Psychotherapy Technique and Emotional Communication: The Relationship Between Technique Use in Psychotherapy and Patient Speech Styles Associated with the Referential Process

Linguistic analysis is a growing field within psychotherapy process research. Computerized measures have been developed to quantify qualities of speech associated with the Referential Process (RP), a construct describing the way in which people communicate emotional experience by cycling through different language styles (Bucci, 2021c). The three phases of RP are arousal, referential activity (RA), and reflection/reorganizing (R/R). Examining the latter two, the current study aimed to determine if therapists’ use of techniques was associated with immediate levels of patient RA and R/R in a sample of three archival psychotherapy sessions. Sessions were coded moment-by-moment (N=263 therapist speech turns) for the therapist’s use of technique using the Comparative Psychotherapy Process Scale (CPPS; Hilsenroth et al., 2005). While the study was exploratory, it was hypothesized that use of technique (vs. no technique use), as well as use of specific techniques, such as discussing the therapy relationship, would be significantly associated with RA or R/R whereas the number of techniques used would not. Results were analyzed using a multilevel modeling approach, controlling for the role of the three different dyads. Among other findings, two techniques were associated with a more reflective style of speech in the following patient speech turn: a) the therapist encouraging discussion of patient’s wishes, fantasies, dreams, or early childhood memories, and b) the therapist focusing discussion on the relationship between the therapist and patient. Results of this study contribute to our understanding of the relationship between therapist technique and patients’ emotional processing of experiences in psychotherapy through the RP.