From conflict and suppression to reflection: longitudinal analysis of multivoicedness in clients experiencing depression

Depression is a worldwide problem requiring more research on clinically effective treatments. This study was based on a conceptualization of the self as multivoiced: constituted of multiple autonomous “I-positions.” We aimed to investigate the relational patterns between voices in patients experiencing depression, and the changes which arise through psychotherapy. Transcripts from the first, middle, and final psychotherapy sessions of five individuals treated for depression—all showing reliable improvement—were analyzed. We used the qualitative method of analyzing multivoicedness (QUAM) to identify I-positions, their relationships, and how these changed over the course of the treatment. In all cases we found two opposing I-positions which were in conflict and a third which served to suppress this conflict and limit affect. At midpoint, an emotional I-position emerged which enabled a working through of previous problematic narratives. In the last session there was an increased degree of reflexivity, which heightened the level of dialogicality between existing I-positions. These findings can be used to develop treatments that can identify inner conflict and suppression, and cultivate reflexivity in patients