THE ALPHABET OF SILENCE: AN EMPIRICAL INVESTIGATION OF PSYCHODYNAMICS OF NON ...

228 Pages·2015·1.81 MB·English

THE ALPHABET OF SILENCE: AN EMPIRICAL INVESTIGATION
OF PSYCHODYNAMICS OF NON-VERBAL
PLAY IN CHILD PSYCHOTHERAPY

Emine Ünlü
112637004

İSTANBUL BİLGİ ÜNİVERSİTESİ
SOSYAL BİLİMLER ENSTİTÜSÜ
KLİNİK PSİKOLOJİ YÜKSEK LİSANS PROGRAMI

YRD.DOÇ.DR. SİBEL HALFON
2015
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Abstract
The purpose of this thesis is to investigate the case Alex, a five- year old boy who preferred to stay
silent in the therapy room however communicated immensely through his non-verbal play
behaviors and bodily gestures. His psychodynamic psychotherapy therapy process over one year
was analyzed through various quantitative and qualitative methods in order to systematically study
his non-verbal behaviors. In the quantitative part, DSM related measures were used to assess his
behavioral functioning; as well as a psychodynamic play therapy instrument to assess his behaviors
in the therapy room, through using 10 sessions belonging to different points of treatment.In the
qualitative part, 4 sessions at four month intervals were analyzed through a close sequence analysis
according to Infant Observation Principles to be further subjected to a systematic thematic analysis.
Findings indicated that, Alex’s silence provided a psychic cocoon developed due to early fragilities
such as early separation from the mother, problems of creating a separate identity as a twin and
being holder of the intergenerational transmission of parental history. The clinical aspects of his
silence were also discussed in relation to the treating therapist’s clinical choices, technical
interventions and countertransference reactions.

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Özet
Bu çalışmanın amacı 5 yaşında olan, terapi odasında konuşmamayı tercih eden, fakat sözel
olmayan oyunu ve bedensel hareketleri ile yoğun bir şekilde iletişim kuran Alex vakasını
incelemektir. Alex’in bir yılı aşkındır devam eden psikodinamik yönelimli psikoterapi süreci, onun
sözel olmayan davranışlarını sistematik bir şekilde anlamlandırmak için kantitatif ve kalitatif
yöntemlerle değerlendirilmiştir. Çalışmanın kantitatif ayağında, vakanın davranışsal profili DSM
yönelimli ölçeklerle değerlendirilmiş; terapi odasındaki davranışları ise terapi sürecinin farklı
dönemlerinden seçilmiş 10 seans üzerinden psikodinamik yönelimli oyun terapisi ölçeği
kullanılarak araştırılmıştır. Çalışmanın kalitatif kısmında ise, 4 ay aralıklarla seçilmiş, terapi
sürecindeki farklı süreçleri yansıtan 4 seans, Bebek Gözlemi Prensiplerine dayanarak deşifre
edilmiş ve daha sonra bu seanslar tematik analize tabi tutulmuştur. Sonuçlar Alex’in, bebeklik
dönemindeki -anneden ayrılma deneyimi gibi- erken dönem hassasiyetlerini tetikleyen durumlar ve
ikizlik durumundan dolayı bağımsız bir kimlik gelişimi oluşturmada yaşadığı güçlükler nedeniyle,
kendisini konuşmayarak ruhsal bir koza içinde tuttuğunu göstermektedir. Bu durumun, Alex’in,
ebeveynlerinin hikayesindeki kuşaklararası aktarılan bazı örüntülerin mirasçısı olması ile pekiştiği
düşünülmektedir. Son olarak, Alex’in terapi odasındaki sessizliğinin anlamları; terapistin klinik
yönelimleri, teknik müdahaleleri, ve karşı aktarımsal deneyimleri üzerinden tartışılmıştır.

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Acknowledgments
This thesis is about the transformation process of an encapsulated child within a containing
environment. The process of studying this program and producing this thesis has played a critical
role in my personal transformation as a beginner therapist and as a women belonging to mid-
twenties. First of all, I want to thank to Alex who took the leading role in thesis for participating
this research and encouraging me to reach my encapsulated parts while he was trying to confront
with his enclosed self. For directing me into this elaborative, deep thinking process and research,
providing a holding and inspiring environment in which my transformation and this pleasurable
creation process came true, I feel deeply thankful to my thesis supervisor and mentor Sibel Halfon. I
appreciate her flexible, creative and containing accompany to me a lot in this both progressive and
regressive, pleasurable and sometimes, frustrating journey.
I also want to thank to my second thesis advisor Yudum Söylemez Akyıl. I always felt held
up with her encouraging contributions and thoughtful attitudes in this process. Moreover, I want to
thank to Jeannne Magagna who is another valuable member of my defense jury. She put valuable,
profound and inspiring contributions into this work and widened my perspective a lot with her
sincere and wise approach.
I also thank to my supervisor Göver Kazancıoğlu for her leading me to a nuanced, deep and
creative thinking process about internal process of my patients, especially Alex. She helped me a lot
in understanding deeply what I have been trying to do as a psychotherapist.
I want to thank to TUBİTAK for providing scholarship throughout my academic process, it
supported very much in reaching my academic goals.
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Another special thankfulness is for my dearest friend Damla Okyay who accompanied with
me in this journey with her genuine, emphatic existence. She always made me burst into laughs
when I felt like bursting into tears due to difficulties of this process.
Moreover, I am very thankful to my very close friends Özgün Taktakoğlu, Ozan Salamcı.
They have always been there for me and helped me to feel held and secure like a family. More
thanks to Zeynep Türkmen and Altuğ Öztürk for their deep friendship and strong support. Also, I
want to thank deeply my lovely friends Canan Altındaş, Cansu Torun and Zeynep Kocaoğlu for
their constant, valuable emotional presence and generous academic recommendations in writing this
thesis.
For their helpful, crucial academic touches to this work, I want to thank Dilay Karadöller
and Ebru Salman.
Also, I want to express my thankfulness to all my friends in this program. We could have a
chance to enjoy an efficient learning and growth process together with a constructive, understanding
and containing interactions.
Lastly, I want to present my special thanks to my parents Ayşen and Dursun Ünlü for their
constant belief, support and encouragement. Also, I want to thank my lovely sister Ezgi Ünlü. She
has always influenced me a lot with her lasting creativeness and playfulness.

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Table of Contents

1. Introduction…………………………………………………………………………...1
1.1. Participant ……………………………………………………………………...1
1.1.1. Presenting Problem and developmental History………………………...1
1.1.2. Background Information………………………………………………..2
1.1.3. Family Configuration…………………………………………………..4
1.1.4. First Evaluation with Alex and His family…………………………….6
1.2. Rationale and Aim of the Study………………………………………………..7
1.3. Research Hypothesis……………………………………………………………8
1.4. Theoretical Analysis…………………………………………………………….9
1.4.1.Considerations about Different Functions of the Silence………………10
1.4.2. Considerations about What Silence Communicates in the
Therapy Room………………………………………………………………………14
1.4.3. Considerations about Technique When Working with a
Silent Child……………………………………………………………………........16
1.4.4. Summary of Theoretical Analysis……………………………………...24
1.5. Empirical Analysis…………………………………………………………....25
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1.5.1. Single Case studies………………………………………………….27
2. Methods………………………………………………………………………….31
2.1. Rationale for the Participant Selection……………………………………..31
2.2. Data Collection and Ethical Considerations………………………………..31
2.3. Measures……………………………………………………………………32
2.3.1. DSM Related Measures…………………………………………….32
2.3.1.1. Children Behavior Checklist (CBCL-6/18)………………..32
2.3.1.2. Children Global Assessment Measure (CGAF)…………...33
2.3.2. Psychodynamic Assessment Measure…………………………….33
2.3.2.1. Children’s Play Therapy Instrument (CPTI)……………...33
2.4. Procedure and Plan for Data Analysis……………………………………..39
3. Quantitative Findings………………………………………………………….. 41
4. Qualitative Data Analysis……………………………………………………....56
4.1. Infant Observation Techniques……………………………………………..56
4.2. Thematic Analysis………………………………………………………….96
5. Qualitative Findings………………………………………………………….…96
6. Discussion………………………………………………………………….......112
6.1. The Encapsulated State of Mind and its Transformation…………………116
VII
6.2. Development toward Dyadic Relationship & Twinship…………………..120
7. Conclusion……………………………………………………………………..128
7.1. My Psychotherapeutic Encounter with Alex……………………………...128
8. Limitations and Further Researches………………………………………........129
References………………………………………………………………………………131
Appendices……………………………………………………………………….…….138

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List of Appendices
Appendix A. Informed Consent Form.............................................................................152
Appendix B. Template of Children Play Therapy Instrument ……………………...….155
Appendix C. Session transcripts ……………………………………………………......157
Appendix D. Tables……………………………………………………………………..195

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