Navigating the complexities of the psychotherapy process: a multi-method investigation on the role of therapist responsiveness

Understanding how treatment works is a crucial objective in psychotherapy research. Studies have highlighted the therapist effects on the psychotherapy process; however, there is still a gap on the specific role of the clinicians’ interpersonal skills. This thesis focused on therapist responsiveness—the capacity to effectively meet patients’ needs—and examined its relationship with other critical factors, such as therapeutic alliance, therapist emotional responses, and session outcomes measured in terms of depth of elaboration. Therapist-patient dyads completed self-report instruments and responded to open-ended questions. Study One found that therapist responsiveness was a more robust predictor of depth of elaboration than therapeutic alliance underscoring its significance. Mixed models were used considering the nested data structure. Study Two focused on the therapist perspective, revealing that deeper sessions were characterized by greater therapist responsiveness and positive countertransference whereas shallower sessions showed lower responsiveness and more negative countertransference. In Study Three a thematic analysis identified core aspects of therapist responsiveness within sessions. Responsive moments were marked by therapist attunement and insight promotion, while non-responsive moments involved feelings of inadequacy, misattunement, and disagreement on treatment objectives. Study Four applied network analysis to therapist responsiveness, therapeutic alliance, and depth of elaboration as evaluated by both therapists and patients. Interconnections between variables underscored that the therapeutic relationship can be better viewed as a complex system where both members reciprocally influence each other. Overall, therapist responsiveness emerged as a pivotal factor in promoting positive outcomes. Converging findings across various methodologies enriched our understanding on the mechanisms of change in psychotherapy underscoring the need for tailored interventions that address patients’ needs.