title: Narrative and interactional process for preventing harmful struggle in therapy: an integrative empirical model.
abstract: Resistance or struggle in therapy looms large as a predictor of treatment outcomes. This study organizes the significant empirical data on struggle into a coherent, operational framework for use by therapists in preventing and/or ameliorating harmful struggle in therapy. First, we review the prevalence and significance of struggle. Second, we offer a historical and conceptual overview, with emphasis on a contemporary interactional/systemic perspective on struggle. Third, we provide a synthesis of peer-reviewed research, profiling struggle at speech-act and episode levels of interaction process and across assessment/joining, intervention, and integration-consolidation phases of therapy. Fourth, based upon this review, we propose a three-factor model--consisting of eliciting dialogue, enactments, and accommodation--for successful therapy process relative to the occurrence of struggle.
authors.affiliation: School of Family Life, Marriage and Family Therapy Graduate Programs, Brigham Young University, Provo, UT 84602-8601, USA. Mark_Butler@BYU.edu
authors.forename: M H
authors.initials: MH
authors.lastname: Butler
authors.forename: M H
authors.initials: MH
authors.lastname: Bird
mesh_terms: D001521:Behavior Therapy / Q000379:methods*; D003142:Communication; D006302:Health Services Research; D006801:Humans; D008960:Models, Psychological; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011369:Professional-Patient Relations; D016896:Treatment Outcome