The nature and features of patient-therapist transactions using the Structural Analysis of Social Behavior (SASB) model

INTRODUCTION. Psychotherapy research has extensively shown that the therapeutic relationship plays a pivotal role in determining patient change. This relationship should serve as a corrective interpersonal experience providing the patient with more adaptive and constructive interpersonal and intrapsychic patterns of behavior. The present study looks into the connection between patient-therapist transactions and therapy outcome by measuring moment-by-moment communication exchanges and comparing them across good- versus poor-outcome cases. METHOD. Twenty patient-therapist dyads, divided into two matched good- and poor-outcome subgroups, were intensively observed for eight therapy sessions each, and their exchanges were coded using the Structural Analysis of Social Behavior (SASB; Benjamin, 1974, 1979, 1996, 2002) method. This resulted in nearly 30,000 thought units (i.e., speech portions expressing a complete thought) being coded and subsequently analyzed with the software T-LAB. RESULTS. Sequence chains analyses comparing good- and poor-outcome cases showed the presence of distinctive antecedents and consequents in the patient-therapist exchanges. The main therapist technique variables in good-outcome cases were self-disclosing and expressing communications, evoking, as a consequent, the same patterns in patients. Regarding the poor-outcome cases, patients’ attempt to control the setting (i.e., the therapist) by “managing” or “recoiling” were followed by complex communication codes (i.e., mixed positive and negative affiliative communications), initiated both by the patient or the therapist. DISCUSSION. The underlying echo between these therapist and patient behaviors will be discussed, along with the technical use of the therapeutic relationship as capable of providing the framework for and the essence of psychological change.