Microprocess examination of therapeutic immediacy during a dynamic research interview.

This study examines the interviewer's use of immediacy during a dynamic interview to enhance the patient's ability to process affective material and deepen personal exploration. Using a microprocess design, immediacy events were identified and rated using the Consensual Qualitative Rating method. Moment-to-moment in-session activity was rated by trained observers with a focus on measuring patient process using the Therapist-Patient Interaction Rating Scale and interviewer process using the Therapeutic Environment Scale. Five immediacy events were identified and were found to range in depth from mundane exchanges to more active exchanges with affective depth. Mundane events were characterized by little attention to the affective component of the here-and-now relationship, dismissive and unsupportive comments, and had either no effect, or a negative effect on patient process. In contrast, immediacy events characterized by even limited affect and acknowledging engagement between patient and interviewer were followed by greater patient disclosure and increased capacity to process emotional information. Thus, attention to the quality of the immediacy intervention in future research appears warranted.

A view from Riggs: treatment resistance and patient authority--VII. A team approach to treatment resistance.

Treatment resistant patients frequently require treatment modalities beyond combined psychopharmacology and individual psychotherapy. They often require a team effort to manage crises, contain anxiety, and create a psychological space for examining the impact and meaning of behavior. The use of a treatment team as an adjunctive therapeutic modality helps individual team members understand regressions as repetitions of family dynamics, unearths the underlying meaning of behavior, engages patients' authority, and prioritizes the importance of relationships in effecting change. Through engagement with team members and with the team leader's authority, patients may assume responsibility for their behavior, reevaluate familiar roles, and increase self-awareness and psychological integration. The team helps its members identify, bear, and metabolize negative countertransference, address associated anxieties realistically, and optimize the environment for change.