Facial-affective communication and verbal relational offers during ruptures and resolution strategies: A systematic single case study

Research on the therapeutic relationship has underscored its central role for the therapeutic change process, indicating the relevance of determining the specific elements and mechanisms involved in its configuration (Knobloch-Fedders, Elkin, & Kiesler, 2014). Research on ruptures of the therapeutic relationship has yielded particular contributions to better understanding the interpersonal negotiation process involved in the patient-therapist interaction. Although previous studies have contributed to the objective characterization and the exhaustive description of ruptures, more research is needed to further specify markers that allow a better understanding about how patterns of affective regulation between patient and therapist are involved and contribute to the emergence of these events and the attempts at reparation. The aim of this study is to characterize patient’s and therapist’s facial-affective behavior associated to verbal relational offers (RO) during rupture (R) and resolution strategy (RS) events in a brief psychodynamic therapy. Facial-affective behavior was determined using the Facial Action Coding System (FACS), ROs were derived from the content analysis of session transcripts, and R and RS were determined using the 3RS. Nested analyses were carried to establish associations between variables. Results indicate characteristic patient-therapist facial-verbal regulatory patterns for both rupture and resolution strategy events. These findings underscore the value of combining multiple approaches to allow an access to observable indicators of dyadic affect regulatory processes that can contribute to better understand and be attentive to the oscillations of the therapeutic relationship.