Is there a relationship between therapist language use, patient defensive functioning and therapeutic alliance? A pilot study of in-session processes

Abstract

Aim: Interpretations are a key technique that distinguishes psychodynamic therapies from many other treatment modalities [1,37]. Research has explored elements of interpretations (e.g., accuracy, timing, depth) and their impact on various variables such as patient defensive functioning, therapeutic alliance and treatment outcome. However, while there is a universal agreement among psychodynamic scholars and clinicians [e.g., 4,5,35] that therapists should refrain from using psychological jargon and overly technical language when making interpretations, this question had not yet been investigated empirically. Method: This study examined 32 psychotherapy sessions (15 high alliance and 17 low alliance) of 17 students in therapy at a university counselling center and aimed to examine the relationship between the therapists' verbosity when interpreting defenses, patient defensive functioning and therapeutic alliance. Three components of therapist verbosity in interpretation of defenses (TVID) were explored: average length of interpretation, average word length per interpretation, and total number of technical words in interpretations, to determine their relationship to-therapeutic alliance and patient defensive functioning. Results: Results indicated no significant differences between different components of TVID and therapeutic alliance. However, average word length of therapist interpretations was negatively associated with overall patient defensive functioning. Discussion: While few associations were found between the language used by the therapist and patient functioning, this study suggests that interpretations need to be stated in a concise manner so that patients are able to process them more easily [6]. Clinical implications of these results, and directions for future research are discussed.