THE PROCESS OF IMMEDIACY IN BRIEF PSYCHOTHERAPY: COMPONENTS, EVENTS AND RELATIONSHIP TO IN-SESSION CLIENT CHANGE WITHIN A SINGLE CASE

Abstract

This study examined the process of immediacy, defined as conversations in-session about the immediate client-therapist relationship. Therapist immediacy interventions, the relationship between immediacy and client involvement, and immediacy events within a single-case were examined. The client was a 24-year-old Middle-Eastern female and the therapist was a 51-year-old Caucasian male. The psychotherapy was interpersonal and included 12 total weekly sessions. Psychotherapy outcome was measured by the OQ 45.2 (Outcome Questionnaire 45.2), IIP-32 (Inventory of Interpersonal Problems-32), and the SUIP-R (Self-Understanding of Interpersonal Patterns - Revised). Session measures included the SEQ-D (Session Evaluation Questionnaire - Depth) and the WAI-S (Working Alliance Inventory - Short). Immediacy and Client Involvement were both judge rated measures and coded based on speaking turns. Immediacy events were identified and analyzed by two judges.

Results indicated the sessions were deep and the working alliance was strong overall. The client ended treatment with more symptoms and interpersonal problems, but with a greater understanding of her interpersonal patterns. Results also indicated the therapist used one immediacy intervention, inquiry about the client-therapist relationship, most often and the other two immediacy interventions, self-involving statements and feedback, much less frequently. The client appeared more involved in session when the therapist inquired about their relationship and appeared less involved in session when the therapist used self-involving statements.

Client involvement was slightly higher before and after immediacy events than during immediacy events. Nine types of immediacy events were found, none of which involved difficult events (i.e., misunderstandings, alliance ruptures). Events fell into two categories: process and here-and-now events. Process events included reflecting on treatment and the client-therapist-relationship, and drawing the parallel between therapy and outside relationships. Process events occurred throughout treatment. Here-and-now events included the therapist's expression of disappointment, care, and sadness in relation to the client and a desire to connect with the client. There was a changing pattern over time in the occurrence of here-and-now events. The client had the strongest reactions after sessions to here-and-now events, but did not directly express these strong reactions to the therapist in session. Limitations and implications for practice and future research are discussed.