The “dyadic dance”: Exploring therapist–client dynamics and client symptom change using actor–partner interdependence modeling and multilevel mixture modeling.

Abstract

Using longitudinal actor-partner interdependence modeling and multilevel mixture modeling, the aims of this study were to investigate the therapist-client dyadic dynamic patterns (i.e., therapist and client consistency and their mutual influences in perceptions of working alliance) and how these dynamic patterns related to client symptom change with varied treatment lengths. Data set included 1,520 sessions conducted by 85 master's level therapist trainees with their 283 clients in China. Before every session, clients reported their symptom; after every session, both therapists and clients rated their working alliance. (a) Therapist consistency was positively associated with greater client symptom improvement, especially in relatively longer therapy course. (b) Client consistency and therapist-client mutual influence dynamics did not individually relate to client symptom improvement. (c) Two subgroups of therapist-client dyads with distinct dyadic dynamic patterns were identified: one subgroup (Dyadic Independence) showing significant self-consistency and nonsignificant mutual influence and the other subgroup (Mutual Influence) showing significant self-consistency as well as mutual influence. (d) The mutual influence subgroup was associated with greater client improvement than the dyadic independence subgroup, especially in shorter therapy. A dyadic dynamic pattern characterized by the presence of therapist and client self-consistency as well as mutual influence may be conducive to positive therapeutic outcome in terms of client symptom improvement. Public Significance StatementIt may be helpful for the therapist to maintain some levels of consistency or stability in how they evaluate their therapy process and therapeutic relationship with the client. A therapist-client dynamic pattern characterized by therapist and client maintaining a level of consistency of their own perceptions but also having mutual influences appears to be associated with more positive client symptom improvement. To achieve this, the therapist may try to stay open to the client's experiences by which they let themselves be impacted while also maintaining an internal stability within themselves. The therapist may also exert necessary therapeutic influences on the client when clinically indicated.

Therapist emotion and emotional change with clients: Effects on perceived empathy and session quality.

“…For the client, learning to empathize with others (Chui et al, 2021; MacFarlane et al, 2017; Yalom, 2002), in this case to the therapist’s emotional experience, may be an important part of the psychotherapy process and also interpersonal learning and growth. A recent study also showed that mutual influence between therapist and client is associated with positive client outcome (Li, 2021). In short, the effect of AA on client-rated therapist empathy and session quality may be attributed to both members of the dyad.…”

The development of a Brief Working Alliance Inventory for clients and therapists using multilevel factor analysis and item response theory in the United States and China.

“…For example, a host of studies have suggested that both the therapist’s and the client’s WA perceptions could predict session outcomes and client outcomes either individually (e.g., Kivlighan et al, 2014; Zilcha-Mano et al, 2018) or jointly through their synchrony/congruence (e.g., Marmarosh & Kivlighan, 2012; Zilcha-Mano, 2017) or shared component (Li et al, 2021). In addition, using a dynamic modeling approach, Li (2022) revealed that a dynamic pattern characterized by the therapist and client maintaining some consistency of their own perceptions of WA but also having mutual influences on each other’s WA perceptions was associated with more positive client symptom improvement. These findings lend support to the need for the therapist to track and be attuned to the client’s WA perceptions by being open, curious, and perceptive in the session, but perhaps also through an instated tracking system of therapists’ and clients’ treatment process, and outcome variables (such as WA).…”