Exploring Typologies of Immediacy Events in Psychodynamic Therapy: A Latent Class Analysis.

Abstract

Immediacy is a therapeutic intervention that entails the explicit discussion between therapist and client about their relationship in the here-and-now. It is considered a potentially powerful intervention that can facilitate relational processing, especially in psychodynamic psychotherapies. Τhis study aims to explore the use of immediacy in psychodynamic psychotherapy through a case-series analysis. Videos of 139 sessions, drawn from 7 psychotherapies with 2 therapists, were coded in terms of the type of immediacy used and its immediate effects, as reflected in the client's response. A total of 121 immediacy events were identified in 57 sessions, occupying 8% of the total therapy time; the majority were initiated by the therapist. A Latent Class Analysis was conducted to explore where there exist clusters of immediacy events that share patterns of immediacy type and effect. Two distinct clusters of immediacy events were identified. The most common group, which we termed 'limited engagement in immediacy', was characterised by a primarily insight-oriented agenda on the therapist's part, smooth collaboration during the immediacy event, and limited engagement on the client's part. The second cluster, termed 'mutual engagement in immediacy,' reflected more complex processes characterised by conflict, with the therapist using a range of interventions (from alliance-building to insight-oriented interventions), evidence of disruption in the therapist-client collaboration, and the client showing increased engagement and reporting improvement. The findings are discussed drawing upon the literature on the processes of repairing ruptures in the therapeutic alliance and clinical implications regarding the use of immediacy.