Interpersonal Process Recall Research Articles

Understanding self-forgiveness in emotion-focused therapy: An interpersonal process recall study with men in recovery from addiction.

Understanding self-forgiveness in emotion-focused therapy: An interpersonal process recall study with men in recovery from addiction.

The Operators Model of Psychoanalytic Clinical Reasoning.

In this paper, the authors develop a model of psychoanalytic clinical reasoning as the inferential process by which analytic therapists are able to arrive at an understanding of the clinical material. Starting from Bion's theory of functions, the authors propose that a "function" can be thought of as a condition-action sequence that analytic therapists implicitly use to respond to certain configurations of elements in the material by executing conceptual or reflective operations. To investigate the main families of functions that are used by analytic therapists in everyday practice, the authors used an interpersonal process recall procedure based on supervision sessions from a theoretically heterogeneous group of participants. A consensual procedure was developed to identify operations, spell out the underlying functions, and group functions into families. Twelve families of functions were identified that appear to be used by analytic therapists regardless of their schools of thought. The authors call them the "operators" of psychoanalytic clinical reasoning. According to the operators model, the process of psychoanalytic clinical reasoning consists in the chaining together of operations using functions from different families. A specific collection of "clinical reasoning styles" seems to be interwoven in this process. Different avenues open up for research, clinical practice, and training.

Application of Bernard’s Discrimination Model in a Mental Health Agency: Implications for Practice

ABSTRACT This study explored the delivery of Bernard’s Discrimination Model (DM) in a post-masters agency setting and what supervisors did under varying conditions as they applied the model. Researchers examined the relationship between the frequency of application for the four DM foci and three supervision roles. Utilization of supervision interventions related to DM was also explored. Sixty-six (66) master’s-level mental health clinicians [half fully licensed, half provisionally licensed] were assessed using a multi-rater observational approach. Results revealed that clinical supervisors worked with the majority of clinicians on the focus of skills, and supervisors spent most of their time within the teaching and counseling roles. General patterns of use by supervisory interventions were that Interpersonal Process Recall (IPR) and micro-training were utilized the most frequently, with structuring and role play utilized less so. Chi-square analyses indicated significant differences in expected use of interventions by foci and roles. Implications are included.

What are the experiences of people with learning disabilities, and their support workers, when negotiating access to opportunities for developing relationships and intimacy?

IntroductionPeople with learning disabilities (PWLD) are often described as ‘vulnerable’ and needing protection. This contributes to a lack of involvement in decision making. Despite recent positive shifts in societal attitudes surrounding sex and PWLD, gaps between attitudes and practice remain (Shakespeare & Richardson, 2018). There is confusion about how to effectively support and empower PWLD to engage in intimate relationships whilst minimising potential harm. This study aimed to explore the experiences of PWLD and their support workers, when negotiating access to relationships and intimacy. The voices of PWLD were at the centre of this research.MethodA qualitative methodology was used to explore the topic. Three PWLD and three support workers participated. It consisted of two parts: part one was data creation using prompt cards to facilitate discussion between PWLD and support workers and part two was a semi structured interview with individual participants using an Interpersonal Process Recall (IPR) framework. Data was analysed using a multi perspective Interpretative Phenomenological Analysis (IPA) approach.ResultsPersonal experiential themes (PETs) and subthemes represented the experiences of each participant and were then analysed in the context of their pair (PWLD and support workers). Group experiential themes (GETs) were developed for the group as a whole, paying particular attention to any similarities or differences between PWLD and support workers. Four overarching GETs were: intersecting layers of vulnerability, navigating without a compass, the struggle for control and fearing negative consequences.DiscussionThis study provided each participant with a rare opportunity to safely discuss relationships and intimacy in a scaffolded space. The outcomes highlight a need for further education and guidance for both PWLD and support workers as the current lack of this contributed to parallel experiences of perceived vulnerability. This often led to avoidance and restriction of PWLD’s right to engage in relationships and intimacy.

Moments of change: Clients’ immediate experiences when sharing emotions in psychotherapy

Objective: In-session processing of emotions is important in facilitating psychotherapeutic change. This study explores how clients in active treatment experience inner changes when sharing emotions in psychotherapy sessions. The aim was to retrieve in-depth knowledge about clients’ moment-by-moment experiences of change in a naturalistic psychotherapy context. Method: Two psychotherapy sessions (session 3 or 4 and session 7 or 8) were videotaped and immediately followed by semi-structured interviews with clients (n = 11) in the format of Interpersonal Process Recall (IPR). Interviews were analysed using thematic analysis. Results: Four themes resulted from analysis: (1) reaching a new clarity about inner struggles; (2) a shift in how I approach and experience my feelings; (3) grieving losses and gaining a more positive understanding of myself; (4) feeling relief and liberation when allowing difficult emotions. Conclusion: The resulting themes took into account the importance of the felt quality of change experiences within sessions, which appears to be important in making micro-processes of change salient. Across themes, we found accounts of shifts in awareness and self-compassion, which we discuss as micro-outcomes that clients can ideally be guided to dwell with.

How therapists respond to "uneven"alliances in couple and family therapy: A conversation-analytic study.

This articleexamines how family and couple therapists respond to uneven alliances with their clients at the micro-level of therapeutic exchanges in the context of Interpersonal Process Recall (IPR) interviews. We operationalize uneven alliance with the interactional concept of asymmetry of affiliation. To this end, first, using conversation analysis (CA), we identify episodes of asymmetry of affiliation in the moment-by-moment conversation between the therapist and the client in therapy consultation. Second, applying CA to the IPRinterview data, we examine how therapists orient to the episodes of the session in which the asymmetry of affiliation was identified. The findings demonstrate therapists'two key practices of orienting to the episodes of asymmetry of affiliation: (1) therapists'exclusive identification with one participant by typically invoking gender roles and (2) therapists'investigation of their agency in the emergence of asymmetry.

Clients' and genetic counselors' perceptions of empathy in Japan: A pilot study of simulated consultations of genetic counseling.

The rapidly increasing availability of genetic testing is driving the acceleration of genetic counseling implementation. Empathy is important in medical encounters in general and forms a core component of a successful genetic counseling session; however, empirical evidence on empathy in genetic counseling is minimal. This study aimed to explore the perceptions of empathy in simulated genetic counseling consultations from the perspectives of clients and genetic counselors. Semi-structured interviews and interpersonal process recall were used with participants of simulated genetic counseling consultations to elicit their experiences of empathy. A constructivist grounded theory was used for data analysis. A total of 15 participants, including 10 clients and 5 genetic counselors, participated in 10 simulated counseling sessions. The genetic counselors attempted to demonstrate empathy and were sensitive toward detecting changes in clients. Meanwhile, the clients' perceptions represented their feelings and thoughts elicited through the counselors' empathic approaches. This was the first process study to examine empathy in simulated genetic counseling sessions. Our model of communication of empathy is a process in which counselors try to address implicit aspects of clients, and clients are provided with time and a safe place for introspection, which contributes to discussions on building good relationships with patients. There is also a suggestion of the utility of simulated consultations for healthcare providers to learn empathic communication.

Mentor-mentee Relationship Using Video Elicitation Interviews.

To explore aspects that define successful mentor-mentee relationships in medical education from a mentor and mentees' perspective. Qualitative study. Place and Duration of the Study: Bahria University Health Sciences, Karachi campus, from May to October 2022. Data were collected using observations of mentoring sessions by recording videos, video-elicitation interviews for mentors and focus group discussions for mentees. Mentor Evaluation Tool (MET) questions were used during focus group discussions to gain detailed feedback from mentees on mentors and additional questions were added regarding the mentoring sessions' organisation and environment. During video-elicited interviews with mentors, an interpersonal process recall strategy was used to explore factors that define a mentor-mentee relationship. Video recordings of the mentoring sessions were used as an elicitation tool to guide the interviews. Giorgi's method was used for data analysis. Transcripts of observations by video recordings, video elicitation interviews, and focus group discussions were analysed first separately and then compared and integrated. According to mentors, the true essence of mentoring is mutual respect and confidentiality. Mentees suggested multiple mentors for professional development in different attributes. The mentors' commitment to their mentees and the mentees' respect and trust is the foundation of a successful mentor-mentee relationship. Mentor, Mentee, Relationship, Mentoring and Medical Education.

Persevering professionals: dilemmas of relationships and self-determination in work with people with intellectual disability - a multi-method study based on interpersonal process recall.

The article focuses on social educators' reflections on their own professional practice in encounters with people with intellectual disability receiving services. Drawing on Interpersonal Process Recall, a video-assisted method, together with a focus group interview, the study explores the experiences from in-situ encounters of five social educators employed in a Norwegian municipality. The key findings are that they view relationship-building as integral to their work, they grant primacy to the ideal of autonomy and they strive towards realizing this in their daily work. The study however displays how these emphases might lead to dilemmas, especially between the wish to support the service users' self-determination and the urge to protect them from harm. Of special note was how the service users' increasing use of social media was perceived as a particular challenge for social educators, who were left with an experience of being unable to protect.

The patient-practitioner interaction in post bariatric surgery consultations: an interpersonal process recall study

Purpose The patient-practitioner relationship is fundamental to rehabilitation practice and patients’ health and wellbeing. Dissonance between patients who have had bariatric surgery and health care practitioners about what supportive care and good outcomes are can undermine care. To address the mechanisms of this process, we conducted an Interpersonal Process Recall study. Materials and Methods We interviewed patients (11), video recorded consultations (10), conducted video-assisted individual interviews with patients (10) and practitioners (11) and a dyadic data analysis. Results We identified relational states and shifts in the clinical encounter 2–3 years post-surgery, described in themes: a) Playing by the Book – Making it Easier for Each Other, b) Down the Blind Alley – Giving up on Each Other, and c) Opposite Poles – Towards and Away from Each Other. Conclusions The post-surgery consultations facilitated responsibility for health and self-care but did not invite dialogues about the psychosocial burdens of living with obesity and undergoing bariatric surgery. Patients and practitioners tried to avoid creating conflict, which in turn seemed to foster distance, rather than human connection. This limits the encounter’s benefit to both parties, leaving them frustrated and less willing to either meet again or take any gains into their future lives. IMPLICATIONS FOR REHABILITATION Illness evokes feelings of stress and uncertainty and is experienced very differently from the perspective of patients and health care practitioners (HCPs), who encounter each other in a field fraught with tension. Bodily changes and difficult emotions related to food and eating are to be expected when undergoing bariatric surgery, and to explicitly “notice, name and validate” emotions can promote the patient’s capacity to sustain self-care, lifestyle change, weight loss and health gains. Making interpersonal connection and interaction between patient and HCP the centre of bariatric aftercare can enhance engagement in and outcomes of the post-surgery clinical encounter

Engaging with difficult topics and emotional experiences in psychotherapy: A study of helpful therapist acts

Objective The purpose of this study was to explore moments during psychotherapy sessions in which clients experience that they have an opportunity to approach and engage with difficult topics and emotional experiences, with the aim of describing therapists’ acts that support clients’ in-session engagement. Methods Two treatment sessions of 11 participants were videotaped and immediately followed by an in-depth semi-structured interview, using the interpersonal process recall (IPR) interview method. A follow-up interview was conducted 3 months after the final IPR interview. Participants’ accounts were analyzed using thematic analyses. Results Five themes of engagement-supportive acts resulted from our analyses: 1. inviting the client by showing acceptance; 2. recognizing the clients’ hints and try-out signs; 3. providing information on the process and evaluating clients’ expectations; 4. actively helping the clients to notice and stay with difficult experience and 5. showing sensitivity to the client’s needs for micropauses. We discuss these themes as acts of recognition. Conclusion Clients found it was engagement-supportive when therapists implicitly and explicitly recognized the challenges of being in psychotherapy. This recognition could be achieved through the engagement-supportive acts described in the five themes. Therapists should continually make space for and seek a balance between different engagement-supportive acts.

Relationship and Alliance Formation Processes in Psychotherapy: A Dual-Perspective Qualitative Study.

ObjectiveTo explore how therapists and clients act dyadically to establish a therapeutic relationship during the first five sessions of psychotherapy. The study aimed to identify both relational facilitative and hindering processes occurring in routine care.MethodsUsing the method ‘interpersonal process recall’ (IPR), we videotaped the third and fifth session of 12 psychotherapy dyads, and conducted video-assisted interviews with each therapist and client separately. In total, the data material consist of 47 IPR interviews. Data were analyzed using a thematic approach.ResultsThe analysis process revealed two main groups. The first group consisted of dyads with a positive relational outcome, and the second group consisted of dyads with a troubled or frail relational outcome. During the initial phase of therapy, clients described feeling overwhelmed by fear and shame. Positive relational development occurred when these emotions were successfully accommodated and replaced with a growing sense of safety with the therapist. However, the relationship became troubled when the client experienced an increase in shame and/or fear during the first sessions. When forming a therapeutic relationship, it is vital that the client experience the therapist as genuine and skilled, and that the therapist is able to engage and connect deeply with the client on a person-to-person level. The article further provides a discussion on how these dyadic experiences align with the working alliance and real relationship, and how the two consolidate during the first sessions of psychotherapy.ConclusionThe current study explored the complex relational processes underlying the formation of the therapeutic relationship. Core aspects of the real relationship are prerequisites to forming a collaborative working alliance in which both therapist and client are actively engaged. Facilitating a positive relationship is crucial in the early phase of psychotherapy, and therapists can actively identify and repair ruptures at this time.

Balancing responsibility, boundaries and time: social workers’ experiences in service user meetings – a multi-method study based on Interpersonal Process Recall

ABSTRACT The article focuses on social workers’ reflections on their own professional practice in conversations with vulnerable service users in the Norwegian Labour and Welfare Administration (Nav). Drawing on Interpersonal Process Recall (IPR), a video-based method, together with a focus group interview, the study explores the experiences and reflections of five social workers of in-situ encounters with service users. A key finding is that the social workers, who worked in two different offices within the work and activation field, perceived their professional practice as highly complex, negotiated, and ambiguous. The social workers nevertheless displayed a multitude of knowledge and competences, expressed through practical synthesis in the conversations. The article argues that more attention should be paid to ethical aspects of professional knowledge, such as when balancing contradictory considerations towards national workfare policies and vulnerable service users, and how to set the limits for their own professional responsibility in the work towards the service users. Furthermore, the article also directs the attention to another area of professional knowledge, as it explores time as an embedded and ubiquitous aspect of, and condition for, professional knowledge to unfold.

Israeli Parents’ Lived Experiences of Music Therapy With Their Preterm Infants Post-Hospitalization

In the current study, we aimed to explore the lived experience of Israeli parents who engaged in musical dialogues with their preterm infants during music therapy (MT) after being discharged from the neonatal intensive care unit (NICU), as a part of the multinational LongSTEP RCT. Seven participants of the main trial were invited to engage in semi-structured in-depth interviews intertwining listening to audio recordings from their music therapy sessions in an adapted interpersonal process recall (IPR) procedure. The interviews were transcribed and analyzed using interpretative phenomenological analysis (IPA). We understood the participants' experiences to reflect two main themes: 1) Music therapy as a potential means of transformation in communication skills, resourcefulness and sense of agency; and 2) emotional and musical preconditions for parental engagement in MT. The findings illustrate how a specific group of Israeli parents experienced MT as offering them a means of expanding their relationship with their preterm infants after discharge. Based on our findings, we recommend that music therapists consider parents' musical and emotional resources during post-discharge MT to meet the individual needs of families.

Covert therapeutic micro-processes in non-recovered eating disorders with childhood trauma: an interpersonal process recall study

MethodTo uncover therapeutic micro-processes from the perspectives of eating disorder (ED) treatment non-responders with childhood trauma (CT) late effects, we explored in-session experiences of poor long-term outcome patients. Female inpatients aged 28–59 (M = 40.2, SD = 5.0) from a randomised trial comparing Compassion Focused Therapy for EDs (n = 3) with Cognitive Behavioural Therapy for EDs (n = 3) were interviewed with video-assisted recall about a self-selected session. Data were analysed through Interpretative Phenomenological Analysis (IPA) with Grounded Theory (GT) elements.ResultsCovert patient strategies included self-effacement, regulating therapeutic distance to open up, and engaging with reflective rather than experiential interventions. First, self-effacement included submissive, passive or pretend responses to perceived criticising or violating therapist behaviours as well as other orientation and submission for approval. Second, some preferred a close patient–therapist alliance with therapist self-disclosure and reciprocity was a requirement for opening up; others required distance. Third, informants detached from experiential trauma work while engaging in joint reflection on post-trauma responses.ConclusionInformants were preoccupied with calibrating the emotional–relational landscape in session; we hypothesized that psychological insecurity and affective intolerance from CT limit their freedom to explore own in-session experiences.

Kariyer Yapılandırma Görüşmesi ile Anlam Oluşturma: Bir Vaka Çalışması

This study examined (a) what changes career construction counseling used the Career Construction Interview (CCI), integrated with Interpersonal Process Recall (IPR) brought about on the client (b) how the IPR uncovered insights and unspoken inner experiences during career counseling, and (c) how the CCI prompted the solutions for client’s career problem. The study based on a case study with 24 years-old, the fourth-year student in a private university. Findings revealed that (a) examining role models, early recollections and motto during the CCI uncovered self-awareness and insights about the self, career indecision and motivation needed for the vocational future, (b) the IPR revealed values, the role of significant people on career decision process of the client and the need for approval from them, and (c) the CCI contributed the client’s career decision making process, motivation and taking an action. The study verified the use of the CCI and the IPR in career counseling process, theoretically and brought new, dynamic and meaning making methods to career counseling practices in higher education.

Self-reported camouflaging behaviours used by autistic adults during everyday social interactions.

Autistic people may camouflage their innate autistic social behaviours to adapt to, cope within and/or influence the predominately neurotypical social landscape. This study describes behaviours exhibited, altered or avoided by autistic adults whilst camouflaging (i.e. camouflaging behaviours). Using Interpersonal Process Recall methodology, 17 autistic adults (8 women, 6 men and 3 agender/gender neutral individuals) participated in a brief social task designed to replicate a common day-to-day social situation. Participants then watched a video of their interaction with a researcher, actively identifying and describing camouflaging behaviours. Using qualitative content analysis, descriptions of 38 camouflaging behaviours described by participants were clustered into four main categories and seven subcategories: (1) masking, (2) innocuous engagement (subcategories: passive encouragement, centring social partner, deferential engagement and reducing social risk), (3) modelling neurotypical communication and (4) active self-presentation (subcategories: reciprocal social behaviours, risky social behaviours, and comfortable and familiar social behaviours). The novel use of Interpersonal Process Recall methodology addressed limitations in existing camouflaging research and facilitated the identification of previously unreported camouflaging behaviours. These camouflaging behaviours are discussed with reference to literature concerning interpersonal research and theory within and outside the field of autism.Lay abstractCamouflaging can be thought of as the process through which autistic people modify their natural social behaviours to adapt to, cope within or influence the largely neurotypical (non-autistic) social world. Many autistic people experience negative reactions to their natural or intuitive social behaviours when interacting with non-autistic people. Over time, in response to these negative reactions, autistic people’s social behaviour often changes. We refer to autistic people’s changed behaviours as ‘camouflaging behaviours’. Research exploring camouflaging behaviours is still at an early stage. This study investigated camouflaging behaviours used by autistic adults in everyday social interactions using a research method that was new to the field of autism. Specifically, 17 autistic adults were filmed taking part in a common everyday social situation – a conversation with a stranger. With the help of the video of this conversation, they then showed and described their camouflaging behaviours to a researcher. These autistic people identified and described a total of 38 different camouflaging behaviours. The detailed and specific information provided by autistic adults about camouflaging behaviours generated important new insights into the ways in which autistic people adapt to, cope within and influence the neurotypical (non-autistic) social world.

Introduction to Special Issue Quality in Qualitative Approaches: Celebrating Heterogeneity

ABSTRACT Debates regarding quality in qualitative research are longstanding. There are continued calls for additional quality indicators that account for the heterogeneity of qualitative methodologies. In this introduction to the special issue, we take up the idea that quality criteria are often specific to a given methodological approach. Thus, included within this special issue, and overviewed in this introductory paper, are seven articles that outline the quality criteria related to specific qualitative methodologies, including grounded theory, thematic analysis, narrative methodology, interpretative phenomenological analysis, video-reflexive ethnography, discursive psychology, and conversation analysis and interpersonal process recall.

Camouflaging in an everyday social context: An interpersonal recall study.

Camouflaging is a social phenomenon operating within everyday social interactions of autistic and non-autistic people. The current study explored autistic adults’ camouflaging in an everyday social context via interpersonal process recall methodology (Kegan, 1969). A total of 17 autistic adults (8 females, 6 males and 3 agender/gender-neutral individuals) participated in a 10-min controlled social task designed to replicate a common day-to-day social situation. Participants then watched a video of their interaction with a researcher, actively identifying instances of camouflaging and discussing their experiences of camouflaging. Using thematic analysis, four themes were generated: (1) a strong desire for, yet uncertainty in, securing social acceptance and connection; (2) camouflaging, developed over time, as a means to achieve social acceptance and connection; (3) experiencing intrapersonal and interpersonal camouflaging consequences during social interactions; and (4) authentic socialising as an alternative to camouflaging. These findings are discussed with reference to the existing literature on stigma management outside the field of autism.Lay abstractMany autistic people report that, despite personal costs, they use strategies to hide their autistic characteristics or appear non-autistic at work, school or university, when speaking with health professionals, or while socialising with certain friends and family members. These strategies are often referred to as camouflaging. This study explores camouflaging during everyday social interactions. A total of 17 autistic adults were filmed taking part in a common everyday social situation – a conversation with a stranger. They then watched the video of this conversation with a researcher and answered questions about camouflaging. These autistic people told us that they (1) had a strong desire to socialise with and be valued by other people but, because of negative past experiences, they often felt unsure about their ability to do so; (2) used camouflaging to help them to socialise and be valued by others; (3) experienced negative consequences when camouflaging (e.g. fatigue, anxiety and difficulties in friendships); and (4) sometimes socialised in more autistic ways instead of camouflaging. This study shows us how autistic people often change their behaviour because of the way they are treated by nonautistic people and that autistic people may benefit from programmes that help them to socialise in more authentically autistic ways, but only if their autistic social behaviour is met with understanding and acceptance from non-autistic people.

Opening Up: Clients' Inner Struggles in the Initial Phase of Therapy.

ObjectiveTo explore how clients in clinical settings experience the process of opening up and sharing their inner experiences in the initial phase of therapy.MethodsTwo psychotherapy sessions of clients (N = 11) were videotaped and followed by interviews. Interpersonal process recall was used to obtain in-depth descriptions of clients’ immediate experiences in session. A follow-up interview was conducted 3 months later. The interviews were analyzed using thematic analysis.ResultsThe data revealed how and why clients distanced themselves from inner experiences in the initial phase of therapy. The overarching theme was “Holding back and struggling to open up,” which included four subthemes: (a) fearing the intensity and consequences of negative emotions; (b) experiences of being incapable and bodily stuck; (c) being insecure about one’s worthiness and right to share inner experiences with the therapist; and (d) struggling with feeling disloyal to loved ones.ConclusionThe participants held back because they feared different consequences of opening up. A range of concerns led participants to distance themselves from their inner experiences and/or to refrain from openly talking about them to the therapist. Concerns related to appropriate interpersonal conduct as client were especially important. This knowledge is highly relevant to clinicians when building safety for psychotherapeutic work.