Studying the Therapeutic Process by Observing Clinicians' In-Session Behaviour.

UNLABELLED: This paper presents a further step in the use and validation of a systematic, functional-analytic method of describing psychologists' verbal behaviour during therapy. We observed recordings from 92 clinical sessions of 19 adults (14 women and 5 men of Caucasian origin, with ages ranging from 19 to 51 years) treated by nine cognitive-behavioural therapists (eight women and one man, Caucasian as well, with ages ranging from 25 to 48 years). The therapists' verbal behaviour was codified and then classified according to its possible functionality. A cluster analysis of the data, followed by a discriminant analysis, showed that the therapists' verbal behaviour tended to aggregate around four types of session differentiated by their clinical objective (assessment, explanation, treatment and consolidation). These results confirm the validity of our method and enable us to further describe clinical phenomena by distinguishing psychologists' classes of clinically relevant activities. Specific learning mechanisms may be responsible for clinical change within each class. These issues should be analysed more closely when explaining therapeutic phenomena and when developing more effective forms of clinical intervention. KEY PRACTITIONER MESSAGE: We described therapists' verbal behaviour in a focused fashion so as to develop new research methods that evaluate psychological work moment by moment. We performed a cluster analysis in order to evaluate how the therapists' verbal behaviour was distributed throughout the intervention. A discriminant analysis gave us further information about the statistical significance and possible nature of the clusters we observed. The therapists' verbal behaviour depended on current clinical objectives and could be classified into four classes of clinically relevant activities: evaluation, explanation, treatment and consolidation. Some of the therapist's verbalizations were more important than others when carrying out these clinically relevant activities. The distribution of the therapists' verbal behaviour across classes may provide us with clues regarding the functionality of their in-session verbal behaviour.

Investigación de resultados y de procesos sobre la técnica de reestructuración cognitiva / Research results and technical processes on cognitive restructuring

En este trabajo se presenta una revisión actualizada de la literatura científica que existe sobre la reestructuración cognictiva, tanto en cuanto a los estudios de los resultados como de proceso. Se ha escogido esta técnica de entre las muchas posibles por su relevancia clínica y por la cantidad de aspectos que quedan sin resolver en la literatura. Se comienza con una exposición de las principales carazterísticas de la investigación de resultados (estudio de los tratamientos de elección para distintos problemas psicológicos) y de la investigación de procesos (estudi de los mecanismos responsables del cambio) en la psicoterapia en general; más adelante se hace un resumen de ambos tipos de estudios en la reestructuración cognictiva. Se puede concluir que la reestructuración funciona, pero continuamos sin conocer cuáles son los mecanismos responsables de su éxito. Se apunta que es necesaria la investigación de lainteracción terapeuta-cliente para poder avanzar en el tema(AU)

This paper presents an updated review of scientific literature exists on the restructuring cognictiva, both in terms of outcome studies and process. This technique was chosen from among the many possible clinical relevance for and the number of issues still unresolved in the literature. It begins with an outline of the main carazterísticas of outcomes research (the study of different treatments of choice for psychological problems) and the research process (students of the mechanisms of change) in psychotherapy in general later a summary of both types of studies cognictiva restructuring. It can be concluded that the restructuring work, but we still do not know what are the mechanisms responsible for its success. It is noted that research is needed lainteracción therapist-client to make progress in the field(AU)

Estudio comparativo de la conducta verbal del terapeuta según su experiencia durante la evaluación clínica / Comparative study of therapist’s verbal behavior according its experience during clinical assessment

En el presente trabajo se ha realizado una primera aproximación al estudio de las diferencias entre terapeutas con diversos grados de experiencia. La lógica de este tipo de trabajos se centra en el supuesto de que el terapeuta experto es el que lo hace bien y analizar su comportamiento nos permitirá aprender cómo hacer terapia más eficientemente. La metodología de trabajo empleada es la observación y análisis de sesiones terapéuticas grabadas directamente y registradas mediante un sistema de categorías construido a tal efecto. Los resultados muestran que las categorías Función Discriminativa, Función de Refuerzo y Otras son las más utilizadas por los terapeutas inexpertos mientras que las categorías Función de Castigo, Función Evocadora, Función Motivadora, Función Instruccional y Función Informativa son las más usadas por expertos, observándose en la mayoría de los casos valores intermedios en los terapeutas de mediana experiencia. A pesar de las limitaciones encontradas, estos resultados indican que pueden existir diferencias tanto cuantitativas como cualitativas respecto a lo que hacen los terapeutas en sesión en función de su grado de experiencia (AU)

The present study is an initial approach to the study of differences between therapists with regard to their experience level. This type of study is based on the assumption that it is the expert therapist who does things well, and that the analysis of his/her behaviour will enable us to learn how to do therapy more efficiently. We used an observational methodology for the analysis of video-taped sessions. Verbal behaviour was coded with a coding system created for that purpose. Results show that the Discriminative, Reinforcement and “Others” functions were the most used by inexpert therapists, while Punishment, Elicitation, Motivating, Instructional, and Informative were the functions most used by expert therapists. Intermediate values were observed for most therapists with a middle degree of experience. Despite certain limitations, results indicate that there may be quantitative, as well as qualitative, differences with respect to what therapists do in session as a function of their experience level (AU)

Descriptive analysis of the verbal behavior of a therapist: a known-group validity analysis of the putative behavioral functions involved in clinical interaction.

This study analyzes the interobserver agreement and hypothesis-based known-group validity of the Therapist's Verbal Behavior Category System (SISC-INTER). The SISC-INTER is a behavioral observation protocol comprised of a set of verbal categories representing putative behavioral functions of the in-session verbal behavior of a therapist (e.g., discriminative, reinforcing, punishing, and motivational operations). The complete therapeutic process of a clinical case of an individual with marital problems was recorded (10 sessions, 8 hours), and data were arranged in a temporal sequence using 10-min periods. Hypotheses based on the expected performance of the putative behavioral functions portrayed by the SISC-INTER codes across prevalent clinical activities (i.e., assessing, explaining, Socratic method, providing clinical guidance) were tested using autoregressive integrated moving average (ARIMA) models. Known-group validity analyses provided support to all hypotheses. The SISC-INTER may be a useful tool to describe therapist-client interaction in operant terms. The utility of reliable and valid protocols for the descriptive analysis of clinical practice in terms of verbal behavior is discussed.

El Proceso Terapéutico "Momento a Momento" desde una Perspectiva Analítico-Funcional / A "Moment-to-Moment" Analysis of the Therapeutic Process Using a Functional-Analytic Approach

Este trabajo describe cómo se desarrolla el proceso terapéutico en un caso concreto mediante el estudio de las posibles funciones de la conducta verbal del terapeuta durante la interacción con su cliente. Para ello, se procedió a la observación de las grabaciones de las 10 sesiones que constituyeron la totalidad de la intervención terapéutica del caso estudiado. La categorización del comportamiento verbal del psicólogo en sesión fue realizada mediante el software The Observer® XT y la aplicación del Sistema de Categorización de la Conducta Verbal del Terapeuta (SISC-CVT) desarrollado por las autoras y asociado a altos niveles de concordancia inter e intra observadores. El análisis de los registros permitió una primera aproximación a la formulación de una "radiografía funcional" del proceso terapéutico que puede tener importantes implicaciones para el estudio y comprensión del fenómeno clínico así como para el diseño, entrenamiento y aplicación de formas más efectivas de intervención psicológica (AU)

This study analyzes the potential functions of the therapist's verbal behavior during actual in-session therapist-client interactions. The complete therapeutic process of a clinical case was recorded (10 sessions). The therapist's verbal behavior was coded by means of The Observer® XT software and the Therapists' Verbal Behavior Category System (SISC-CVT), which has shown high levels of inter and intra-rater agreement. Results showed a descriptive analysis of the therapeutic process. Our results help to understand the functional relations and learning mechanisms that may be involved during in-session verbal interaction. The approach illustrated in the present study could serve a first step to designing, training and putting into practice more effective psychological interventions (AU)

Aproximación al Estudio Funcional de la Interacción Verbal entre Terapeuta y Cliente Durante el Proceso Terapéutico / An Approach to the Functional Study of the Verbal Interaction Between Therapist and Client During the Therapeutic Process

En este trabajo se presenta el desarrollo de un sistema de categorías de la conducta verbal del terapeuta (SISC-CVT) y su aplicación para el análisis de sesiones de terapia; el objetivo fue identificar topografías del comportamiento verbal de los clínicos que podrían corresponderse con las posibles funcionalidades de tal comportamiento. Se trabajó con 101 sesiones procedentes de 21 casos de adultos tratados por 8 terapeutas. La hipótesis de partida era que las categorías de la conducta verbal de los terapeutas se distribuirían en la intervención clínica de manera que se podría establecer un modelo de actuación verbal relacionado con el objetivo clínico durante el proceso terapéutico. Los resultados de los análisis realizados confirman esta hipótesis y permiten afirmar que lo que se relaciona con el tipo de comportamiento verbal emitido por los terapeutas es la actividad clínicamente relevante que se está llevando a cabo en sesión. Según estos resultados los terapeutas realizan cuatro tipos de actividades clínicamente relevantes (evaluación, explicación, tratamiento y consolidación del cambio) que están relacionadas con el tipo de categorías de la conducta verbal que predomina en cada una de ellas más que con el momento temporal de la terapia en el que tienen lugar (AU)

This paper presents the development process of a coding system of the verbal behavior of therapists (SISC-CVT) and its application in the analysis of a series of clinical sessions. The aim was to identify topographies of the clinicians' verbal behavior that could be related to the hypothesized functions of this behavior. We analyze the recordings of 101 sessions, corresponding to 21 adult clinical cases. The initial hypothesis was that the categories of therapists' verbal behavior are distributed throughout the clinical intervention in such a way that a model of verbal performance could be established related to the clinical objective pursued by the psychologist during the therapeutic process. The results have confirmed this hypothesis and support the conclusion that what is related to the type of verbal behavior emitted by cognitive-behavioral therapists is the clinically relevant activity that is being carried out in session. According to these results, therapists perform four types of clinically relevant activity (assessment, explanation, treatment and consolidation of change). These are related to the type of categories of verbal behavior that are most frequent during each activity, rather than to the temporal moment of therapy in which they occur (AU)

Study of the Socratic method during cognitive restructuring.

Cognitive restructuring, in particular in the form of the Socratic method, is widely used by clinicians. However, little research has been published with respect to underlying processes, which has hindered well-accepted explanations of its effectiveness. The aim of this study is to present a new method of analysis of the Socratic method during cognitive restructuring based on the observation of the therapist's verbal behaviour. Using recordings from clinical sessions, 18 sequences were selected in which the Socratic method was applied by six cognitive-behavioural therapists working at a private clinical centre in Madrid. The recordings involved eight patients requiring therapy for various psychological problems. Observations were coded using a category system designed by the authors and that classifies the therapist's verbal behaviour into seven hypothesized functions based on basic behavioural operations. We used the Observer XT software to code the observed sequences. The results are summarized through a preliminary model which considers three different phases of the Socratic method and some functions of the therapist's verbal behaviour in each of these phases: discriminative and reinforcement functions in the starting phase, informative and motivational functions in the course of the debate, and instructional and reinforcement functions in the final phase. We discuss the long-term potential clinical benefits of the current proposal.

Analysis of the therapist's verbal behavior during cognitive restructuring debates: a case study.

This paper reports a case study in which the authors analyze the application of the debate technique in cognitive restructuring so as to obtain a deeper understanding of the relevant behavioral processes. The authors examined the recordings of a clinical case of low mood disorder and selected five debates that dealt with the same problem. After their transcription, the authors analyzed the client-therapist verbal interaction. Results show changes in the verbalizations of both parties as the treatment progresses. The authors propose a new explanation of these changes, constituting a step forward in the theoretical explanation of the debate technique within the cognitive-behavioral approach.

[Therapists' verbal behavior category system]. / Sistema de categorización de la conducta verbal del terapeuta.

This paper presents the theoretical and methodological basis of a therapist's verbal behavior category system that allows us to study clinical psychologists' language from a functional-analytic framework and with a rigorous observation method. The procedure to develop the coding system is explained in detail from a very early stage of exploratory observation, to the systematic observation through the use of The Observer XT software. An analysis of intra- and inter-rater reliability using the kappa coefficient and taking into account the factors that affect the values of Cohen's index was carried out. Results show high levels of observer accuracy (between approximately 87% and 93%) that justify the application of this category system to study therapists' verbal behavior in session.

Sistema de categorización de la conducta verbal del terapeuta / Therapists’ verbal behavior category system

En este trabajo se presentan los fundamentos teóricos y metodológicos para el desarrollo de un sistema de categorización de la conducta verbal del psicólogo clínico durante la intervención terapéutica, que nos permita el estudio de ésta desde una perspectiva analítico-funcional basada en una rigurosa metodología observacional. El procedimiento de construcción de dicho sistema es detallado desde las etapas iniciales de observación exploratoria hasta la observación sistemática de la conducta a analizar con la ayuda del software The Observer XT. Asimismo, se lleva a cabo un estudio del grado de acuerdo inter e intra observadores mediante el cálculo del coeficiente kappa y la consideración de los factores que afectan a los valores de dicho índice. Los resultados del análisis muestran altos niveles de precisión de los observadores (entre un 87 y un 93%, aproximadamente) que justifican la utilización del sistema de categorías elaborado para el estudio del lenguaje de los terapeutas en la clínica

This paper presents the theoretical and methodological basis of a therapist’s verbal behavior category system that allows us to study clinical psychologists’ language from a functional-analytic framework and with a rigorous observation method. The procedure to develop the coding system is explained in detail from a very early stage of exploratory observation, to the systematic observation through the use of The Observer XT software. An analysis of intra- and inter-rater reliability using the kappa coefficient and taking into account the factors that affect the values of Cohen’s index was carried out. Results show high levels of observer accuracy (between approximately 87% and 93%) that justify the application of this category system to study therapists’ verbal behavior in session

¿Por qué la gente cambia en terapia? Un estudio preliminar / Why do people change in therapy? A preliminary study

El presente trabajo representa el inicio de una nueva forma de estudiar los procesos que potencialmente explican el cambio terapéutico. La metodología de trabajo empleada es la observación y análisis de sesiones terapéuticas grabadas directamente y desarrolladas dentro de un enfoque conductual de intervención. El sistema de categorías elaborado busca la codificación de la conducta del psicólogo atendiendo a su funcionalidad y no a su topografía. Con ello se pretende llevar a cabo un análisis funcional de la interacción terapeuta-cliente que permita identificar los procesos de aprendizaje que operan en la clínica y que subyacen al éxito en terapia. Los resultados y conclusiones del estudio, aunque provisionales, dejan entrever las importantes implicaciones que el desarrollo de esta línea de trabajo puede tener para la comprensión del fenómeno clínico y ponen de manifiesto la relevancia de los procesos de aprendizaje asociativo en el cambio terapéutico

This work represents the beginning of a new way to study the processes that can explain the therapeutic change. The method used is the observation and analysis of therapeutic sessions directly recorded and developed inside a behavioural approach. The category system tries to carry out a functional analysis of the therapist-client interaction which enables the identification of learning processes that work in clinical setting and explain success in therapy. Outcomes are provisional but show the utility of this initial trend of investigation to the comprehension of clinical phenomenon. Conclussions also emphasize the importance of associative learning processes on the therapeutic change

[Why do people change in therapy? A preliminary study]. / ¿por qué la gente cambia en terapia? Un estudio preliminar.

Why do people change in therapy? A preliminary study. This work represents the beginning of a new way to study the processes that can explain the therapeutic change. The method used is the observation and analysis of therapeutic sessions directly recorded and developed inside a behavioural approach. The category system tries to carry out a functional analysis of the therapist-client interaction which enables the identification of learning processes that work in clinical setting and explain success in therapy. Outcomes are provisional but show the utility of this initial trend of investigation to the comprehension of clinical phenomenon. Conclusions also emphasize the importance of associative learning processes on the therapeutic change.

Literatura científica y práctica clínica. Un estudio comparativo sobre la intervención en los problemas obsesivo-compulsivos / Scientific literature and clinical practice. A comparative study on obsessive-compulsive problems

Si algo caracterizó a la terapia comportamental en sus orígenes fue el desarrollo integrado de los ámbitos académico y aplicado de la disciplina, ahora bien, ¿sigue siendo ésta una de las características fundamentales de la modificación de conducta hoy en día?. El presente trabajo pretende analizar las diferencias y semejanzas existentes entre la literatura científica y la práctica clínica real que se viene desarrollando en nuestro país respecto al abordaje terapéutico de los comportamientos obsesivo-compulsivos. La comparación entre casos clínicos publicados y aquellos procedentes de gabinetes privados pone de manifiesto importantes diferencias en el tipo de problemas tratados, la duración de los tratamientos llevados a cabo, así como los resultados terapéuticos alcanzados. En este sentido, parece que los casos presentados en la literatura se asocian, sistemáticamente, con índices más positivos de efectividad y eficiencia terapéutica además de reflejar los comportamientos obsesivo-compulsivos más prototípicos

The origin of behaviour therapy witnessed a comprehensive development both of academic and applied fields. Could we say that this is still the case of today´s behaviour therapy?. This paper addresses differences and similarities that exist between literature and clinical practice with obsessive-compulsive disorders in Spain. A comparison between cases in literature and those reported by private therapists shows significant differences in the kind of problems that are addressed, the duration of treatments and the outcome. Likewise, cases in literature are systematically associated with higher therapeutic effectiveness rates. They also reflect the most paradigmatic obsessive-compulsive behaviours