“Immediacy is the act of discussing in the here-and-now how the therapist is feeling about the patient, about himself/herself in relation to the patient, or about the patient-therapist relationship,” said A. Jill Clemence of the Department of Psychiatry at Albany Medical College. Immediacy has been shown to be a critical component of the therapeutic alliance and can have a significant impact on the client’s ability to process emotions. “Immediacy is also conceptualized as a potent technique for managing an alliance rupture, for moving beyond a patient’s defenses, and for providing emotional support,” said Clemence, lead author of a recent study highlighting the effects of in-session immediacy.
Previous research has shown that clients respond better when a therapist readily identifies a disturbance in the therapeutic relationship and addresses it in a positive way. However, few studies have looked at immediacy as it occurs. “Because the act of disclosing alone is insufficient for facilitating change, the ways that timing, tact, and competent delivery of immediacy interventions impact the patient’s ability to process affective material and deepen personal exploration requires further investigation,” Clemence said, explaining the motivation for her study. Using the Therapeutic Environment Scale (TES) and the Therapist-Patient Interaction Rating Scale (TPIRS), Clemence examined the effects of immediacy in a session between a therapist (Dr. V) and client (Alice) as it occurred.
“Immediacy, when used in an active and acknowledging way by Dr. V, was found to deepen Alice’s exploration of affective and interpersonal material,” Clemence said. The alliance was ruptured from the onset, and when Alice’s attempts at immediacy were ignored, it worsened. “However, when Dr. V actively engaged Alice using immediacy during a later segment of the interview, this appeared to move the pair out of rupture and into a more effective working alliance.” Clemence added, “The ability and willingness of the interviewer to engage the patient on an affective level in active discussion of the here and-now relationship may create the opportunity for building a positive alliance and furthering exploration of relationship themes in the moment.”
Clemence, A. J., Fowler, J. C., Gottdiener, W. H., Krikorian, S., Charles, M., Damsky, L., & Johnson, B. (2011, December 19). Microprocess Examination of Therapeutic Immediacy During a Dynamic Research Interview. Psychotherapy: Theory, Research, Practice, Training. Advance online publication. doi: 10.1037/a0026090
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