Dynamic dyadic processes in psychotherapy: Introduction to a special section

Abstract

There is a growing consensus among psychotherapy theoreticians and researchers that psychotherapy processes are an interpersonal phenomenon that can be studied as a dynamic system. The aim of this special section is to highlight the importance of exploring the complex processes that emerge over time from interactions and feedback loops amongst sub-components (e.g., emotions, non-verbal behavior, physiology, voice, subjective experience) within and between clients and therapists. The articles featured in this special section discuss multiple methods and angles to study dynamic dyadic processes in psychotherapy that can better capture the complexity of the therapeutic process and the ways it can lead to favorable outcomes. Future research that focuses on dynamic dyadic processes in psychotherapy is outlined.

C'è un crescente consenso tra i teorici e i ricercatori di psicoterapia sul fatto che i processi psicoterapici siano un fenomeno interpersonale che può essere studiato come un sistema dinamico. Lo scopo di questa sezione speciale è quello di evidenziare l'importanza di esplorare i processi complessi che emergono nel tempo dalle interazioni e dai cicli di feedback tra alcuni aspetti (ad esempio, emozioni, comportamenti non verbali, fisiologia, voce, esperienza soggettiva) nei clienti e tra i clienti e i terapeuti. Gli articoli presentati in questa sezione speciale discutono i molteplici metodi da diverse angolazioni, per comprendere i processi diadici dinamici in psicoterapia che possono descrivere meglio la complessità del processo terapeutico e i modi in cui esso può portare a risultati favorevoli. E’ delineata anche la ricerca futura che si concentra sui processi diadici dinamici in psicoterapia.

Resumo

Existe um consenso crescente entre teóricos e pesquisadores em psicoterapia de que os processos de psicoterapia são um fenômeno interpessoal que pode ser estudado como um sistema dinâmico. O objetivo desta seção especial é destacar a importância de explorar os processos complexos que emergem ao longo do tempo a partir de interações e ciclos de feedback entre subcomponentes (por exemplo, emoções, comportamento não verbal, fisiologia, voz, experiência subjetiva) dentro e entre clientes e terapeutas. Os artigos apresentados nesta seção especial discutem vários métodos e ângulos para estudar a dinâmica diádica de processos em psicoterapia que podem capturar melhor a complexidade do processo terapêutico e as maneiras pelas quais ele pode levar a resultados favoráveis. Pesquisas futuras focadas em processos diádicos dinâmicos em psicoterapia são descritas.

摘要 心理治療理論家和研究者日益形成共識，即心理治療歷程是一種能被視為動態系統來進行研究的人際現象。本期專題的宗旨在於強調探討隨著時間，出現在個案與治療師各自之內與二者之間的子成分(例如: 情緒、非口語行為、生理、聲音、主觀經驗)之互動與循環回饋整個複雜歷程的重要性。本期專題各篇論文的特色為運用多重方法與多重角度來研究心理治療的動態對偶歷程，藉此能夠更有效的捕捉到治療歷程的複雜性，以及其如何導致更好的結果。此專題亦說明未來心理治療可進行的動態對偶歷程研究。

Keywords:

• dyadic processes
• dynamic systems
• synchrony
• coregulation
• process-outcome research

Keywords:

• processi diadici
• sistemi dinamici
• sincronia
• coregolazione
• ricerca sui processi e sugli esiti

Palavras-chave:

• processos diádicos
• sistemas dinâmicos
• sincronia
• coregulação
• pesquisa de resultado do processo

關鍵詞:

• 對偶歷程
• 動態系統
• 同步性
• 相互調節
• 歷程效果研究

Clinical and methodological significance of this article: This special section offers multiple lenses on dynamic dyadic processes in psychotherapy and demonstrate how focusing on interdependence processes within and between the client and the therapist can help to better capture the complexity of the therapeutic process and the ways it can lead to favorable outcomes.

There is a growing consensus in the field of psychotherapy that to better understand the mechanisms of change behind gains in psychotherapy, it is essential to study treatments as dynamic systems, focusing not only on processes within the client or the therapist (i.e., intrapersonally), but also between the client and the therapist (i.e., interpersonally; Muran, Eubanks, & Samstag, 2019). While in the past, process-outcome research tended to view the therapeutic process as unidirectional with the therapist “doing” and intervening and the client “affected” and changed, the fact that the therapist is also significantly involved in the process of change is now being increasingly recognized (e.g., Muran et al., 2019). These ideas have emerged from relational and interpersonal psychotherapy theoreticians who argue that the complexity of the therapeutic process can only be understood in terms of the inherently dynamic nature of the therapeutic interaction, where both client and therapist are mutually but asymmetrically shaped and transformed over time as a function of their responsibilities and roles (e.g., Aron & Harris, 2014).

The importance of studying interdependent dyadic processes such as synchrony, co-regulation, congruence, influence and receptiveness in interpersonal relationships, given their pervasive documented association with healthy development and wellbeing across the life span (Butler, 2015), has recently led psychotherapy researchers to focus on these dynamic dyadic processes as a way to better understand mechanisms of change in psychotherapy (e.g., Atzil-Slonim et al., 2018; Koole & Tschacher, 2016). This line of research has gained momentum through advances in technology that allow collecting dense repeated measurement data, and new sophisticated data analytic methods that can handle the complexity of psychotherapy interactions.

The primary aim of this special section is to highlight the importance of studying psychotherapy processes as dynamic systems emerging from complex interactions and feedback loops between and within clients and therapists. The five articles in this section focus on a different type of dynamic dyadic process (synchrony, co-regulation, congruence, influence and receptiveness) and cover different channels/ modalities of the therapeutic interaction (audio, movement, physiology, self- reports), using a variety of novel methodological approaches.

Soma et al. (2019) used vocal arousal measures and dynamic systems models to assess whether and how clients and therapists co-regulate each other’s emotions. They report a moment-to-moment bidirectional linkage of clients’ and therapists’ emotional experiences. When clients became more emotionally labile over the course of a session, therapists became less so, and when changes in therapist arousal increased, the client’s tendency to become more aroused during session slowed. In addition, when changes in client arousal increased, the therapist’s tendency to become less aroused slowed.

Altmann et al. (2019) examined movement synchrony to assess its impact on treatment outcome and the nature of the therapeutic alliance in clients suffering from social anxiety disorder in Cognitive Behavioral Therapy (CBT) versus Psychodynamic Therapy (PDT). Movement synchrony was more frequent in CBT than in PDT. Frequent movement synchrony predicted a better therapeutic alliance and reduced interpersonal problems but did not predict improvement in depression. Interestingly, movement synchrony with a leading therapist (rather than with a leading client) was associated with better therapeutic outcome.

In a study on non-verbal synchrony Ramseyer (2019) investigated how synchrony in therapeutic dyads develops and its association with post-session outcome, using quantitative idiographic process analysis. Synchrony was stronger in real dyads than in pseudo-dyads. However, non-verbal synchrony did not predict alliance or session outcome. Sessions characterized by high movement synchrony were associated with lower session outcome.

Tschacher and Meier (2019) explored physiological synchrony by examining the coupling of respiratory behavior, heart rate, and heart rate variability through two different methods of synchrony estimation. They differentiated between in-phase and anti-phase synchrony. The physiological synchrony between the client and the therapist was significantly present, speaking for sympathetic and parasympathetic coupling of therapist and client, and was positively linked to the therapeutic alliance and session outcomes.

Li and Kivlighan (2019) used a differential equation model in a multilevel framework to examine the dynamic mutual influence patterns between clients’ and therapists’ perceptions of the therapeutic alliance, and the association between these dynamics and clients’ session evaluations. When therapists were generally more consistent in perceiving their alliance with all of their clients, they tended to have higher client evaluations of session outcomes. When therapists were generally not influential or not receptive to clients’ influence, therapists’ higher influence or openness to being influenced with a client was related to better session outcome. By contrast, when therapists were generally highly influential, the more they influenced a client, that client reported worse session outcome.

Taken together, these five articles offer multiple lenses on dynamic dyadic processes in psychotherapy and demonstrate how focusing on interdependent processes within and between the client and the therapist can help to better capture the complexity of the therapeutic process and the ways it can lead to favorable outcomes.

The results of the studies in this special section suggest that the therapeutic relationship involves a process of ongoing mutual influence between therapist and client where both have an impact on the experience of the other (Li & Kivlighan, 2019; Soma et al., 2019). They suggest that synchrony between clients and therapists is an indicator of therapeutic success (Tschacher & Meier, 2019), but not under all conditions (Altmann et al., 2019; Ramseyer, 2019).

The different dynamic dyadic processes described here, such as interpersonal reactivity, synchrony and co-regulation are not independent and can become interconnected. To achieve a fuller picture of these dynamic dyadic processes and their contribution to the outcome of psychotherapy, future studies could explore the interdependence between different dynamic dyadic processes by studying for example how more objective (physiological) processes relate to subjective (experienced) processes, and how components acting on different time scales and measured with different methods interrelate. More research is needed to assess which dynamic dyadic processes are most pertinent to psychotherapy gains, and how they can be fostered to promote clients’ wellbeing.