Verbal expressions used by anaclitic and introjective patients with depressive symptomatology: Analysis of change and stuck episodes within therapeutic sessions

Abstract

A person's speech makes it possible to identify significant indicators which reflect certain characteristics of his/her personality organization, but also can vary depending on the relevance of specific moments of the session and the symptoms type. The present study analyzed 10 completed and successful therapeutic processes using a mixed methodology. The therapies were video-and audio-taped, as well as observed through a one-way mirror by trained observers. All the sessions of each therapy were considered (N = 230) in order to identify, delimit, transcribe, and analyze Change Episodes (CEs = 24) and Stuck Episodes (SEs = 26). Each episode was made up by patients' speech segments (N = 1,282), which were considered as the sampling unit. The Therapeutic Activity Coding System (TACS-1.0) was used to manually code each patient's verbalizations, nested within episodes and individuals, in order to analyze them using Hierarchical Linear Modelling (HLM). The findings suggest that anaclitic patients tend to use more verbalizations in order to ask for feedback or to be understood by their therapists (attune), whereas introjective patients tend to use more verbalizations in order to construct new meanings (resignify) during therapeutic conversation, but especially during SEs. Clinical implications to enrich the therapeutic practice are discussed.

The Action of Verbal and Non-verbal Communication in the Therapeutic Alliance Construction: A Mixed Methods Approach to Assess the Initial Interactions With Depressed Patients

“…This notion of communication allows analyzing the therapeutic interaction by identifying those actions whereby both the therapist and the depressed patient participate in the TA construction and the verbal and non-verbal coordination processes. These aspects are at the basis of therapeutic change, as new ways for the patient to give meaning, interpret, and represent the inner reality and the surrounding world (Arístegui et al, 2004;Valdés and Krause, 2015). The results of the early TA study during the mutual regulation processes corroborate that the verbal and FIGURE 4 | Vectorial maps of the statistically significant relationships for the therapist (A), considering the communicative intent Global Exploration (CIGET) as focal behavior and CIS-P categories [Direct Collaborative Processes on Negotiation Tasks/Goals (DCP1) and Affects (DCP2); Indirect Collaborative Processes on Facts (ICP1), Affects (ICP2), and Meaning (ICP3); Direct Rupture Markers on Relationship (DRM2); Indirect Rupture Markers as Linguistic Avoidance (IRM1) Affective Avoidance (IRM2), Self-esteem Regulation Strategies (IRM3), Indirect Allusions (IRM4), and Acquiescence (IRM5)] as conditional behaviors, and for the group of depressed patients (B), considering the communicative intent Global Exploration (CIGEP) as focal behavior and CIS-T categories [Direct Collaborative Interventions on Task/Goal (DCI1), Affects (DCI2), and Meaning (DCI3); Indirect Therapist Interventions on Facts (ICI1), Affects (ICI2), and Meaning (ICI3); Rupture Interventions as Linguistic Avoidance (RI1) and Hostility (RI3)] as conditional behaviors.…”

“…The results obtained advance in understanding the verbal and non-verbal communication modes that foster the TA construction between therapist and depressed patients in the initial stages of psychodynamic psychotherapy. Precisely, the study provides a measure of those elements of communication that may sustain depressed patients to overcome the difficulties in accessing their inner world and emotions and in regulating their relational distance in interaction with the therapist (Valdés, 2014;Valdés and Krause, 2015). These represent typical aspects of the functioning profile of depressed patients that derive from the first cognitive-affective representations and impact on the development and maintenance of the TA (Levy and Wasserman, 2009;Balsters et al, 2012;Smirnova et al, 2018).…”

“…Patients, therefore, live the therapeutic relationship and the alliance construction by manifesting different experiential and behavioral modalities through verbal and non-verbal communication (Tomicic et al, 2009;Valdés and Krause, 2015), as an expression of their psychological processes and symptoms (Valdés, 2014;Elvevåg et al, 2016). Depressed patients, in particular, show difficulties in developing and maintaining the TA because of the specific verbal and non-verbal correlates that define their communicative behaviors (Balsters et al, 2012;Smirnova et al, 2018).…”

“…According to the psychodynamic approach, these behaviors reflect the broad range of depressed patients' defensive, adaptation, and cognition styles deriving from the early cognitive-affective representations where anger and aggression are predominant (Levy and Wasserman, 2009). This kind of patients has difficulty in accessing their inner world and emotions and in maintaining an adequate relational distance (Valdés, 2014;Valdés and Krause, 2015) which are manifested, on the one hand, through a rambling, repetitious, and vague speech (Bucci and Freedman, 1981), and from the other, through slow and monotonous speech with less volume and voice modulation (Rottenberg and Gotlib, 2004). These aspects vehicle the egocentric view of self, lack of empathy, interpersonal problems, and relational dependence typical of depressed patients who tend to exhibit hopelessness and passiveaggressive behaviors (Levy and Wasserman, 2009) through verbal and non-verbal communication that impact on the construction of a collaborative relationship.…”

Beyond self-criticism and dependency: structural functioning of depressive patients and its treatment

“…Finally, when studying psychotherapeutic processes, Valdés and Krause (2015), using the Therapeutic Activity Coding System (TACS-1.0) (Valdés, Tomicic, Pérez, & Krause, 2010), analyzed patient and therapist speech during the session by identifying communicative actions (that is, how they say what they say) and the contents conveyed (that is, what is transmitted when speaking), noting that patients with anaclitic depression tended to resignify during change episodes (as expected), while those with introjective depression tended to resignify during stuck episodes.…”