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A significant number of psychotherapy clients remain untreated, and dropping out is one of the main reasons. Still, the literature around this subject is incoherent. The present study explores potential pre-treatment predictors of dropout in a sample of clients who took part in a clinical trial designed to test the efficacy of narrative therapy for major depressive disorder compared to cognitive-behavioral therapy. Logistic regression analysis showed that: (1) treatment assignment did not predict dropout, (2) clients taking psychiatric medication at intake were 80% less likely to drop out from therapy, compared to clients who were not taking medication, and (3) clients presenting anxious comorbidity at intake were 82% less likely to dropout compared to those clients not presenting anxious comorbidity. Results suggest that clinicians should pay attention to depressed clients who are not taking psychiatric medication or have no comorbid anxiety. More research is needed in order to understand this relationship.

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.)

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., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: The quality and strength of the therapeutic collaboration, the core of the alliance, is reliably associated with positive therapy outcomes. The urgent challenge for clinicians and researchers is constructing a conceptual framework to integrate the dialectical work that fosters collaboration, with a model of how clients make progress in therapy., Aim: We propose a conceptual account of how collaboration in therapy becomes therapeutic. In addition, we report on the construction of a coding system - the therapeutic collaboration coding system (TCCS) - designed to analyse and track on a moment-by-moment basis the interaction between therapist and client. Preliminary evidence is presented regarding the coding system's psychometric properties. The TCCS evaluates each speaking turn and assesses whether and how therapists are working within the client's therapeutic zone of proximal development, defined as the space between the client's actual therapeutic developmental level and their potential developmental level that can be reached in collaboration with the therapist., Method: We applied the TCCS to five cases: a good and a poor outcome case of narrative therapy, a good and a poor outcome case of cognitive-behavioural therapy, and a dropout case of narrative therapy., Conclusion: The TCCS offers markers that may help researchers better understand the therapeutic collaboration on a moment-to-moment basis and may help therapists better regulate the relationship., (© 2012 The British Psychological Society.)

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 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.

The target article from Madureira--The psychological basis of homophobia: Construction of a cultural barrier--is a very rich theoretical proposal, drawing on from different fields, from cultural psychology to the dialogical theories of the self. Despite its richness, in this commentary we will question some of its implicit and explicit assumptions. It seems to us that the author treats "homophobia" as a hegemonic cultural discourse, ignoring that a mixture of opposing discourses are nowadays available at a cultural level towards lesbians and gays, with important consequences at interpersonal and intrapersonal level. In addition, the very concept of "homophobia" (with its implicit assumptions from the field of psychopathology: "phobia") suggests a very static and intrapersonal way of understanding the diversity of the social mechanisms that underlie sexual prejudice. The way the author describes and tries to clarify the semiotic processes implied in the construction of the interpersonal and psychological barrier involved in "homophobia", in our opinion, also needs to be further developed. The use of the opposition between HEIMWEH and FERNWEH in the explanation of the barrier it is not, from our view, a description of a (semiotic) process but more a description of an outcome. In order to overcome these problems, we suggest some possible ways to approach this phenomenon from a semiotic and dialogical perspective.