OBJECTIVE This study explored how nonverbal relational competence was experienced, reflected upon, and developed across psychotherapy and supervision in five training therapies. METHODS Using a multimodal design, video recordings of psychotherapy and supervision informed Interpersonal Process Recall interviews with clients, therapists, and supervisors. Interview and supervision material was analyzed using Reflexive Thematic Analysis. RESULTS Three themes were developed: 1. Clients, therapists, and supervisors were sensitive to embodied and nonverbal relational processes, but this sensitivity took different forms and was not always explicitly reflected upon; 2. Clients and therapists retrospectively wished that embodied relational information had been used more actively in therapy, while therapists described having hesitated to do so out of concern that clients might feel criticized or devalued; and 3. Verbally addressing nonverbal experience could facilitate feeling seen, but also exposed, depending on how, when, and within what relational context it was addressed. CONCLUSION The findings suggest that nonverbal relational competence involves sensitivity to nonverbal processes, embodied self-awareness, reflective capacity, and clinical judgement about how embodied relational information may inform therapeutic responsiveness. Supervision may support its development by creating opportunities for tacit embodied experience to become available for reflection while preserving uncertainty about its meaning.
Objective It has been hypothesized that shame and fear of receiving compassion from others are interrelated processes in psychotherapy. However, little is known about how these factors influence each other in a clinical setting. This study examined the relationships between shame, fear of receiving compassion from others, and symptom distress at a within-patient level throughout psychotherapy.Method The transdiagnostic sample consisted of 1,134 inpatients at Modum Bad receiving psychological treatment. Weekly self-reports measured symptom distress, fear of receiving compassion, and shame. The Latent Curve Model with Structured Residuals was used to examine the relationships between the variables at a within-patient level throughout therapy.Results At a within-patient level, reciprocal predictive relationships were found between shame and symptom distress, and between fear of receiving compassion and symptom distress. Shame also predicted fear of receiving compassion, but not vice versa. Sensitivity analyses supported the relationship between shame and symptom distress across treatment units but indicated greater variation in relationships involving fear of receiving compassion.Conclusion The findings suggest that shame and fear of receiving compassion are dynamically involved in symptom change during psychotherapy. Shame appears particularly central, whereas the role of fear of receiving compassion may vary across treatment contexts. Trial registration: ClinicalTrials.gov identifier: NCT03503981.Conclusion The findings suggest that shame and fear of receiving compassion are dynamically involved in symptom change during psychotherapy. Shame appears particularly central, whereas the role of fear of receiving compassion may vary across treatment contexts. Trial registration: ClinicalTrials.gov identifier: NCT03503981.
