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.

Luca Del Giacco,M Teresa Anguera,Silvia Salcuni

doi:10.3389/fpsyg.2020.00234

Luca Del Giacco, M Teresa Anguera + Show 1 more

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https://doi.org/10.3389/fpsyg.2020.00234

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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 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.

Highlights

We focus on the lag sequential analysis and polar coordinate analysis of the specific communicative modes implemented by the therapist and depressed patients that affect the reciprocal construction of a positive therapeutic alliance (TA) by each participant during the mutual regulation processes in the initial stages of psychotherapy
Our study aimed to analyze how specific verbal and non-verbal modes, implemented by the therapist and depressed patients, could influence and foster the reciprocal construction of a good TA, a relational and collaborative dimension that proved to be an active agent in the process of psychotherapy change (Colli and Lingiardi, 2009) during the mutual regulation processes emerging in the initial stages of therapy
The findings presented propose a perspective of investigation on the psychotherapeutic exchange that emphasizes the importance of the joint action of what is said and how it is said, as an interacting system of verbal and non-verbal behaviors that acts by spreading information within a mutual regulation process between participants (Del Giacco et al, 2019)

Summary

Introduction

According to the psychodynamic approach, the therapeutic setting is the place where the therapist and patient establish a specific and asymmetric dialogue to explore and co-construct meanings through the intertwinement of verbal and non-verbal communication (Molina et al, 2013). In psychotherapy research, these components of communication have always been considered independent (Westland, 2015) and studied separately (e.g., Salvatore et al, 2010; Tomicic et al, 2011; Ruiz-Sancho et al, 2013). Verbal communication (through the structural form and communicative intents of the content), voice (through prosodic modulations), and cooperative/competitive interruptions (through behaviors of involvement or dominance) interact by spreading information and determining the mutual regulation between participants in the form of conversational sequences, observable and recordable during communicative exchanges (Li, 2001; Valdés et al, 2010; Tomicic et al, 2015b; Westland, 2015)

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