Clinical Mutual Attunement and the Development of Therapeutic Process: A Preliminary Study

Abstract

Despite the identification of many factors that play a central role in the development of the psychotherapy process, there is still a lack of evidence about the basic relational mechanisms that pave the way to its working. In this pilot study, we focus on nonverbal microprocessual attunement as the basic mechanism grounding the displacing of discrete factors in shaping the clinical process. Two single sessions of two short-term psychodynamic treatments, selected respectively from a good- and a poor-outcome treatment, have been coded in terms of patient and therapist speech rate, coordination in ruptures, resolution of the therapeutic alliance, and patient's displayed thinking processes. Two dynamic structural equation models focusing on clinical attunement as a factor able to activate the interplay of the assessed clinical dimensions have been theoretically designed and tested in both cases. The driven theoretical structural equation models fit the data, suggesting a different role of nonverbal attunement as a moderating factor. The obtained results are consistent with the hypothesis claiming that a good-outcome psychotherapy session is characterized by a mechanism of clinical attunement that enforces the therapist–patient relationship and promotes the integration of formal thinking processes that affect emotional and cognitive domains.

Notes

¹Pauses of 3 seconds or less in the pronounced phrases were included in our measurement of the total time taken to produce the phrases. Pauses that exceeded 3 seconds were treated as 3-s pauses. For instance, if a pause lasted 3.5 seconds, it was recorded as a 3-s pause. It was necessary to establish this cutoff to avoid speech rate values being compromised by excessively long pauses that were due not to cognitive or emotional processing but to, for example, crying.

²Bucci and colleagues (2004) defined an IU as the patient's segment of speech able to capture a single “shot” or “frame” of a narrative. The bound of an UI is defined by changes in the mood or feeling of the passage, the introduction of new imagery, or shifts in experiential quality, as well as by changes in scene or person. Concerning identification of IU boundaries, Bucci and colleagues (2004) argued that the knowledge of what an idea is, and where one ends and another begins, is a part of linguistic competence, shared by speakers of a language, and applied intuitively, without explicit rules.