C. E. Hill (2004) recently developed the concept of therapist immediacy to capture discussion by the therapist about the therapeutic relationship that occurs in the here-and-now of a therapy session. This concept has been expanded to include discussion about the therapeutic relationship by both the client and therapist, captured by the term therapeutic immediacy (K. Kuutmann & M. Hilsenroth, 2011). Although prior research has examined the use of therapeutic immediacy across short-term treatment, the present study is the first to examine the use of immediacy across a long-term (4 years) psychotherapy. Also, this is the first study to assess the interrater reliability of therapeutic immediacy, which was found to achieve good to excellent levels across raters. The most frequently used categories of client and therapist immediacy are presented. Finally, the authors provide an in-depth qualitative examination of 5 therapeutic immediacy segments across the treatment judged by the raters to have high levels of depth/intensity (4.5 or higher out of 5) to examine the role of therapeutic immediacy in exploring meaningful treatment issues. Clinical utility, potential limitations, and future research on therapeutic immediacy are discussed.

Aims: This study addresses the effects of structured training on the development of coding skills used in psychotherapy process research. Method: Participants included graduate trainees enrolled in an APA approved Clinical PhD programme. A course outline for training is reviewed and examined in relation to ratings of therapist techniques used during psychotherapy sessions. Results: The effects of this structured training protocol for raters resulted in good to excellent levels of interrater reliability. Different groups of raters were compared along multiple factors such as level of graduate training, training received on a particular measure, and psychotherapy experience. Discussion: The implications of these findings for rater training in psychotherapy process research are discussed.

Patient Session Evaluation Questionnaire (SEQ: Stiles, 1980) ratings from early in treatment were examined in relation to outcomes during psychodynamic psychotherapy. Twenty-eight therapists treated 73 patients at a university-based clinic. A relationship between Smoothness ratings and symptom improvement approached statistical significance using bivariate correlations and multilevel analyses. A significant relationship was found between Positivity ratings and a broad scale of patient-rated functional improvement across many domains (i.e., psychopathology, interpersonal, occupational, and social) before and after accounting for therapist effects.

This study investigates the relationship between therapist techniques with patient and therapist ratings of session Depth (powerful, valuable, deep, full, and special). Eighty-three patients were admitted to a university-based community outpatient psychological clinic, and videotapes of an early treatment session were reliably rated by trained coders to identify techniques used by therapists. Overall amount of psychodynamic-interpersonal technique was found to have a significant positive correlation with patient-rated session Depth, and a trend toward significance was observed with therapist-rated session Depth. In addition, clinically relevant covariates (e.g., patient and clinician ratings of psychiatric severity, degree of Axis II pathology, and therapeutic alliance) of this session Depth and technique relationship were examined and found to have a nonsignificant impact. (PsycINFO Database Record (c) 2010 APA, all rights reserved).