Interaction structures in the psychodynamic psychotherapy of a patient with chronic diseases and somatic symptoms

Abstract

Objective This study aimed to identify and analyze the interaction structures (ISs) (patterns of reciprocal interaction between the patient-therapist dyad) that characterize the process of a successful long-term psychodynamic psychotherapy (28 months) of a patient with chronic diseases (lupus and fibromyalgia) and somatic symptoms. Methods The 113 sessions were videotaped and analyzed alternately (n = 60) by independent judges using the Psychotherapy Process Q-Set. Inter-rater reliability ranged from 0.60 to 0.90, with a mean of r = 0.71 (Pearson’s correlation). Through a principal component exploratory factor analysis, four ISs were identified. Result The patterns of interaction between patient and therapist showed clinical validity (i.e., they were easily interpretable in the context of the case under study). The ISs were non-linear and more or less prominent across different treatment sessions and stages. Some ISs were similar to those in other studies, and others were probably unique to the present process. In addition, some ISs were independent, whereas others were interrelated over time. Conclusion Process studies, such as the present one, seek to address questions about the characteristics of the interaction between patient and therapist as well as to identify particular patterns of interaction that are most prominent with a specific patient at a specific condition or time. Therefore, these studies can provide some support in establishing knowledge for clinical practice, assisting in the training of therapists, as well as in the elaboration of general guidelines for the technical management of patients with specific characteristics.

Interaction Structures in the Online Psychodynamic Psychotherapy of a Patient with Anxiety Symptoms

“…Considering the IS, the findings confirm that it is possible to identify relational patterns of the therapeutic dyad throughout an online treatment, as seen in face‐to‐face psychotherapies (Goodman, Edwards & Chung, 2014; Laskoski et al ., 2019; Serralta, 2016), even though the percentage of total process variance explained by the IS in this case is small. Despite de small number of sessions, it was possible to identify meaningful interpretative IS, as already demonstrated in another study with time‐limited therapy (Serralta, 2016).…”

“…Although IS can be captured simply based on the descriptive analysis of the variation of the items throughout the treatment, many studies rely on a more robust method of detection that uses the Q‐type factorial analysis to reduce the data and generate the factors (items of the pair correlated throughout the process), that is, the IS. These studies have contributed to understanding the patterns that are characteristic of the dyad studied and those that are repeated in various cases (Goodman, Edwards & Chung, 2014; Laskoski et al ., 2019; Serralta, 2016).…”

“…IS have already been verified in a series of clinical cases with adults with different psychopathological conditions (Ablon & Jones, 2005; Goodman, Edwards & Chung, 2014; Jones, 2000; Laskoski et al ., 2019; Serralta, 2016). Research with IS contributes to the understanding of many aspects of the psychotherapeutic relationship, including intersubjectivity and transference and countertransference patterns (Jones, 2000).…”

Psychotherapy Dropout: Using the Adolescent Psychotherapy Q-Set to Explore the Early In-Session Process of Short-Term Psychodynamic Psychotherapy

“…Whereas a few multiple-case and single-case studies have identified a number of interaction structures and linked these with outcome in adult psychotherapy (Ablon et al, 2011;Goodman et al, 2014;Serralta, 2016;Laskoski et al, 2019) and child psychotherapy (Goodman and Athey-Lloyd, 2011;Goodman, 2015;Ramires et al, 2017Ramires et al, , 2020Odhammar et al, 2019), there is only one study that explored these in adolescents (Calderón et al, 2019) and none in individuals of any age range who dropped out of treatment. Philips et al (2018) utilised the PQS to explore the early psychotherapy process between completers and dropouts of six adult patients with a dual diagnosis who received mentalisation-based treatment (MBT).…”