Table 3.
Main disciplinary findings in the studies.
| References (country) | Subjectivity definition | Intersubjectivity definition | Psychotherapeutic change | Change facilitators/change barriers | Therapeutic interventions from dialogical/narrative models |
|---|---|---|---|---|---|
| Kay et al. (2023) (UK) | The self is conceptualized as a multiplicity of interacting voices engaged in communicative interchange | The internalized psychotherapist, in the form of an external I-position, becomes bonded to an already existing I-position. This strengthens the external I-position's abilities within the repertoire, as it becomes a hybridized version of its previous self | Longitudinal changes in the pattern of I-positions | Experiencing emotion—in the form of emotional I-positions manifested in psychotherapy—may enable subsequent growth in reflexive capacity. Growth of the emotional I-positions, which may facilitate an increase in the breadth of dialogicality, leading to further integration On the other hand, monological organization and the absence of dialogue between I-positions, coupled with the dominance of the suppressive I-position, can be understood as hindering reflexive growth and the development of a meta-position | To promote meta, I use positions that reflect and facilitate dialogue Empathic awareness of the nature of the client's psychological boundaries. These intrapersonal processes could be understood as the relations between external I-positions and internal I-positions Offering empathy to all I-positions may encourage each of them to be manifest and thereby open to transformation during the psychotherapy process |
| Chiara et al. (2023) (Italy) | The self as a narrative organization The self is relational The self is inhabited by a multiplicity of selves and “voices.” The inner world is seen as organized, starting with the social and relational world in which they take part | Human beings are relational and inhabited by a multiplicity of selves; their stories are no longer seen as a unit but as multiple and are socially constructed in dialogue with other people | New narratives and counter-narratives to dominate ones of victimization | Shared emotional experience Not sharing narratives in meaningful emotional contexts | Explore ways to generate a dialogue with other I-positions expressing an alternative or counter-narrative Participating in social events and dealing with an experience in a shared, emotionally dense context can promote PTG (post-traumatic growth) The therapist manages the I-position of “I, the victim” and the victimizing narratives by listening and accepting, allowing the dominant I-position of victimization to be expressed Therapists can explore ways to generate dialogue with other I-positions expressing an alternative or counternarrative |
| Hills (2023). (UK) | Self-conceptualized as moving I-positions mobilized by other internal and external voices | Intersubjectivity implies purposefulness and directionality in the therapist's response to clients as a consequence of holding a coherent model of change | An evolving internalized map of self and world, with a corresponding change in embodied experience Moments of innovation include a migration from one I-position to an alternative I-position, and this formed the basis of an initial theory of change | To recognize painful somatic symptoms and connect emotionally with oneself Not to be able to relate somatic troubles, emotions, and feelings | Use of externalizing problems (White and Epston, 1990) to mobilize other I positions Observing the novelty of I positions. Offering the client a language to make sense of the innovation Framing the innovation as part of a change process |
| DiMaggio et al. (2003) (Italy) | The self is a narrative that arises out of a relationship between characters negotiating the meaning of events with each other, with one of them emerging as the dominant one and taking control of the action Patients describe their subjective experiences by narrating stories | Intersubjectivity is expressed as partners in dialogue pursuing a common goal | The patient's negative emotions diminish in intensity, and dependent characters, suffering from guilt feelings, give way in the texts to narratives in which the self-acts independently and without feeling it is harming others if it accomplishes its own objectives | The self is able to narrate itself and admit voices that allow new meanings, writing and narrating a means to achieve it | Psychotherapists are influential in the modification of the dialogue that takes place between the characters inhabiting a patient's self. This rewriting takes place on two levels: in the patients' mind and in the dialogue between the patient and therapist |
| Mellado et al. (2022a) (Chile) | The self is composed of various I-positions or self-states. These self-states interact continuously as individuals engage in internal and external dialogues. A personal position is one of the possible states of the self, influenced by individual background and subject to change from one moment to another | The others are presented in a double protagonist position, internal and external, that is constituted during the history of interpersonal relationships and that situates them as characters that form part of the self in an inner scenario, influencing the subjective dynamics | Dysfunctional elements of the self can be changed as part of a repertoire of broader, organized positions. Functional parts of the self can facilitate the modification of dysfunctional parts and enable their inclusion as components of broader and more adaptive coalitions The notion of therapeutic change is a transformation of patients' subjective theories about themselves, their relationship to the environment, and their problems | Voices of the self that hinder or facilitate dialogue with the patient | Recognizing possible moments of change or enhancing therapeutic conversations from positions that are related to the change of the patient. Self-recognition and partial recognition of personal positions may be possible to the extent that patterns have already been identified and established at relevant moments in psychotherapy |
| Mellado et al. (2022b) (Chile) | As self-narrated in different voices, narrated stories emerge every time subjective positions are endowed with these voices, which can engage in dialogical interactions that give them dynamism | The creation of meanings is not understood as the production of particular content but rather is subject to a structure based on the activation of an intersubjective space that delimits the possibility of certain contents and meanings | A process of subjective transformation from a monological to a dialogical dimension, a more fluid exchange among the different voices of the self. A transition from a state of dissociation to a reorganization of subjectivity | Positive outcomes of the therapy are associated with the quality of the voice and position patterns that are formed in the process, which sustain these changes through the particular subjective structure that was consolidated. | Promote the construction of dialogical spaces (integrating the different positions) and the development of a reflective metaposition Talking about what has not been talked about before, reflecting on what she is talking about, and reducing monological interactions, allowing dialogical interactions to be achieved |
| Steen et al. (2023) (Netherlands) | Organized aspects of self-knowledge into an overarching autobiographical narrative | Respect for others and a desire for contact and union with others are characterized by care, love, intimacy, and tenderness Furthermore, visions of the good related to recognition of the self can be understood in terms of so-called S-motives, which reflect the desire for self-enhancement. In stories that people tell about themselves | To reconstruct their life narratives to become richer and more flexible, thus increasing their sense of agency and purpose Change is a recognition of the self and respect for others, and it is how being vulnerable becomes more valuable | Notions about “the good” are oriented toward meaning in life versus notions of self-blaming and disorienting purpose | Improved interpersonal functioning by identifying aspects of life and relationships as “good” through interventions by counselors |
| Dawson et al. (2021) (Australia) | Articulation of internal and external voices that are arranged in scenarios of greater or lesser positional hierarchy | Negotiation of silenced and blocked voices in relational scenarios of openness, closeness, and authentic listening | Renegotiation of notions of competence and collaboration in meaningful listening settings, different and differentiable from previous experiences with other health and social services | Re-signifying power relations in a web of horizontally arranged voices | Open dialogue guidelines (Seikkula et al., 2003) |
| Kay et al. (2021) (UK) | Internal I-positions, external I-positions, and their interactions | There is a permanent interrelation between polyphony and multivocality, attending to external and internal voices that stress mutual assemblages and resonances | The origins and changes in the relationship between internal and external I-positions | Facilitating the transit of I-positions by identifying each of these positions in each context of psychosocial application | Not made explicit |
| Råbu et al. (2019) (Norway) | The self is understood as a constellation of narrative accounts of one's own experiences in specific situations of personal and professional development | Intersubjectivity is understood as a collective autoethnography in which lived and enhanced experiences are made available to others through personal and collective storytelling | Change takes place through subtle learning processes that are set to establish the link between having been a client and working as a therapist, i.e., I-position, as a subjective and reflexive process of reworking meanings in the search for professional sensitivity | Facilitators and hindrances are in different areas of learning: negative experiences reinforce one's own convictions to act differently; positive experiences serve as inspiration and support; coming to therapy early in life represents an important formative experience; working through complex personal problems in therapy brings value in identifying similar conflicts | Learning transfer strategies and subjective and reflective processes of re-elaboration |
| Penttinen et al. (2016) (Finland) | Different positions of the self may emerge, among which may be metapositions that adopt the perspective of an author who observes the other positions and how they function as actors in certain circumstances. This dynamic allows for self-awareness and the ability to make relevant connections in one's own life experiences A community of voices in which each of them can be used when necessary | The dialogical space of encounter among interpersonal positions (therapist and patient) can be defined according to the Vygotskian concept of zone of proximal development (ZPD) (Leiman and Stiles, 2001) | Increase in patients' reflexivity and assimilation of their problematic experiences. Reflexivity at the first level allows an observational stance of one's own experiences or internal processes, and at the second level, observations about one's own way of interpreting experiences Problematic voices are accepted and integrated into the dominant community of voices | Assess patients' ability to accept the point of view being offered; assess the particular stage of the assimilation process each patient is in; Support all voices in the community. The opposite may be understood as a barrier | The therapist's responsiveness and work within the zone of proximal development (ZPD) regarding the process of assimilating patients' voices Formulation of patients' problematic experiences, empathic listening, empathetic expression, clarification, reconstruction, and gentle confrontation regarding issues that need to be constructed by the patients and their problematic experiences |
| Cardoso et al. (2016) (Portugal) | Development of symbolic representations of internal (including the self) and external experience. Construction of meanings from new understandings through the articulation of micronarratives and the development of macronarratives | It cannot be inferred | Coherent meaning construction is based on the interconnection and articulation of life experiences The emergence of a new narrative order and the transformation of the self | Stimulation of reflective operations that enable the construction of a coherent and continuous narrative. These can be understood as barriers, but they are the opposite | Tasks aimed at exploring patients' emotional experiences to facilitate their symbolic representation Practices that help patients connect feelings, behaviors, and life episodes promote a better understanding of the causes and consequences of their issues |
| Piazza-Bonin et al. (2016) (USA) | The internal world is shaped by self-narratives, which are overall cognitive-affective behavioral structures that organize daily micronarratives into macro-narratives that consolidate the understanding of the self | It cannot be inferred | The transition from narratives saturated with problems to broader, more flexible, and adaptive ones Formation and reconstruction of self-narratives | Identification, elaboration, and expansion of new events in the patients' self-narratives; reconceptualization and formation of a meta-position that makes the processes of change conscious; there is a need for affirmation and empowerment. Short-term psychotherapies can be considered barriers | Interventions for meaning generation Balance between supportive and challenging techniques so that new experiences can be better tolerated, considered, and integrated. Not to exceed the Zone of Proximal Development (ZPD) in psychotherapy |
| Boothe et al. (2010) (Switzerland) | Subjectivity refers to the individual's personal perspective, experiences, feelings, and interpretations that shape the narrative account. The patient's narrative is a reflection of their own subjective experience and understanding of their thoughts, emotions, and interactions | An interaction and mutual understanding between the patient and the therapist, where both parties engage in reflecting upon and exploring the patient's narrative in the context of their shared therapeutic experience | Psychological change in this context encompasses the evolution of the narrator's thoughts, emotions, and strategies as they navigate their inner conflicts and interact with external influences, ultimately leading to shifts in their understanding of themselves and their situation | Evolution of initiative: The change in initiative control from others to the ego figure indicates a potentially positive change Narrative centralization: The ego figure's transition to a central position in the narratives during the final phase suggests increased self-expression and ownership of the stories Oedipal themes and anxieties: The presence of oedipal wish and anxiety themes, as well as anxieties related to steering and control, can be challenging for the narrator Defense mechanisms: The continued use of defense mechanisms like identification with the aggressor, rationalization, and intellectualization suggests resistance to deeper emotional processing Power and autonomy axes: The continued emphasis on power and autonomy, along with a relatively unimportant closeness axis, might reflect challenges in forming close, trusting relationships | The analysis of multiple narratives and the identification of wish/anxiety/defense patterns Exploration of changes in narratives: The change in the centralization of the ego figure in the narratives Exploration of conflict themes: the identification of wish themes, anxiety themes, and conflict dynamics to identify and explore underlying conflict themes in their emotional experience Alignment of self-concept: the identification of changes in the power and autonomy axes Consideration of significant relationships: The focus is on relationships with other actors in the narratives |
| Danner et al. (2007) (USA) | Subjectivity refers to personal experiences, thoughts, and emotions. The Hmong women's subjective experiences of illness and healing are influenced by their cultural background. Descriptions of dreams, fears, and hopes for healing, unique perspectives on their mental health struggles, and understanding of their condition | Intersubjectivity refers to the sharing of subjective experiences and meanings, especially within a cultural context. The concept of “soul loss” or “fate” causing illness highlights a shared cultural understanding that contributes to how Hmong women perceive their mental health issues | The concept of change was referred to as overcoming psychological distress and cultural adaptation. The goal of the intervention was to facilitate a process of change that alleviates symptoms of depression, anxiety, and posttraumatic stress disorder while enhancing social support networks and coping strategies | Connection and social support: The therapy intervention created a space for connecting with others, sharing experiences, fostering understanding, and providing emotional support Learning and coping skills: Participants gained valuable coping skills through relaxation techniques, Tai Chi, and other activities. These skills empower them to manage their symptoms, reduce stress, and improve their wellbeing Practical support: Assistance with practical matters, such as help with citizenship applications and coordination with social service agencies Provider relationship: Participants established a positive and supportive relationship with the therapy facilitators, fostering trust, hope, and a sense of guidance Commitment to family and support systems: Participants found strength in their commitment to their families and children, as well as in their religious faith, providing a sense of purpose and resilience against challenging thoughts Limited transfer of skills: struggles to apply the skills to daily lives outside of the therapy sessions Persistent depression: Many participants continued to struggle with persistent depression and physical symptoms, indicating that the intervention did not completely alleviate their distress Perceived short duration: The limited number of sessions in the therapy intervention hindered participants' ability to fully delve into their concerns and make lasting changes. Some felt that more time was needed for deeper exploration |
Sharing Personal Stories: This aligns with narrative therapy's focus on helping individuals construct and reframe their life stories in a way that empowers them to overcome challenges Empowerment Through Storytelling: The participants' positive experiences in sharing their stories and listening to others' stories allow them to externalize their problems and re-author their narratives Co-Construction of Meaning: The therapists collaborate with participants to co-construct meaning and explore alternative perspectives Externalization of Problems: The therapy intervention encourages participants to view their problems as external to themselves to help them separate from their difficulties Connection and Social Support: The sense of connection among participants and their shared experiences demonstrates dialogic therapy's emphasis on the importance of relationships and social support in healing and growth Open Dialogue: The participants engage in open discussions within the therapy group, allowing them to express their thoughts and emotions openly Collaborative Exploration: The multidisciplinary team of facilitators collaborates with participants to explore various aspects of their experiences and to create a space for mutual understanding and growth External Input and Community Involvement: The involvement of various community members and experts in the therapy sessions reflects dialogic therapy's broader view of therapy, where external perspectives and contributions from the community are valued |
| Pote et al. (2003) (UK) | Narratives, or stories, are based on behaviors and beliefs that are constructed by language and interactions among individuals who construct reality | Intersubjectivity could be considered collaborative and dynamic | Psychological change in family dynamics | The manualization process seeks to standardize therapeutic interventions. This consistency provides a structured approach that therapists can use to target specific therapeutic goals, which contributes to the facilitation of psychological change Putting principles and theoretical concepts into a manual provides a theoretical foundation for interventions. It helps therapists navigate complex family dynamics and guide their efforts toward fostering change through systemic understanding and interactional interventions Over-prescription: a manual might become overly prescriptive and restrict therapists' creativity | Narrative Exploration: The importance of understanding family members' stories and narratives Cultural Context: In a narrative framework, therapists would collaborate with families to understand the cultural stories that shape their identities and relationships Co-constructed Practice: The principle emphasizes the collaborative nature of therapy. This involves engaging in meaningful conversations that lead to new meanings and perspectives, echoing the dialogical idea of co-creating new understandings Circularity and Connections: The emphasis on circular patterns of behavior and connections focuses on understanding relational dynamics and interdependencies among family members |