Flexibility between immersion and distancing: Relationship with depressive symptoms and therapeutic alliance.

Objectives: High levels of change are linked to the flexibility between immersion and distancing, as well as to higher levels of therapeutic alliance. This study aims to explore the evolution of flexibility between immersion and distancing throughout the entire therapeutic process and its relationship with therapeutic alliance and depressive symptoms in a clinical case.

Method: We analyzed five sessions of a good outcome case of depression undergoing cognitive-behavioral therapy. We assessed the distancing/immersion of these sessions using the Measure of Immersed and Distanced Speech, and therapeutic alliance with the Working Alliance Inventory-Short Form. The depressive symptoms were assessed from the Beck Depression Inventory-II.

Results: Flexibility and therapeutic alliance from both client's and therapist's perspectives increased throughout the therapeutic process. A strong negative correlation was found between flexibility and depressive symptoms.

Conclusions: The increase in flexibility can be an adaptive pattern associated with the decrease in depressive symptoms, the increase in therapeutic alliance (from both the client's and the therapist's perspective), and therapeutic success.