Therapist interpersonal responsiveness: Being interpersonally flexible in response to client collaboration

Objective: We assessed a new methodological and analytical approach for examining how therapist moment-to-moment interpersonal flexibility and responsiveness influence subsequent client collaboration. Therapist interpersonal flexibility was conceptualized as one of the crucial components of interpersonal responsiveness and operationalized as adjustments in therapists' interpersonal behaviors between speaking turns. To uncover the context-dependent nature of the responsiveness, the study also explored how these turn-to-turn adjustments, in relation to previous client collaboration, influence subsequent client collaboration. Method: This study involved 1107 speaking turns nested in 12 sessions nested within three therapist-client dyads. Three raters assessed therapist interpersonal behaviors in dominance-submission and approach-avoidance dimensions for each therapist speaking turn and the level of client collaboration for each client speaking turn. Distance scores and Dynamic Structural Equation Modeling (DSEM) were used to explore the hypothesized effects at a within-session level. Results: We found when therapists adjusted their interpersonal styles to a moderately high degree, clients were more collaborative than usual. We also found therapist turn-to-turn adjustments had a significantly positive effect on subsequent client collaboration only when clients were not collaborative before such adjustments were made. Conclusion: Overall, this study offers a methodological advancement in the study of therapist responsiveness by demonstrating the nuanced clinical insights offered by use of sophisticated analyses (i.e., within-session moment-to-moments responsiveness, Euclidean distance scores, Dynamic Structural Equation Modeling [DSEM]). Findings suggest a moderate level of turn-to-turn interpersonal adjustment may benefit subsequent client collaboration. Findings also suggest that a therapist's turn-to-turn adjustment in response to previous low client collaboration may facilitate subsequent client collaboration. Strengths, methodological limitations, and clinical implications are discussed.