A comparative analysis of the qualities of therapists' communications in three empirically-supported psychotherapies.

摘要

The facilitative qualities of therapists' communications, in terms of their level of attunement, tentativeness, and meaning exploration, were examined in three empirically-supported psychotherapies for depression. Transcripts from the early and working phases of therapy for a total of 85 clients receiving either Process-Experiential (PE), Interpersonal (IPT) or Cognitive-Behavioural (CBT) treatment, were used to explore how the qualities of therapists' communications: a) changed over time, b) differed across and within therapies, and c) related to clients' in-session perceptual processing and experiencing, the working alliance, and treatment outcome. Results indicated that therapists were consistent in the manner of responding to clients throughout therapy. Variations in the qualities of therapists' communications were found across and within therapies. Across therapies, PE therapists were significantly higher in their levels of attunement than CBT therapists, and both PE and CBT therapists were more tentative and focused on meaning exploration than IPT therapists. Within all treatment conditions, therapists tended to exhibit higher levels of attunement and tentativeness than meaning exploration. In relation to process and outcome, PE therapists' levels of attunement tended to be higher with clients who were lower in perceptual processing, and who exhibited higher levels of depression and general distress at treatment termination. IPT therapists were more focused on meaning exploration with clients exhibiting higher levels of perceptual processing, and their communications were higher in attunement when they were engaged in stronger working alliances. CBT therapists were more tentative when communicating with clients exhibiting lower levels of in-session experiencing. Implications of the results for psychotherapy research, training and clinical practice are discussed in the context of each therapeutic approach, and across the different forms of psychotherapy.