Narrative and discursive approaches to the analysis of subjectivity in psychotherapy

Beyond the Asylum Walls: Tracing the Tapestry of Mental Health Interventions Across Eras and Cultures

This article offers an extensive review of the changing field of mental health therapies, charting a transformational path from traditional methods to modern breakthroughs and speculating on potential future developments. The story develops by investigating historical viewpoints while reflecting on the present and highlighting the lessons learned and their impact on contemporary practices. We have advanced from the stigmatized constraints of asylums to a paradigm that puts human rights, dignity, and individualized, culturally sensitive treatment first. Modern methods are much more varied and evidence-based, from cutting-edge technical advancements to evidence-based psychotherapies. The ethical considerations arising from the delicate balance of pharmacological therapies underline the responsibility of administering drugs that significantly affect mental health. Cultural factors become a pillar, highlighting how crucial cultural sensitivity is to promoting tolerance. By acknowledging how many facets of the human experience are interrelated, holistic methods help close the gap between the mind and body. Integrative medicine and alternative therapies represent a shift away from reductionist approaches and toward a holistic viewpoint. The delivery of mental health treatment is being reimagined by technological advancements, with virtual and digital environments opening up new access and support channels. These developments cut beyond regional boundaries, reinventing conventional therapy dynamics and paving the way for individualized therapies. Cultural concerns highlight the significance of cultural competency in navigating the complex mental health treatment system and adapting interventions to fit the particular requirements of various cultural contexts. With telepsychiatry, virtual reality, and artificial intelligence among the new technologies that promise to further revolutionize mental health therapies, the essay looks to the future. This review concludes by imagining a day when mental health is prioritized, therapies are available, and the diversity of human experience is valued. The path to a society that values, nurtures, and celebrates mental health continues.

Identification of Dynamic Patterns of Personal Positions in a Patient Diagnosed With Borderline Personality Disorder and the Therapist During Change Episodes of the Psychotherapy

Personal positions and voices of a patient diagnosed with borderline personality disorder (BPD) and the therapist during long-term psychotherapy were studied aiming to find differences in the patterns formed in these aspects of subjectivity according to the level of elaboration of the change episodes achieved by the patient. This case study considered a stage of qualitative analysis where change episodes of the patient were traced through the Change Episodes Model. Later, through the Model of Analysis of Discursive Positioning in Psychotherapy (MAPP), the voices and personal positions of the patient and her therapist were identified in each of the change episodes. In the stage of quantitative analysis, dynamic patterns in the voices and personal positions were established, accounting for hypothetical attractors using the Space State Grid (SSG) technique in each of the three different levels of subjective elaboration that constitute the change episodes. The results established differentiated dynamic patterns in the change episodes, coherent with the patient’s change process, and formation of propositive/reflective specific patterns as the patient evolved in the three different levels of subjective elaboration. The above suggests that a subjective transformation process is displayed, and this is manifested in the different voices and personal positions that emerged as the change episodes evolve. The identified dynamic patterns can be considered nonlinear and emergent subjective exchanges between the patient and the therapist throughout the psychotherapy.

NARRATIVES ON DEPRESSION, MASCULINITY AND WORK. A STUDY WITH LIFE STORIES OF CHILEAN MEN

Abstract: Each year in Chile, one in ten men have demonstrated signs or symptoms of depression. (MINSAL, 2018; Center for Conflict and Social Cohesion Studies, 2018). However, both in the country and in the rest of Latin America, there are few studies that address male depression from its qualitative and narrative aspects. The aim of this study was to analyze reports of depression in men and their references to concepts of hegemonic masculinity. A qualitative study was carried out with interviews with five Chilean men who experienced a depressive process. With a life story methodology, the depressive processes in each biography were explored. The results show that men report depression and malaise from a crisis or main drama, and according to aspects that challenge the values of hegemonic masculinity.

NARRATIVAS SOBRE DEPRESIÓN, MASCULINIDAD Y TRABAJO. UN ESTUDIO CON RELATOS BIOGRÁFICOS DE HOMBRES CHILENOS

Resumen: En Chile, uno de cada diez hombres presenta indicios o síntomas de depresión cada año. (MINSAL, 2018; Centro de Estudios de Conflicto y Cohesión Social, 2018). Sin embargo, tanto en el país como en el resto de Latinoamerica, son escasos los estudios que aborden la depresión masculina desde sus aspectos cualitativos y narrativos. El objetivo de este estudio fue analizar los relatos de depresión en hombres y sus referencias a los valores de la masculinidad hegemónica. Se realizó un estudio cualitativo con entrevistas a cinco hombres chilenos que habían pasado por un proceso depresivo. Con una metodología de relato de vida, se exploraron los procesos depresivos en su biografía. Los resultados muestran que los hombres narran la depresión y su malestar a partir de una crisis o drama principal y según aspectos que desafían los valores de la masculinidad hegemónica.

Discourses of development in the consulting room: Analysing family therapy with children

This paper aims to highlight the potential contribution of the arguments developed in Burman’s Deconstructing Developmental Psychology for exploring the implications of discourses around development for the practice of family therapy with children. Through the analysis of one brief systemic therapy with a stepfamily, formed following the mother’s death, this paper examined how discourses from developmental psychology, including representations of children, father, mother, stepmother and family, are implicated in the construction of the problem and in the positioning of the participants. The diverse ways in which the family members made sense of their difficulties and the positions they assumed were shown to be intimately linked with culturally dominant representations of the biological nuclear family ideal and with representations of parents as responsible for their children’s difficulties. The position of stepmother in particular was shown to be characterised by conflict and ambiguity, reflecting discourses that idealise motherhood and vilify stepmothers. Moreover, the children were found to be positioned as ‘half-members’ at several points in the conversation, whilst at other points they themselves resisted calls to a more equal positioning, particularly when disagreeing with the adults’ talk. Family therapy, as an institutional practice, was shown to be intimately linked with developmental psychology accounts about childhood, family life and parenthood and Deconstructing Developmental Psychology was shown to provide valuable insights in researching family therapy with children. Based on the analysis, it is argued that paying attention to the social, ideological and cultural context in which family therapy takes place opens up novel ways of conceptualising and researching the process of therapy and allows the exploration of taken-for-granted assumptions about childhood, adulthood, parenthood and the family.

Psychotherapy as a discursive genre: A dialogic approach

This study seeks to display therapeutic dialogue as a discursive genre. By using dialogic discourse analysis, the psychotherapeutic dialogue present in a set of excerpts from a time-limited psychotherapy is analyzed. This micro analytical methodology makes it possible to account for both the dialogal and the dialogic level of therapeutic conversation. The results show the linguistics markers employed by the participants and the voices in their speech. This enables us to illustrate how it is possible to perform a discursive analysis of therapeutic interaction. The value of approaching psychotherapy as a discursive genre and its methodological implications for research are discussed.

A Lacanian view on Balint group meetings: a qualitative analysis of two case presentations

BACKGROUND

GPs' subjectivity is an intrinsic instrument in their daily work. By offering GPs a platform to present and discuss difficult interactions with patients, Balint group work be might provide them an opportunity to explore and articulate aspects of their subjectivity. In order to get a more profound understanding of what participation in a Balint group can offer, we focused on the process of change that can be observed during Balint group meetings. To that end, this study scrutinized two Balint group case discussions on a micro-level.

METHOD

Two cases were selected from a larger data set of 68 audio-taped case discussions in four Balint groups. In order to shed light on the type of change that characterizes the presenter's narrative, we used Lacan's theoretical distinction between imaginary and symbolic modes of relating to the other.

RESULTS

In both case discussions, the GPs presenting the case initially appeared to be stuck in a fixed image of a situation, referred to as 'imaginary relating to the other.' Through a range of interactions with the group, the presenters were encouraged to explore different subject positions, which allowed them to broaden their initial image of the situation and to discover other issues at stake. This was referred to as a more symbolic way of relating to the other.

CONCLUSION

This study throws light on the type of change Balint group participation allows for and on the way this might be achieved. We conclude that Balint group work is potentially beneficial to the participating GPs as well as to the relationship with their patients.

Shifts in subjectivity during the therapy for psychosis

OBJECTIVES

This paper examines the process of therapy with families in which a member has a diagnosis of psychosis. On a methodological level, the study aims to demonstrate the usefulness of discourse analysis as a method for analysing texts produced in therapy in the context of process research. On a clinical and theoretical level, it aims to contribute to the literature that approaches psychosis and its treatment from the viewpoint of narrative and discourse.

DESIGN

Several contemporary conceptualizations emphasize the role of discursive processes, such as a collapse of meaning and narrative and an alienation from shared communicative practices, in psychosis. Drawing from this perspective, discourse analysis was used on family therapy session transcripts to empirically examine these processes. Moreover, given that in different conceptualizations psychosis is seen to entail a profound disturbance to the person's sense of self, the analysis focuses more specifically on the identified patients' subjectivity.

METHODS

Seven sessions were analysed, drawn from the beginning, middle, and end phases of two therapies with families with a member with a diagnosis of psychosis. Discourse analysis was used and the analysis focused on the transformation of meaning and more specifically on shifts in the subject positions occupied by the identified patient in the clinical dialogue.

RESULTS

With regards to the identified patients' subjectivity, the analysis suggests that (a) psychosis was associated with the 'patient' being rigidly positioned exclusively through the psychiatric discourse in the first case and the lack of a voice in the second, and (b) that therapeutic change was associated with increased flexibility in the subject positions that the identified patient occupied in the first case and with the emergence of a personal and reflective voice in the second.

CONCLUSIONS

The findings in this study suggest that an important aspect in clinical work with families with a member with a diagnosis of psychosis relates to de-centring the dominant, pathology maintaining accounts and to the emergence of a wider range of less problematic explanatory frames.