Doctor of Philosophy
University of Wollongong. Dept. of Psychology
Grenyer, Brin, Mastery through psychotherapy, Doctor of Philosophy thesis, University of Wollongong. Dept. of Psychology, University of Wollongong, 1996. http://ro.uow.edu.au/theses/1667
This study investigated the relationship between the mastery of maladaptive interpersonal patterns, assessed from narratives told during psychotherapy, and outcome of psychotherapy. A psychoanalytic account of the processes of mastery through psychotherapy was developed and empirically tested. Mastery was hypothesized to develop as long standing repetitive core conflictual relationship themes are worked through in psychotherapy. Mastery was defined as the development of self-control and self-understanding in the context of interpersonal relationships. A content analysis Mastery Scale was developed to quantify degrees of self-control and self-understanding in the accounts of relationship narratives patients tell early and late in psychotherapy. Verbatim transcripts of 41 patients (29 females, mean age 25) seen in dynamic therapy were scored for mastery. Results indicated: (1) The inter-rater and test-retest reliability of the Mastery Scale was excellent. (2) Changes in mastery level over the course of therapy were significantly related to changes in observer ratings of psychological health-sickness and therapist ratings of patient satisfaction, success and improvement. In addition, the patient's own judgements of changes in their symptoms and main target problems paralleled changes in the mastery of interpersonal conflicts found in their narratives. (3) Early therapeutic alliance predicted gains in mastery over therapy, and (4) changes in the response of self component of the Core Conflictual Relationship Theme paralleled changes in mastery. (5) Patients with a personality disorder appeared to make particularly clinically significant gains in mastery. (6) Of all the narratives of relationships told by patients in psychotherapy, changes in mastery of the relationship with their parents showed the strongest association with clinical changes. This suggests that mastery of this primary relationship with the parents is particularly therapeutic. Overall these results are consistent with the proposition that symptoms abate with the mastery of core interpersonal conflicts. The results support the importance of the development of mastery as an central mechanism of improvement through psychotherapy.