Academic journal article Journal of Cognitive Psychotherapy

"Consciousness Streaming": A Single-Subject within Session Analysis of Therapeutically Relevant Verbalizations

Academic journal article Journal of Cognitive Psychotherapy

"Consciousness Streaming": A Single-Subject within Session Analysis of Therapeutically Relevant Verbalizations

Article excerpt

A case study is presented that exposes the psychotherapy technique of "consciousness streaming" to an empirical analysis of its potency. This technique is proposed to be one way of reducing "resistance" (as defined herein) of some clients. The subject was an adult female with a diagnosis of major depression and borderline personality disorder. Applied behavioral analyses of her in-therapy, verbal responses to consciousness streaming and therapeutic interviewing are compared. The data indicated that the consciousness streaming technique was superior to therapeutic interviewing in producing higher purity ratios (as opposed to frequency) of therapeutically relevant client verbalizations. A discussion on the utility of this experimental demonstration is presented, and suggestions are offered for future research and clinical application.

One of the greatest challenges to psychotherapists is effectively dealing with client "resistance." Resistance in psychotherapy is defined in a variety of ways, depending on the theoretical orientation of the researcher-writer. Resistance has many global connotations but has been more specifically classified as defensive versus cooperative statements made during a session in response to therapist statements (Chamberlain, Patterson, Reid, Kavanaugh, & Forgatch, 1984). Chamberlain et al. (1984) and others have discovered that treatment outcome, in this case dropouts, is related to the amount of resistance manifested by the client (Munjack & Oziel, 1978).

Munjack and Oziel (1978) propose and define five levels or types of resistance: (1) Clients do not understand what they are supposed to do; (2) clients do not know how to appropriately implement the therapist's suggestions due to a lack of skill; (3) clients show a lack of motivation to work on problems; (4) client resistance can also result from anxiety or guilt that arises from previous behavior or that is induced during therapy; and (5) client resistance can arise from secondary gain that clients may derive from the expression of symptoms.

Kaplan and Sadock (1981) define resistance similar to types 3,4, and 5 as listed above by Munjack and Oziel (1978). They write, "Resistance may be expressed by the patterns of communication during the interview. Silence, garrulousness, censoring or editing thoughts, intellectualization, generalization, and preoccupation with one phase of (the client's) life - such as symptoms, or past history - are common examples of resistance" (pp. 176-177).

Mahoney (1985) and Kris (1982) conceptualize resistance as the client's avoidance of certain core material of most concern and greatest importance relative to the problems a client brings to therapy for resolution. Mahoney and Kris's conceptualizations are reflective of the common elements represented in most theoretical discussions of client resistance, including the conceptualizations presented above. Mahoney (1985) further clarifies resistance in therapy as a client's avoidance of core areas related to identity, power, values, and concept of reality.

As Kaplan and Sadock (1981) note, "Silence is one of the most common forms of resistance - sometimes interviewers unwittingly provoke silences by assuming a disproportionate responsibility for keeping the interview going" (p. 177). In this current study, the dependent measure of resistance was conceptualized and operationally defined as a client's avoidance of discussing content that relates specifically to themes of therapeutic relevance. These themes, for the purposes of this study and ones held by many clinicians to be of curucial relevance to adult psychotherapy (Mahoney, 1985), are identity, power, reality, and values. Mahoney (1985) also notes that these particular client themes are among those that are the most difficult to change. Mahoney (in press) writes, "Any time an individual is struggling with an issue that deals with reality (the order of experience), identity (boundaries of self), values (good/bad, right/wrong), or power (control/viability), 'resistance' and difficulties in change will be encountered. …

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