Therapeutic process as a complex system: a network analysis working alliance, therapist responsiveness and depth of elaboration

Background: The present work stems from an effort to apply complex systems theories in the field of psychotherapy research by capturing the opportunity to look at the therapeutic process holistically. The goal of this study is to identify and emphasize the interconnectedness of the elements underlying the dynamics that develop between clinician and patient and to shed light on the processes that promote patient changes. Given the complex nature of the process in psychotherapy, this empirical investigation aimed to explore the network structure involving the dimensions of working alliance (i.e., bond, task, and goal), therapist responsiveness and depth of elaboration in psychotherapy sessions. Methods: 77 therapist-patient dyads completed the Patient’s Experience of Attunement and Responsiveness, the Working Alliance Inventory-Short Form and the Depth Scale of the Session Evaluation Questionnaire. We applied network analysis to examine interconnections between variables, calculated centrality metrics, and assessed the robustness of estimates by evaluating the accuracy of edge weights and the stability of centrality indices through the correlation stability coefficient (CS). Results: The most central therapist node was the task, while the most central patient node was the goal. The patient nodes were closely interconnected with each other. Several interconnections also emerged among the therapist nodes. The bond (therapist) was connected to the bond (patient), and the task (patient) was connected to the task (therapist). Depth showed a range of interconnections in both the patient and the therapist, but in the group of therapists this variable closely correlated only to therapist responsiveness. The CS was .36. Discussion: Our results seem to show that the depth of content elaboration that emerges in psychotherapy sessions is closely related to the responsiveness of the therapist, especially in the clinician group. In addition, clinician responsiveness is associated with both task and bond in both the patient and therapist groups. These two alliance dimensions are crucial because they enable mutual interaction between clinicians and patients, supporting evidence on the exquisitely intersubjective nature of clinical exchange and the impact of relational variables on successful psychotherapies.