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Comprehensive discourse analysis of symbolic externalization Wiebe, Katharine

Abstract

The purpose of this study was to discover how therapist and clients co-create relational novelty using symbolic externalization intervention in successful Experiential Systemic Therapy (ExST) for marital treatment of alcohol dependence through a single case study design. A comprehensive discourse analysis method was used to study the therapeutic conversation within a 15 minute therapy episode in which therapist and clients externalized the problem of alcohol. The therapy episode was video-taped, audio-taped, transcribed and then analyzed according to the procedures of comprehensive discourse analysis. The analysis of the clients' and therapist's discourse revealed eight themes that contributed to co-creating relational novelty at the intrapersonal, interpersonal and symptomatic system levels. The themes co-constructed by the therapist and clients to attain relational novelty included: (a) creating and maintaining a collaborative atmosphere; (b) challenging propositions and competence; (c) refraining alcohol as a seducer; (d) moving from an individual to a relational understanding of the role of alcohol in the couple’s relationship; (e) re-defining and accenting the couple’s commonalities; (f) diffusing tension and defensiveness; (g) regulating the intensity of experiences; and (h) deepening contrasting experiences. The therapeutic process involved movement away from the old, restrictive story or meaning of the alcohol dependence toward a new perspective while simultaneously moderating the atmosphere and character of the therapy. The outcome, the proximal in-session relational novelty, that the therapist and clients co-created using the symbolic externalization intervention demonstrated that therapeutic change is a dynamic, interactive, and context dependent process.

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