UNDERSTANDING THERAPIST-CLIENT SYNCHNORY IN PERCEIVING INTERVENTIONS: ITS ASSOCIATIONS WITH THERAPY PROCESS AND OUTCOME AND THERAPIST CULTURAL HUMILITY

Abstract

Recent research highlights the significance of mutual therapy experiences between therapist and client (Chen et al., 2022; Fitzpatrick et al., 2005; Kivlighan & Arthur, 2000). However, little is known about a therapy dyad’s mutual experiences in perceiving interventions used session by session and their potential associations with therapeutic alliance and outcomes. At the same time, relational and cultural theories suggest that therapists’ culturally humble interpersonal attitudes put them and their clients on the same page so that they can work better in concert (Mosher et al., 2019). However, the possible session-by-session influence of therapist cultural humility on clients’ and therapists’ mutual perceptions remains unexplored. The current study fills these gaps by examining (a) the between-session associations of therapist-client congruence in their perceptions of therapeutic interventions with therapeutic process and outcome; and (b) the between-session relationship between therapist cultural humility and therapist-client congruence in intervention perceptions. Using the Directional and Nondirectional Difference framework(DNDD, Bednall & Zhang, 2020), this study analyzed longitudinal data from 536 measurements taken at every third session of 108 clients working with 17 doctoral student therapists in open-ended psychodynamic psychotherapy at the within-dyad level. Results showed that greater-than-usual congruence between therapist and client perceptions of exploration interventions was associated with a better-than-usual alliance, while their congruence regarding insight interventions was linked to worse-than-usual alliance. While perceptual congruences were not directly associated with client-reported outcomes, they were indirectly related to outcomes through the alliance. Furthermore, therapists rated by their clients as more culturally humble than usual were more-than-usual congruent with their clients in perceiving exploration and insight interventions used in therapy. These findings support intersubjective and cultural perspectives in contemporary psychodynamic theories. Implications for practice and research are discussed, emphasizing the role of therapist-client mutuality and therapist cultural humility in psychotherapy in the therapeutic process.