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The development of cognitivecomplexity during thepsychotherapeutic process:A comparative study betweenpsychotic and non-psychotic patientsGómez, A.M., Pacheco, M., Botella, L.,Herrero, O. y Corbella, S.Ramon Llull University
Grid Technique (Kelly 1955/1991) is increasingly used as apsychotherapy research instrument (Winter, 2003). Using GridTechnique allows the researcher to study cognitive complexity. Both inStudy 1 and 2, and following Adams-Webber (1979) and Botella &Gallifa (2000) we adopted a conception of cognitive complexity as atwo-dimensional space, made up of a combination of differentiationand integration. As can be seen in Table 1, we considered differentcognitive profiles as a function of the combination of both axes. Theassessment of cognitive complexity was carried out in both studies bymeans of the Structural Quadrants Method (Botella & Gallifa, 2000).IntroductionHIGHINTEGRATIONLOWINTEGRATIONHIGHDIFFERENTIATIONComplex FragmentedLOWDIFFERENTIATIONMonolithic SimpleTable 1.Cognitive complexity asa two-dimensionalfactor: a proposal ofcognitive profiles.
HypothesisAt the end of effective individual therapy subjects with non-psychotic psychotherapy complaints tend to simplify theirrelational construction system, since differentiation andintegration decrease, and both processes are linked tosymptomatic improvement.Study 1:SubjectsAfter eliminating drop out cases (n = 10) and single sessionconsultations (n = 8) the final sample was reduced to 34participants (28 females and 6 males). They were in therapyfor an average of 15 sessions and all of them finishedtherapy successfully.
Using Grid Technique and CORE Outcome QuestionnaireSocial self complexity was assessed by means of the adaptation ofGrid Technique (Kelly, 1955/1991) developed by Butt & Bannister(1987) and Butt, Burr & Bell (1997). Cognitive complexity indexes werecalculated by means of the Structural Quadrants Method algorithmBotella & Gallifa (2000).Symptomatic state was assessed by means of the CORE OutcomeQuestionnaire (Core System Group, 1998).Procedure1st Phase: Sample selection.2nd Phase: Assessment. Instruments described in the section Materialwere administered.-Initial administration: during the initial session.-Intermediate administration: between therapy sessions 8th and 9th.-Final administration: during the final session or after 9 months since thebeginning of therapy.3rd Phase: Data analysis, with SPSS 10.0 program and the StructuralQuadrants Method algorithm Botella & Gallifa (2000).
ResultsTherapy was effective29.414.76061.7638.0916.668.8257.1483.330102030405060708090Initial CORE 8th Ses. CORE Final COREClinic Level ofSymptomatologySubclinic Level ofSymptomatologyNo Clinic Level ofSymptomatology
Figure 3. The evolution ofdifferentiationFinalDifferent.8th Ses. Different.InitialDifferent.Mean,5,4,3,2FinalIntegration8th.Ses. IntegrationInitialIntegrationMean,8,7,6,5At the end of effective group therapy clients tend to simplify theirrelational construction system, and differentiation and integrationdecrease.Figure 2. The evolution ofdifferentiation
As long as Initial and Final Differentiation correlatesignificantly with level of symptomatology at the end oftherapy, we can affirm that the decreasing ofdifferentiation is associated to the decreasing ofsymptoms and, consequently, to symptomaticimprovement. Integration does not correlate significantlywith the level of symptomatology at any point duringtherapy.
HypothesisAt the end of group therapy subjects diagnosed withparanoid schizophrenia tend to simplify their relationalconstruction system, since differentiation and integrationdecrease, and both processes are linked to symptomaticimprovement.Study 2:Subjects30 patients who complied with the study’s inclusion criteriawere selected from a mental health center. Among these 30participants, 15 were selected at random and were assignedto a treatment group, while the other 15 were assigned to acontrol group. These latter ones kept receiving their regularout-patient treatment.
Using de Grid Technique and PANSSWe administrated the Self-Grid (Kelly 1955/1991) and the Positiveand Negative Syndromes Scale (PANSS) (Peralta & Cuesta, 1994).Procedure1st Phase: Sample selection.2nd Phase: Assessment. Instruments described in the sectionMaterial were administered.-Initial administration: before the psicosocial interventionbeginning.-Intermediate administration: after 12 months since thebeginning of the psicosocial intervention.-Final administration: after 24 months since the beginning ofthe psicosocial intervention.3rd Phase: Data analysis, with SPSS 10.0 program and theStructural Quadrants Method algorithm Botella & Gallifa(2000).
ResultsIn intergroup results, there were no statistically significantdifferences after 2 years group treatment. In the intragroupresults, after 12 months since the beginning of theintervention, integration (see Figure 5) and symptomatic state(see Figures 6, 7 and 8) decreased in a statistically significantway in the treatment group.
After 24 months from the treatment groupbeginning, integration and differentiation did not showchanges and positive and negative symptomsdecreased in a significantly way once more (seeFigures 5, 6 and 7). Integration and differentiationdecreasing determined that treatment group presenteda self constructive system that evolved from monolithicto simple.
Differentation 3Differentation 2Differentation 1Mean,24,22,20,18,16,14,12Integration 3Integration 2Integration 1Mean,6,5,4,3The evolution of differentiation and of the integrationFigure 4 Figure 5
Both in Study 1 and 2, symptomatology decreasessignificantly. In Study 1, non-clinic level symptomatologyincreases up to 83,33% of cases at the end of therapy, thesub-clinic level decreases until 16’66% and clinic leveldecreases until it disappears.In Study 2, symptomatic state of treatment group participantswas decreasing progressively during the 2 years ofpsychosocial intervention, and this proves treatment validity.As regards PANSS intragroup results, all the scales werestatistically significant, showing a symptomatology decreasingfrom the pretreatment administration to the 2 years of groupintervention.Discussion:
As regards cognitive complexity, Study 1 results and theintragroup ones in Study 2 show that at the end ofintervention subjects tend to simplify their relationalconstruction system, as differentiation and integrationdecrease. In Study 1, differentiation decrease correlatessignificantly with symptomatic improvement.
Adams-Webber, J.R. (1979). Personal construct theory: Concepts andapplications. New York: Wiley.Bell, R.C. (1987). G-PACK: A computer program for the elicitation and analysis ofrepertory grids. Unpublished document: Department of Psychology, University ofMelbourne.Butt, T. & Bannister, D. (1987). Better the devil you know. In W. Dryden (Ed.), Keycases in Psychotherapy. (pp.121-147). London: Croom Helm.Butt, T., Burr, V. & Bell, R. (1997). Fragmentation and the sense of self.Constructivism in the Human Sciences. 2 (1), 12-29.Gallifa, J. & Botella, L. (2000). The structural quadrants method: A new approach tothe assessments of construct system complexity via the Repertory Grid. Journalof Constructivist Psychology, 13, 1-26.Kelly, G.A. (1955/1991). The Psychology of Personal Constructs (Vols. 1 y 2).London: Routledge.Peralta, V. & Cuesta, M.J. (1994). La validación de la escala de síndromes positivoy negativo (PANSS). Actas Luso Españolas de Neurología, Psiquiatría y CienciasAfines, 22, 171-177.Winter, D.A. (1992). Personal Construct Psychology in Clinical Practice.Theory, Research and Applications. London: Routledge.Winter, D.A. (2003). Repertory Grid Technique as a psychotherapy researchmeasure. Psychotherapy Research, 13 (1), 25-42.