From the theoretical perspective of expert clinicians representing PDT and CBT, a focus on RF appears to be a common process factor in the way both treatment models are conceptualized. The CPQ can also be a useful instrument in teaching psychotherapy process from different theoretical perspectives and training future clinicians in their application. Future researchers can use these prototypes to explore process in actual sessions.

Transference-focused psychotherapy (TFP) and dialectical behavior therapy (DBT) are 2 treatment models designed to treat patients with borderline personality disorder (BPD). Although originating in separate theoretical orientations, TFP and DBT have been effective in treating BPD patients. Reflective functioning (RF), defined as interpreting the behaviors of self and others as motivated by the underlying mental states of self and others, has been suggested as an effective therapeutic process common to all BPD treatment models. Expert raters provided TFP and DBT prototypes as well as a prototype of RF process using the Psychotherapy Process Q-Set. Three hypotheses were tested: (1) The TFP prototype would be positively correlated with a previously constructed psychodynamic therapy (PDT) prototype and not with a previously constructed cognitive-behavioral therapy (CBT) prototype or the DBT prototype, (2) the DBT prototype would be positively correlated with the CBT prototype and not with the PDT prototype, and (3) the RF process prototype would be positively correlated with both the TFP and DBT prototypes. The TFP and DBT prototypes loaded onto 2 independent factors. The RF process prototype loaded onto both factors. The TFP prototype was positively correlated with the PDT prototype and not with the CBT or DBT prototypes. The DBT prototype was positively correlated with both the CBT and PDT prototypes. The RF process prototype was highly correlated with all prototypes. It is argued that enhancing RF in BPD patients is an implicit process inherent to TFP and DBT and should be explicitly acknowledged.

Leading the charge to link intervention research with clinical practice is the development of process research, which involves a detailed analysis of specific therapeutic processes over the course of treatment. The delineation of interaction structures -repetitive patterns of interactions between patient and therapist over the course of treatment -can inform therapists of what may be expected from patients with particular patterns of symptoms or behaviours in their clinical practice and how interactions change over time. Using the Child Psychotherapy Q-Set, this study aims to compare the different interaction structures that emerged in the two-year psychotherapy of a six-year-old child conducted, for one year each, by two doctoral-student therapists in a university-based community mental health clinic. The study allows for exploration of the independent role of the therapist in the psychodynamic therapy of a child diagnosed with Asperger's disorder. The results suggest that four distinct interaction structures between child and therapist could be identified in this psychotherapy and that the interaction structures differed between the two therapists and also differed over time within each treatment. The implications of these findings for training and clinical practice are discussed.

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An effective treatment model for BPD patients in crisis needs to promote the emergence of empathically attuned interactions as well as supportive and directive interventions as dictated by the patient's individual needs. These treatments require flexibility to accommodate the patient's unique presentation in crisis. The therapeutic dyad senses which interaction structures to increase or decrease over time to reduce the patient's distress.