Shift in representation and symbolisation of affective experience: A paradoxical outcome in therapy

Lars Henrik Kaasen Thoresen,Hans Hella Thørnquist,Erik Stänicke,John Mcleod

doi:10.1080/13642537.2021.1923048

Abstract

Shift in representation and symbolisation of affective experience: A paradoxical outcome in therapy: Defining outcome represents a key challenge for psychotherapy theory, research and practice. The present paper uses a case study of a client with anorexia nervosa to contribute to the development of conceptual understanding of the nature of paradoxical outcome. In this case, different sources of outcome data offered different answers to the question of whether or not the therapy had been successful. Qualitative thematic analysis of therapy transcriptions was carried out, using Interpretative Phenomenological Analysis (IPA). Both the process of change that occurred in this case, and the conflicting outcome indicators, could be explained in terms of a model of affect elaboration. These findings are discussed in terms of the need for caution when interpreting results from outcome measures in psychotherapy research and practice.

Highlights

Defining and measuring outcome represent two of the most challenging and complex tasks of modern psychotherapy research
To help us understand the observed changes in our material, we found it helpful to drawn on the Lecours and Bouchard (1997) theory of the process of mentalisation in psychotherapy because its explicit emphasis on how affects are transformed from the body to the mind seemed to be relevant to patterns that the themes that were observed in this case
Lisa herself expressed that the therapy had been helpful, she reported that a close observer of her life had noticed significant gains, there were clear links between key elements of therapy process and eventual outcomes, and there were no extra-therapy factors that could account for these results

Summary

Introduction

Defining and measuring outcome represent two of the most challenging and complex tasks of modern psychotherapy research. Through an analysis of therapy transcripts, we looked at the client’s experience in therapy as a way of helping us understand how we can make sense of this type of paradoxical outcome This case analysis is intended to shed light on a phenomenon that might be quite frequent in clinical practice, that is, a case where the therapy outcome measures indicate a paradoxical result. In psychotherapy research, there seems to be a more general perspective on outcome that categorizes it as either good/positive or bad/negative. From this perspective, if symptom scales show deterioration, the therapy is understood as having been ineffective. Our aim in the present study was to use an intensive analysis of a single case to explore this topic

Methods

Results

Discussion

Conclusion