Edited by: Pietro Cipresso, IRCCS Istituto Auxologico Italiano, Italy
Reviewed by: Antonio Calcagnì, University of Trento, Italy; Eleonora Riva, Università degli Studi di Milano, Italy
*Correspondence: Eulàlia Arias-Pujol
This article was submitted to Quantitative Psychology and Measurement, a section of the journal Frontiers in Psychology
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Group psychotherapy is a useful clinical practice for adolescents with mental health issues. Groups typically consist of young people of similar ages but with different personalities, and this results in a complex communication network. The goal of group psychoanalytic psychotherapy is to improve participants' mentalization abilities, facilitating interactions between peers and their therapist in a safe, containing environment. The main aim of this study was to analyze conversation turn-taking between a lead therapist, a co-therapist, and six adolescents over the course of 24 treatment sessions divided into four blocks over 8 months. We employed a mixed-methods design based on systematic observation, which we consider to be a mixed method itself, as the qualitative data collected in the initial observation phase is transformed into quantitative data and subsequently interpreted qualitatively with the aid of clinical vignettes. The observational methodology design was nomothetic, follow-up, and multidimensional. The choice of methodology is justified as we used an
Peer groups are a natural setting for young people (Erikson,
Little has been published on group therapy in children or adolescents. Most of the studies conducted to date have reported on brief cognitive-behavioral interventions with specified diagnostic populations (Pollock and Kymissis,
More research has been conducted in adults. A recent meta-analysis of group psychotherapy for social anxiety disorders concluded that group interventions were as effective as individual psychotherapy or pharmacotherapy (Barkowski et al.,
In pyschotherapy research, there is growing concern for integrating qualitative methods, which provide a more holistic view of the person, and quantitative methods, which seek to provide a more objective view (Lutz and Hill,
In this article, we describe the results of a study based on systematic observation, which we consider to be a mixed method in itself (Anguera and Hernández-Mendo,
The aim of the group therapy analyzed was to promote autonomy and maturity through interactions between peers and their therapist in a safe, containing environment (Torras de Beà,
Psychodynamic interventions have been described as “conversation therapies,” as the relationship between the person seeking treatment and the therapist forms the basis of the therapy (Malmberg and Fenton,
Foulkes (
In the group studied, interventions by a therapist largely seek to (a) facilitate conversation and (b) promote mentalization, i.e., stimulate thought, reflection, and understanding about oneself and one's relationships with others.
In the
The second group of interventions in the observation instrument was called MNT to reflect the concept of mentalization described by Fonagy et al. (Fonagy,
At the beginning of these group sessions, communication is generally radial, i.e., it diverges outwards toward the participants from the formal leader of the group, the therapist. With time, it becomes circular, with participants spontaneously intervening and demonstrating interest in each other. This shift in the direction of communication is an indicator of the group process, and our aim was to objectively analyze this process by studying the therapist's interventions.
The main aim of this study was to apply polar coordinate analysis to analyze conversation turn-taking and DYN and MNT interventions in a group therapy program involving a lead therapist, a co-therapist, and six adolescents. The program consisted of 24 group sessions, divided into four blocks, held over a period of 8 months.
In this mixed-methods study, we applied systematic observation, which meets the rigorous standards of scientific inquiry while at the same time offers the flexibility needed in real-life settings. Observational methodology permits the capture of spontaneous behaviors as they occur in a natural environment (Sackett,
There are eight possible study designs in observational methodology (Blanco-Villaseñor et al.,
The systematic observation was non-participative and the behaviors were highly perceivable.
There were eight participants: the therapist (T), the co-therapist (coT), and six adolescents (G, D, JM, F, L, M). The adolescents (four boys and two girls) had requested support at the Center for Child and Adolescent Mental Health of the
Patient characteristics.
Gabriel | 14 | Male | 111 | 313.83/315.02/313.81.1 |
Danny | 14 | Male | 110 | 309.23/313.0 |
John M. | 14 | Male | 92 | 309.23/300.00.1/301.4.01 |
Fred | 13 | Male | 90 | 309.23/297.3 |
Lucy | 15 | Female | 84 | 309.23/315.5/313.81.1 |
Meg | 13 | Female | 110 | 309.23/300.21/300.2 |
The inclusion criteria were (a) an age of 12–15 years and (b) recommendation for group therapy following diagnostic evaluation at the Mental Health Center. The exclusion criteria were (a) anticipated difficulty attending all the therapy sessions and (b) contraindication for group therapy.
The group was led by an expert therapist, assisted by a co-therapist who participated as an observer. Both were clinical psychologists trained in group psychoanalytic psychotherapy.
In accordance with the principles of the Declaration of Helsinki and the Ethical Code of the General Council of the Official College of Psychologists of Spain, the participants were informed that they were being filmed. They were shown the location of the video cameras, which were positioned discretely to minimize reactivity bias. Informed consent was also obtained from the parents of the minors.
In systematic observation (Anguera,
The group sessions were recorded using two video cameras, two microphones, two video units, and two screens comprising a closed-circuit television system. The dataset was built in the software program GSEQ5, v.5.1 (Bakeman and Quera,
According to the terminology proposed by Bakeman (
The
The 15 dimensions included in the observation instrument are Facilitating of conversation, Reflective function, Expressivity, Defensive expressions, Dislike, Ordering, Humor, Confrontation, Exclamation, Degradation of vocal behavior, Whispering, Touching, Noise, Surrounding noise, and Silence (Table
Dimensions and category systems in the observation instrument for therapists and patients.
DYN Facilitating of conversation | DYN = {FF, FO, RP, RT, QA, QC, QV} | |
MNT | MNT = {MNT} | |
EXP | EXP = {RA EC CD RB} | |
DEF | DEF = {RD_N_P CT} | |
DIS | DIS = {ED PD} | |
ORD | ORD = {ORD} | |
HUM | HUM = {R EO} | |
CFR | CFR = {CFR} | |
EX | EX = {EX} | |
S4 | S4 | |
WHI | WHI = {S5} | |
TO | TO = {TO} | |
NOI | NOI = {MO S2 S3} | |
S1 | S1 | |
Q | Q = {Q} |
It should be noted that some dimensions gave rise to a single category, but given their conceptual relevance, we considered it important to include them as dimensions in the instrument. The dimensions and categories are shown in Table
The parents of the six adolescents were notified that their children had been proposed for group therapy after a diagnostic evaluation period. In addition, they all agreed to participate in a parallel group led by another therapist.
All the sessions were video-recorded and transcribed in full. Thirty sessions were held but due to technical difficulties with the recording, six were discarded because of poor audio. Therefore, 24 sessions were included in the final analysis. Each of the sessions lasted an hour. The sessions were grouped into four periods spanning an 8-month period.
For the data quality control analysis, two observers analyzed and coded four of the therapy sessions. They had been previously trained using the approach described by Anguera (
Polar coordinate analysis was used to analyze DYN and MNT interventions in accordance with the study objective. Polar coordinate analysis is a commonly used quantitative analytical method in observational methodology that identifies the statistical relationship between a behavior of interest (referred to in polar coordinate analysis as the
Lag sequential analysis produces large volumes of data, which are subsequently reduced through a powerful data reduction algorithm based on the Zsum =
Polar coordinate analysis integrates the prospective and retrospective perspectives with the help of a vectorial map that contains four quadrants in which the prospective and retrospective Zsum values are plotted along the X and Y axis, respectively. Each target behavior analysis thus can be located in one of the four quadrants depending on the combination of negative/positive signs (Table
Polar coordinate analysis results corresponding to interventions by the therapist (T) as the focal behavior and interventions by the participants (G D JM F L M), interventions by the co-therapist (CT), and silence as conditional behaviors.
CT | I | 1.96 | 3.64 | 0.88 | 4.13 ( |
61.78 |
G | III | −3.59 | −5.52 | −0.84 | 6.58 ( |
236.98 |
D | I | 4.03 | 2.57 | 0.54 | 4.78 ( |
32.52 |
JM | I | 1.27 | 2.86 | 0.91 | 3.13 ( |
66.01 |
F | I | 3.69 | 6.02 | 0.85 | 7.06 ( |
58.45 |
L | III | −4.54 | −5.7 | −0.78 | 7.28 ( |
231.49 |
M | III | −4.51 | −2.93 | −0.54 | 5.38 ( |
212.99 |
Q | I | 3.01 | 3.48 | 0.76 | 4.61 ( |
49.13 |
CT | I | 4.81 | 4 | 0.64 | 6.26 ( |
39.74 |
G | III | −7.33 | −5.58 | −0.61 | 9.21 ( |
217.31 |
D | III | −6.62 | −5.93 | −0.67 | 8.89 ( |
221.85 |
JM | IV | 0.07 | −0.21 | −0.95 | 0.22 | 288.21 |
F | I | 3.8 | 0.86 | 0.22 | 3.89 ( |
12.74 |
L | IV | 0.81 | −1.06 | −0.8 | 1.34 | 307.19 |
M | I | 5.17 | 5.39 | 0.72 | 7.47 ( |
46.16 |
Q | I | 5.15 | 5.4 | 0.72 | 7.46 ( |
46.39 |
CT | I | 8.63 | 7.43 | 0.65 | 11.38 ( |
40.71 |
G | III | −16.95 | −16.15 | −0.69 | 23.41 ( |
223.62 |
D | III | −19.21 | −15.73 | −0.63 | 24.83 ( |
219.32 |
JM | I | 7.42 | 8.75 | 0.76 | 11.48 ( |
49.71 |
F | I | 13.93 | 11.89 | 0.65 | 18.32 ( |
40.46 |
L | III | −2.08 | −5.61 | −0.94 | 5.99 ( |
249.64 |
M | III | −1.83 | −3.04 | −0.86 | 3.55 ( |
239.03 |
Q | I | 6.48 | 6.39 | 0.7 | 9.1 ( |
44.59 |
CT | I | 8.36 | 7.87 | 0.69 | 11.48 ( |
43.26 |
G | III | −5.44 | −4.19 | −0.61 | 6.86 ( |
217.62 |
D | III | −11.09 | −9.16 | −0.64 | 14.38 ( |
219.56 |
JM | III | −2.66 | −2.93 | −0.74 | 3.96 ( |
227.78 |
F | I | 6.57 | 3.78 | 0.5 | 7.58 ( |
29.92 |
L | III | −11.6 | −14.96 | −0.79 | 18.93 ( |
232.22 |
M | III | −5.97 | −7.98 | −0.8 | 9.97 ( |
233.19 |
Q | I | 3.98 | 10.16 | 0.93 | 10.91 ( |
68.59 |
Polar coordinate analysis uses the prospective and retrospective Zsum values for each conditional behavior to calculate the length and angle of the corresponding vector, thus allowing these to be graphically represented. The length of the vector is
The meanings of the different quadrants are shown in Figure
Characteristics of the quadrants in which the vectors are located according to the activation (+) or inhibition (–) sign carried by the Prospective and Retrospective Zsum values.
Quadrants I and III are symmetrical in terms of the relationship they depict between the focal behavior and the different conditional behaviors they contain. Quadrant I (++) indicates mutual activation while quadrant III (−) indicates mutual inhibition. Quadrants II and IV, in turn, depict asymmetrical relationships. Quadrant II (−+) indicates that the focal behavior inhibits but at the same time is activated by the conditional behaviors, while quadrant IV (+−) indicates the opposite (i.e., the focal behavior activates and is inhibited by the corresponding conditional behaviors).
The polar coordinate analysis for this study was performed in HOISAN v. 1.6.3.2 (Hernández-Mendo et al.,
Polar coordinate analysis has been used in certain areas of clinical psychology, such as groups of children with autistic siblings (Venturella,
In the sections below, we describe the relationships detected between interventions by the therapist and the group participants using polar coordinate analysis.
The focal behavior was intervention by the therapist (T) and the conditional behaviors were interventions by the participants (G, D, JM, F L, and M), interventions by the co-therapist (coT), and silence (Q) in the four blocks of sessions spanning 8 weeks.
As shown in Table
The graphs in Figure
Vectors corresponding to interventions by the therapist (T) as the focal behavior and interventions by the participants (G, D, JM, F L, and M), interventions by the co-therapist (coT), and silence (Q) as conditional behaviors. Session blocks 1-2-3-4 (from left to right).
Again, the focal behavior was intervention by the therapist (T) and the conditional behaviors were the DYN categories FF, FO, RP, RT, QA, QC, and QV and the MNT category.
The majority of results in this case were also significant (Table
Polar coordinate analysis results with interventions by the therapist (T) as the focal behavior and DYN categories (broken down) and MNT as conditional behaviors.
QA | IV | 2.36 | −3.87 | −0.85 | 4.54 ( |
301.4 |
QC | III | −4.61 | −4.61 | −0.71 | 6.52 ( |
224.98 |
FF | II | −0.42 | 1.94 | 0.98 | 1.99 ( |
102.32 |
FO | IV | 0.11 | −1.99 | −1 | 2 ( |
273.02 |
RP | I | 1.28 | 5.16 | 0.97 | 5.32 ( |
76.07 |
QV | III | −1.53 | −1.59 | −0.72 | 2.2 ( |
226.01 |
RT | II | −0.07 | 0.31 | 0.98 | 0.32 | 102.7 |
MNT | III | −3.91 | −1.89 | −0.44 | 4.34 ( |
205.83 |
QA | IV | 4.9 | −1.81 | −0.35 | 5.22 ( |
339.72 |
QC | III | −3.54 | −2.49 | −0.58 | 4.33 ( |
215.2 |
FF | I | 1.36 | 3.06 | 0.91 | 3.35 ( |
66.01 |
FO | I | 0.74 | 2.15 | 0.95 | 2.28 ( |
71.07 |
RP | I | 4.83 | 6.78 | 0.81 | 8.33 ( |
54.5 |
QV | I | 1.46 | 1.07 | 0.59 | 1.81 | 36.25 |
RT | II | −2.56 | 0.47 | 0.18 | 2.61 ( |
169.63 |
MNT | II | −2.88 | 1.96 | 0.56 | 3.48 ( |
145.78 |
QA | L | 14.08 | 6.32 | 0.41 | 15.43 ( |
24.17 |
QC | III | −1.11 | −3.01 | −0.94 | 3.21 ( |
249.85 |
FF | I | 3.49 | 5.31 | 0.84 | 6.35 ( |
56.66 |
FO | I | 3.61 | 4.11 | 0.75 | 5.47 ( |
48.65 |
RP | I | 3.72 | 4.87 | 0.79 | 6.13 ( |
52.64 |
QV | I | 5.39 | 3.69 | 0.56 | 6.54 ( |
34.38 |
RT | II | −2.11 | 3.14 | 0.83 | 3.78 ( |
123.86 |
MNT | II | −0.32 | 5.49 | 1 | 5.5 ( |
93.33 |
QA | I | 10.12 | 4.3 | 0.39 | 10.99 ( |
23.01 |
QC | IV | 0.38 | −1.51 | −0.97 | 1.56 | 284.25 |
FF | I | 4.96 | 6.75 | 0.81 | 8.38 ( |
53.72 |
FO | I | 4.7 | 3.78 | 0.63 | 6.03 ( |
38.83 |
RP | I | 4.59 | 5.54 | 0.77 | 7.2 ( |
50.39 |
QV | I | 4 | 1.46 | 0.34 | 4.26 ( |
20.04 |
RT | II | −1 | 2.74 | 0.94 | 2.91 ( |
110.1 |
MNT | I | 3.86 | 9.43 | 0.93 | 10.19 ( |
67.76 |
The graphs in Figure
Vectors corresponding to interventions by the therapist (T) as the focal behavior and conversationfacilitating DYN categories (FF, FO, RP, RT, QA, QC, QV) and the mentalizing or reflective function MNT category as conditional behaviors. Session blocks 1-2-3-4 (from left to right).
Below we discuss the significance of the relationships detected by polar coordinate analysis in five sections. We also illustrate our findings with clinical vignettes containing coded transcripts of the interventions.
All the significant results are located in two opposing quadrants, indicating two clearly differentiated types of relationship: mutual activation and mutual inhibition. The therapist always facilitates intervention by Fred, the participant with the greatest difficulty relating to others, and in the early phases of therapy, she also encourages interaction from Danny, John M, and Meg. Her interventions never activate those of the two impulsive participants, Gabriel and Lucy. This does not mean that she excludes these participants, simply that they intervene on their own initiative. The changes detected in Danny, John M, and Meg are an indication of the progress they make over the therapy. Block 1 is characterized by radial communication between the therapist and all the participants. Vignette 1 shows an example of an interaction between the therapist and Danny (Table
Clinical vignette 1.
Vignette 1 (Block 1). Danny has been on a trip to a museum with his school. |
T – It's a different museum, right? [QA] |
D – Yes, it was an industry. [RA] |
T – It was an industry; is it located in an old factory? [RP] [QA] |
D – Yes, in a factory, they used an industry from the 1960s. [RA] |
T – Hmmm…And you said that you had to do an assignment? [FF] [PA] |
D – They gave us a sheet of paper and we had to fill it in. [RA] |
T – With the things you were seeing and the explanations they were giving you? [QA] |
D – Yes. [RB] |
However, not all interactions are the same. Gabriel and Lucy, for example, spontaneously take turns in these early sessions (Table
Clinical vignette 2.
Vignette 2 (Block 1). The topic of conversation is about getting down to studying and passing and failing subjects |
G – Yes, at the beginning you see it as far off, Well…that's what I think, and you do nothing. [RA] |
T – Hmmm. [FF] |
G – But then, when you see that you are getting bad marks, and that if you don't get your act together, well, they will fail you, then you study. [EC] |
T – Is that the same with all of you? [QA] |
L – For me it's the opposite. [RA] |
T – Aha. [FF] |
L – In the first, in the first term, well that was it, I had to study, and because I spent the summer studying…, I mean, I don't care, the truth is that it doesn't matter if it's at the beginning of the year or at the end [EC] |
G – That's the bad thing, like she says, yes, because if you have to study in September, yuck! In my school, they do courses in July, right there, and I spend a month at school. They give you minimum goals and at the end of the course, they test you, you can do at least three…[EC] |
L – Yeah, well imagine if you've got seven subjects left for the summer, for September. [EC] |
Lucy raises conflicts about herself that interest everyone (Table
Clinical vignette 3.
Vignette 3 (Block 1). |
Lucy has just explained that she has been to different schools: |
T – And now, how are you? (current school) [QA] |
L – Fine, but I don't like it, I don't like any of the girls in my class. [RA] |
T – What do you mean? What don't you like about the girls in your class? [QC] [QA] |
L – That they're always saying I'm very childish because I don't wear make-up or show my thighs, I don't like that! [RA] |
T – Hmmm [FF] |
L – And they say I'm very childish because I'm 15 but I don't like wearing make-up or going off into corners kissng guys. I'm not into that, but that's what they appear to do. [EC] |
T – Hmmm. [FF] |
L – And when they ask me if I'm coming with them, I don't go. I'm not into that [EC] |
T – Hmmm. What do the rest of you think about what Lucy is saying? [FF] [QA] |
M – Good. [RB] |
T – Good. What do you mean? [RP] [QC] |
M – That…She will end up better than them, they're the ones going astray. [RA] |
John M is a reserved person with anxiety problems. He has difficulty intervening and when he does, he often mumbles, says very little, and adheres to what has just been said (Table
Clinical vignette 4.
Vignette 4 (Block 1). |
The topic of conversation is about marks and exams. They have all explained how they are assessed. John M says nothing until the therapist asks him directly. |
T – And what about you, John M? How are you assessed? [QA] |
JM – Like her. [RA] |
I suppose you're referring to Lucy, who has just spoken. |
T – Exactly exactly like her? [QA] |
JM (in a low voice)- Yes [RB] |
Haen and Weil (
Clinical vignette 5.
Vignette 5 (Block 4). |
Lucy is explaining that she's going to be in a play in a village near the Mental Health Center. Meg asks her directly: |
M (addressing L) – And you don't feel embarrassed? [QA] |
L – Yes, and they say that they're going to throw eggs at us. [RA] |
D – Jeez. [EE] |
JM – Count me in. [EO] |
D – You know what I mean, yahoo! One by one! (gestures of throwing eggs) [EO] [EE] [EO] |
JM – Haha. [R] |
L – I hope they're joking, because if not, they'll get in trouble. [CFR] |
M (addressing L) – Can you get there by train? [QA] |
L – Yes. [RB] |
M (in a low voice) – Darn. [EE] |
L – If you can get there by train? [RT] |
D – I'll bring some hens, hahaha. [EO] [R] |
JM – Let's go, yay! [EO] [EE] |
M – You get there by train? [PV] |
D – Yes! [RB] |
L – Or you can go by car or…[EC] |
D – There are tracks and a station, hahaha. [EO] [R] |
M – Bah! I'm not going by train. [EE] [EC] |
JM – Hee hee. [R] |
JM – Hee hee hee. How are you going to go, on foot? Haha. [R] [EO] [R] |
JM – Haha. [R] |
M – Haha. No. [R] [RB] |
M – No, because of what happens to her with the underground (referring to being afraid to ride alone) [EXP] |
JM and D in unison – The same things happens to you with the train. [CFR] |
M – No, because the first time I go on a train alone, well …[DEF] |
D – You'll get lost…[CFR] |
M – No…[DEF] |
The co-therapist and the therapist was mutually activated (quadrant 1). The co-therapist's interventions reflect her role of interfering as little as possible in the group dynamics. They complement those of the main therapist. Together, they form a team and create and maintain a safe environment (Shechtman 2007; Torras de Beà,
The therapist generates silence but also breaks it (quadrant 1).
The examples below show how the adolescents fall silent when faced with difficult issues, such as verbalizing why they are in the group or talking about their relationship with their parents or their concerns about sexuality (Tables
Clinical vignette 6.
Vignette 6 (block 2). The therapist challenges the participants with questions, she takes them to a level of mentalization that they are not ready for yet and they become inhibited. |
T – Why are we coming to the group? And why? We are all coming for something, aren't we? [MNT] |
Silence. [Q] |
T – Why do you think you are coming? How are we are trying to help you here? [MNT] |
Silence. [Q] |
T – Maybe we have to go over this again…[EXP] |
Clinical vignette 7.
Vignette 7 (block 3). At another moment, silence allows the adolescents to express themselves with sincerity: |
T – How would you like your parents to treat you? What do you expect? [MNT] |
Silence. [Q]g |
D – Them not to use such tough punishments [EXP] |
T – Not to use such tough punishments [EXP] |
G – They always use the worst possible punishments [EXP] |
T – The worst? What does that mean, what you like most? [QV] [MNT] |
G – Yes, they punish you with the things you like most. [EC] |
T – And what happens then? How do you feel? [MNT] |
G (in a very low voice) – Crap…[EXP] |
Silence. [Q] |
T – How do you all feel? Do you get discouraged? Do you feel that they are disheartening you? [MNT] |
Silence. [Q] |
Clinical vignette 8.
Vignette 8 (Block 3) |
This silence expresses the difficulty talking about sexuality. |
T – Maybe you talk about condoms at school, do you? Amongst ourselves too, right? [QA] |
Silence. [Q] |
T – No? [PV] |
JM – Haha. [R] |
G – Haha. [R] |
T – Jokingly, jokingly, it makes you laugh. I think that it is, that it's something that's talked about at school, about their use, right? [MNT] [QA] |
Silence. [Q] |
T – You're all a little quiet, aren't you? Eh? What do you think about condoms? Do you know anything? Do you talk about them with each? [MNT] [A] |
Pause. [Q] |
T – Before you were talking about AIDS, somebody said this word like with a lot of disgust, about the risk of infection …[MNT] |
G burps and covers his mouth, mumbles something to D that I don't understand. [NOI] [S4] |
D – Brrr. [EE] |
G – But blood doesn't have to come out to get an infection. [EXP] |
The different strategies for facilitating conversation (FF, FO, RP, RT, QA, QC, and QV) showed varying patterns of change over the course of therapy but converged at the end.
Repetition (RP) was the most powerful strategy, as it activated conversation from the start of the therapy program. The next most powerful strategies were phatic function (FF) and greetings (FO). The transcripts of the sessions show that in the early sessions, it was the therapist who verbally greeted the adolescents (by saying hello and goodbye). However, few of them responded and the others returned the greeting or made a non-verbal gesture. This behavior changes after the first block, indicating an increase in reciprocity between the therapist and the participants.
The appearance of QA (questions directed at others) in the second half of the therapy is, in our opinion, a highly significant indicator of the group process. It tells us that the communication is no longer radial and that the adolescents have achieved one of the most important benefits of group therapy, which is showing interest in others (Yalom,
It is also interesting to see how QV (repetition of a previous utterance in the form of a question) changes from being mutually inhibitory to being mutually activating. We think that this strategy initially surprised the adolescents but was then gradually adopted by them. The same was not observed for QC (clarifying questions), which were used only by the therapist when the adolescents were “doing their own thing” and she was “excluded” from the group. Examples of what she said were: “I'm not quite following you now…maybe I'm being a bit dense, can you help me understand what's going on?” This strategy is similar to the attitude of respectful curiosity shown by therapists in the Adolescent Mentalization-Based Integrative Treatment (AMBIT) approach (mentalizing stance), which is designed to help put a halt to non-mentalization mental states (Benvington et al.,
Bringing back a central topic of conversation (RT) and suggesting looking at this in greater depth was only done by the therapist.
At the end of therapy, all the categories in the DYN dimension except RT are located in the mutually activating quadrant. This supports the idea that the communication strategies used by the therapist were adopted by the participants, enabling them to talk more autonomously and facilitating their personal growth (Yalom,
The changes observed in the MNT category, which corresponds to interventions aimed at improving the adolescents' mentalization abilities, also reflect interesting aspects of the group process. The MNT category changed from inhibitory (quadrant III) to partially inhibitory (quadrant II) and finally to mutually activating (quadrant I). The changes also show that the therapist's role changed over time, as mentalization strategies were only used by her. We can deduce that the participants gradually overcame their early inhibitions and dependence and acquired more sophisticated mentalizing abilities, helping them to become more aware of themselves and of others. This result is consistent with the concept known as the interpretative function of the therapist within the theories of Foulkes (
Polar coordinate analysis provides a new approach for gaining insights into dialogue in group pyschotherapy. The results show that the technique provides a novel means of analyzing the role of the therapist and describing her conversational style. The therapist proved to be an expert in creating a communicative environment that allowed the adolescents to grow. She employed four core strategies: (1) she did not facilitate communication equally for all participants, (2) she encouraged turn-taking by the more inhibited members of the group, (3) she stimulated conversation from the early stages of therapy, and (4) she promoted mentalization toward the end of therapy.
We were particularly pleased to see that the use of repetition (RP) facilitated communication flows from the beginning. The positive results indicate that rather than simply acting as an echo or a loudspeaker, this strategy produces a mirroring effect similar to that described in the social biofeedback theory of parental affect-mirring (Gergely and Watson,
Observational methodology and polar coordinate analysis could prove to be of great value for detecting changes in psychotherapy models based on spoken conversation.
EA developed the project. MA performed the method section and polar coordinate analysis. Both authors have participated in the writing of the article.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
We thank all those at the Center for Child and Adolescent Mental Health of the