When is therapist metacommunication followed by more client collaboration? The moderation effects of timing and contexts.

Therapist self-disclosure (TSD) and immediacy (Im; see next section for operational definitions) have long been controversial. Psychoanalytic theorists (Curtis, 1981(Curtis, , 1982Greenson, 1967) traditionally urged analysts to be blank screens, allowing clients to project their feelings and perceptions onto the clinician. More recent relational psychoanalysts (Eagle, 2011;Levenson, 2010;McWilliams, 2004), by contrast, have suggested that therapists can facilitate the therapeutic process by disclosing and talking about the relationship. Humanistic theorists (Bugental, 1965;Farber, 2006;Jourard, 1971), having long advocated therapist transparency and genuineness, have viewed TSD and Im as curative elements of psychotherapy.

Section: Tabulation Of Resultsmentioning

confidence: 99%

Section: Qualitative Meta-analytic Review Of Tsd and Immentioning

confidence: 99%

Therapist self-disclosure and immediacy: A qualitative meta-analysis.

Hill¹,

Knox²,

Pinto-Coelho³

2018

“…The UTIS requires judges to rate client collaboration on a 5-point scale ranging from 1 ( counterproductive use ) to 5 ( optimal use ). The intraclass correlation for three raters assessing client collaboration in Li, Jauquet, and Kivlighan (2016) was .79. In terms of validity, client collaboration has been related in theoretically meaningful ways to session effectiveness (Allen et al, 1990) and therapist metacommunication (Li et al, 2016).…”

Section: Methodsmentioning

confidence: 97%

Silence is golden: A mixed methods investigation of silence in one case of psychodynamic psychotherapy.

Hill¹,

Kline²,

O’Connor³

et al. 2019

Self Cite

We investigated the antecedents, occurrences, and consequences of 183 silence events in the first 5 and last 5 sessions of a 73-session case of successful psychodynamic psychotherapy. Silences generally occurred within client speaking turns, such that the client often paused to reflect while speaking. In the last 5 sessions, as compared with the first 5 sessions, the client was more collaborative before and after silences, silences were shorter, the therapist was more connectional during silences (e.g., shared emotion and meaning with client), and the client was more emotional after silences. Antecedent client collaboration, duration of the silence, therapist behavior during silence events, client behavior during silence events, and who broke the silence all related to change in collaboration from before to after the silence events. We concluded that silence was helpful in this case because of client factors (the client naturally paused a lot during discussion, the client was quite reflective and insightful), therapist factors (the therapist was comfortable with and believed in silence), and relationship factors (there was a strong therapeutic relationship).

“…The intraclass correlation coefficient (ICC) for three raters assessing client collaboration in Li, Jauquet, and Kivlighan (2016) was .79. In terms of validity, client collaboration has been related in theoretically meaningful ways to session effectiveness (Allen et al, 1990) and therapist metacommunication (Li et al, 2016). For the present study, we relied on consensus among judges after discussion for final judgments.…”

Section: Methodsmentioning

confidence: 99%

“…The Use of Therapist’s Interventions Scale (Allen, Gabbard, Newsom, & Coyne, 1990) assesses judge-rated client collaboration using a 5-point scale ranging from 1 ( counterproductive use ) to 5 ( optimal use ). The intraclass correlation coefficient (ICC) for three raters assessing client collaboration in Li, Jauquet, and Kivlighan (2016) was .79. In terms of validity, client collaboration has been related in theoretically meaningful ways to session effectiveness (Allen et al, 1990) and therapist metacommunication (Li et al, 2016).…”

Section: Methodsmentioning

confidence: 99%

Facilitating client collaboration and insight through interpretations and probes for insight in psychodynamic psychotherapy: A case study of one client with three successive therapists.

Hill¹,

Lu²,

Gerstenblith³

et al. 2020

We investigated therapist interpretations (Ints) and probes for insight (PIs) in relation to changes in client collaboration and insight for 1 male client paired with 3 successive doctoral student therapists in psychodynamic psychotherapy for 192 sessions over 5 years. Judges coded client collaboration and insight in the antecedent and subsequent 3 min for all Ints and PIs in each of 6 middle sessions for each treatment. Qualitative analyses showed that PIs were more helpful than Ints for this defended client. More gains in collaboration were found when antecedent client collaboration was high, antecedent client insight was low, and therapists gave PIs instead of Ints, but no differences were found among therapists. More gains in insight were found when antecedent insight in a given session was higher than in other sessions with the same therapist, with Therapist 3 facilitating more insight than Therapist 1; no differences were found between Ints and PIs. Clinical Impact StatementPsychodynamic theorists consider client collaboration and insight to be desirable, but minimal evidence exists about what skills therapists should use to facilitate these processes. Question: We examined whether therapist interpretations (Ints) and probes for insights (PIs) facilitate client collaboration and insight. Findings: When the client was initially collaborative but not insightful and the therapist gave PIs, the client was likely to be more collaborative. When the client was more insightful than usual with the therapist, the client was likely to gain insight. Meaning: Therapists need to be aware of the client level of collaboration and insight when deciding about giving Ints and PIs, and PIs are more likely than Ints to facilitate collaboration, but both are equally likely to facilitate insight. Next Steps: Researchers could examine other cases, whether other therapist interventions facilitate client collaboration and insight and whether Ints and PIs facilitate other client outcomes.