Table 2.
Characteristics of the reviewed studies.
| References (country) | Participants (N) | Interventions (techniques and methodologies) | Comparator | Results | Study design |
|---|---|---|---|---|---|
| Kay et al. (2023) (UK) | Five patients ranged from 20 to 30 (three men and two women). Four therapists ranged from 28 to 48 (1 male, three female) | Transcripts from the first, middle, and final psychotherapy sessions of five individuals treated for depression, all showing reliable improvement, were analyzed Qualitative method of analyzing multivoicedness (QUAM) | Not applicable | Two voices were identified in patients after treatment. Opposing voices during depression are submissive and assertive, agentic, and reflecting voices after treatmentA third one can be used to develop treatments that can identify inner conflict and suppression and cultivate reflexivity in patients | A qualitative descriptive study |
| Chiara et al. (2023) (Italy) | Five female patients ranged from 20 to 30 | Narrative psychotherapy journey. A thematic analysis was conducted on the transcripts of the therapeutic pathways, highlighting the positions of the self-identified Dialogical self-theory qualitative analysis of psychotherapy sessions | Not applicable | Two main themes in the narratives facilitating PTG (post-traumatic growth) were identified, and three in the narratives acted as barriers there, too | A qualitative descriptive study |
| Hills (2023) (UK) | Four patients, 1 therapist | Multicase study of the researcher's own clinical work Autoethnographic account in which the researcher uses supervision, personal therapy, dreams, and life events Sessions were audio-recorded and coded for qualitative markers indicating the emergence of novel self-narratives within a narrative-dialogical framework | Not applicable | The study highlights the use of self as a research instrument and offers a candid and intimate example of how practitioner research might be structured and delivered | A qualitative descriptive study |
| DiMaggio et al. (2003) (Italy) | Two patients (one male aged 15, one female aged 25) | Analysis of a clinical case to show how a patient put together her set of narratives using the tool of self-investigation through writing a diary Qualitative microanalysis of the diaries written by the patient during psychotherapy | Difference in the intensity of negative emotion expression between the beginning and end of therapy | The patient's negative emotions diminished in intensity, and guilt feelings gave way in the texts to better narratives | A qualitative descriptive study |
| Mellado et al. (2022b) (Chile) | One female patient is aged 53 years, and one male therapist is aged 31 years | Dynamic patterns were identified, and the hypothetical attractors (i.e., the most stable patterns in the interaction of voices) were defined using the Space State Grid (SSG) Voices and personal positions were identified by the Model of Analysis of Discursive Positioning in Psychotherapy (MAPP) | Different stages of psychotherapy | Differentiated dynamic patterns of voices were identified depending on the stage of psychotherapy Subjective transformation from a monological to a dialogical dimension, a transition from a state of dissociation of the patient to a reorganization of her subjectivity | A mixed-design case study |
| Mellado et al. (2022a) (Chile) | One female patient is aged 53 years, and one male therapist is aged 31 years | Change episodes of the patient were traced through the Change Episodes Model Dynamic patterns of voices were identified by the Space State Grid (SSG) Voices and personal positions were identified by the Model of Analysis of Discursive Positioning in Psychotherapy (MAPP) | Change episodes of different types of subjective elaboration | The results established differentiated dynamic patterns in the patient's change episodes | A mixed-design case study |
| Steen et al. (2023) (Netherlands) | 15 life stories of patients | Seven themes were selected from patients diagnosed with personality disorders Investigate meaning in life in 15 life stories of patients with PD before and after intensive psychotherapy Qualitative narrative analysis uses a holistic content approach and theoretical thematic analysis | Pre-treatment life stories and post-treatment are presented in seven theoretical themes | Pre-treatment and post-treatment comparison of themes The presence and/or emergence of specific meaning in life themes could result from attaining treatment goals that ameliorate personality dysfunction The results are proposed as an alternative to the DSM-5 as a model for personality disorders | A qualitative descriptive study |
| Dawson et al. (2021) (Australia) | 13 women (six service users and seven practitioners) | The psychotherapy context is based on Open Dialogue (Seikkula et al., 2003) training, where practitioners receive regular Open Dialogue supervision Qualitative interviews | Not applicable | The findings suggested that dialogical processes created safety by attending to multiple voices in nonviolent ways that reduced perceived hierarchies. Notions of expertise were renegotiated, which allowed the women to feel heard in significant ways that were different from their previous experiences with other social and healthcare services | A qualitative descriptive study |
| Kay et al. (2021) (UK) | One patient (30-year-old) male | Patient Health Questionnaire (PHQ-9) Generalized anxiety disorder 7 (GAD-7) Qualitative method for analyzing multivoicedness (QUAM) | Not reported | QUAM permitted a close inspection of the individual in their social context through an examination of the dialogs that were generated around a range of internal and external I-positions Two prominent opposing internal I-positions appeared to dominate: I-as-monitor (patient observed and monitored by himself) and I-as craving (no control over his food consumption) I-as-repulsive (had a strong emotional valence), and I-as vulnerable (had a gentler and more sensitive quality, and a pensive, thoughtful delivery) | A mixed-design case study |
| Råbu et al. (2019) (Norway) | Six therapists-researchers | Collective autoethnography | Not applicable | Negative experiences could strengthen one's own convictions for acting differently; positive experiences worked as inspiration and support; being in therapy early in life represented a significant formative experience; and working through complex personal issues in therapy gave the courage to identify similar conflicts in the fantasies and realities of clients | A qualitative descriptive study |
| Penttinen et al. (2016) (Finland) | Female patient (~40 years old); male therapist (~50 years old) The Assimilation of Problematic Experiences Scale (APES) | Assimilation analysis (Honos-Webb et al., 2003) | Not applicable | Progress was found in the patient's assimilation process when she adopted a reflective stance regarding her internal experience or external actions. Reflexivity manifests in different forms and at different levels. The therapist's responsiveness facilitated the patient's increased reflexivity and her progress in assimilation | A qualitative descriptive study |
| Cardoso et al. (2016) (Portugal) | Four adolescent patients, 18 years old (one male, four females) | Interpersonal Process Recall Inquiry Interviews (Kagan, 1975) Thematic analysis is a theory-driven process (Watson and Rennie, 1994) | Not applicable | Four basic sequential operations of meaning construction were identified in the patients: symbolic representation of experience, making new realizations, reflexive self-examination, and revisioning self. Additionally, during the negative moments of the sessions, they described feelings of vulnerability, and during the positive moments, feelings of security | A qualitative descriptive study |
| Piazza-Bonin et al. (2016) (USA) | Three adult female patients and three male therapists [a commercially distributed video series created by the American Psychological Association (APA)] Global Assessment of Functioning (GAF) | Innovative Moments Coding System (Gonçalves et al., 2011) Segmented Working Alliance Inventory–Observer-Based Measure (S-WAI-O) | Not reported | The patients maintained a good alliance and achieved satisfactory overall outcomes The results highlight the presence of innovative moments of reflection and reconceptualization in the reconstruction of meanings in these grief therapies | A mixed-design case study |
| Boothe et al. (2010) (Switzerland) | Twenty-three sessions with a female patient. The process lasted for 61/2 years, with a total of 326 sessions | Narrative Analysis: Examining and deconstructing patients' narratives to gain insights into their psychological processes, conflicts, and coping mechanisms JAKOB Narrative Analysis (Boothe, 2004): Systematic interpretation of narratives in psychotherapy. Focus on the communicative category “narrative.” The analysis can consider neither the therapist's comments nor the interaction The transition from textual analysis to the development of psychodynamic hypotheses represents a shift from the construction of the narrative to the exploration of psychological regulation | Not reported | Narratives and conflicts between desires and defenses Characteristic desire/anxiety/defense movements of the patient/narrator are identified, compared, and combined for a broader interpretation In the final phase of therapy, significant changes in narrative dynamics are observed. The initiative for action is concentrated in the ego, which also holds a central position, while other actors are marginalized. Defense mechanisms reveal that the ego does not handle the oedipal desire, confronting it with childish anxieties and distancing it | A qualitative case study |
| Danner et al. (2007) (USA) | Fourteen women were referred to the therapy group. The average age of the participants was 42.6 years | Brief Interview. An 11-item interview was conducted during the initial screening session A Hmong adaptation of the Beck Depression Inventory The main technique was an exploratory focus group. The questions focused on the women's perceptions of their concerns and problems and their expectations for the therapy group. Post-treatment focus group questions assessed the women's experience of the therapy group | Not reported | The intervention was effective in helping Asian participants gain social and emotional support, identify coping mechanisms, and integrate Western practices with those from their own culture Positive therapy feedback: (1) getting out of the house; (2) discussions with other women and meetings with friends; (3) assistance with citizenship applications; (4) learning relaxation techniques; (5) calling others for support; (6) advice and education on coping skills; and (7) identification of lasting coping mechanisms Negative feedback: (1) positive effects limited to time in a group; (2) still struggling with depression and physical symptoms after completing the group; and (3) 10 sessions are not enough | A mixed descriptive study |
| Pote et al. (2003) (UK) | Five senior family therapists from the LFTRC (Leeds Family Therapy and Research Center) in the UK Fifteen videotapes of therapy sessions were purposefully sampled from the library of therapy sessions held at LFTRC | Semi-structured interviews with therapists. The Brief Structured Recall (BSR) method was adapted for the interviews, requiring therapists to review and comment on videos of their own practice Videotapes were selected from the beginning, middle, and end sessions of therapy. These were observed while looking to rate (1) the therapist's intention, (2) the family trigger event, (3) the therapist's techniques, and (4) the content of the discussion Grounded Theory (Strauss and Corbin, 1990) | Not applicable | It is possible to manualize TFS (functional family therapy), taking care of methodological and ethical aspects Regarding the objectives, therapists used different interventions, using linear and circular questions to understand perspectives. For complex goals, circular questions and statements were used to distinguish the ideas of the team and therapists Notable differences were observed in therapist and family activities at different stages of therapy, allowing the structuring of prescriptions in the manual for opening, middle, and closing sessions Therapists showed high adherence to the manual prescriptions in the questionnaire and in the mid-sessions | A qualitative descriptive study |