Therapeutic Immediacy Shows Promise in Two Case Studies

Therapeutic immediacy (TI) is a term used to encompass any discussion between a client and therapist during a session. The therapeutic alliance formed between the two parties as a result of the discussion is fundamental to the success of treatment. “Recently, in order to capture the more interactive and dyadic nature of the therapeutic relationship, this definition has been broadened to also include any client-initiated disclosures of feelings about the therapist or their relationship, and the revised term of therapeutic immediacy has been suggested,” said Jason Mayotte-Blum of the Derner Institute of Advanced Psychological Studies at Adelphi University, and lead author of a recent study on the effect of TI. “Typical examples of therapeutic immediacy include exploring parallels between external relationships and the therapy relationship; client or therapist expression of in-session emotional reactions; inquiring about the client’s reactions to therapy; the therapist commenting on his or her experience of the client; supporting, affirming, and validating the client’s feelings in the therapy relationship; and expressing gratitude. Use of therapeutic immediacy in the therapeutic relationship can then act as a template for interpersonal functioning in the client’s outside relationships.”

Mayotte-Blum analyzed data from two case studies for his recent study. In both instances, the clients and therapists were not told that TI was the focus of the study. Mayotte-Blum and his colleagues examined data from 16 sessions over a four-year period and found that TI was used quite often by both the therapist and the client. Mayotte-Blum said, “Session excerpts of therapeutic immediacy identified prominent areas of treatment focus such as (a) the building of trust, mutual respect, and recognition of deep feelings with a male figure; (b) the generation of new relational templates and skills related to in-session discussion of the therapeutic relationship; and (c) Ann’s [client] increasing ability to tolerate intense affect such as sadness and anger.” He added, “Although it is unclear to what extent the use of immediacy was responsible for these therapeutic gains, we can surmise from these direct client reports that the use of immediacy was at least experienced as a positive and facilitative intervention during their treatment.”

Mayotte-Blum, J., Slavin-Mulford, J., Lehmann, M., Pesale, F., Becker-Matero, N., & Hilsenroth, M. (2011, November 7). Therapeutic Immediacy Across Long-Term Psychodynamic Psychotherapy: An Evidence-Based Case Study. Journal of Counseling Psychology. Advance online publication. doi: 10.1037/a0026087

© Copyright 2011 by By John Smith. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Hollis

    November 12th, 2011 at 11:49 AM

    Obviously the more interaction and discussion that goes on between the client and the therapist, the greater the gains in patient improvement we will see. There has to be that development of trust, so that the patient feels safe in that setting. Once that is established there are a number of ways that the relationship can be successful. If the patient feels that there is no connection then it is no surprise that the relationship is not going to be one that offers success to either party.

  • Kaye F

    November 12th, 2011 at 4:32 PM

    As long as those being studied and surveyed are being forthright and honest then there is certainly a lot to be learned from this.

  • Aidan Rutherford

    November 12th, 2011 at 8:01 PM

    Isn’t that what they do anyway? Talk to the person that they’re giving therapy to? I’m really not seeing the point of that. Nothing listed there under the therapeutic immediacy sounds any different from what the normal course of a conversation between therapist and client would be. The article translates to simply therapists who do their job get good results.

  • william mcmillan

    November 12th, 2011 at 10:03 PM

    @Aidan Rutherford: I thought it was going to be about getting therapy as soon as possible, which has results that are even more obvious. If my therapist was to sit there and doodle in his notebook while I spilled all of my secrets to him I don’t think I would get anywhere. It would also be a complete waste of my time and his! Not to mention my money.

    I’d be very disappointed if the interaction was any less than detailed there in the article.

  • SlyPickett

    November 12th, 2011 at 11:22 PM

    If my therapist didn’t talk to me in a manner that felt useful, I would be reporting them to the medical board so fast he would need his own therapy for the whiplash as his career slammed on the brakes.

    I don’t expect an awful lot of folks but I know when a professional person isn’t doing what they’ve been paid to do and it’s unacceptable. At the price they charge I’m perfectly entitled to snatch it right back if I don’t connect with them IMHO.

  • roseanne adams

    November 12th, 2011 at 11:46 PM

    Two case studies aren’t much of a base to draw conclusions from. These sample sizes are getting smaller and smaller every time I see them. If this keeps up, someone could go into the South, ask about Obama, and say “Survey shows that the President has a 0% approval rating. I asked Bob and Joe.”

  • jake

    November 13th, 2011 at 4:58 AM

    although good understanding n connection between the 2 parties in therapy is beneficial no doubt I do not think there could be a ‘template’ for this sorta thing.therapy is like snowflakes-no two are exactly the same n so a template will just not cut it.

  • Shelby T. Barnes

    November 13th, 2011 at 6:40 PM

    @roseanne adams–Case studies are still far more effective and accurate even with a small sample size than asking random questions in the street since most people don’t care about your research and will say anything. See, a case study relies upon solid facts as a foundation, not opinion.

  • Anna Steele

    November 14th, 2011 at 5:19 AM

    If you can find a way to interact with your therapist in a positive way then hopefully this will also begin to help you with those outside relationships as well.

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