-273), τόμ. Α΄. Εκδόσεις Καστανιώτη.
Beaudon, M-T & Zimmerman, J. (2011). Narrative therapy and interpersonal neurobiology: Revisiting classic practices, developing new emphases. Journal of Systemic Therapies, 30, 1-13. https://doi.org/10.1521/jsyt.2011.30.1.1
Bednar, R.L. and Kaul, T. (1994). Experiential group research, in A.E. Bergin and S.L. Garfield (eds.) Handbook of Psychotherapy and Behavior Change (pp. 631–63). Wiley.
Benitez, J.L., Abascal, A., Garrido, M. & Escudero, V. (2019). Building an Expanded Therapeutic Alliance: A Task Analysis with Families Trapped in Parental – Adolescent Conflict. Family Process, x:1-19. https://doi.org/10.1111/famp.12435
Blatt, S. J., Sanislow, C. A., Zuroff, D. C., & Pilkonis, P. A. (1996). Characteristics of effective therapists: Further analysis of data from the National Institute of Mental Health treatment of depression collaborative research program. Journal of Consulting and Clinical Psychology, 64, 1276–1284. https://doi.org/10.1037/0022-006X.64.6.1276
Bowlby, J. (1969). Attachment and loss, volume 1: Attachment. Basic Books.
Bordin, E. S. (1994). Theory and research on the therapeutic working alliance: New directions. In A. O. Horvath & L. S. Greenberg (Eds.), Wiley series on personality processes. The working alliance: Theory, research, and practice (p. 13–37). John Wiley & Sons.
Bordin, E. S. (1989). Building therapeutic alliances: The base for integration. Paper presented at the Society for Psychotherapy Research, Berkley, CA.
Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research, and Practice, 16, 252-260. https://doi.org/10.1037/h0085885
Bordin, E. S. (1975). The working alliance: Basis for a general theory of psychotherapy.[Paper presentation]. Society for Psychotherapy Research, Washington, DC.
Bruner, J. (1990). Acts of meaning. Harvard University Press.
Burlingame, G., McClendon, D. & Alonso, J. (2011). Cohesion in group psychotherapy. In J.C. Norcross (ed.) A Guide to Psychotherapy Relationships that Work, 2nd ed. (pp. 110-31). Oxford University Press.
Burlingame, G.M., Mackenzie, K.R. and Strauss, B. (2004). Small- group treatment: evidence for effectiveness and mechanisms of change. In M.J. Lambert (ed.) Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change, 5th ed. Wiley.
Byng-Hall, J. (2008). The crucial roles of attachment in family therapy. Journal of Family Therapy, 30, 129-146. https://doi.org/10.1111/j.1467-6427.2008.00422.x
Byng-Hall, J. (1995). Creating a secure base: Some implications of attachment theory for family therapy. Family Process, 34, 45-58. https://doi.org/10.1111/j.1545-5300.1995.00045.x
Cozolino, L. (2010). The neuroscience of psychotherapy: Healing the social brain. 2nd ed. Norton.
Cozolino, L. (2006). The neuroscience of human relationships: Attachment and the developing social brain. Norton.
Dallos, R. (2006). Attachment narrative therapy. Integrating narrative, systemic and attachment therapies. Open University Press.
Dallos, R. (2004). Attachment narrative therapy: Integrating ideas from narrative and attachment theory in systemic family therapy with eating disorders. Journal of Family Therapy, 26, 40 – 66. https://doi.org/10.1111/j.1467-6427.2004.00266.x
Dallos, R. & Vetere, A. (2009). Systemic therapy and attachment narratives. Applications in a range of clinical settings. Routledge.
Fife, S. T., Whiting, J. B., Bradford, K. P. & Davis, S. D. (2014). The therapeutic pyramid: A common factors synthesis of techniques, alliance, and way of being. Journal of Marital and Family Therapy, 40, 20-33. https://doi.org/10.1111/jmft.12041
Fishbane, M. D. (2007). Wired to connect: Neuroscience, relationships, and therapy. Family Process, 46, 395–412. https://doi.org/10.1111/j.1545-5300.2007.00219.x
Fishbane, M.D. (2001). Relational narratives of the self. Family Process, 40, 273– 291. https://doi.org/10.1111/j.1545-5300.2001.4030100273.x
Fisher, J. (2010). Brain to brain: The talking cure goes beyond words. Psychotherapy Networker, https://www.psychotherapynetworker.org/magazine/article/441/brain-to-brain
Flaskas, C. (2002). The Therapeutic Relationship in Systemic Therapy. Journal of Family Therapy, 19(3), 263-282. https://doi.org/10.1111/1467-6427.00052
Fosha, D., Siegel, D. J. & Solomon, M. (2009). The healing power of emotion: Affective neuroscience, development & clinical practice. Norton.
Freud, S. (1913). On beginning the treatment. In J. Strachey (Ed. And Trans.), The standard edition of the complete psychological works of Sigmund Freud, vol. 12 (p.p. 112-144). Hogarth Press (original work published 1913).
Friel, J. A. (2016). What detoxifies shame in integrative psychotherapy? An Interpretative Phenomenological Analysis. British Journal of Psychotherapy, 32, 532–546. https://doi.org/10.1111/bjp.12246
Frieswyk, S.H., Allen, J.G., Colson, D.B. Coyne, L., Gabbard, G.O., Horwitz, L. & Newson, G. (1986). Therapeutic alliance: its place as a process and outcome variable in dynamic psychotherapy research. Journal of Consulting and Clinical Psychology, 54, 32-38. https://doi.org/10.1037/0022-006X.54.1.32
Gelso, C. J., & Carter, J. A. (1985). The relationship in counseling and psychotherapy: Components, consequences, and theoretical antecedents. The Counseling Psychologist, 13, 155-243. https://psycnet.apa.org/doi/10.1177/0011000085132001
Gelso, C. J., & Carter, J. A. (1994). Components of the psychotherapy relationship: The during treatment. Journal of Counseling Psychology, 41, 296-306.
https://doi.org/10.1037/0022-0167.41.3.296
Glebova, T., Foster, S.L., Cunningham, P.B., Brennan, P.A. & Whitmore, E.A. (2018). Therapists’ and Clinets’ Perceptions of Bonding as Predictors of Outcome in Multisystemic Therapy. Family Process, 57(4), 867-883. https://doi.org/10.1111/famp.12333
Henry, W.P. & Strupp, H.H. (1994). The therapeutic alliance as interpersonal process. In A.O. Horvath & L.S. Greenberg (Eds.), The working alliance: Theory, research, and practice. Wiley & Sons.
Hersoung, A.G., Hoglend, P., Monsen, J.Y. &Havik, O.E. (2001). Quality of working alliance in psychotherapy: Therapist variables and patient/therapist similarity as predictors. Journal of Psychotherapy Practice and Research, 10 (4), 205-216.
Hillard, R. B., Henry, W. P., & Strupp, H. H. (2000). An interpersonal model of psychotherapy: linking patient and therapist developmental history, therapeutic process, and types of outcome. Journal of Consulting and Clinical Psychology, 68, 125–133. https://doi.org/10.1037/0022-006X.68.1.125
Hilsenroth, M. J., Cromer, T. & Ackerman, S. (2012). How to make practical use of therapeutic alliance research in your clinical work. In R. A. Levy J. S. Ablon, & H. Kaechele (Eds.), Psychodynamic psychotherapy research: Evidence-based practice and practice-based evidence (pp. 361–380). Springer Press.
Holmes, J. (2001). The search for the secure base. Routledge.
Horvath, A. O. (2001). The alliance. Psychotherapy: Theory, Research, Practice, Training, 38, 365-372.
Horvath, A. O., & Bedi, R. P. (2002). The alliance. Ιn J. C. Norcross (ed.), Psychotherapy relationships that work: Therapist contributions responsiveness to patients (pp. 37–70). Oxford University Press.
Horvath, A. O., & Luborsky, L. (1993). The role of the therapeutic alliance in psychotherapy. Journal of Consulting and Clinical Psychology, 61(4), 561–573. https://doi.org/10.1037/0033-3204.38.4.365
Imel, Z. and Wampold, B. (2008). The importance of treatment and the science of common factors in psychotherapy, In S.D. Brown and R.W. Lent (eds.) Handbook of Counseling Psychology, 4th ed. (pp. 249–62). Wiley.
Johnson, J.E., Burlingame, G.M., Olsen, J.A., Davies, D.R. and Gleave, R.L. (2005). Group climate, cohesion, alliance, and empathy in group psychotherapy: multilevel structural equation models, Journal of Counseling Psychology, 52, 310–21. https://doi.org/10.1037/0022-0167.52.3.310
Καλαρρύτης, Γ. (2005). Ψυχοθεραπεία και νευροεπιστήμη. Νέοι δρόμοι σύνθεσης. Στο Γ. Καλαρρύτης & Τ. Μπαφίτη (Eπιμ.), Σώμα υγιές σε νου υγιή (σελ. 107-134). Ελληνικά Γράμματα.
Kalarritis, G. (2013, September). The neurobiological basis of attachment-links with systemic psychotherapy. [Paper Presentation]. 8th Continuing Education Meeting of NOPG, “Psychotherapy and neurobiology; Recent neuro-endocrinology findings in psychotherapy”, Athens.
Katakis, C. (1990). Stages of long-term psychotherapy: Progressive re- conceptualizations as a self-organizing process. Psychotherapy: Theory, Research and Practice, 26, 484-493. https://doi.org/10.1007/BF00890022
Kivlighan, D.M., Patton, M.J. & Foote, D. (1998). Moderating effects of client attachment on the counselor experience- working alliance relationship. Journal of Counseling Psychology, 45, 274-278. https://doi.org/10.1037/0022-0167.45.3.274
Larkin, M., Watts S. & Clifton, E. (2006). Giving voice and making sense in interpretative phenomenological analysis. Qualitative Research in Psychology, 3, 102-120. https://doi.org/10.1191/1478088706qp062oa
LeDoux, J.E. (2002). Synaptic self: How our brains become who we are. Viking.
Main, M. (1991). Metacognitive knowledge, metacognitive monitoring, and singular (coherent) vs. multiple (incoherent) model of attachment: Findings and direction s for future research In C.M. Parkes, J. Stevenson-Hinde, & P. Marris (Eds.) Attachment across the life cycle (pp. 127-159). Routledge.
Martin, D. J., Garske, J. P., & Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. Journal of Consulting and Clinical Psychology, 68, 438–450. https://doi.org/10.1037/0022-006X.68.3.438
McLeod, J. (2001). Qualitative Research in Counseling and Psychotherapy. Sage.
McLeod, J. (1997). Narrative and psychotherapy. Sage.
Μπαφίτη, Τ. (2005). Απ’ τα δεσμά στους δεσμούς: σχέσεις που «αρρωσταίνουν», σχέσεις που θεραπεύουν. Στο Γ. Καλαρρύτης, Τ. Μπαφίτη (Επιμ.), Σώμα υγιές σε νου υγιή (σ.145-157). Ελληνικά Γράμματα.
Μπαφίτη Τ., Ανδρουτσοπούλου Α., Καλαρρύτης Γ. (2018). ‘Από τέσσερις σκοπιές’ Το εμπλουτισμένο συστημικό μοντέλο SANE – System Attachment Narrative Encephalon ®. Στο Π. Ασημάκης (Επιμ.) Σύγχρονες ψυχοθεραπείες στην Ελλάδα (σ.231-244). Εκδόσεις Π. Ασημάκης.
Norcross, J. c. (ed.). (2002). Psychotherapy relationships that work: Therapist contributions and responsiveness to patients. Oxford University Press.
Orlinsky, D.E., Grawe, K. & Parks, B.K. (1994). Process and outcome in psychotherapy. In A.E. Bergen & S.L. Garfield (Eds.), Handbook of psychotherapy and behavior change (pp. 270-376). Wiley.
Papageorgiou, S., Filia, M., Gkotsi, G., Regli, D., Zougrou, K., & Androutsopoulou, A. (2017).‘Seeing eye to eye’: A qualitative case study of significant moments in a systemic group therapy session. Human Systems: The Journal of Therapy, Consultation and Training, 28 (2), 235-244.
Parkes, C.M., & Stevenson-Hinde, J, & Marris, P. (1991). Attachment across the life cycle. London: Routledge.
Paul, S. (2012). Group counselling and therapy. In C. Feltham and I. Horton (eds.) The Sage Handbook of Counselling and Psychotherapy (3rd ed.). Sage.
Paul, S. and Charura, D. (2014) An Introduction to the Therapeutic Relationship in Counselling and Psychotherapy. Sage.
Paul, S., & Haugh, S. (2008). The relationship, not the therapy? What the research tells us. In. S. Haugh & S. Paul (Eds.), The therapeutic relationship: Perspectives and themes. PCCS Books.
Penn, P. (2001). Chronic illness: Trauma, language, and writing. Family Process, 40, 33-52. https://doi.org/10.1111/j.1545-5300.2001.4010100033.x
Penn, P. (1994). Creating a participant text: Writing, multiple voices, narrative multiplicity. Family Process, 33, 217-231. https://doi.org/10.1111/j.1545-5300.1994.00217.x
Real, T. (1990). The therapeutic use of self in constructionist / systemic therapy. Family Process, 29, 255-272. https://doi.org/10.1111/j.1545-5300.1990.00255.x
Rogers, C. (1957) 'The necessary and sufficient conditions of therapeutic personality change', Journal of Consulting Psychology, 21, pp. 95-103. https://doi.org/10.1037/h0045357
Saketopoulou, A. (1999). The therapeutic alliance in psychodynamic psychotherapy: theoretical conceptualizations and research findings. Psychotherapy, 36, 329–342. https://doi.org/10.1037/h0087663
Sarbin, T. R. (1986). The narrative as a root metaphor for psychology. In T. R. Sarbin (Ed.), Narrative psychology: The storied nature of human conduct (pp. 1-37). Preager.
Schore, A. N. (2003). Affect regulation and the repair of the self. WW. Norton
Siegel, J. D. (1999). The developing mind: How relationships and the brain interact to shape who we are. Guilford Press.
Siegel, J. D. (2010). The complexity choir. Psychotherapy Networker, https://www.psychotherapynetworker.org/magazine/article/443/complexity-choir
Siegel, D. J. & Solomon, M. (2003). Healing trauma: Attachment, mind, body, and brain. Norton.
Sluzki, C.E. (2007). Interfaces: Toward a new generation of systemic models in family research and practice. Family Process, 46, 173-184. https://doi.org/10.1111/j.1545-5300.2007.00202.x
Smith, J. A., Flowers, P. & Larkin, M. (2009). Interpretative Phenomenological Analysis: Theory, method and research. Sage.
Σταλίκας, Α. & Μέρτικα, Α. (2004). Η Θεραπευτική Συμμαχία. Ελληνικά Γράμματα.
Stiles, W. B., Agnew-Davies, R., Hardy, G. E., Barkham, M., & Shapiro, D. A. (1998). Relations of the alliance with psychotherapy outcome: findings in the second Sheffield Psychotherapy Project. Journal of Consulting and Clinical Psychology, 66, 791–802. https://doi.org/10.1037/0022-006X.66.5.791
Tapson, C. (2016). Counselling and Professionalism: A Phenomenological Analysis of Counsellor Experience. The European Journal of Counselling Psychology, 4 (2), 148-165. https://doi.org/10.5964/ejcop.v4i2.51
Tryon, G.S. & Winograd, G. (2002). Goal consensus and collaboration. In J.C. Norcross (Ed), Psychotherapy relationships that work (pp. 109-125). Oxford University Press.
Vassiliou, G. & Vassiliou, V. (1970). On aspects of child rearing in Greece. In J. E. Anthony (Ed.), The child in his family. Wiley.
Watkins, H. (2014). Therapeutic Alliance in Couple and Family Therapy: Therapist Experiences and Perspectives on Multidirected Partiality [Doctoral Dissertation, University of Guelph, Ontario]. https://atrium.lib.uoguelph.ca/xmlui/bitstream/handle/10214/8356/Watkins_Hanna_201408_MSc.pdf?isAllowed=y&sequence=1
White, M. & Epston, D. (1990). Narrative means to therapeutic ends. Norton.
Zuroff, D.C., Blatt, S.J., Sotsky, S.M., Krupnick, J.L., Martin, D.J, Sanislow, C.A. &Simmens, S. (2000). Relation of therapeutic alliance and perfectionism to outcome in brief outpatient treatment of depression. Journal of Consulting and Clinical Psychology, 68, 114-124. https://doi.org/10.1037/0022-006X.68.1.114