Objective Measures of Subjective Experience: The Use of Therapist Notes in Process-Outcome Research

Abstract

Computerized linguistic measures of emotional engagement, and reflective and affective language, previously applied to session transcripts, were applied to notes of 14 treatments by candidates under supervision at the New York Psychoanalytic Society and Institute, covering the five decades from the 1950s to the 1990s. The findings indicate a strong relationship between candidates' subjective experience as represented unintentionally in the linguistic style of their case notes and the effectiveness of their clinical work. The treatments were evaluated for effectiveness by experienced clinicians using the Global Assessment of Functioning (GAF) and the Psychodynamic Functioning Scales of Høglend and colleagues; a Composite Clinical Effectiveness (CCE) measure was constructed based on level and change in these measures. The Mean High Weighted Referential Activity Dictionary (MHW), a computerized measure of emotional engagement developed in the framework of Bucci's theory of multiple coding and the referential process, showed a positive correlation of .73 with CCE. The Hostility subcategory of the Negative Affect Dictionary (ANH) showed a negative correlation, -.48, with CCE. In a multiple regression analysis, these two variables accounted for over three-quarters of the variance in the CCE. Implications of the findings for process/outcome research and supervision and evaluation of trainees are discussed.

The Referential Process as a Common Factor Across Treatment Modalities

“…These measures have been applied and validated in several clinical and experimental studies in English (Bucci & Maskit, 2007;Bucci, Maskit, & Hoffman, 2012). The English versions of the dictionaries are defined in our website www.thereferentialprocess.org.…”

Linguistic measures of the referential process in psychodynamic treatment: The English and Italian versions

“…In addition to the linguistic evaluations, we attempt to provide clinical validation for the Italian measures by examining several predictions, based on the theoretical framework of the referential process (Bucci, 1997(Bucci, , 2002a(Bucci, , 2002b and supported in English studies by statistics for patient and therapist speech in psychotherapy sessions from 24 distinct treatments (Maskit, 2012), and from six sessions each from six psychoanalytic treatments (Maskit & Bucci, 2008), as well as previous findings from other clinical applications (Andrei, 2011;Bucci & Maskit, 2007;Bucci et al, 2012).…”

“…A study of 14 sets of treatment notes by candidates at the Treatment Center of the New York Psychoanalytic Society and Institute was conducted by Bucci, Maskit and Hoffman (2012). Treatment effectiveness was measured by clinical readings of the beginning and ending segments of these notes and evaluating them for the Global Assessment of Functioning scales (GAF), and for five of the six scales in the Psychodynamic Functioning Scales of Høglend and colleagues (Høglend et al, 2000).…”

“…In addition, the construct validity of the English WRAD as well as the derived measures, including the Mean High WRAD, the High WRAD Proportion and the REF/ WRAD covariation, was further developed through clinical applications (Andrei, 2011;Bucci & Maskit, 2007;Bucci et al, 2012). The same approach has been used here to develop construct validation for the IWRAD, as well as the derived Italian measures.…”

Discussion of “Psychodynamic Therapies with Infants and Parents: A Critical Review of Treatment Methods”

“…In some of my recent work we have begun to study varieties of mutative mechanisms in therapy and analysis (verbal and nonverbal or symbolic and sub-symbolic, to use the language of Wilma Bucci ;Bucci, Maskit, & Hoffman, 2012;Hoffman, 2012;Hoffman, Algus, Braun, Bucci, & Maskit, 2013;Tokgoz, 2014). It is relatively easier to systematically study the interaction among people by just considering the literal meaning of the words they use.…”