Mind the gap: In-session silences are associated with client attachment insecurity, therapeutic alliance, and treatment outcome

Daniel, Sarah Ingrid Franksdatter; Folke, Sofie; Lunn, Susanne; Gondan, Matthias; Poulsen, Stig

doi:10.1080/10503307.2016.1177673

Cited by 13 publications

(46 citation statements)

References 30 publications

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“…The current study findings might imply that patients, such as Mary, who present short and infrequent pauses and low jitter values may progress rapidly in forming an alliance with their therapist. Previous studies have shown an association between infrequent pauses and verbal fluency (Martins, Vieira, Loureiro, & Santos, 2007) and a tendency to engage and bond easily (Daniel, Folke, Lunn, Gondan, & Poulsen, 2018; Levitt, 2001). Also, Mary's low pretreatment jitter values reflect a steady, non‐trembling voice quality, which previous studies have associated with low distress and low anxiety levels (Juslin & Scherer, 2005).…”

Section: Resultsmentioning

confidence: 97%

“…The current study findings might imply that patients, such as Aaron, who present pretreatment high levels of jitter and pauses may progress slowly in forming an alliance with their therapist. Moreover, previous studies have shown an association between high pause levels and a tendency to disengage from the therapy, a dynamic that can undermine alliance formation (Daniel, Folke, Lunn, Gondan, & Poulsen, 2018; Levitt, 2001).…”

Section: Resultsmentioning

confidence: 99%

“…Pauses are silent speech intervals during speech. Previous studies have shown that pauses are valid markers of the treatment alliance in psychotherapy (Daniel, Folke, Lunn, Gondan, & Poulsen, 2018; Levitt, 2001). Pauses were found to be associated with reluctance to open up to therapists, which has been suggested to hinder therapeutic engagement (Daniel, 2011).…”

Section: Introductionmentioning

confidence: 99%

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What do these sounds tell us about the therapeutic alliance: Acoustic markers as predictors of alliance

Nof

Amir

Goldstein

et al. 2020

Clin Psychology and Psychoth

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Predicting the trajectories of alliance formation that the patient is likely to establish with the therapist during treatment, even before their first meeting, can help prevent the potentially harmful consequences of deterioration in alliance, such as poor outcome and premature dropout. The present study aimed to examine the ability of four pretreatment acoustic markers to predict the alliance that is likely to be formed in the course of treatment: F0 span, speech rate, pause proportion and jitter. Data from 560 observations of 38 patients were collected as part of an ongoing randomized clinical trial of short‐term psychotherapy for major depressive disorder. The acoustic markers were measured using high‐quality recordings at baseline, before the patient and therapist ever met or had any type of communication. A multilevel model was used to examine the ability of the four acoustic markers to predict the slopes of alliance formation in the course of treatment, all markers being introduced in the same model. The clinical utility of the acoustic markers was explored in two case studies. The model explained 22% of the variance in alliance formation. Higher levels of both jitter and pause proportion at baseline predicted less strengthening of the alliance in the course of treatment. The findings, which should be replicated in larger samples, suggest that much of the therapeutic alliance can be predicted based on the acoustic characteristics of the patient's voice in the first 3 min of their intake, before they even meet their therapist.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

What do these sounds tell us about the therapeutic alliance: Acoustic markers as predictors of alliance

Nof

Amir

Goldstein

et al. 2020

Clin Psychology and Psychoth

View full text Add to dashboard Cite

show abstract

“…Hoey, 2020). We applied the same 3-s minimum criterion as was applied in Levitt's research (1998Levitt's research ( , 2001 and also in the studies that used the PICS manual for their data analysis (Frankel et al, 2006;Stringer et al, 2010;Daniel et al, 2018). The rationale behind the minimum duration of 3 s is that these silences are considered meaningful and not just accidental disfluencies (Stringer et al, 2010).…”

Section: Methodsmentioning

confidence: 99%

How Speakers Orient to the Notable Absence of Talk: A Conversation Analytic Perspective on Silence in Psychodynamic Therapy

et al. 2020

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Silence has gained a prominent role in the field of psychotherapy because of its potential to facilitate a plethora of therapeutically beneficial processes within patients’ inner dynamics. This study examined the phenomenon from a conversation analytical perspective in order to investigate how silence emerges as an interactional accomplishment and how it attains interactional meaning by the speakers’ adjacent turns. We restricted our attention to one particular sequential context in which a patient’s turn comes to a point of possible completion and receives a continuer by the therapist upon which a substantial silence follows. The data collection consisted of 74 instances of such post-continuer silences. The analysis revealed that silence (1) can retroactively become part of a topic closure sequence, (2) can become shaped as an intra-topic silence, and (3) can be explicitly characterized as an activity in itself that is relevant for the therapy in process. Only in this last case, the absence of talk is actually treated as disruptive to the ongoing talk. Although silence is often seen as a therapeutic instrument that can be implemented intentionally and purposefully, our analysis demonstrated how it is co-constructed by speakers and indexically obtains meaning by adjacent turns of talk. In the ensuing turns, silence indeed shows to facilitate access to the patient’s subjective experience at unconscious levels.

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“…In contrast to secure patients, dismissing patients detail narratives infrequently or their narratives are exceedingly terse (Daniel, 2011 ) they contain more pauses (Daniel, Folke, Lunn, Gondan, & Poulsen, 2018 ), and lack vividness (Talia et al, 2017). While these patients’ discourse is coherent and easy to follow, it may give the impression that the speaker is not interested in receiving support or validation from the therapist.…”

Section: Attachment and Communication In The Clinical Contextmentioning

confidence: 99%

Advances in research on attachment-related psychotherapy processes: seven teaching points for trainees and supervisors

Talia¹,

Taubner²,

Miller-Bottome³

2019

ResPsy

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While the rich body of attachment theory and research has inspired many psychotherapists, trainees and less experienced clinicians interested in attachment-informed work can often feel unsure about what processes are attachment-related and how to attend to them during therapy. Recent advances in attachment-informed psychotherapy research offer some practical guidance. Studies published over the last five years show that patients and therapists of different attachment classifications communicate in distinct ways during therapy sessions. In particular, Talia and his colleagues have introduced the Patient Attachment Coding System and the Therapist Attunement Scales, two measures that accurately predict patients’ and therapists’ Adult Attachment Interview and Reflective Functioning score based on the occurrence of distinct communication markers during therapy sessions. This paper discusses the implications of these recent studies for psychotherapy training and presents seven teaching points for supervisors and for the next generation of clinicians.

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Mind the gap: In-session silences are associated with client attachment insecurity, therapeutic alliance, and treatment outcome

Abstract: The study further validates the PICS. Findings indicate that therapists may be able to use in-session silences as an indicator of client attachment insecurity and as a prognostic sign of eventual treatment outcome.

Cited by 13 publications

References 30 publications

What do these sounds tell us about the therapeutic alliance: Acoustic markers as predictors of alliance

What do these sounds tell us about the therapeutic alliance: Acoustic markers as predictors of alliance

How Speakers Orient to the Notable Absence of Talk: A Conversation Analytic Perspective on Silence in Psychodynamic Therapy

Advances in research on attachment-related psychotherapy processes: seven teaching points for trainees and supervisors

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