Psychotherapist’s persuasiveness in anxiety: Scale development and relation to the working alliance.

Abstract

Communicating a persuasive rationale that explains the client’s problems and how psychotherapy can relieve them, has been proposed as a crucial determinant of outcomes that combats the client’s state of distress, promotes positive expectations, and facilitates the working alliance. However, it remains 1 of the least investigated psychotherapist’s facilitative interpersonal skills without a validated measure. The present correlational observational study aimed to develop a rating scale that measures the psychotherapist’s persuasiveness, and to examine its relationship with the working alliance. Based on a literature review of the psychotherapist’s persuasiveness, the Therapist’s Persuasiveness Rating Scale (TPRS) was constructed. Seventeen psychotherapy session recordings were used to validate the scale through exploratory and confirmatory factor analysis, validity, reliability, and sensitivity assessment. Fourteen psychotherapy session recordings with clients suffering from anxiety were rated using the TPRS and the Working Alliance Inventory-Observer Version-Short Form (WAI-O-S) to examine the relationship between the 2 variables. The validation process resulted in a 4-factor 10 items scale. Except for the discriminant validity, which was revealed to be inadequate, the TPRS showed to be a valid, reliable, and sensitive measure of the psychotherapist’s persuasiveness. Despite a nonsignificant correlation found in Spearman’s correlation, a linear regression model suggested that the psychotherapist’s persuasiveness explains 65.1% of the working alliance at the beginning of the session. The TPRS revealed a promising measure with good psychometric qualities to advance the research on the psychotherapist’s persuasiveness. There is some suggestion of the psychotherapist’s persuasiveness effect on the working alliance, but the result missed statistical significance.

The psychotherapist’s persuasiveness: Relation to the working alliance and facilitative interpersonal skills.

“…This is supported by reviews that propose that the establishment of the working alliance is facilitated by the psychotherapist’s charismatic behaviors, such as the exploration of the client’s beliefs, validation of the client’s feelings, and providing an explanation for the client’s symptoms and suggesting therapeutic actions (Hilsenroth & Cromer, 2007; Zimermann & Haes, 2011). These are integral behaviors for the psychotherapist persuasiveness (Frank & Frank, 1993) assessed by the TPRS (Afonseca et al, 2023). These results also align with theoretical assumptions that relational factors are essential in establishing a working alliance (Castonguay, 2002).…”

“…This study has strengths that should be mentioned. Firstly, this study sought to overcome Afonseca et al (2023) small-sample limitation, by securing a larger sample. It is also important to note that the psychotherapist’s in this study’s sample presented diverse psychotherapeutic approaches.…”

“…The TPRS presented good internal consistency (α = .833) in its validation study (Afonseca et al, 2023). Except for the rationale subscale, which demonstrated relatively low reliability (α = .568), the preconditions (α = .647), nonverbal behaviors (α = .884), and influence (α = .728) subscales had satisfactory reliability.…”

“…The TPRS is an observer-rated scale developed by Afonseca et al (2023), based on Jerome Frank’s theorization of psychotherapist persuasiveness (Frank & Frank, 1993). It rates the psychotherapist’s persuasiveness in a psychotherapeutic context on a 5-point Likert-type scale (1 = strongly uncharacteristic to 5 = strongly characteristic ).…”

“…The psychotherapist’s persuasiveness is not limited to the coconstruction of therapeutic rationale and is relevant throughout the therapeutic process. There are verbal and nonverbal behaviors, such as the ability to communicate fluently with an affectively responsive tone of voice, maintain eye contact, and make responsive hand gestures and facial expressions, that are essential for the psychotherapist to be perceived as credible to the client and enhance their persuasiveness (Afonseca et al, 2023; Vaz & Sousa, 2021). Establishing preconditions in the therapeutic process by exploring the client’s beliefs and expectations for psychotherapy and stimulating the client’s emotions is also suggested as a component of persuasiveness as it allows the psychotherapist to convey interpersonal messages that resonate with the client (Frank, 1961; Frank & Frank, 1993).…”