Internalized relationships and narrative change in psychotherapy: a thematic analysis case study

Abstract

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.