Abstract
Conducted within a mixed methods framework, this study focuses on the conversation-facilitation role of a lead therapist during group psychotherapy with adolescents. Conversation is an essential component of psychoanalytic psychotherapies and there is growing interest in describing and studying the impact of conversational techniques. One way to do this is to report on specific approaches, such as questioning, paraphrasing, and mentalization in intervention turns and to analyze their impact on the therapist-patient relationship. The main aim of this study was to investigate differences in communication strategies used by a lead therapist in the early and late stages of therapy with six adolescents aged 13–15 years. We employed a mixed methods design based on systematic direct observation supplemented by indirect observation. The observational methodology design was nomothetic, follow-up, and multidimensional. The choice of methodology is justified by our use of an ad hoc observation instrument for communication strategies combining a field format and a category system. We analyzed interobserver agreement quantitatively by Cohen’s kappa using GSEQ5 software. Following confirmation of the reliability of the data, we analyzed the lead therapist’s conversation-facilitation techniques in sessions 5 and 29 of a 30-session program by quantitatively analyzing what were initially qualitative data using T-pattern detection (THEME v.6 Edu software), lag sequential analysis (GSEQ5 software), and polar coordinate analysis (HOISAN v. 1.6.3.3.6. software and R software). The results show changes in the techniques used from the start to the end of therapy. Of the 28 communication strategies analyzed, three were particularly common: questioning and paraphrasing in session 5 and questioning and mentalization in session 29. This mixed methods study shows that combined use of T-pattern detection, lag sequential analysis, and polar coordinate analysis can offer meaningful and objective insights into group psychotherapy through the lens of the therapist.
Highlights
The use of mixed methods in psychotherapy research has grown in recent years (Bartholomew and Lockard, 2018; Del Giacco et al, 2019, 2020; Halfon et al, 2019; Roberts and Allen, 2019; Venturella et al, 2019)
An observational methodology is perfectly suited to the study of spontaneous behavior in natural settings (Anguera et al, 2018), and as such, is ideal for analyzing the regular interactions that occur between therapists and patients in a range of psychotherapy settings and, in psychoanalytic therapy settings (Arias-Pujol and Anguera, in press)
The results obtained in the T-pattern, lag sequential, and polar coordinate, analyses all show changes in the conversationfacilitation techniques used by the lead therapist from the start to the end of therapy
Summary
The use of mixed methods in psychotherapy research has grown in recent years (Bartholomew and Lockard, 2018; Del Giacco et al, 2019, 2020; Halfon et al, 2019; Roberts and Allen, 2019; Venturella et al, 2019). Psychotherapy research covers a field of great complexity. Some of this flexibility can be captured and understood through the analysis of qualitative and quantitative data within a mixed methods design to shed light on what lies beneath multimodal interactions that precede change in psychotherapy. A mixed methods design offers an objective and scientifically rigorous yet flexible approach for capturing change and continuity over the course of psychotherapy. The process for analyzing change in psychotherapy is well established and plenty of opportunities exist within this process (from the definition of the research question to the interpretation of systematically collected and recorded data) to integrate both qualitative and quantitative elements
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