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Kleinbub, Johann Roland (2016) The rhythm of therapy: psychophysiological synchronization in clinical dyads. [Tesi di dottorato]

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Abstract (inglese)

Rhythmicity and synchronization are fundamental mechanisms employed by countless natural phenomena to communicate. Previous research has found evidence for synchronization in patients and therapists during clinical activity, for instance in their body movements (Ramseyer & Tschacher, 2011) and physiological activations (e.g. Marci et al, 2007; Kleinbub et al., 2012; Messina et al., 2013). While this phenomenon has been found associated with different important aspects of clinical relationship, such as empathy, rapport, and outcome, and many authors suggested that it may describe crucial dimensions of the therapeutic dyad interaction and change, a clear explanation of its meaning is still lacking. The goals of the present work were to:
1) Provide a solid theoretical and epistemological background, in which to inscribe the phenomenon. This was pursued by crossing neurophenomenology’s sophisticated ideas on mind-body integration (Varela, 1996) and Infant Research’s detailed observations on development of infants’ Self through their relationships. The common ground for this connection was the complex systems theory (von Bertalanffy, 1968; Haken, 2006).
2) Contribute to literature through two replications of existing studies (Kleinbub et al., 2012; Messina et al., 2013) on skin conductance (SC) synchronization. In addition to the original designs, secure attachment priming (Mikulincer & Shaver, 2007) was introduced to explore if observed SC linkage was susceptible to manipulation, accordingly to the developmental premises defined in the theoretical chapters. Study 1 focused on synchrony between students and psychotherapists in simulated clinical sessions; Study 2 reprised the same methodology with two principal changes: first the clinician’s role was played by psychologists without further clinical trainings, and second, each psychologist was involved in two distinct interviews, in order to assess the impact of individual characteristics on SC synchrony.
3) Provide an ideographical exploration of the psychotherapy processes linked to matched SC activity. In study 3 the highest and lowest synchrony sequences of 6 sessions of psychodynamic psychotherapy were subject of a detailed phenomenological content analysis. These micro-categories were synthetized in more abstract ones, in order to attempt the recognizing of regularities that could shed light on the phenomenon.
4) To explore the pertinence of employing mathematical properties derived from the application of system theory in psychological contexts. In study 4, Shannon’s entropy and order equations (1948) were applied on the transcribed verbal content of 12 depression psychotherapies, to assess both intra-personal and inter-personal (dyad) order in verbal categories.
Results from these studies provided further evidence for the existence of a synchronization mechanism in the clinical dyads. Furthermore the various findings were generally supporting the dyad system theoretical model, and its description of regulatory dynamics as a good explanation of the synchronization phenomena. Discrepancies with previous literature highlighted the need for further studies to embrace more methodological sophistication (such as employing lag analysis), and cautiousness in the interpretation of results.

Abstract (italiano)

Ritmo e sincronia sono meccanismi fondamentali alla base dello scambio di informazione in innumerevoli fenomeni naturali. Ricerche precedenti hanno evidenziato la presenza di meccanismi di sincronizzazione in pazienti e terapeuti durante la pratica clinica, ad esempio nei loro movimenti corporei (Ramseyer & Tschacher, 2011) e nelle attivazioni fisiologiche (es. Marci et al, 2007; Kleinbub et al., 2012; Messina et al., 2013). Nonostante tale fenomeno sia stato associato a diversi importanti aspetti della relazione terapeutica, quali l’empatia, il rapport, l’esito del percorso clinico, e nonostante molti di tali autori siano concordi nel suggerire che tale meccanismo possa descrivere dimensioni cruciali della relazione terapeutica e dei suoi processi di cambiamento, una chiara spiegazione e comprensione del suo significato è ancora assente. Pertanto gli obiettivi del presente lavoro sono:
1) Fornire un solido background teorico ed epistemologico nel quale inscrivere tale fenomeno. Tale obiettivo è stato perseguito tracciando un ideale filo rosso fra la sofisticata integrazione fra corpo e mente ad opera del pensiero neurofenomenologico (Varela, 1966), e le dettagliate osservazioni sull’evoluzione del Se nei bambini attraverso le loro relazioni primarie ad opera del movimento dell’Infant Research. Il terreno comune per operare tale connessione è stato fornito dalla teoria dei modelli complessi (von Bertalanffy, 1968; Haken, 2006).
2) Contribuire alla letteratura attraverso due replicazioni di studi precedenti (Kleinbub et al., 2012; Messina et al., 2013) sulla sincronizzazione della conduttanza cutanea (CC). In aggiunta ai disegni originali, è stata introdotta una tecnica di priming della sicurezza di attaccamento (Mikulincer & Shaver, 2007), per osservare se e come la coordinazione nella CC nella diade terapeutica fosse soggetta a manipolazione, e coerente col modello di sviluppo scelto per interpretare il fenomeno. Lo studio 1 si focalizza sulla sincronia fra studenti e psicoterapeuti durante simulazioni di colloqui clinici; lo studio 2 riprende tale metodo con due differenze significative: il ruolo di clinico è stato ricoperto da psicologi senza ulteriore formazione, ed ogni psicologo ha condotto due colloqui, al fine di investigare l’impatto delle caratteristiche individuali sulla sincronia.
3) Fornire una esplorazione ideografica dei processi terapeutici connessi all’attivazione CC simultanea. Nello studio 3 le sequenze di maggiore e minore sincronia di 6 sessioni di psicoterapia psicodinamica sono state analizzate attraverso una dettagliata analisi del contenuto fenomenologica. Le micro-categorie da essa ottenute sono poi state sintetizzate in categorie più astratte al fine di cercare di riconoscere la presenza di regolarità che potessero gettare luce sul fenomeno.
4) Esplorare la pertinenza dell’utilizzo di proprietà matematiche derivate dall’applicazione della teoria sistemica nei contesti psicologici. Nello studio 4, le formule di entropia e ordine di Shannon (1948), sono state applicate sui trascritti del contenuto verbale di 12 psicoterapie di pazienti depressi, per investigare la presenza di ordine nelle categorie verbali sia intra-personali, che inter-personali (diade).
Gli esiti di tali studi hanno rivelato ulteriore evidenza rispetto all’esistenza di meccanismi di sincronizzazione nella diade clinica. Inoltre i vari risultati erano generalmente in supporto al modello sistemico diadico e la sua descrizione delle dinamiche di regolazione si è rivelata una buona spiegazione dei processi di sincronizzazione. Discrepanze minori rispetto alla letteratura sottolineano il bisogno di proseguire la ricerca in questo settore attraverso una maggiore accortezza metodologica (ad esempio tramite lag-analysis), e cautela nell’interpretazione dei risultati.

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Tipo di EPrint:Tesi di dottorato
Relatore:Sambin, Marco
Dottorato (corsi e scuole):Ciclo 28 > Scuole 28 > SCIENZE SOCIALI: INTERAZIONI, COMUNICAZIONE, COSTRUZIONI CULTURALI
Data di deposito della tesi:31 Gennaio 2016
Anno di Pubblicazione:31 Gennaio 2016
Parole chiave (italiano / inglese):interpersonal physiology, skin conductance, synchronization, neurophenomenology, complex system, psychotherapy, process research
Settori scientifico-disciplinari MIUR:Area 11 - Scienze storiche, filosofiche, pedagogiche e psicologiche > M-PSI/07 Psicologia dinamica
Struttura di riferimento:Dipartimenti > Dipartimento di Filosofia, Sociologia, Pedagogia e Psicologia Applicata
Codice ID:9464
Depositato il:07 Ott 2016 12:52
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