Challenges and added value of measuring embodied variables in psychotherapy

Abstract

Research on embodied aspects of clinical encounters is growing, but discussion on the premises of including embodied variables in empirical research is scarce. Studies have repeatedly demonstrated that embodied aspects of psychotherapy interaction are vital in developing a therapeutic alliance, and these should be considered to better understand the change process in psychotherapy. However, the field is still debating which methods should be used and which features of the embodied aspects are relevant in the clinical context. The field lacks methodological consistency as well as a theoretical model. In the Relational Mind research project, we have studied the embodied aspects of interaction in the context of couple therapy for almost a decade and have gained experience with the positive and negative aspects of studying embodied variables in quantitative and qualitative studies. We have set out to develop the methodology (or procedures) for studying embodied variables in a multiperson setting, concentrating on interpersonal synchrony of sympathetic nervous system responses and movements, and we have strived to create methods for integrating information from different embodied modalities. In this narrative review, we share our experiences of the challenges and added value of studying embodied aspects in psychotherapy. The research field urgently needs an ongoing discussion of what researchers should take into consideration when studying the embodied aspects of interaction. We urge researchers to collaborate between research groups to jointly decide on the basic parameters of studies on the different embodied modalities of the research so that the individual researcher can become more aware of the impact the methodological choices have on their studies, results, and interpretations. We also see the use of embodied variables as having added value in the clinical work of psychotherapists, since it not only deepens our understanding about what is helpful in psychotherapy but will enable fine-tuning therapy processes to better suit clients who are verbally less fluent.

“INTEGRO INTEGRated Psychotherapeutic InterventiOn” on the Management of Chronic Pain in Patients with Fibromyalgia: The Role of the Therapeutic Relationship

“…In our opinion, in order to untangle this complex interaction, the process should be analyzed with different coding and interpretation keys, which include both conscious (verbal or written reports) and less consciously controllable aspects (such as physiological reactivity, i.e., concordance indices skin conductance and heart rate variability [92]), together with observational coding systems of the interaction between the patient and the therapist, as additional indicators of the quality of attachment and reciprocal relationship (such as, for instance, the patient attachment coding system-PACS [93]-and the therapist attunement scales-TASC [94]). As suggested by Nyman-Salonen et al [95], embodied aspects are one of the "common factors shared among psychotherapy approaches that account for the effectiveness of the treatment" [95][96][97][98]. This because part of the change during the psychotherapy process occurs through the embodied connection between the therapist and client, revealing important bonding aspects which cannot be symbolized verbally, particularly when considering patients with somatising disorders.…”

“…Although physiological measures may reflect autonomic phenomena which are not consciously controllable, revealing unaware aspects of the quality of the therapeutic relationship, they do not allow univocal meanings and reflect a non-specific physiological activation, which needs careful interpretation [39,95,106].…”

The Automated Test of Embodied Cognition: Concept, Development, and Preliminary Findings

“…In recent years, there has been a growing body of research regarding the relevance of EC to treatment mechanisms and outcomes in psychotherapy [ 20 , 21 ]. The ATEC offers psychotherapy researchers and practitioners a highly accessible tool for assessing psychotherapeutic outcomes related to EC, circumventing the prohibitive cost and time associated with conventional neurocognitive assessment.…”

Interoceptive awareness and therapist characteristics

“…This underlines the usefulness and importance of studying the therapist's body, making it an interesting topic for research. Yet, there has been limited research on the significance of the therapist's physical presence (Athanasiadou & Halewood, 2011); nonetheless, there is a growing recognition of its importance, resulting in the incorporation of therapist body-related factors into recent research (Nyman-Salonen et al, 2022). Craig (2002) defines interoceptive awareness as the subjective assessment of one's own state; that is, how the nervous system perceives and interprets signals originating from within the body.…”