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Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht.

In psychotherapy, ambivalence may be conceptualized as a conflict between two distinct motivations: one that is favorable to change (pro-change) and another that favors the maintenance of a problematic pattern (pro status quo). Previous studies identified two processes by which clients resolve this conflict: imposing the innovative part and silencing the problematic one (dominance), and establishing negotiations between the innovative and the pro status quo parts (negotiation). The present exploratory study examined ambivalence resolution in a sample of clients diagnosed with complicated grief. Results revealed that, in recovered cases, negotiation increases and dominance decreases from the beginning until the middle sessions of therapy and the opposite tendency is observed from the middle to the final sessions. Unchanged cases reveal an overall high proportion of dominance and an overall low proportion of negotiation. These results are partially divergent from those reported in previous studies with samples of clients diagnosed with major depression., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Innovative moments (IMs) are moments in which the previous problematic pattern of meaning is challenged. Studies have shown that IMs are associated with good psychotherapy outcomes. A three-level hierarchy of IMs was observed in recent studies, with level 1 IMs being more elementary and levels 2 and 3 being more complex and associated with treatment success. However, studies with manualized protocol treatments are thus far lacking. This study analyzed the longitudinal progression of IMs in the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) and explored its associations with changes in psychological distress., Methods: Data were collected from a Portuguese university-based outpatient clinic and included 18 cases with positive outcomes. Nine sessions of each case were coded with the IM coding system ( N =162)., Results: Multilevel analyses showed a significant increase in all IM levels across treatments. The decrease in psychological distress predicted an increase in level 2 IMs in the same session., Conclusion: The evolution of IMs is similar to what was found previously in other studies. Contrary to what was found in previous studies, IMs did not predict outcomes in the following session, whereas the reduction in psychological distress predicted the emergence of level 2 IMs.

Ambivalence towards change is an expected, recurrent process in psychological change. However, the prolonged experience of ambivalence in psychotherapy contributes to client disengagement, which could result in treatment dropout. Considering the negative effects of premature termination of therapy and the convenience of the identification of clients who are at risk of dropping out before achieving good-outcome, the current study explored the predictive power of ambivalence for premature therapy termination using a multilevel time-backwards model (i.e., considering the session of the dropout as session zero and then modelling what occurred from the dropout until session 1). Participants included a total of 96 psychotherapy clients (38 dropouts) treated in a university-based clinic following the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Multilevel modelling using a time-backwards model to analyse dropout data provided evidence of the predictive power of ambivalence evolution throughout treatment on the decision to prematurely discontinue treatment (p < .0001; R 2 adj  = .29). Specifically, good-outcome dropouts presented a decreasing ambivalence trend throughout treatment, whereas poor-outcome dropouts tended to experience the same levels of ambivalence before deciding to drop out (time × dropout; β 11  = .64, p = .014). Additionally, poor-outcome dropouts presented higher levels of ambivalence (β 01  = 9.92, p < .0001) in the last session. The results suggest that the pattern of client ambivalence towards change is a predictor of premature termination of therapy. Implications for clinical and research contexts are discussed., (© 2021 John Wiley & Sons, Ltd.)

Research emphasizes that individuals' engagement with change process is a significant predictor of therapeutic outcomes. Ambivalence is a natural phenomenon in change processes, but when individuals cannot overcome it, their problems may intensify. Ambivalence towards change, a client variable characterized by an intrapersonal conflict between two positions of the self, one in favour of change and another one in favour of the status quo, is shown to play a determinant role in psychotherapy. Despite its importance, few empirical studies have examined this process, and the considerable methodological differences among existing studies make it difficult to generalize results. Therefore, instruments measuring ambivalence in an effective way can help broaden the understanding of the process. First, we performed a content analysis of ambivalence events identified in psychotherapy sessions from previous studies using an observational coding system. The factor structure, reliability and validity of the measure were tested using 91 and confirmed with 223 psychotherapy clients at any time during the therapeutic process. A two-factor structure was found, suggesting two components of Ambivalence-Demoralization and Wavering. The results indicated that the Ambivalence in Psychotherapy Questionnaire exhibits good psychometric properties, including good convergent and divergent validity. The implications are discussed., (© 2020 John Wiley & Sons, Ltd.)

Objectives: In previous studies, reconceptualization innovative moments were associated with successful psychotherapy. Reconceptualization has two components-(a) a positive temporal contrast between the past self and the present self (contrasting self [CS]) and (b) a description of how and/or why this change has occurred (change process [CP])-from the perspective of the client. The aim of this study is to analyse if CS and CP have the same association with outcomes as reconceptualization., Method: Sixteen cases of clients with major depression (305 sessions) were analysed. Longitudinal regression models were used to explore if proportions of CS, CP, and reconceptualization predicted outcome measures and if outcome measures predicted CS, CP, and reconceptualization., Results: Reconceptualization is less frequent than CS and CP taken separately, but reconceptualization was a better predictor of treatment outcomes than were its separate components. Moreover, symptom improvement did not predict reconceptualization., Conclusion: The construction of new meanings is important in improving depressive symptomatology. Psychotherapists can elicit these new meanings in their regular practice by posing questions that may help clients to conceptualize what is changing in themselves (CS) and questions of how this change is occurring (CP). The construction of an integrative account of these new meanings is associated with psychotherapeutic gains, and thus, reconceptualizing change could improve symptoms of depression., (© 2018 John Wiley & Sons, Ltd.)

Aims: The present study focuses on the analysis of novelty emergence in classic Gloria Films with Rogers, Perls, and Ellis to understand how the same client formulated her own problem and if and how change occurred in those three sessions., Method: The Innovative Moments Coding System was applied to track innovative moments (IMs) and their themes., Results: The session with Rogers showed more diversity in disclosed problems and themes of IMs, as well as a higher proportion of reflection IMs. The session with Perls demonstrated a high proportion of protest IMs. The session with Ellis showed less innovation than other sessions. The changes found were based mostly on reflection and protest IMs in three sessions., Conclusion: Narrative innovations occurred in the three single sessions. The type of dominant innovation is consistent with the therapeutic model and the IMs model. The exploration of the IMs' themes allowed a more precise identification of Gloria's new narrative positions and their development throughout those sessions.

This article explores the role of ambivalence in grief therapy within a narrative framework. From this perspective, change starts with the occurrence of innovative moments, which can be nullified by reaffirmation of the problematic self-narrative as a sign of ambivalence. This study analyzed ambivalence in six complicated grief cases using the "Return to the Problem Coding System." Markers of ambivalence emerged in all cases, with a decreasing profile in cases with greater symptomatic improvement, suggesting an association between clinical change and ambivalence evolution in therapy. Addressing ambivalence may bring to light important aspects of client's self-reconstruction after a major loss.

Several studies have suggested that the process of narrative change in psychotherapy occurs through the emergence and expansion of moments of novelty, known as innovative moments (IMs), that allow changes in the problematic self-narrative responsible for the client's suffering. However, as these IMs challenge typical (and problematic) ways of acting, feeling, and thinking, they may also generate discrepancy or uncertainty. Clients may reduce uncertainty by returning to the problematic self-narrative immediately after the emergence of an IM, thus ensuring the homeostasis of the previous meaning system. This cyclical movement is a form of ambivalence, which can maintain problematic stability across therapy and lead to therapeutic failure. In this study, we identified return to the problem markers (RPMs), which are empirical indicators of the ambivalence process, for all IMs in two cases of constructivist grief psychotherapy. Both cases evidenced a high percentage of IMs with RPMs, and the evolution of IMs and RPMs along treatment was significantly correlated. We suggest that stability of the ambivalence process in grief psychotherapy may represent a form of self-protection from the anxiety or guilt of releasing pain as a disconnection from the deceased., ((c) 2014 APA, all rights reserved.)

Objectives: We understand ambivalence as a cyclical movement between two opposing parts of the self. The emergence of a novel part produces an innovative moment, challenging the current maladaptive self-narrative. However, the novel part is subsequently attenuated by a return to the maladaptive self-narrative. This study focused on the analysis of the therapeutic collaboration in episodes in which a relatively poor-outcome client in narrative therapy expressed ambivalence., Method: For our analysis we used the Therapeutic Collaboration Coding System, developed to assess whether and how the therapeutic dyad is working within the therapeutic zone of proximal development (TZPD)., Results: Results showed that when the therapist challenged the client after the emergence of ambivalence, the client tended to invalidate (reject or ignore) the therapist's intervention., Conclusions: This suggests that in such ambivalence episodes the therapist did not match the client's developmental level, and by working outside the TZPD unintentionally contributed to the maintaining the client's ambivalence.

The Assimilation of Problematic Experiences Scale (APES) and the Innovative Moments Coding System were applied to transcripts of a successful case of linguistic therapy of evaluation independently by different research groups. Assimilation theory and research suggest that higher APES scores reflect therapeutic gains, with a level of approximately 4.0 separating good from poor outcome cases. The innovative moments (IMs) model suggests that IMs classified as reconceptualization and performing change occur mainly in good outcome cases, whereas action, reflection and protest occur in both good and poor outcome cases. Passages coded as reconceptualization and performing change were rare in this case, but 100% of them were rated at or above APES 4. By contrast, 63% passages coded as action, reflection or protest were rated below APES 4 (Chi-square = 28.62, p < .001). Implications for research are discussed.

Objective: Ambivalence can be understood as a cyclical movement between an emerging narrative novelty-an Innovative Moment (IM)-and a return to a problematically dominant self-narrative. The return implies that the IM, with its potential for change is devalued right after its emergence. Our goal is to test the hypothesis that the probability of the client expressing such form of ambivalence decreases across treatment in good-outcome cases but not in poor-outcome cases., Method: Return-to-the-Problem Markers (RPMs) signaling moments of devaluation of IMs were coded in passages containing IMs in six clients with major depression treated with emotion-focused therapy: three good-outcome cases and three poor-outcome cases., Results: The percentage of IMs with RPMs decreased across therapy in good-outcome cases, whereas it remained unchanged and high in the poor-outcome cases., Conclusions: These results were consistent with the theoretical suggestion that therapeutic failure may be associated with this form of ambivalence.

According to the narrative approach, change in self-narratives is an important part of successful psychotherapy. In this view, several authors have highlighted the usefulness of narrating new experiences (like actions, thoughts, and stories) during therapy in contrast with maladaptive client self-narratives. These new experiences are termed here innovative moments (IMs), and different types can be specified: action, reflection, protest, reconceptualization, and performing change. With the aim of understanding which therapist skills are related to client IMs, we analyzed the association between exploration, insight, and action skills and IMs in two initial, two middle, and two final sessions of three good outcome (GO) and three poor outcome (PO) cases of emotion-focused therapy (EFT) for depression. IMs occurred more often in GO than PO cases. Furthermore, in GO more than PO cases, exploration and insight skills more often preceded action, reflection, and protest IMs in the initial and middle phases of EFT, but more often preceded reconceptualization and performing change IMs in the final phase. Action skills were more often associated with action, reflection, and protest IMs across all phases, especially in the final phase, of GO EFT., ((c) 2012 APA, all rights reserved.)

This article presents an intensive analysis of a good outcome case of constructivist grief therapy with a bereaved mother, using the Innovative Moments Coding System (IMCS). Inspired by M. White and D. Epston's narrative therapy, the IMCS conceptualizes therapeutic change as resulting from the elaboration and expansion of unique outcomes (or as we prefer, innovative moments), referring to experiences not predicted by the problematic or dominant self-narrative. The IMCS identifies and tracks the occurrence of 5 different types of innovative moments: action, reflection, protest, re-conceptualization, and performing change. Results documented the process of meaning reconstruction over the 6 sessions of treatment, and demonstrated the feasibility and reliability of analyzing narrative change in this form of grief therapy, opening it to comparison with other approaches.

This article presents a method for the assessment of innovative moments, which are novelties that emerge in contrast to a client's problematic self-narrative as expressed in therapy, the innovative moments coding system (IMCS). The authors discuss the theoretical background of the IMCS as well as its coding procedures. Results from several studies suggest that the IMCS is a reliable and valid coding system that can be applied to several modalities of psychotherapy. Finally, future research implications are discussed.

This study focuses on how the emergence of innovative moments (IMs), which are exceptions to a person's dominant self-narrative (i.e., his or her usual way of understanding and experiencing), progresses to the construction of a new self-narrative. IMs challenge a person's current framework of understanding and experiencing, generating uncertainty. When uncertainty is excessively threatening, a semiotic strategy to deal with it often emerges: attenuation of novelty's meanings and implications by a quick return to the dominant self-narrative. From a dialogical perspective, a dominant voice (which organizes one's current self-narrative) and a non-dominant or innovative voice (expressed during IMs) establish a cyclical relation, mutual in-feeding, blocking self-development. In this article, we analyze a successful psychotherapeutic case focusing on how the relation between dominant and non-dominant voices evolves from mutual in-feeding to other forms of dialogical relation. We have identified two processes: (1) escalation of the innovative voice(s) thereby inhibiting the dominant voice and (2) dominant and innovative voices negotiating and engaging in joint action.

This study aims to further the understanding of how innovative moments (IMs), which are exceptions to a client's problematic self-narrative in the therapy dialogue, progress to the construction of a new self-narrative, leading to successful psychotherapy. The authors' research strategy involved tracking IMs, and the themes expressed therein (or protonarratives), and analysing the dynamic relation between IMs and protonarratives within and across sessions using state space grids in a good-outcome case of constructivist psychotherapy. The concept of protonarrative helped explain how IMs transform a problematic self-narrative into a new, more flexible, self-narrative. The increased flexibility of the new self-narrative was manifested as an increase in the diversity of IM types and of protonarratives. Results suggest that new self-narratives may develop through the elaboration of protonarratives present in IMs, yielding an organizing framework that is more flexible than the problematic self-narrative.

According to the author's narrative model of change, clients may maintain a problematic self-stability across therapy, leading to therapeutic failure, by a mutual in-feeding process, which involves a cyclical movement between two opposing parts of the self. During innovative moments (IMs) in the therapy dialogue, clients' dominant self-narrative is interrupted by exceptions to that self-narrative, but subsequently the dominant self-narrative returns. The authors identified return-to-the-problem markers (RPMs), which are empirical indicators of the mutual in-feeding process, in passages containing IMs in 10 cases of narrative therapy (five good-outcome cases and five poor-outcome cases) with females who were victims of intimate violence. The poor-outcome group had a significantly higher percentage of IMs with RPMs than the good-outcome group. The results suggest that therapeutic failures may reflect a systematic return to a dominant self-narrative after the emergence of novelties (IMs).

The aim of this study was to advance understanding of how clients construct their own process of change in effective therapy sessions. Toward this end, the authors applied a narrative methodological tool for the study of the change process in emotion-focused therapy (EFT), replicating a previous study done with narrative therapy (NT). The Innovative Moments Coding System (IMCS) was applied to three good-outcome and three poor-outcome cases in EFT for depression to track the innovative moments (IMs), or exceptions to the problematic self-narrative, in the therapeutic conversation. IMCS allows tracking of five types of IMs events: action, reflection, protest, reconceptualization, and performing change. The analysis revealed significant differences between the good-outcome and poor-outcome groups regarding reconceptualization and performing change IMs, replicating the findings from a previous study. Reconceptualization and performing change IMs seem to be vital in the change process.

This special section contains studies in which innovative moments are used as markers of changes in meaning in psychotherapy. Innovative moments, as an empirical operationalization of the concept of "unique outcomes" from narrative therapy, have been used as a strategy to evaluate changes in meaning in psychotherapy sessions and interviews. Innovative moments are defined as exceptions to the problematic pattern of meaning that is associated with clients' suffering. The emergence of these change markers indicates that flexibility is occurring in the meaning system. This special section contains five studies. Esposito et al. address innovative moments in group intervention by considering the idea that these events are not just individual but also interactional and collective events. Shimshi et al. study shifts between self-states and their relation to innovative moment production in therapy. These shifts are associated with the production of innovative moments, providing further support for the idea that flexibility and the emergence of these change markers are associated. Leeav et al. analyze the relationship between innovative moment production and the therapeutic alliance in a single case study. Fernandez-Navarro et al. interview therapists to understand whether coding innovative moments in sessions may help therapists become more attuned to these events in practice. Finally, Koustafa et al. analyze the evolution of innovative moments in a small sample of individuals with bulimia nervosa. Together, these studies illustrate the potential of this concept as well the domains in which it may be applicable. [ABSTRACT FROM AUTHOR]

Introduction: Innovative moments (IMs) pinpoint new and more adaptative meanings that emerge in clients' discourse during psychotherapy. Studies with adult clients have found a greater proportion of IMs in recovered compared to unchanged cases, but similar studies have yet to be conducted with adolescents. Aims: The paper aims (1) to study retrospectively the emergence of IMs in therapy, using a post‐therapy interview, in adolescents that underwent psychotherapy for depression, and (2) to characterize the themes present in IMs identified retrospectively in the interviews. Method: Semi‐structured post‐treatment interviews conducted with 24 adolescents on the experience of taking part in a clinical trial of youth depression, were coded using the Innovative Moments Coding System. After identifying IMs, a thematic analysis identified the prominent themes within them. Results: Higher presence of IMs were found in recovered compared to unchanged cases. Two main themes emerged in the IMs, changes that occurred with therapy and attributions of changes. Recovered cases presented more IMs centred on the self, whereas unchanged cases identified more non‐specific changes. Conclusion: This study suggests that it is possible to code IMs, identified retrospectively, based on post‐therapy interviews with adolescents. Meaningful differences were found between recovered compared to unchanged cases. Therapeutic recovery was associated with a higher focus on the self and more specificity in clients' representations of the change process. [ABSTRACT FROM AUTHOR]

Copyright of Psico-USF is the property of Universidade Sao Francisco, Programa de Pos-Graduacao Stricto Sensu em Psicologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This case study explores the collaboration that occurs between therapist and client when reconceptualization innovative moments emerge. Reconceptualization innovative moments are exceptions to the problematic self-narrative that brought the client to therapy and are associated with successful psychotherapy. Reconceptualization innovative moments have two main components: a contrast between a past problematic facet and a current, more adjusted one (e.g., before I did/thought/felt X..., now, I do/think/feel Y) and an attribution for what allowed this transformation to occur (e.g., this was possible because I realized Z). The collaboration between therapist and client was analyzed using the Therapeutic Collaboration Coding System, which conceptualizes the relationship as collaborative or as noncollaborative. The majority of interactions in this case were clearly collaborative, with the therapist and client working inside the therapeutic zone of proximal development, which is typical of successful psychotherapy cases. Reconceptualization innovative moments begin with collaborative exchanges in which the therapist supported the problem and the client elaborated on the change afterward. Implications of these findings for change in psychotherapy are discussed. [ABSTRACT FROM AUTHOR]

Portugal is one of the European countries that implemented early protective measures in the context of the COVID-19 pandemic. Portugal declared a state of emergency on 18 March, and a set of regional and national preventive public health measures was progressively implemented. Studies on the psychological impact of pandemics show evidence of the negative impact on mental health. Of particular concern are individuals with previous fragility (e.g. personal, family or occupational) and those undergoing life transitions. In this paper, we present a telephone-based psychological crisis intervention that was implemented to provide brief, appropriate, and timely psychological help. This intervention follows standard models of crisis intervention and is structured in five phases and five different intervention modules to take into account the impact of the pandemic on the mental health of specific risk groups. With these support services, we hope to help our community better cope with the immediate impact of the pandemic and to contribute to preventing serious mental health problems in the medium and long term. [ABSTRACT FROM AUTHOR]

Copyright of Análise Psicológica is the property of Instituto Superior de Psicologia Aplicada and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The FIND (Feedback Initiated Narrative Development) protocol was designed to foster the availability of clients' resources in psychotherapy. This protocol consists of two brief interviews and an observation of an early psychotherapy session, centered on the elicitation of the client's personal resources. The contents of both the interviews and the observed session are summarized for clients and therapists in the form of therapeutic letters. The theoretical background of this protocol is presented in this paper, which focuses on the first part of the protocol, illustrating it with clinical vignettes. The FIND protocol was developed after more than 10 years of research on innovative moments in psychotherapy and is based on narrative therapy practices and dialogical self theory tenets. Other research and models further contributed to the development of this protocol, such as the hypothesis of capitalization of resources; studies that emphasize clients´ active role in their own change; and research on autobiographical memories and narrative construction of identity. Drawing on these models, the FIND protocol attempts to prime and activate the client´s resources (i.e., potential innovative moments) from the beginning of therapy, with the aim of improving psychotherapy efficacy. [ABSTRACT FROM AUTHOR]

Objectives: Innovative moments (IMs) are exceptions to the maladaptive framework of meaning that causes distress. Dialogically, IMs can be seen as new, neglected or silenced I-positions that can prompt an alternative, more satisfying self-narrative to emerge. Research has suggested that IM production is associated with recovery in psychotherapy and is mediated by relational schemas. This exploratory research aims to study how relational I-positions are organized at the onset of treatment and how they evolve and reorganize along treatment. Method: A thematic analysis approach was used in a case study of a client diagnosed with major depressive disorder treated successfully with cognitive behavior therapy. Results: Three overarching themes (defending myself, being with me, and bonding with others) that encompassed the relational I-positions were expressed in more than half of the IMs. The themes were further divided into subthemes. The subthemes progressively displayed a more adaptive and integrated set of relational I-positions along treatment. Discussion: Relational I-positions are present in the IMs from the beginning of psychotherapy. IMs seem to include progressively more relational I-positions played out in clients' interpersonal encounters. In addition, the relational I-positions became more adaptive as psychotherapy progressed. This exploratory study suggests that the relational I-positions present in IMs are associated with increased flexibility along treatment. [ABSTRACT FROM AUTHOR]

Reasoning may help solving problems and understanding personal experiences. Ruminative reasoning, however, is inconclusive, repetitive, and usually regards negative thoughts. We asked how reasoning as manifested in oral autobiographical narratives might differ when it is ruminative versus when it is adaptive by comparing two constructs from the fields of psychotherapy research and narrative research that are potentially beneficial: innovative moments (IMs) and autobiographical reasoning (AR). IMs captures statements in that elaborate on changes regarding an earlier personal previous problem of the narrator, and AR capture the connecting of past events with other parts of the narrator's life or enduring aspects of the narrator. A total of N = 94 university students had been selected from 492 students to differ maximally on trait rumination and trait adaptive reflection, and were grouped as ruminators (N = 38), reflectors (N = 37), and a group with little ruminative and reflective tendencies ("unconcerned," N = 19). Participants narrated three negative personal experiences (disappointing oneself, harming someone, and being rejected) and two self-related experiences of more mixed valence (turning point and lesson learnt). Reflectors used more IMs and more negative than positive autobiographical arguments (AAs), but not more overall AAs than ruminators. Group differences were not moderated by the valence of memories, and groups did not differ in the positive effect of narrating on mood. Trait depression/anxiety was predicted negatively by IMs and positively by AAs. Thus, IMs are typical for reflectors but not ruminators, whereas the construct of AR appears to capture reasoning processes irrespective of their ruminative versus adaptive uses. [ABSTRACT FROM AUTHOR]

This paper aims to describe the Innovative Moments (IM) Coding System (IMCS), an idiographic and transtheoretical methodology that allows the identification of IMs—markers of changes in the client's initial maladaptive framework of meaning—throughout psychotherapy. The present study introduces the theoretical background underlying this methodology, along with the main empirical findings resulting from former studies that have applied this tool to clinical data. The IMCS application is also detailed: the coding phases, the training steps and inter‐rater agreement measures. In order to illustrate the application of IM coding, a case study is presented. Although a partial coding was used, the results are in line with previous research. Discussion is centred on the usefulness of the IMCS for the advance of process research in psychotherapy, and the potential use of this methodology in group format. [ABSTRACT FROM AUTHOR]

Background: The identification of poor outcome predictors is essential if we are to prevent therapeutic failure. Ambivalence – defined as a conflictual relationship between two positions of the self: one favoring change and another one favoring problematic stability – has been consistently associated with poor outcomes. However, the precise relationship between ambivalence and clients' symptomatology remains unclear. Objective: This study aims at assessing ambivalence's power to predict symptomatology, using a longitudinal design. Methods: The complete 305 sessions of 16 narrative and cognitive-behavioral cases have been analyzed with the Ambivalence Coding System and outcome measures have been used for each session. Results: Ambivalence emerged as a significant predictor of subsequent symptomatology suggesting that ambivalence is not only related to treatment outcomes, but that it represents a strong predictor of subsequent symptomatology. Discussion: The implications of ambivalence's power to predict outcomes for research and clinical practice are discussed. [ABSTRACT FROM AUTHOR]

Objectives: Innovative moments (IMs) are exceptions to the maladaptive framework of meaning that typically motivates clients to seek psychotherapy, and previous studies have shown that IMs are associated with psychotherapy outcomes. While IMs are exceptions that occur at the level of the therapeutic conversation, relational schemas are more stable patterns, and their increased flexibility may facilitate change during psychotherapy. With this in mind, we tested the hypothesis that IMs contribute to outcomes by improving the flexibility of relational schemas. Method: The Core Conflictual Relationship Theme (CCRT) was used to assess relational schemas. IMs were evaluated using the Innovative Moments Coding System. The sample included 22 clients diagnosed with major depressive disorder. The flexibility of the three components of the CCRT (Wishes, responses of the self (RS), and responses of others (RO)) were tested as mediators between IMs and outcomes. Results: The flexibility of the RS was a mediator between IMs and outcomes, but Wishes and RO were not. Conclusion: These findings align with previous research showing that RS is the component most open to change, whereas the other components seem less sensitive to change during brief therapy. [ABSTRACT FROM AUTHOR]

Objective: A large proportion of psychotherapy patients remain untreated, mostly because they drop out. This study compares the short- and long-term outcomes of patients who dropped out of psychotherapy to those of therapy completers. Methods: The sample included 63 patients (23 dropouts and 40 completers) from a controlled clinical trial, which compared narrative therapy vs. cognitive-behavioral therapy for major depressive disorder. Patients were assessed at the eighth session, post-treatment, and at 31-month follow-up. Results: Dropouts improved less than completers by the last session attended, but continued to improve significantly more than completers during the follow-up period. Some dropout patients improved with a small dose of therapy (17% achieved a clinically significant change before abandoning treatment), while others only achieved clinically significant change after a longer period (62% at 31-month follow-up). Conclusion: These results emphasize the importance of dealing effectively with patients at risk of dropping out of therapy. Patients who dropped out also reported improvement of depressive symptoms without therapy, but took much longer to improve than did patients who completed therapy. This might be attributable to natural remission of depression. Further research should use a larger patient database, ideally gathered by meta-analysis. [ABSTRACT FROM AUTHOR]

Narrative and dialogical perspectives suggest that personal meaning systems' flexibility is an important resource for change in psychotherapy. Drawn from these theoretical backgrounds, a research program focused on the identification of Innovative Moments (IMs)—exceptions to the inflexible meaning systems present in psychopathological suffering—has been carried out. For this purpose, three process-oriented coding systems were developed: The IMs Coding System, the Ambivalence Coding System, and the Ambivalence Resolution Coding System. They allow, respectively, for the study of change, ambivalence, and ambivalence resolution in therapy. This paper presents these coding systems, the main findings that resulted from their application to different samples and therapeutic models, the main current and future lines of research, as well as the clinical applications of this research program. [ABSTRACT FROM AUTHOR]

Objective:Innovative moments (IMs) are moments in the therapeutic dialog that constitute exceptions toward the client's problems. These narrative markers of meaning transformation are associated with change in different models of therapy and diverse diagnoses. Our goal is to test if IMs precede symptoms change, or, on the contrary, are a mere consequence of symptomatic 15 change.Method:For this purpose, IMs and symptomatology (Outcome Questionnaire-10.2) were assessed at every session in a sample of 10 cases of narrative therapy for depression. Hierarchical linear modeling was conducted to explore whether (i) IMs in a given session predict patients' symptoms in the following session and/or (ii) symptoms in a given session predict IMs in the next session.Results:Results suggested that IMs are better predictors of symptoms than the reverse.Conclusions:These results are discussed considering the contribution of meanings and narrative processes' changes to symptomatic improvement. [ABSTRACT FROM PUBLISHER]

Copyright of Revista de Psicoterapia is the property of Revista de Psiquiatria y Psicologia Humanista, S.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Psicoterapia is the property of Revista de Psiquiatria y Psicologia Humanista, S.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Systematic studies of the efficacy of Narrative Therapy (NT) for depression are sparse.Objective: To evaluate the efficacy of individual NT for moderate depression in adults compared to Cognitive-Behavioral Therapy (CBT).Method: Sixty-three depressed clients were assigned to either NT or CBT. The Beck Depression Inventory-II (BDI-II) and Outcome Questionnaire-45.2 (OQ-45.2) were used as outcome measures.Results: We found a significant symptomatic reduction in both treatments. Group differences favoring CBT were found on the BDI-II, but not on the OQ-45.2.Conclusions: Pre- to post-treatment effect sizes for completers in both groups were superior to benchmarked waiting-list control groups. [ABSTRACT FROM AUTHOR]

Background In a previous clinical controlled trial ( Lopes et al., 2014 ), narrative therapy (NT) showed promising results in ameliorating depressive symptoms with comparable outcomes to cognitive-behavioral therapy (CBT) when patients completed treatment. This paper aims to assess depressive symptoms and interpersonal problems in this clinical sample at follow-up. Methods Using the Beck Depression Inventory-II and Outcome Questionnaire-45.2 Interpersonal Relations Scale, naturalistic prospective follow-up assessment was conducted at 21 and 31 months after the last treatment session. Results At follow-up, patients kept improving in terms of depressive symptoms and interpersonal problems. The odds that a patient maintained recovery from depressive symptoms at follow-up were five times higher than the odds that a patient maintained recovery from interpersonal problems. In the same way, the odds of a patient never recovering from interpersonal problems were five times higher than the odds of never recovering from depressive symptoms. Limitations The study did not control for the natural course of depression or treatment continuation. Conclusions For depressed patients with greater interpersonal disabilities, longer treatment plans and alternative continuation treatments should be considered. [ABSTRACT FROM AUTHOR]

Departing from Frank's (1961) proposal that psychotherapeutic change involves change in meanings, we suggest that meanings are organized into narratives, and that narratives have authors (I-positions according to Hermans) that are actively telling their stories. To study change in psychotherapy, according to these assumptions, the Innovative Moment Coding System was created, which provides a systematic and reliable method for the identification of the novelties emerging in psychotherapy sessions, which we call innovative moments (IMs). These innovative moments emerge in successful psychotherapy and disrupt the dominance of the problematic self-narratives that brought the client to therapy, thus allowing for new I-positions to come to the foreground and tell stories that are outside the scope of the former problematic self-narratives. After describing this coding system, we present a model of psychotherapeutic change and a model of therapeutic stability grounded on the empirical results obtained until now. From here we explore two main questions: (1) Which processes block the development of innovative moments from the middle of the therapy to the end, particularly the emergence of reconceptualization? (2) Why is reconceptualization so central in the change process? [ABSTRACT FROM AUTHOR]

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No processo psicoterapêutico a mudança constrói-se através da emergência e expansão de excepções ao funcionamento problemático do cliente. Contudo, o potencial de mudança destas excepções ou inovações pode ser abortado através da atenuação do seu significado quando o cliente as desvaloriza, trivializa ou nega. Quando este processo se repete ao longo da terapia estamos na presença de ambivalência, na medida em que ocorre uma oscilação recorrente entre duas posições opostas (inovação-retorno ao funcionamento problemático). O presente estudo exploratório tem como principal objectivo descrever a interacção terapêutica nestes momentos de ambivalência, num caso de insucesso psicoterapêutico, recorrendo ao Sistema de Codificação da Colaboração Terapêutica. Os resultados sugerem que a ambivalência emerge maioritariamente no seguimento de intervenções em que a terapeuta desafia a perspectiva habitual da cliente. Os resultados mostram ainda que a terapeuta tende a responder à ambivalência da cliente com um novo desafio, sendo que a cliente tende a expressar novamente ambivalência ou a discordar da terapeuta. Deste modo, quando a terapeuta persiste no desafio verifica-se frequentemente uma escalada no desconforto da cliente, que se manifesta na evolução de uma resposta de ambivalência para uma resposta de invalidação por parte da cliente. [ABSTRACT FROM AUTHOR]

Aims: To analyse a poor outcome case of narrative therapy with a woman victim of intimate violence. Method: The Innovative Moments Coding System: version 1 was applied to all sessions to track the innovative moments (i-moments) in the therapeutic process. I-moments are the narrative details that occur in psychotherapeutic conversations that are outside the influence of the problematic narrative. This research aims to describe the processes involved in the stability of meanings in psychotherapy through a dialogical approach to meaning making. Findings: Contrarily to what usually occurs in good outcome cases, re-conceptualization i-moments are absent. Moreover, two specific types of i-moments emerged with higher duration: reflection and protest. Qualitative analysis showed that the potential meanings of these i-moments were surpassed by a return to the problematic narrative. Conclusion: The therapeutic stability seems to be maintained by a systematic return to the problematic narrative after the emergence of novelties. This process was referred from a dialogical perspective as a mutual in-feeding of voices, one that emerges in the i-moment and another one that supports the problematic narrative, which is maintained by an oscillation between these two types of voices during therapy. [ABSTRACT FROM AUTHOR]

This commentary focuses on Cross's (2010, this issue) work as an opportunity to elaborate upon how to study narrative-dialogical processes from the perspective of complexity. We start by elaborating on the notion that narrative development is a multidimensional activity that extends through several organizational levels and on the limitations of conventional research methods for narrative analysis. Following this, we focus on our experience of research on narrative change in psychotherapy in order to exemplify this point. From our perspective, clients' problematic self-narratives can be challenged by the emergence of innovative ways of thinking and behaving that the client narrates during the therapeutic conversation (innovative moments or i-moments). Our results suggest that the reconstruction of a person's self-narrative depends on the structure of relations between i-moments, rather than on the mere accumulation of i-moments. Therefore, we are particularly interested in looking at how clusters of i-moments create a pattern, which we call protonarrative. We are interested in the dynamic processes between former self-narrative, i-moments, protonarratives and new emergent self-narratives. Hence, we have developed a research strategy that allows tracking these different levels of narrative development in psychotherapy. In the remaining of our commentary we will briefly present our research strategy. [ABSTRACT FROM AUTHOR]

This commentary focuses on Ligorio's (2010) and O'Sullivan-Lago and de Abreu's (2010) work as an opportunity to elaborate upon discontinuity emergence and continuity restoration within the Dialogical Self. We depart from the pair rupture-transition as a unit of analysis for understanding the flow of change within the Dialogical Self and the centrality of ambivalence as a development catalyser to focus on the way change and maintenance of problematic self-narratives in psychotherapy are pictured by the innovative moments model. We have argued that innovative moments (or i-moments) can be understood as episodes of rupture or discontinuity, since they challenge a person's usual way of understanding and experiencing (i.e., the problematic narrative), generating ambivalence or uncertainty. We have suggested that avoiding this ambivalence, by means of semiotic attenuation of i-moments, can foster the maintenance of the problematic self narrative. In fact, when ambivalence is not overcome, i-moments and the problematic narrative may establish a cyclical relation throughout the therapeutic process, blocking the self's development. [ABSTRACT FROM AUTHOR]

The article focuses on a research program on the narrative construction of change. It notes that the research program seeks to determine the role of the so-called unique outcomes, defined as all details that are outside the domain of the dominant narrative, in psychotherapy. The unique outcomes have been regarded as innovative moments or i-moments in the study.

AbstractObjectivesMethodsResultsConclusionsAlthough psychotherapy research suggests that clients’ resources are related to positive outcomes, there is a lack of clinical tools available to consider their integration into psychotherapy. In this exploratory research, we studied the feasibility of a semi-structured interview to identify resources reported by clients at the onset of therapy and the relationship between resources and therapy outcomes.Data consisted of interviews with 30 clients from a clinical trial, in which elicitation of resources and their relationship with the outcomes were the main study objectives.This interview was content analyzed and both adaptative resources and maladaptive resources (dysfunctional coping strategies) were identified. The association between the adaptive resources and the evolution of outcomes throughout treatment was analyzed. Time (i.e. sessions) and resources were negatively correlated with psychological distress. Moreover, resources positively influenced the impact of time on distress.Clinicians should not take at face value resources that are self-reported, as they may reflect the maladaptive functioning of the client. The finding that clients with higher resources at onset have better outcomes points to the need to study how resources may be elicited effectively during therapy, and if this improves psychotherapy outcomes. [ABSTRACT FROM AUTHOR]