A theoretical and methodological proposal for the descriptive assessment of therapeutic interactions.

OBJECTIVE: The goal of this study is to show the development of a strategy for a descriptive assessment of the therapeutic interaction. METHOD: In this study, we develop an observational methodology to analyze the dialogues that took place during 92 sessions conducted in a psychological center in Madrid, Spain, in which 19 adults were treated for various psychological problems by 9 behavioral therapists. A system was developed to codify vocal behavior of both the therapists and the clients; the software The Observer XT was used for recording. Therapeutic interactions were analyzed using sequential analysis. RESULTS: There are three main sequences that synthesize the therapist-client interaction: first, an utterance by the client preceded by a therapist's verbalization, specifically a question (discriminative morphology) and followed by an expression of approval (reinforcement morphology); second, verbalizations of failure or discomfort uttered by the client, followed most often by verbalizations of disapproval (punishing morphology) uttered by the therapist; and third, verbalizations uttered by the client that are discriminated by the therapist after an in-depth explanation and followed by different therapist's utterances (expressions of approval, technical information, etc.). CONCLUSIONS: Depending on how the client responds the results in this study present a starting point for the study of the functional sequences that form the basis of therapeutic change.

Análisis de la conducta verbal del cliente durante el proceso terapéutico / Analysis of the client's verbal behavior during the therapeutic process

En el presente trabajo llevamos a cabo un análisis del cliente centrándonos en la actividad principal que se desempeña en sesión: hablar. Utilizando metodología observacional realizamos un estudio topográfico de la conducta verbal de los clientes a través del desarrollo de un instrumento de medida generado por el grupo de investigación: el Sistema de Categorización de la Conducta Verbal del Cliente (SISC- CVC). Se observaron y registraron 92 sesiones terapéuticas procedentes de 19 casos tratados por 9 terapeutas distintos. Los resultados muestran que, en líneas generales, el cliente principalmente ofrece información descriptiva relevante para la terapia, muestra su aceptación y entendimiento ante verbalizaciones del terapeuta cuya finalidad sea informar, motivar o instruir y expresa en mucha mayor medida contenidos relacionados con el cambio clínico frente a contenidos alejados de los objetivos perseguidos. Podemos concluir, además, que la conducta verbal de los clientes varía en función de la actividad terapéutica que se esté llevando a cabo y es independiente de la problemática tratada, las características personales del cliente o el estilo terapéutico del clínico (AU)

In this paper we conduct an analysis of the client behavior focusing on the main activity that is performed in session: talking. Using observational methodology we performed a topographical study of clients’ verbal behavior through the development of a measuring instrument by our research group: Categorization system of the interaction of client´s verbal behavior during the session (SISC- CVC). 92 clinical sessions from 19 cases treated by 9 therapists were observed and recorded. The results show that, in general, the client mainly provides descriptive information relevant to therapy, shows acceptance and understanding to the therapist’s verbalizations aiming to inform, motivate or instruct, and expresses more frequently contents related to clinical change compared to contents opposed to the objectives pursued. We can also conclude that the clients’ verbal behavior varies depending on the therapeutic activity that is taking place and is independent of the problems treated, the personal characteristics of the client or the clinician's therapeutic style (AU)

Functional analysis of the verbal interaction between psychologist and client during the therapeutic process.

The goal of this study is to analyze the verbal interaction that takes place between client and therapist over the course of a clinical intervention so as to analyze the potential learning processes that may be responsible for changes in the client's behavior. A total of 92 sessions were analyzed, corresponding to 19 clinical cases treated by 9 therapists specializing in behavioral therapy. The variables considered were therapist and client verbal behaviors, and these were categorized according to their possible functions and/or morphologies. The Observer XT software was used as a tool for the observational analysis. The results led to the conclusion that the therapist responds differentially to client verbalizations, modifying the verbal contingencies as his or her client content approaches or becomes more distant from therapeutic objectives. These results suggest the possible existence of verbal "shaping" processes through which the therapist guides the client's verbal behavior toward more adaptive forms. In addition, this study proposes an alternative to the traditional controversy regarding the relevance of the therapeutic relationship versus the treatment techniques used to explain clinical change. This article suggests that such differentiation is unnecessary because the therapeutic relationship and the treatment techniques should act in the same manner, this is, in providing the context for the occurrence of what is truly therapeutic, namely, the learning processes.