Diego Rocco

Deconstructive and Constructive Dynamics in the Clinical Process: A Step Further in the Validation of the Two-Stage Semiotic Model

The two-stage semiotic model (TSSM) suggests that the basic dynamics of a psychotherapy process could be described in terms of alternation of two different processes aimed respectively at constraining patients’ meanings regulating experience and action (deconstructive process) and at supporting the elaboration of innovative meanings (constructive process). The present case study tests the specificity of each of these processes in terms of clinically relevant features detected at interpersonal, intrapsychical, and clinical levels. A 76-session good-outcome psychodynamic treatment was studied. The results enable constructive and deconstructive sessions to be differentiated in terms of interaction modalities and the patients modalities of thinking. This is consistent with the TSSM hypothesis that the constructive and deconstructive sessions are composed of qualitatively different clinical processes.

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

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 patients 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.

Dynamic Mapping of the Structures of Content in Clinical Settings (DMSC). A new coding system for analysing the patient's narratives

OBJECTIVES The paper presents a method of content analysis framed within a semiotic and contextual model of the psychotherapy process as a situated dynamics of sensemaking: the Dynamic Mapping of the Structures of Content in Clinical Settings (DMSC). DESIGN DMSC is a system of content analysis focused on a generalized level of meaning, concerning basic aspects of the patients narrative (e.g., if the narrative concerns herself or other than herself). METHOD The paper presents the result of the application of DMSC to an intensive single-case analysis (Katja). The method has been applied by judges to the transcripts of sessions and is aimed at identifying patterns of combinations (defined: Patterns of content) of the categories characterizing the patients narratives (pattern analysis approach) as well as at mapping the transition among these patterns (sequential analysis approach). RESULTS These results provide evidence of its construct validity. In accordance with the theoretical model grounding the method, we have found that: (a) DMSC provides a meaningful representation of the patients narratives in terms of Patterns of content; (b) the probability of transition among the Patterns of content have proved to be significantly associated with the clinical quality of the sessions. CONCLUSION The DMSC has to be considered an attempt paving the way for further investigations aimed at developing a deeper understanding of the role played by the dynamics of sensemaking in the psychotherapy process.

Beyond Verbal Behavior: An Empirical Analysis of Speech Rates in Psychotherapy Sessions

Objective: The present work aims to detect the role of the rate of speech as a mechanism able to give information on patients intrapsychic activity and the intersubjective quality of the patient–therapist relationship. Method: Thirty clinical sessions among five patients were sampled and divided into idea units (N = 1276) according to the referential activity method. Each idea unit was rated according to referential activity method and in terms of speech rate (syllables per second) for both patient and therapist. A mixed-effects model was applied in order to detect the relationship between the speech rate of both the patient and the therapist and the features of the patients verbal production in terms of referential activity scales. A Pearson correlation was applied to evaluate the synchrony between the speech rate of the patient and the therapist. Results: Results highlight that speech rate varies according patients ability to get in touch with specific aspects detected through referential activity method: patient and the therapist speech rate get synchronized during the course of the sessions; and the therapists speech rate partially attunes to the patients ability to get in touch with inner aspects detected through RA method. Conclusion: The work identified speech rate as a feature that may help in the development of the clinical process in light of its ability to convey information about a patients internal states and a therapists attunement ability. These results support the intersubjective perspective on the clinical process.

A pilot study of the Italian adaptation of the Session Evaluation Questionnaire fourth version

The Session Evaluation Questionnaire (SEQ) measures the impact of counselling and psychotherapy sessions; it may be conceived as a bridge between psychotherapy process and outcome. Even if the original American SEQ has been translated into many languages, only a few translations have been validated. This is a pilot study that attempted to replicate the five-dimensional structure of the fourth version of the Anglo-American SEQ, for the Italian population. The SEQ is a self-report tool asking patients about their experience with the clinical session just ended; it consists of 27 adjectives in semantic differential scale, divided into three thematic parts: evaluation of the session itself, feelings after the session, and evaluation of the therapist. Data were collected on 111 outpatients attending the Dynamic Psychological Service for University Students, after their first two clinical interviews. Exploratory factor analyses were performed on each of the three parts of the SEQ. Results confirmed the original factorial structure, for Depth, Smoothness, Positivity and Arousal dimensions; Good Therapist dimension overlapped perfectly with the original one. The Italian SEQ showed adequate internal consistency. Convergent validity measured with an index of perceived satisfaction in the counselling process showed significant positive correlations. This pilot study showed that the Italian SEQ is a reliable instrument to measure the impact of clinical sessions. Validation studies are needed, especially to replicate the factor structure of the instrument and to better assess its validity.