The Capacity for Self-Observation in Psychotherapy

The phenomena of self-awareness and self-observation are thought by many to be uniquely human qualities, and questions about how they develop have engaged philosophers and spiritual thinkers throughout history. More recently these issues have come to occupy psychologists, psychotherapists, and researchers of diverse clinical psychology orientations as well. This dissertation aimed to explore conceptual issues and empirical measurement methods related to the phenomena of selfawareness and self-observation capacities. The four included studies approached this from different angles: Study I used mainly qualitative methods to study post-treatment processes, in particular the phenomenon of self-analysis, related to continuing clinical improvement after termination of long-term psychotherapeutic treatments. The main finding was that self-analysis seemed to be related to continued clinical improvement after formal ending of therapy, but contrary to our hypothesis there was no difference between psychotherapy and the more intensive psychoanalysis in this regard. Study II tested the measurement of mindfulness by self report questionnaires in a sample of experienced Buddhist meditators. The findings confirmed relationships between the measure of mindfulness and psychological well-being, but raised doubt about the instrument’s sensitivity to change at high levels of mindfulness. Study III compared different methods for measuring theoretically related concepts of self-awareness and selfobservation: mindfulness, mentalization (Reflective Functioning), and affect consciousness. This study showed surprisingly and intriguingly little common variance particularly between affect consciousness and mentalization/mindfulness. Finally, study IV found that in patients diagnosed with clinical depression, an application of the Reflective Functioning scale to a brief interview about depressive symptoms predicted aspects of the initial psychotherapy process better than the usual application of the Reflective Functioning scale to the Adult Attachment Interview. In conclusion, it seems that there are several forms of selfobservation, and that these different forms may not be strongly related to each other. Moreover, it seems likely that selfobservation skills vary significantly across contexts. The Reflective Functioning scale may be especially context sensitive and the implications of differences in Reflective Functioning may need to be studied using contextually appropriate methods (e.g. RF about depressive symptoms as opposed to RF about attachment). Methods for measuring mindfulness may be too little context sensitive, making this concept seem more stable (trait-like) than it is according to theory. Taken together, these four studies show the complexity of research on such an elusive concept as self-observation. The relationships between variables related to self-awareness and selfobservation, their measurements, and their relationships to the psychotherapy process seem more complex than would be expected from most current theories. A model for thinking about different forms of self-observation in the process of change in psychotherapy is tentatively proposed.