The Self and Its Intersubjective Synchrony in Psychotherapy: A Systematic Review

IF 3.2 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Clinical psychology & psychotherapy Pub Date : 2025-07-01 DOI:10.1002/cpp.70110

Lorenzo Lucherini Angeletti, Bianca Ventura, Ferdinando Galassi, Giovanni Castellini, Valdo Ricca, Andrea Scalabrini, Georg Northoff

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Abstract

The self is pivotal in psychotherapy, integrating internal (interoexteroceptive) and external (exteroproprioceptive) layers of experience necessary to create an intersubjective space in psychotherapeutic relationship to foster self-reorganization. Patient–therapist intersubjective experience of synchrony seems to be core in better alliance and connectedness, favouring therapeutic progresses. However, the biobehavioural aspects of intersubjective synchrony are often disconnected from the self, leaving gaps in understanding its role in shaping therapy processes and outcomes. Following PRISMA guidelines, 32 studies measuring intersubjective synchrony during psychotherapy sessions were identified, covering interoexteroceptive (n = 11), exteroproprioceptive (n = 18) and interbrain (n = 4) synchrony. Exteroproprioceptive synchrony, particularly nonverbal, was primarily associated with the therapeutic alliance: This was further supported by interbrain studies, whereas interoexteroceptive synchrony was mainly linked to moment-to-moment emotional experience. On the other hand, we found mixed findings on the associations of exteroproprioceptive synchrony with overall therapy outcomes, whereas interoexteroceptive synchrony seemed to be positively associated with session-level outcomes. Moreover, pre-session intra-subjective traits (e.g., patients' well-being and psychopathology, therapists' attachment and expertise) influenced intersubjective synchrony patterns. Finally, we found that degrees of synchrony varied across patients suggesting different experiences of optimal psychotherapeutic relationship. Findings highlighted the layered dynamics of synchrony in psychotherapy. Achieving effective therapeutic engagement involves balancing context-sensitive synchrony at different layers through intersubjective interaction for a self-reorganization of the patients' dynamics. Future research should further explore how distinct layers and dynamics interact both at intrasubjective and intersubjective levels. A spatiotemporally informed emphasis on self-related dynamics can illuminate common therapeutic factors and clarify their role in short- and long-term outcomes.

Summary

The self is a dynamic, multilayered system that underlies coregulation processes within the therapeutic relationship. In this context, intersubjective synchrony reflects the encounter of self-dynamics between patient and therapist, fostering alliance and emotional resonance.
Physiological synchrony (interoexteroceptive) supports moment-to-moment affective attunement, whereas behavioural synchrony (exteroproprioceptive) sustains long-term relational engagement.
Therapist-led nonverbal synchrony is particularly associated with stronger therapeutic alliance and better outcomes.
Presession intrapsychic traits—such as patient well-being or therapist expertise and attachment—modulate synchrony patterns and therapeutic responsiveness.
Intersubjective synchrony offers a promising marker for precision psychotherapy, guiding self-reorganization through tailored relational dynamics.

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心理治疗中的自我及其主体间共时性：系统回顾

自我在心理治疗中是关键的，整合内部（内外感受）和外部（外本体感受）体验层，在心理治疗关系中创造一个主体间空间，促进自我重组。同步性的患者-治疗师主体间体验似乎是更好的联盟和连通性的核心，有利于治疗进展。然而，主体间同步的生物行为方面往往与自我脱节，在理解其在形成治疗过程和结果中的作用方面留下了空白。遵循PRISMA指南，在心理治疗过程中确定了32项测量主体间同步性的研究，包括外感受间（n = 11）、外本体感受间（n = 18）和脑间（n = 4）同步性。外本体感觉同步，尤其是非语言同步，主要与治疗联合有关：脑间研究进一步支持了这一点，而外感受同步主要与即时情绪体验有关。另一方面，我们发现关于外本体感觉同步与整体治疗结果的关系的混合结果，而外感受间同步似乎与疗程水平的结果呈正相关。此外，会前的主观内特征（例如，患者的幸福感和精神病理学，治疗师的依恋和专业知识）影响主体间同步模式。最后，我们发现患者的同步性程度不同，表明最佳心理治疗关系的不同经历。研究结果强调了心理治疗中同步性的分层动态。实现有效的治疗参与包括通过主体间互动来平衡不同层次的上下文敏感同步，以实现患者动态的自我重组。未来的研究应该进一步探索不同的层次和动态是如何在主体内和主体间水平上相互作用的。时空信息强调自我相关动力学可以阐明常见的治疗因素，并阐明它们在短期和长期结果中的作用。自我是一个动态的、多层次的系统，是治疗关系中协同调节过程的基础。在这种情况下，主体间同步反映了患者和治疗师之间自我动力的相遇，促进了联盟和情感共鸣。生理同步（内外感受）支持时刻到时刻的情感调谐，而行为同步（外本体感受）维持长期的关系参与。治疗师主导的非语言同步尤其与更强的治疗联盟和更好的结果相关。抑郁症的内在心理特征——如患者的幸福感或治疗师的专业知识和依恋——调节同步模式和治疗反应。主体间同步为精确心理治疗提供了一个有希望的标志，通过量身定制的关系动态来指导自我重组。

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来源期刊

Clinical psychology & psychotherapy PSYCHOLOGY, CLINICAL-

CiteScore

6.30

自引率

5.60%

发文量

106

期刊介绍： Clinical Psychology & Psychotherapy aims to keep clinical psychologists and psychotherapists up to date with new developments in their fields. The Journal will provide an integrative impetus both between theory and practice and between different orientations within clinical psychology and psychotherapy. Clinical Psychology & Psychotherapy will be a forum in which practitioners can present their wealth of expertise and innovations in order to make these available to a wider audience. Equally, the Journal will contain reports from researchers who want to address a larger clinical audience with clinically relevant issues and clinically valid research.