Interactional positioning and narrative self-construction in the first session of psychodynamic–interpersonal psychotherapy

The purpose of this study is to identify possible Session 1 indicators of end-of-treatment psychotherapy outcome using the framework of three types of interactional positioning; client's self-positioning, client's positioning between narrated self and different partners, and positioning between client and therapist. Three successful cases of eight-session psychodynamic–interpersonal (PI) therapy were selected on the basis of Beck Depression Inventory scores. One unsuccessful case was also selected against which identified patterns could be tested. The successful clients were more descriptive about their problems and demonstrated active rapport building, and the therapist used positionings expressed by the client to explore the positionings developed between them during therapy. The unsuccessful case was characterized by a lack of positive self-comment, minimization of agentic self-capacity, and empathy-disrupting narrative confusions. The authors conclude that the theory of interactional positioning is useful in identifying patterns worth exploring as early indicators of success in PI therapy.