This study followed 47 adult outpatients over the course of psychotherapy in a naturalistic treatment setting. Their mental health and personal narratives were assessed at 12 points, beginning prior to the first session of treatment and after every session for the following 11 sessions. Mental health was assessed with a multi-dimensional measure and clients were also asked to write about their evolving experiences in treatment, focusing on the ways in which the therapy was impacting their sense of self. Finally, other elements of personality, including the Big Five personality traits and ego development, were assessed. Nearly 600 client narratives were collected and blindly coded by reliable judges for the themes of agency, processing, and coherence.
Results indicated that participants' mental health improved over the course of treatment. In addition, clients’ narratives showed increases in both themes of agency and processing (but not coherence) over time. However, only the theme of agency was seen to have a significant relationship with changes in mental health. Lagged growth curve modeling revealed that shifts in clients' narratives, towards being more agentic, occurred temporally prior to improvements in their mental health (and not in the opposite direction). While the design of the present study does not permit causal interpretations to be drawn, the findings suggest that psychotherapy clients begin to construct a new story about their experiences and then live their way into it.
This study has implications for researchers interested in personality development as well as for psychotherapy process and outcome researchers and practicing therapists. From the perspective of personality researchers, the present study encourages the adoption of a personological approach, the continued emphasis on narratives of key episodes of development, and the identification of themes that relate to mental health, most centrally the theme of agency. From the perspective of psychotherapy researchers and clinicians, the present study supports work focused on clients’ perspectives, the specific emphasis on narrative identity as a key index of therapy process and outcome, and points towards the elicitation of client narratives as a tool for enhancing treatment success.
|Advisor:||McAdams, Dan P.|
|Commitee:||Durbin, Catherine E., Lebow, Jay, McAdams, Dan P., Revelle, William R.|
|School Location:||United States -- Illinois|
|Source:||DAI-B 70/12, Dissertation Abstracts International|
|Subjects:||Clinical psychology, Personality psychology|
|Keywords:||Agency, Coherence, Mental health, Multi-level modeling, Narrative, Psychotherapy outcome, Psychotherapy process|
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