Currently, there is a lack of understanding of how the stages of change (SOC) relate to discussion of interpersonal trauma in therapy. This study aimed to explore the timing and depth of trauma discussion (TD) across the course of therapy in relation to SOC. The client in this single-case study was a 28-year-old African American female who recently moved to California and reported difficulties in relationships and work problems. The course of therapy lasted 21 sessions; of the 15 videotaped sessions, 6 contained discussions of childhood sexual abuse (CSA) and workplace psychological harassment (WPH). Linguistic Inquiry and Word Count (LIWC; Pennebaker et al., 2007) was used to identify the duration and frequency of cognitive processing, insight and causation words (timing and depth of processing), and the University of Rhode Island Change Assessment (URICA; McConnaughy et al., 1983) measured the client's SOC across therapy sessions. Qualitative themes were analyzed to determine SOC during sessions containing TD and other assessment measures were used to understand the context of TD, therapist techniques, and therapy course.
Findings were consistent with literature indicating no specific timing of TD across therapy (Higgins Kessler & Nelson Goff, 2006; Sano et al., 2003). Within-session TD were inconsistent with literature reporting that most intimate disclosures occur at the end of therapy sessions (Strassberg et al., 1978); however, results were consistent with expectations from each SOC. Regarding TD depth, results were consistent with findings that increased use of insight words occurs later in the therapeutic process (Hemenover, 2003); greater percentages of cognitive processing and causation words occurred towards the beginning of therapy. These findings indicated that feelings regarding the cause of trauma became less salient while gaining insight into the meaning of trauma became more salient over time. Also, trauma processing occurred more during contemplation and preparation SOC (when insight was greatest), and occurred less during the action SOC (when insight was lowest). Finally, techniques consistent with SOC theory appeared to facilitate trauma processing.
Given methodological limitations, including the lack of consistent URICA data, future research should incorporate other transtheotretical model components and client cultural factors to gain a more balanced understanding of trauma processing in therapy. Notwithstanding, this study has the potential to contribute to work with trauma survivors, as SOC appears relevant to enhancing clients' success at increasing TD depth.
|Advisor:||Hall, Susan R.|
|Commitee:||Bryant-Davis, Thema, Shelby, Janine|
|School Location:||United States -- California|
|Source:||DAI-B 72/09, Dissertation Abstracts International|
|Keywords:||Psychotherapy, Stages of change, Timing, Trauma discussion|
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