Conceptualizing the therapist’s relational positioning: Basic need support to fa cilitate patient engagement and emotional change
Väitöskirja tarkastelee, miten psykoterapeutti voi edistää asiakkaan autonomista sitoutumista terapiaprosessiin terapian eri vaiheissa, täyttäen näin aukon psykoterapeuttista toimintaa koskevassa prosessitutkimuksessa. Väitöskirja käsitteellistää asiakkaan sitoutumista terapiaan autonomisena motivaationa, jota psykoterapeutti voi edesauttaa tavoillaan asemoitua suhteessa asiakkaaseensa. Tutkimus kehittää ja jäsentää terapeutin suhteessa asemoitumisen käsitteen ja havainnollistaa sen soveltuvuutta erilaisiin terapeuttisiin tilanteisiin. Terapeutin suhteessa asemoitumisen käsite viittaa sekä terapeutin mielensisäiseen, asiakkaan perustarpeita tukevaan suhteessa olemisen tapaan, että terapeutin kielelliseen ja keholliseen terapeuttiseen toimintaan. Terapeutin suhteessa asemoitumisen käsitteen avulla voimme tutkia miten terapeutit voivat parhaiten tukea asiakkaiden autonomian, yhteenkuuluvuuden ja kompetenssin perustarpeita ja tätä kautta edistää asiakkaan autonomista sitoutumista psykoterapiaprosessiin, jossa psyykkinen muutos tapahtuu. Väitöskirja tarkastelee asiakkaan sitouttamista (mitä terapeutti tekee, jotta asiakas sitoutuisi), sekä asiakkaan autonomista sitoutumista (miten asiakas sitoutuu ja mistä sen voi havaita) neljässä eri terapeuttisessa tilanteessa: ensitapaamisen yhteydessä toteutuneessa itsemurhainterventiossa, tunnekeskeisen psykoterapian tuolitekniikassa, terapiaprosessin katkostilanteessa, ja asiakkaan sitoutumisessa terapiahuoneen ulkopuoliseen tehtävään. Suhteessa asemoituminen käsite haastaa näkemystämme perustarpeiden tukemisesta pelkkänä toimintana, laajentaen tukemisen käsitteen sisältämään myös terapeutin asiakkaan kanssa toteuttaman olemisen tavan. Terapeutti voi suhteessa asemoitumisen kautta tukea asiakkaan perustarpeita, ja sitä kautta edistää hänen autonomista sitoutumistaan terapeuttiseen prosessiin, tai tahtomattaan ja huomaamattaan ohittaa näitä perustarpeita, jarruttaen tai jopa estäen asiakkaan psyykkistä muutosta.
Avainsanat: asiakkaan sitoutuminen psykoterapiaterapiaprosessiin, itsemääräytymisteoria, allianssikatkos, tunnekeskeinen terapia, relationaalinen psykoanalyyttinen teoria, terapeuttinen itsemurhainterventio
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This dissertation examines how psychotherapists can engage better clients in the therapeutic process, thereby addressing an important gap in research on therapeutic action. The dissertation develops a new concept, termed the therapist's relational positioning, to analyze how therapists can support clients' basic psychological needs and facilitate their autonomous engagement in important psychotherapy situations, ultimately fostering emotional change. The concept of the therapist’s relational positioning is motivated by the observation that therapeutic action supportive of basic needs comprises various dimensions: it is both intrapsychic and interpersonal, both verbal and nonverbal, and hence a truly multifaceted phenomenon that benefits from an integrative concept. Client engagement and the relational positioning of the therapist that facilitate this are examined in a first encounter suicide intervention, client engagement in the therapeutic task of chair work, client re-engagement in an alliance rupture, and therapeutic action for client engagement with important others. The results show that the therapist's relational positioning supporting clients’ basic needs manifests differently and relies on different theoretical propositions when the client’s problem concerns important others outside therapy than in situations where the client’s problem explicitly concerns the therapist. In relation to theory, this dissertation proposes a thorough examination of the compatibility of therapeutic actions in the different psychotherapeutic traditions with the basic tenets of the self-determination theory (STD). In relation to empirical psychotherapy research, the dissertation proposes extending the use of SDT methods to psychotherapy process research. To facilitate therapeutic engagement in clinical practice, the dissertation highlights the importance of clients’ autonomous motivation and the corresponding therapeutic action supporting clients’ basic needs. This concept of relational positioning shifts our perspective of understanding support for basic needs from merely what the therapist does, to inherently including the therapist’s way of being with her client. Through her relational positioning towards her client, the therapist can both support the client’s basic needs and enhance engagement in the therapeutic process or, alternatively, she can thwart these needs, leading to compliance and limiting long-standing change. The dissertation also shows that the manifestations of relational positioning supporting basic needs depends on the therapeutic situation at hand: it manifests differently and requires from the therapist different skills when the client’s problem is with an important other outside therapy than when the client’s problem is with the therapist.
Keywords: client engagement, self-determination theory, therapist’s relational positioning, alliance rupture, emotion-focused therapy, relational psychoanalytic theory, suicide intervention
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Publisher
Jyväskylän yliopistoISBN
978-952-86-0253-8Contains publications
- Artikkeli I: Holmström, É. (2020). Self-determination theory and the collaborative assessment and management of suicidality. Mental Health Review Journal, 25(1), 75-83. DOI: 10.1108/MHRJ-09-2019-0029
- Artikkeli II: Holmström, É., Kykyri, V.-L., & Martela, F. (2024). Chair Work with the Empathic Other : Providing Basic Need Support for Resolving Unfinished Business. Journal of Contemporary Psychotherapy. DOI: 10.1007/s10879-024-09632-y
- Artikkeli III: Holmström, É., Kykyri, V.-L., & Martela, F. (2024). Pitfalls and Opportunities of the Therapist’s Metacommunication : A Self-determination Perspective. Journal of Contemporary Psychotherapy, 54(1), 9-18. DOI: 10.1007/s10879-023-09598-3
- Artikkeli IV: Holmström, É. (2023). Enhancing the effects of emotion-focused individual and couples therapy by nonviolent communication. Person-Centered & Experiential Psychotherapies, 22(1), 23-40. DOI: 10.1080/14779757.2022.2100809
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- Väitöskirjat [3519]
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