Self-narrative reconstruction after dilemma-focused therapy for depression: a comparison of good and poor outcome cases

Objective: The aim of this study is to improve the understanding of self-changes after an intervention for depression focused
on implicative dilemmas, a type of cognitive conflict related to identity. As recent research has highlighted the relevance of
identity-related dilemmas in clients with depression, we sought to assess the way in which clients resolve such inner
conflicts after a tailored dilemma-focused intervention and how this is reflected in the clients’ self-narratives. Method: We
used three instruments to observe differences between good (n = 5) and poor (n = 5) outcome cases: (i) the Repertory
Grid Technique to track the resolution of dilemmas, (ii) the Change Interview to compile clients’ accounts of changes at
posttreatment, and (iii) the Innovative Moments Coding System to examine the emergence of clients’ novelties at the
Change Interview. Results: Groups did not differ in terms of the number and relevance of client-identified significantly
helpful events. However, between-group differences were found for the resolution of dilemmas and for the proportion of
high-level innovative moment (IM) types. Furthermore, a greater self-narrative reconstruction was associated with higher
levels of symptom improvement. Conclusions: Good outcome cases seem to be associated with the resolution of conflicts
and high-level IMs.
This study has been partially supported by the Portuguese
Foundation for Science and Technology
(PTDC/ PSI-PCL/121525/2010) and the Spanish
Ministry of Economy and Competitiveness
(PSI2011–23246).