Passing patients’ tests and following patients’ coaching communications in psychotherapy: an empirical study

ABSTRACT

According to Control-Mastery Theory, patients attend therapy with an unconscious plan to achieve adaptive goals and disprove their pathogenic beliefs. One important way patients work to disconfirm these beliefs is by testing them. Moreover, patients coach their therapists on what they need at different times during their treatment. The aim of this study is to expand the results of previous studies suggesting that therapists’ responses that support patients’ plan predict progress. We investigated whether therapists' ability to pass patients’ tests correlated with patients' improvement in the following session and whether their ability to follow patients' coaches correlated with immediate improvement. Transcriptions of 98 sessions from six brief psychodynamic psychotherapies were assessed by 12 independent raters. The patients’ plans were formulated, and tests and coaching communications were identified. The accuracy of the therapist’s responses to these tests and coaches was rated, and the impact of the therapist’s interventions on the patient’s following communication was measured. The results showed that when a therapist’s intervention passes a patient's tests, patients show signs of improvement both immediately and in the following session, and when therapists follow patients’ coaches, patients show signs of immediate improvement. The clinical implications and limitations of the findings are discussed.

KEYWORDS:

• Control Mastery Theory
• process research
• patient’s plan
• testing activity
• coaching communications
• responsiveness

Acknowledgments

Francesco Gazzillo contributed to the conceptualization of this study, the data analyses, the design of the methodology, the project administration, the supervision of the project itself, and the writing of the manuscript. Camilla Mannocchi contributed to the data collection, the formal analysis, and the writing of this manuscript. Giuseppe Stefano Biuso, Emma De Luca, Eleonora Fiorenza, Federica Genova, Michela La Stella, Jessica Leonardi, and Martina Rodomonti contributed to the assessment of the material that formed the basis of this study. Ramona Fimiani contributed to the development of the design of the study and provided some data and instruments. John Curtis and George Silberschatz contributed to the conceptualization of the study and the sample collection.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Availability of Data and Material

The data that support the findings of this study are available from the corresponding author (CM, mail: [email protected]), upon reasonable request.

Ethical approval

The study was conducted in accordance with the 1964 Helsinki declaration and was approved by the Local Ethics Committee of the Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome (protocol number: 0000832).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/09515070.2024.2354283

Additional information

Funding

The authors did not receive support from any organization for the submitted work.

Notes on contributors

Francesco Gazzillo

Francesco Gazzillo PhD, psychoanalytic psychotherapist. Associate Professor of the Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza, University of Rome. President of the Control-Mastery Theory Italian Group (CMT-IG), member of the San Francisco Psychotherapy Research Group (SFPRG), of the Division 29 and 39 of the American Psychological Association and of the Italian Association of Psychology (AIP). Author of several books and international papers.

Camilla Mannocchi

Camilla Mannocchi PsyD, psychologist and PhD student of Dynamic Psychology at the Department of Dynamic, Clinical and Health Psychology, Sapienza, University of Rome. Member of the San Francisco Psychotherapy Research Group (SFPRG) and of the Control-Mastery Theory – Italian Group.

John Curtis

John Curtis PhD, psychotherapist and Clinical Professor at the University of California San Francisco School of Medicine. Member of the San Francisco Psychotherapy Research Group. Author of several international papers.

Giuseppe Stefano Biuso

Giuseppe Stefano Biuso PhD, psychodynamic psychotherapist. Member of the San Francisco Psychotherapy Research Group (SFPRG) and vice-president of the Control-Mastery Theory – Italian Group.

Emma De Luca

Emma De Luca PhD, psychodynamic psychotherapist. Member of the Control-Mastery Theory Italian Group (CMT-IG), and of the San Francisco Psychotherapy Research Group (SFPRG). Author of several international papers.

Ramona Fimiani

Ramona Fimiani PhD, psychologist. Member of the San Francisco Psychotherapy Research Group (SFPRG) and of the Control-Mastery Theory – Italian Group. Author of several international papers.

Eleonora Fiorenza

Eleonora Fiorenza PsyD, psychologist and PhD student of Dynamic Psychology at the Department of Dynamic, Clinical and Health Psychology, Sapienza, University of Rome. Member of the San Francisco Psychotherapy Research Group (SFPRG) and of the Control-Mastery Theory – Italian Group. Author of several international papers.

Federica Genova

Federica Genova PhD, psychodynamic psychotherapist. Researcher in Dynamic Psychology at the European University of Rome. Member of the San Francisco Psychotherapy Research Group (SFPRG), of the Control-Mastery Theory – Italian Group and of the Italian Association of Psychology (AIP). Author of several international papers.

Michela La Stella

Michela La Stella PsyD, psychodynamic psychotherapist. Member of the San Francisco Psychotherapy Research Group (SFPRG) and of the Control-Mastery Theory – Italian Group.

Jessica Leonardi

Jessica Leonardi PsyD, psychodynamic psychotherapist and PhD student of Dynamic Psychology at the Department of Dynamic, Clinical and Health Psychology, Sapienza, University of Rome. Member of the San Francisco Psychotherapy Research Group (SFPRG) and of the Control-Mastery Theory – Italian Group. Author of several international papers.

Martina Rodomonti

Martina Rodomonti PhD, systemic psychotherapist. Member of the San Francisco Psychotherapy Research Group (SFPRG) and of the Control-Mastery Theory – Italian Group. Author of several international papers.

George Silberschatz

George Silberschatz PhD, past president of the International Society for Psychotherapy Research and Clinical Professor at the University of California San Francisco School of Medicine. President of the San Francisco Psychotherapy Research Group. Author of several international papers.