Physiological synchronization and innovative moments in psychotherapy: A single-case study of micro-process

Abstract

Objective

Interpersonal synchronization is increasingly studied as a biomarker of empathy, therapeutic alliance, and treatment outcome. However, most studies average data over sessions, leaving associations between synchrony and actual interactions largely unexplored. We aim to showcase a novel approach examining synchronization during specific micro-processes: Innovative Moments (IM) as markers of exceptions to clients’ problematic patterns of meaning.

Methods

Electrodermal activity was recorded over 15 sessions of a psychodynamic psychotherapy single case. Moment-to-moment patient-therapist synchrony was calculated using the Adaptive Matching Interpolated Correlations (AMICo) algorithm. The Innovative Moments Coding System was utilized to identify IMs within session transcripts with precise timing. Monte-Carlo permutation tests were conducted to examine the association between physiological synchrony and IM Levels of increasing complexity (Levels 1–3).

Results

Higher-than-random synchronization emerged during Level 3 IMs (p = 0.046; d = 0.21) but not in lower Levels. Post-hoc qualitative analyses linked high synchrony to sub-processes of Level 3 IMs, such as positive contrasts and attributions for change.

Conclusion

Our findings show it is possible to link moment-by-moment physiological co-regulation to theoretically identified meaning-making processes. While generalization of these observations is undue, this work demonstrates a robust and promising application of a multimodal approach to investigating psychotherapy, providing insights into both the clinical case and the theoretical model adopted.

Keywords::

• physiological synchronization
• innovative moments
• multimodal
• micro-process

Disclosure Statement

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

Supplemental Data

Supplemental data for this article can be accessed at https://doi.org/10.1080/10503307.2024.2352752

Notes

1 A different analysis on the same case was published in Kleinbub et al. (2019). In that study we adopted a nomothetic approach to extract a synchrony value for each session and compare it with the patient’s self-reported outcome. We also employed a different synchronization metric based on the principal components analysis of EDA and heart rate.

2 In psychophysiology epochs are defined as relevant segments of time within a time-series such as a physiological or video recording, defined by precise start and end moments. They can represent a significant episode, a reaction to a stimulus, or generally a segment of the longer time-series that is to be analyzed individually. A similar term, windows, is sometimes used to describe segments of equal length, whereas epochs may represent heterogeneous durations, although the terms are sometimes used interchangeably.

Additional information

Funding

This paper was partially conducted at the Psychology Research Centre – CIPsi (PSI/01662), School of Psychology, University of Minho, supported by Fundação para a Ciência e a Tecnologia (FCT; UID/01662/2020) through the Portuguese State Budget.