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Sequential Consequences of Therapists' Interventions

Received May 14, 1998; revised July 29, 1998; accepted August 21, 1998. From the Department of Psychiatry, University of California, San Francisco, and the Institute of Community and Family Psychiatry, McGill University, Montreal, Quebec, Canada. Address correspondence to Dr. Bond, Institute of Community and Family Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital 4333 Côte Ste-Catherine Road, Montreal, Quebec H3T 1E4, Canada.

Using sequential analysis, the authors examined how therapists' actions related to the verbal disclosure and defensive patterns that followed therapists' interventions within a single therapy hour for 20 patients. At the same time, a new measure, the Psychodynamic Intervention Rating Scale (PIRS), was tested for reliability and construct validity. Results indicated that therapists fit their styles of intervention to patients' levels of distress and functioning. Within the session, patient's emotional elaboration was followed by therapist's defense interpretation, followed by more patient emotional elaboration. Patient elaboration of significance was followed by more transference interpretation, followed by more patient elaboration of significance. Noninterpretive interventions were followed by patient's disclosure of facts, not emotion. Both interpretive intervention process sequences and therapist's use of support predicted posttreatment symptom reduction. The PIRS was shown to have satisfactory reliability and construct validity. (The Journal of Psychotherapy Practice and Research 1999; 8:40–54)

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