Learning from embodied tension:  A naturalistic multimodal single case study of nonverbal expressions and interactions in a psychotherapy  training process

Cecilie Hillestad  Hoff; Helen A. Nissen-Lie; Hanne Strømme

doi:10.24377/EJQRP.article3102

Authors

Cecilie Hillestad Hoff Author
Helen A. Nissen-Lie Author
Hanne Strømme Author

DOI:

https://doi.org/10.24377/EJQRP.article3102

Keywords:

nonverbal psychotherapy skills, synchrony, therapists' emotional regulation, training, video recordings of psychotherapy/supervision

Abstract

This multimodal single case study explored how nonverbal communication was handled in a psychodynamic training process. Using a multimodal qualitative method, video recordings of a 39 sessions psychodynamic therapy process (with a female therapist treating a male client with relational issues), parallel supervision sessions, and Interpersonal Process Recall interviews with the client and therapist, were analyzed within the framework of Reflexive Thematic Analysis (RTA). The analysis yielded three themes: a) The therapist’s insecurity seemed to have compromised her capacity to use her own bodily signals to facilitate the exploration of emotions together with the client; b) The therapist and the supervisor were sensitive to the nonverbal cues from the client, but supervision did not explicitly explore how the therapist could use this sensitivity to moderate her own bodily signals and inform her clinical interventions; and c) Supervision supported the therapist in tolerating embodied tension in the therapeutic relationship. This study illustrates the close relationship between therapists’ capacity for emotion regulation and their nonverbal relational skills. A more open exploration of the trainee’s emotion regulation capacities in supervision may have supported her to deal more effectively with her own and the client’s nonverbal expressions.

Downloads

Download data is not yet available.

References

Altimir, C., & Jiménez J. P. (2021). The clinical relevance of interdisciplinary research on affect regulation in the analytic relationship. Frontiers in Psychology, 12, 718490. http://dx.doi.org/10.3389/fpsyg.2021.718490

Altmann, U., Schoenherr, D., Paulick, J., Deisenhofer, A. K., Schwartz, B., Rubel, J. A., Stangier, U., Lutz, W., & Strauss, B. (2020). Associations between movement synchrony and outcome in patients with social anxiety disorder. Evidence for treatment specific effects. Psychotherapy Research, 30(5), 574-590.

Atzil-Slonim, D., Soma, C. S., Zhang, X., Adar Paz, A., & Imel, Z. E. (2023). Facilitating dyadic synchrony in psychotherapy sessions: Systematic review and meta-analysis. Psychotherapy Research, 33(7), 898-917. https://doi.org/10.1080/10503307.2023.2191803

Bar-Kalifa, E., Goren, O., Gilboa-Schechtman, E., Wolff, M., Rafael, D., Heimann, S., Yehezkel, I., Scheniuk, A., Ruth, F., & Atzil-Slonim, D. (2023). Clients’ emotional experience as a dynamic context for client-therapist physiological synchrony. Journal of Consulting and Clinical Psychology, 91(6), 367–380. https://doi.org.ezproxy.uio.no/10.1037/ccp0000811

Barros, P., Altimir, C., & Pérez, J .C. (2016). Patients’ facialaffective regulation during episodes of rupture of the therapeutic alliance / Regulación afectivo-facial de pacientes durante episodios de ruptura de la alianza terapéutica. Estudios de Psicología, 37(2-3), 580-603. https://doi.org/10.1080/02109395.2016.1204781

Bennecke, C., Peham, D., & Bänninger-Huber, E. (2005). Nonverbal relationship regulation in psychotherapy. Psychotherapy Research, 15(1-2), 81- 90. https://doi.org/10.1080/10503300512331327065

Braun, V., & Clarke. V. (2006) Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. https://doi.org//10.1191/1478088706qp063oa

Braun, V., & Clarke, V. (2013). Successful qualitative research: A practical guide for beginners. Sage.

Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise, and Health, 11(4), 589-597. https://doi.org/10.1080/2159676X.2019.1628806

Braun, V., & Clarke, V. (2021). Can I use TA?: Should I use TA?: Should I not use TA?: Comparing reflexive thematic analysis and other pattern-based qualitative analytic approaches. Counselling and Psychotherapy Research, 21(1), 37-47.

Castonguay, L., Boswell, J. F., Caspar, F., Friedlander, M. L., Gómez, B., Hayes, A. M., Holtforth, M. G., Messer, S. B., Newman, M. G., & Strauss, B. M. (2023). What competencies should therapists acquire and how should they acquire them? In L. G. Castonguay, & C. E. Hill (Eds.), Becoming better psychotherapists: Advancing training and supervision (pp. 13–29). American Psychological Association. https://doi-org.ezproxy.uio.no/10.1037/0000364-002

Deres-Cohen, K., Dolev-Amit, T., Peysachov, G., Ramseyer, F. T., & Zilcha-Mano, S. (2021). Nonverbal synchrony as a marker of alliance ruptures. Psychotherapy, 58(4), 499– 509. https://doi-org.ezproxy.uio.no/10.1037/pst0000384

Doering, S. (2022). Implizite kommunikation in der therapeutischen Beziehung. Klett-Cotta.

Elliot, R. (1986). Interpersonal process recall (IPR) as psychotherapy process research method. In L. Greenberg & W. Pinsof (Eds.), The psychotherapeutic process: A research handbook (pp. 503-526). Guildford Press.

Eubanks, C. F., Muran, J. C., & Samstag, L. W. (2023). Alliancefocused training: Teaching therapists to navigate alliance ruptures. In L. G. Castonguay, & C. E. Hill (Eds.), Becoming better psychotherapists: Advancing training and supervision (pp. 107–126). American Psychological Association. https://doi.org.ezproxy.uio.no/10.1037/0000364-006

Foley, G. N., & Gentile, J. P. (2010). Nonverbal communication in psychotherapy. Psychiatry (Edgemont), 7(6), 38-44.

Flyvbjerg, B. (2006). Five misunderstandings about case-study research. Qualitative Inquiry, 12(2), 219-245.

Grace, M., Kivlighan, D. M., & Kunce, J. (1995). The effect of nonverbal skills training on counselor trainee nonverbal sensitivity and responsiveness and on session impact and working alliance ratings. Journal of Counseling & Development, 73, 547-552.

Gross, J. J., Uusberg, H., & Uusberg, A. (2019). Mental illness and well‐being: An affect regulation perspective. World Psychiatry, 18(2), 130-139. https://doi-org./10.1002/wps.20618

Gullestad, S. E., & Killingmo, B. (2020). The theory and practice of psychoanalytic therapy: Listening for the subtext. Routledge.

Gullestad, S. E. (2022). Finding the mind in the body. Psychoanalytic Inquiry, 42(4), 244-252.

Hill, C. E., Knox, S., Thompson, B. J., Williams, E. N., Hess, S. A., & Ladany, N. (2005). Consensual qualitative research: An update. Journal of Counseling Psychology, 52(2), 196–205. https://doi-org.ezproxy.uio.no/10.1037/0022-0167.52.2.196

Hill, C . E., Gelso, C. J., Chui, H., Spangler, P., Hummel, A., Huang, T., Jackson, J., Jones, R. A., Palma, B., Bhatia, A., Gupta, S., Ain, S. C., Klingaman, B., Lim, R. H., Liu, J., Hui, K., Jezz, M. M., & Miles, J. R. (2014). To be or not to be immediate with clients: The use and perceived effects of immediacy in psychodynamic/interpersonal psychotherapy. Psychotherapy Research, 24(3), 299-315. https://doi-org10.1080/10503307.2013.812262

Hill, C. (2020). Helping skills: Facilitating, exploration, insight, and action. American Psychological Association.

Kinseth, L. M. (1989). Nonverbal training for psychotherapy: Overcoming barriers to clinical work with client nonverbal behavior. The Clinical Supervisor, 7(1), 5-25.

Kiesler, D. J. (1988). Therapeutic metacommunication: Therapist impact disclosure as feedback in psychotherapy. Consulting Psychologists Press.

Levitt. H. (2021). Qualitative generalizations, not to the populations, but to the phenomenon: Reconceptualizing variation in qualitative research. Qualitative Psychology, 8(1), 95-110.

Levitt, H., McLeod, J., & Stiles, W. B. (2021). The conceptualization, design, and evaluation of qualitative methods in research on psychotherapy. In M. Barkham, W.

Lutz, & L. G. Castonguay (Eds.), Handbook of psychotherapy and behavior change (7th ed.), (pp. 51-86). John Wiley & Sons.

McLeod, J. (2010). Case study research in counselling and psychotherapy. Sage Publications Ltd.

Meekums, B., Macaskie, J., & Kapur, J. (2016). Developing skills in counselling and psychotherapy: A scoping review of interpersonal process recall and reflecting team methods in initial therapist training. British Journal of Guidance & Counselling, 44 (5), 504-515.

Muran, J. C., & Eubanks, C. F. (2020). A way to therapist training. In J. C. Muran, & C. F. Eubanks (Eds.), Therapist performance under pressure: Negotiating emotion, difference, and rupture (pp. 103–127). American Psychological Association. https://doi-org.ezproxy.uio.no/10.1037/0000182-006

Orlinsky, D. E., & Rønnestad, M. H. (2005). How psychotherapists develop: A study of therapeutic work and professional growth. American Psychological Association.

Ramseyer, F. T., & Tschacher, W. (2011). Nonverbal synchrony in psychotherapy: Coordinated body movement reflects

relationship quality and outcome. Journal of Consulting and Clinical Psychology, 79(3), 284–295. https://doiorg.ezproxy.uio.no/10.1037/a0023419

Ramseyer, F. T., & Tschacher, W. (2014). Nonverbal synchrony of head- and body-movement in psychotherapy: Different signals have different associations with outcome. Frontiers in Psychology, 5, 979. https://doi-org.10.3389/fpsyg.2014.00979

Ramseyer, F. T. (2020). Exploring the evolution of nonverbal synchrony in psychotherapy: The ideographic perspective provides a different picture. Psychotherapy Research, 30 (5), 622-634.

Rousmaniere, T., & Vaz, A. (Eds.) (2021 - in press). The essentials of deliberate practice. American Psychological Association.

Rønnestad, M. H., & Skovholt, M. T. (2013). The developing practitioner: Growth and stagnation of therapists and counselors. Routledge.

Safran, J. D., Crocker, P., McCain, S., & Murray, P. (1990). Therapeutic alliance rupture as a therapy event for empirical investigation. Psychotherapy (Chicago III), 27(2), 154-165.

Safran, J. D., & Kraus, J. (2014). Alliance ruptures, impasses, and enactments: A relational perspective. Psychotherapy, 51(3), 381–387. https://doi.org/10.1037/a0036815

Zilcha-Mano, S. (2024). How getting in sync is curative: Insights gained from research in psychotherapy. Psychological Review. Advance online publication. https://doi.org/10.1037/rev0000471