Narrative group therapy with outpatient adolescents

198 Pages·2016·3.78 MB·English

by  David Charles Kaptain

Iowa State University Capstones, Theses and
Retrospective Theses and Dissertations
Dissertations
2004
Narrative group therapy with outpatient
adolescents
David Charles Kaptain
Iowa State University
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Kaptain, David Charles, "Narrative group therapy with outpatient adolescents " (2004).Retrospective Theses and Dissertations. 789.
https://lib.dr.iastate.edu/rtd/789
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Narrative group therapy with outpatient adolescents
by
David Charles Kaptain
A dissertation submitted to the graduate faculty
in partial fulfillment of the requirements for the degree of
DOCTOR OF PHILOSOPHY
Major: Human Development and Family Studies
Program of Study Committee:
Jacques Lempers, Major Professor
Mary Huba
Ronald Werner-Wilson
Norman Scott
Harvey Joanning
Iowa State University
Ames, Iowa
2004
UMI Number: 3136322
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For the Major Program
iii
TABLE OF CONTENTS
LIST OF TABLES v
LIST OF FIGURES vi
ABSTRACT vii
CHAPTER 1. INTRODUCTIONS 1
Statement of the Problem 1
Purpose of the study 6
Research questions 6
Hypotheses 7
Design of the study 8
CHAPTER 2. LITERATURE REVIEW 11
Content of Narrative Therapy 11
Narrative Therapy 13
Implications and Connections Inherent to Narrative Therapy 25
Applicability of Narrative Therapy to the Treatment Setting 28
CHAPTER 3. METHODOLOGY 32
Introduction 32
Instruments and Data Collection 41
Procedures for Treatment 51
CHAPTER 4. FINDINGS: DATA ANALYSIS AND RESULTS 71
Quantitative Analysis 71
Qualitative Analysis 81
CHAPTER 5. SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS 114
Summary 114
Conclusions 118
Discussion 121
Directions for Further Research 137
REFERENCES 142
APPENDIX A 153
iv
APPENDIX B 159
APPENDIX C 165
APPENDIX D 166
APPENDIX E 167
APPENDIX F 170
APPENDIX G 181
APPENDIX H 182
APPENDIX 1 183
APPENDIX J 186
ACKNOWLEDGMENTS 189
V
LIST OF TABLES
Table 3.1: Descriptive statistics of variables for participants who were substance involved* 36
Table 3.2: Descriptive statistics of variables for chemically dependent participants 37
Table 3.3: Descriptive statistics of variables for participants who were substance abusers 38
Table 3.4: Descriptive statistics of variables for participants who were non-involved with
substances 39
Table 3.5: Descriptive statistics of variables for participants who received narrative therapy 40
Table 3.6: Descriptive statistics of variables for participants who did not receive narrative therapy 41
Table 4.1: Rotated factor matrix of SASSI-A2, Subscale FYA 73
Table 4.2: Rotated Factor Matrix of Substance Abuse SASSI-A2, Subscale FVOD 74
Table 4.3. Rotated factor matrix of treatment satisfaction questionnaire, subscale SAT* 75
Table 4.4: Rotated factor matrix of treatment satisfaction questionnaire, subscale TASK* 76
Table 4.5. Rotated factor matrix of treatment satisfaction questionnaire, subscale GOAL* 77
Table 4.6: Correlation matrix 79
VI
LIST OF FIGURES
Figure 1. Distribution of themes in comments made regarding narrative therapy
vii
ABSTRACT
Adolescent substance abuse remains a major public health concern. The comprehensive,
detrimental effects of teenage drug use, coupled with troubling relapse rates, highlight the need for
innovative, effective, and helpful treatment interventions. Adolescents in treatment and the adults
that work with them are subject to often negatively influential societal discourses that limit treatment
effectiveness as well as the development of adolescent treatment satisfaction and therapeutic alliance.
Narrative therapy is promoted in theoretical and clinical literature as a viable way of addressing these
problems.
Preliminary work has been done in the area of narrative therapy with adolescents, and
particularly with substance abusing and chemically dependent adolescents. However, empirical and
qualitative research regarding narrative therapy with teens is scarce. Studies examining narrative
therapy in regard to the promotion of treatment satisfaction and therapeutic alliance are virtually non­
existent. This study presents preliminary empirical and phenomenological research that indicates a
positive adolescent response to narrative therapy. These responses involve the development of
greater, subjective understanding of and increased resistance to substance abuse and behavioral
problems. Finally, the information presented in this study points to the development of a potentially
useful group treatment model of narrative therapy with adolescents having substance abuse and other
behavior or emotional problems.
1
CHAPTER 1. INTRODUCTION
Narrative therapy has been promoted as a mode of therapy which is empowering, socially
sensitive, and able to free individuals and families from the subjugating dominance of oppressive
narratives and discourses in their lives. This approach to problems is situated in the theoretical
contexts of social constructionism and post-modernism, and lends itself to a wide variety of
therapeutic circumstances (Parry & Doan, 1994; Freedman & Combs, 1996; Smith & Nylund, 1997).
This paper is a report on a qualitative-quantitative research project involving narrative
therapy approaches with chemically dependent and behaviorally disordered adolescents in an
outpatient clinical setting. Of interest is the effect of narrative therapy on adolescent satisfaction with
treatment and on the development of the therapeutic alliance (Horvath & Greenberg, 1994) between
therapists and adolescent clients. The project assessed these constructs by conducting quantitative
measurement of adolescent client satisfaction with outpatient mental health and substance abuse
treatment and by measuring therapeutic alliance. Qualitative information about adolescent reactions
to and thoughts about narrative therapy was gathered and examined with phenomenological analysis.
Statement of the Problem
Adolescent substance abuse remains a major public health issue (Winters, 1999; Liddle,
Dakof, Parker, Diamond, Barrett, & Tejeda, 2001). National estimates of adolescent substance abuse
indicate, with some exceptions, a steady increase since 1992 (Winters, 1999). The widespread,
damaging effects of adolescent substance abuse are well-established: school failure, delinquency,
motor vehicle accidents, arrests and incarceration, increased risk for human immunodeficiency virus
(HIV) and other physical problems (Liddle et al., 2001; DiClemente, 1990; Hansell, & White, 1991;
Loeber, 1990).
Along with steadily increasing rates of substance abuse, relapse rates of substance abuse
behaviors in adolescents who have received treatment remain high (Center for Substance Abuse