The Therapeutic Alliance in Couple Therapy for Depression: Predicting Therapy Progress and Outcome from Assessments of the Alliance by the Patient, the Spouse, and the Therapists

Change Mechanism of Cognitively-Based Compassion Training for Couples with Depression: An Exploratory Empirical Investigation of Process Variables

Objective: Compassion training seems to be a promising intervention for couples to improve individual psychopathology and relationship quality. Beyond studying the efficacy of training such as Cognitively-Based Compassion Training for Couples (CBCT-fC), it is important to gain insights into the putative mechanisms along the process. Methods: Theoretically derived presumed mechanisms of compassion training (clarification of values, self-regulation, decentering, and exposure) and additional therapeutic factors (emotional bond, social learning, and clarification of meaning) were studied over the course of a 10-session-long group-based CBCT-fC among women with depressive disorders. Results: Dyadic growth curve models indicated that emotional bond, social learning, and clarification of meaning increase over time in both partners. In decentering and clarification of values, women who suffered from depression showed a larger increase than men, while men had higher values at the start of the training. Conclusions: Women with depression seem to benefit from CBCT-fC in terms of an increase in decentering and value clarification, important mechanisms of compassion training. This study is the first to show that theoretically derived mechanisms of compassion and additional therapeutic factors can describe the process along secular contemplative training sessions, which are increasingly implemented in the health care system. Future studies should explore the relationship of mechanisms and the outcome along the process of the training. Study Registration: Trial registration number NCT03080025.

Studying Physiological Synchrony in Couple Therapy through Partial Directed Coherence: Associations with the Therapeutic Alliance and Meaning Construction

In line with the growing recognition of the role of embodiment, affect and implicit processes in psychotherapy, several recent studies examine the role of physiological synchrony in the process and outcome of psychotherapy. This study aims to introduce Partial Directed Coherence (PDC) as a novel approach to calculating psychophysiological synchrony and examine its potential to contribute to our understanding of the therapy process. The study adopts a single-case, mixed-method design and examines physiological synchrony in one-couple therapy in relation to the therapeutic alliance and a narrative analysis of meaning construction in the sessions. Interpersonal Physiological Synchrony (IPS) was calculated, via a windowed approach, through PDC of a Heart Rate Variability-derived physiological index, which was measured in the third and penultimate sessions. Our mixed-method analysis shows that PDC quantified significant moments of IPS within and across the sessions, modeling the characteristics of interpersonal interaction as well as the effects of therapy on the interactional dynamics. The findings of this study point to the complex interplay between explicit and implicit levels of interaction and the potential contribution of including physiological synchrony in the study of interactional processes in psychotherapy.

Nonverbal Synchrony in Couple Therapy Linked to Clients' Well-Being and the Therapeutic Alliance

Nonverbal synchrony between individuals has a robust relation to the positive aspects of relationships. In psychotherapy, where talking is the cure, nonverbal synchrony has been related to a positive outcome of therapy and to a stronger therapeutic alliance between therapist and client in dyadic settings. Only a few studies have focused on nonverbal synchrony in multi-actor therapy conversations. Here, we studied the synchrony of head and body movements in couple therapy, with four participants present (spouses and two therapists). We analyzed more than 2000min of couple therapy videos from 11 couple therapy cases using Motion Energy Analysis and a Surrogate Synchrony (SUSY), a procedure used earlier in dyadic psychotherapy settings. SUSY was calculated for all six dyads per session, leading to synchrony computations for 66 different dyads. Significant synchrony occurred in all 29 analyzed sessions and between the majority of dyads. Complex models were used to determine the relations between nonverbal synchrony and the clients’ well-being and all participants’ evaluations of the therapeutic alliance. The clients’ well-being was related to body synchronies in the sessions. Differences were found between the clients’ and therapists’ alliance evaluations: the clients’ alliance evaluations were related to synchrony between both dyads of opposite gender, whereas the therapists’ alliance evaluations were related to synchrony between dyads of the same gender, but opposite to themselves. With four participants present, our study introduces a new aspect of nonverbal synchrony, since as a dyad synchronizes, the other two participants are observing it. Nonverbal synchrony seems to be as important in couple therapy as in individual psychotherapy, but the presence of multiple participants makes the patterns more complex.

Dialogue and Dominance in Couple Therapy for Depression: Exploring Therapists' Responses in Creating Collaborative Moments

Previous investigations have found specific communication patterns in couples dealing with depression, specifically when depression concurs with conjugal conflicts. The presence of these patterns can reflect couples' difficulties in engaging in collaborative communication during their sessions, posing a real challenge for therapists. This exploratory study uses a dialogical approach to examine issues of dominance and type of dialogue in two couples who differed in terms of their levels of dyadic adjustment. The therapists' reactions were explored in order to detect the kinds of responses that were most effective at engendering a collaborative attitude in therapy sessions. The method used to analyze the dialogue was Dialogical Investigations of Happenings of Change (DIHC). Results on dominance indicated that the degree of quantitative and semantic dominance displayed by a different member of the couple in each case was illustrative of their relational dynamics, while in both cases interactional dominance was exercised by the therapists. Results on dialogue revealed that dialogic dialogue might help to coconstruct new shared meanings of depression. The findings indicated that certain responses by therapists as part of the dialogue could be useful in bringing about a reduction in hostility between the members of a couple, provided that the responses are maintained over the course of the session. Some research and clinical implications that emerge from the results are discussed.

The Psychometric Properties of the Session Rating Scale: A Narrative Review

Background: The Session Rating Scale (SRS) is a measure used in psychotherapy practice. Given its application and frequent use in clinical practice settings, several studies including primary validation studies as well as outcome studies reporting psychometric properties have examined the validity and reliability of the SRS. Because the SRS is designed to be used in clinical practice, demonstration of reliability and validity is ideal with clinical populations instead of non-clinical populations. To our knowledge, there have been no reviews evaluating the psychometric properties of the SRS with clinical populations.Purpose: The aim of this study was to review and synthesize the psychometric properties of the SRS by examining all relevant outcome and validation studies.Methods: We completed an electronic literature search of several online databases in order to identify relevant articles. We identified 12 articles that met our inclusion and analyzed the reliability and validity evidence for the SRS with clinical populations.Results: Findings showed high internal consistency for the SRS and support evidence that the underlying dimension is a measure of therapeutic alliance. Test-retest reliability estimates were reported in 4 of the 12 studies included in this review (ranging from .54 to .70). The SRS had low to moderate concurrent validity with other longer measures of therapeutic alliance (.29 with ORS; .48 with HAQ II; .57-.65 with WAI).Discussion: Clinicians should be aware of the limitations in validity evidence for the SRS that may result from its brevity. However, clinicians should also consider the relative stability of the SRS as a pragmatic global measure of the construct of therapeutic alliance. Future research efforts should focus on validation of the SRS with larger, more diverse samples and specific clinical populations with a wider range of symptom severity.

Pressure to Attend Therapy, Dyadic Adjustment, and Adverse Childhood Experiences: Direct and Indirect Effects on the Therapeutic Alliance in Couples Therapy

In this study we examine the role that pressure to attend therapy, dyadic adjustment, and adverse childhood experiences (ACEs) play in developing the therapeutic alliance. A total of 351 couples received treatment as usual at three family therapy training clinics. Participants rated predictor variables at intake and alliance at the fourth session. Results of a path analysis indicate that each partner's dyadic adjustment is directly associated with the quality of her or his own alliance. In addition, when male partners report more ACEs and pressure to attend treatment, their own alliance scores decrease. Additionally, when one partner reports feeling pressure to attend therapy, the other partner's alliance decreases. Finally, for males, there is an indirect effect of dyadic adjustment on alliance through pressure to attend therapy. These results suggest that clinicians should routinely assess relationship adjustment, how pressured each partner is feeling to attend treatment, and ACEs; as these may impact alliance quality.