Therapist technique and patient defensive functioning in ultra‐brief psychodynamic psychotherapy: a lag sequential analysis

Abstract

This study examined the association between therapist interventions, including interpretations, and patient defensive functioning. The first session of 32 (n = 32) Brief Psychodynamic Interventions were rated for therapist interventions and patient defensive functioning. Lag sequential analysis was used to determine if (a) there are organized sequences of therapist interventions; (b) there are predictable sequences in the patients' level of defensive functioning; (c) there are sequences of therapist interventions leading to change in the patients' defensive functioning; and (d) there are levels of patient defensive functioning leading to organized therapist response. Results suggested that there are organized sequences in the therapists' interventions and that patient in-session defensive functioning is relatively stable. However, no chain of therapist interventions led to a predictable response in the patients' defensive functioning or vice versa.

Modeling Eye Gaze Patterns in Clinician–Patient Interaction With Lag Sequential Analysis

“…Lag-sequential analysis has been widely used in research, specific topics include: foraging patterns in animal behavior research (Butler, 2005), children’s mealtime behaviors before and after parental attention (Woods, Borrero, Laud, & Borrero, 2010), transition patterns of preschooler’s social play (Robinson, Anderson, Porter, Hart, & Wouden-Miller, 2003), precursors of problem behavior in individuals with autism (Borrero & Borrero, 2008), sequences in therapist’s intervention and patient’s levels of defensive functioning (Drapeau, de Roten, Beretta, Blake, Koerner, & Despland, 2008), online asynchronous problem-solving discussion patterns (Hou, Chang, & Sung, 2008), patterns of work group discussions about complaints and solutions (Kauffeld & Meyers, 2009), and communication sequences that contribute to better team performance (Bowers, Jentsch, Salas, & Braun, 1998). …”

Ten Principles to Guide Psychodynamic Technique with Defense Mechanisms: An Examination of Theory, Research, and Clinical Implications

“…Although adaptive defenses did increase in the sample, neither the use of support nor the use of interpretive techniques explained the change. In a study of ultra-brief psychodynamic psychotherapy using sequential analysis, it was determined that therapists typically use supportive interventions to "prepare" patients before making defense interpretations [77]. That study also found that there are predictable ways in which psychodynamic therapists structure and use therapeutic interventions.…”

Investigating defense interpretation depth using lag sequential analysis

“…Several studies [6][7][8] have been drawn to lag sequential analysis in an attempt to capture a more accurate view of how the use of therapeutic techniques in psychotherapy actually transpires. Using lag analysis, Milbrath and colleagues [7] found that therapists structured their interventions around patient level of subjective distress and functioning.…”

“…Drapeau and colleagues [6] found that both therapists' use of interventions and patients' use of defenses could be segmented into predictable chains of sequences. However, they failed to find an interaction between the two.…”

“…This is further confounded by the fact that only session one of the BPI was investigated. In addition, Drapeau et al [6] did not consider the state of the therapeutic alliance for the sessions included in the analysis, which may explain why they failed to find an interaction between therapist interpretation and patient defenses. Also, no study to date has considered the depth of defense interpretation in a lag analysis.…”