Tesis Doctorado
Regulatory function of mentalization in rupture-resolution sequence of the therapeutic alliance during psychotherapy processes with adolescents
Fecha
2019Autor
Martínez, Claudio
UNIVERSIDAD DE CHILE
Institución
Resumen
Introduction: Mentalization, operationalized as reflective functioning (Fonagy, Target, Steele & Steele, 1998), can be conceptualized as a complex psychological function, developmentally critical during adolescence due to brain changes that affect social cognition areas, that “supports” the therapist-patient exchanges, rather than a global capacity that "improves" through psychotherapy.
Based on the consideration that among adolescents, mentalization would accomplish a relevant role in understanding the regulatory processes experienced by therapists and patients during moments of impasse (rupture) and its resolution (Morken, Karterud & Arefjord, 2014; Lingiardi & Colli, 2015) this study aims to describe how mentalization of therapist and adolescent patient is expressed and configured within episodes of rupture and resolution and determine the relationship between these configurations and the result of the resolution (repair v/s not repair).
Method: Five individual psychotherapy process with adolescents from 14 to 19 years old were analyzed. Five pairs of judges trained in the 3RS system (Eubanks-Carter, Muran, & Safran, 2014) jointly rated the sessions of transcribed and videotaped therapies, identifying rupture-resolution (R-R) sequences of the therapeutic alliance. Once R-R was identified, the same pairs of judges established the extent to which the rupture was repaired through the "therapeutic relationship compromise" of Sexton, Littauer, Sexton and Tømmerås (2005). Once the rupture-resolution sequences were identified therapist and patients mentalization was coded through the Observational System of Mentalization in Psychotherapy for adolescents (OSMP-A, Morán, Martínez & Arce, unpublished).
Therapist and patients mentalization ratings were described and compared through multilevel linear regression analysis. Configurations of mentalization were stablish trough Multilevel Latent Class Analysis. Post-hoc analysis determined the probability for each configuration of therapist and patient mentalization to be repaired.
Results: in most of the assessed dimensions both patients and therapists achieved lower ratings of mentalization during episodes of rupture in comparison with episodes of resolution and, with the exception of contingent communication, therapists tended to show higher means of mentalization than patients. Statistically significant differences in mentalization between actors and interactive scenarios of rupture-resolution, as well as interaction effects on some specific dimensions, showed that it is possible to explain the variance of mentalization from each of these predictors (actor and interactive scenario) and, to evaluate the presence of possible specific configurations of mentalization between actors in episodes of rupture and episodes of resolution. As it was observed, 3 interactive scenarios in rupture and 4 interactive scenarios in resolution showed the best fit to describe the possible configurations of therapist-patient mentalization. In turn, each combination of rupture-resolution configurations showed different probabilities of being repaired.
Conclusion: These results show that mentalization assumes a regulatory function of therapeutic interaction during R-R sequences that can be described in clinical terms. It is proposed that therapist actions have a central role in explaining ruptures of patients' mentalization during ruptures, but also for mentalization recovery during resolutions. A contingent response and focusing patients on the present moment would favor both an increase in patients' mentalization and a higher probability of repairing ruptures.