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

Abstract

In psychodynamic psychotherapy, verbal (structures and intents) and non-verbal (voice and interruptions) dimensions of communication intertwine conveying information and determining the mutual regulation between therapist and patient through conversational sequences. The communication components interplay is the foundation for building the therapeutic alliance, a relational dimension that predicts a psychotherapy outcome and change, influenced by patient-therapist exchanges from the initial stages of their encounter. Depressed patients present specific verbal and non-verbal communication and show difficulties in developing and maintaining the therapeutic alliance. Based on the reviewed literature, the main aim of this study was to analyze how the action of specific communicative modes, implemented by the therapist and depressed patients, affect the reciprocal construction of the early therapeutic alliance by each participant during the mutual regulation processes. We employed a mixed methods approach based on a systematic observation of communication and alliance ruptures and repairs within the audio recordings and verbatim transcripts of 20 psychotherapy sessions (6,232 speaking turns) with seven depressed patients. The observational design was nomothetic, follow-up, and multidimensional. The choice of methodology is justified because we developed a comprehensive procedure that integrates an ad hoc indirect observation system (the Communicative Modes Analysis System in Psychotherapy), analyzing verbal and non-verbal communication, and an observational tool with deductive categories (the Collaborative Interactions Scale-Revised), assessing the therapeutic alliance construction. Once we confirmed the intra-and inter-observer reliability for the ad hoc system and the inter-rater reliability for the tool with deductive (or theoretical) categories, we performed descriptive statistics (to describe quantitatively communicative modes and alliance Del Giacco et al. Communication Acts on Therapeutic Alliance ruptures and repairs), lag sequential analysis (to detect stable patterns in communication-alliance interactions), and polar coordinate analysis (to identify significant relationships between communicative modes and alliance ruptures and repairs). Results confirm that the therapist's verbal (asking and exploring) and non-verbal (elaborating and cooperatively interrupting) modes and the depressed patients' verbal (asserting and exploring) and non-verbal (expressing emotions and cooperatively interrupting) modes determine stable patterns and significant associations with collaborative behaviors connected to the reciprocal construction of alliance by each participant. All this may provide professionals with useful information to increase the psychotherapy effectiveness with depressed patients.

A Mixed Methods Framework for Psychoanalytic Group Therapy: From Qualitative Records to a Quantitative Approach Using T-Pattern, Lag Sequential, and Polar Coordinate Analyses

“…Lag sequential analysis has been successfully applied in many direct and indirect observation studies conducted over the past 25 years in clinical psychology (e.g., Martínez del Pozo, 1993 ; Arias-Pujol and Anguera, 2004 , Arias-Pujol and Anguera, 2005 ; Roustan et al, 2013 ; Arias-Pujol et al, 2015 ; Venturella et al, 2019 ; Del Giacco et al, 2020 ).…”

“…Like T-pattern detection, polar coordinate analysis has been used in a wide range of fields, including clinical psychology ( Arias-Pujol and Anguera, 2017 ; Rodríguez-Medina et al, 2018 ; Alcover et al, 2019 ; Del Giacco et al, 2020 ).…”

“…The use of mixed methods in psychotherapy research has grown in recent years ( Bartholomew and Lockard, 2018 ; Del Giacco et al, 2019 , 2020 ; Halfon et al, 2019 ; Roberts and Allen, 2019 ; Venturella et al, 2019 ). Researchers working as psychotherapists have underlined the need to integrate the objectivity of quantitative methods with the creativity of qualitative and mixed methods in order “to put the flesh of clinical meaning on the bones of quantitative outcomes” ( Target, 2018 , p. 18).…”

“…From a mixed methods perspective this question can be addressed by analyzing communication and therapeutic discourse interactions using an ad hoc observation instrument ( Arias-Pujol et al, 2015 ; Arias-Pujol and Anguera, 2017 ; Del Giacco et al, 2019 , 2020 ). Conversation and the therapeutic alliance are essential components of psychoanalytic therapy ( Manzano et al, 2018 ).…”

The Analysis of Interpersonal Communication in Sport From Mixed Methods Strategy: The Integration of Qualitative-Quantitative Elements Using Systematic Observation

“…The transformation of the qualitative record register is possible both in direct observation (Sánchez-Algarra and Anguera, 2013 ) and indirect observation (Anguera et al, 2018b ), and both are possible in interpersonal communication in sport. In many fields of interpersonal communication application, such as in clinical psychology (Roustan, 2010 ; Roustan et al, 2013 ; Anguera, 2017 ; Arias-Pujol and Anguera, 2017 , 2020 ; Del Giacco et al, 2019 , 2020 ; Anguera, in press, 2020 ), or in educational psychology (Tronchoni et al, 2018 ; Belza et al, 2019a , b ; Escolano-Pérez et al, 2019 ; Sagastui et al, 2020 ), or in family psychology (Cuervo, 2014 ), the focus on verbal, or vocal, or both behavior is becoming more interesting, so that one more step of the procedure is the transformation of the registry in a code matrix.…”