Developing a discourse analytic approach to change processes in psychodynamic-interpersonal psychotherapy
This thesis develops a discourse analytic approach to change processes in psychotherapy and addresses the question: 'how does change occur in psychodynamicinterpersonal psychotherapy? '. An extended rationale for utilising discourse analysis (Potter & Wetherell, 1987) is provided by way of a detailed deconstruction of an alternative stage model approach as represented by the assimilation of problematic experiences scale (Stiles, Elliott, Llewelyn, Firth-Cozens, Margison, Shapiro, & Hardy, 1990). Discursive analysis is then applied to the study of three cases of psychodynamic-interpersonal psychotherapy selected from the Second Sheffield Psychotherapy Project (Shapiro, Barkham, Hardy, & Morrison, 1990). Cases were selected on the criterion of client Beck Depression Inventory scores; two successful cases and one unsuccessful case of therapy. Analysis focuses on a resolved client-specified problematic theme from each of the successful cases, and on an unresolved theme from the unsuccessful case. Findings suggest that the pattern of change promoted by psychodynamicinterpersonal psychotherapy is (1) the identification of a problem internal to the client, and (2) accomplishing an account of this problem implicating an external attribution of blame. Further research is required to assess the generalisability of this, pattern and whether clients co-operating with such accounts are more likely to be helped by this form of therapy than those who do not. Specific rhetorical strategies utilised in negotiating and legitimating such accounts are identified and linked to the protocol of psychodynamic-interpersonal psychotherapy and the three stages of problem (re)formulation established by Davis (1984,1986). Findings are discussed in relation the connection between therapy processes and the moral sphere, particularly in relation to the negotiation of rights and obligations, responsibility and blame. Moreover, discursive psychology is offered as a means of facilitating the development of research on depression and attribution. Conceptualising accounts as occasioned versions of the world, rather than as verifiable descriptions of states of affair, speculation is made regarding the therapeutic utility of matching clients' preferred problem accounts with the preferred accounts implicit in therapeutic rationales.