An exploration of therapist intersession experience

Background: The research project aims to explore the mental representations therapists have about their patients and therapy between sessions (Intersession Experience, ISE) through exploratory mixed method sequential design. The study aims to gain an understanding of the way UK therapists make sense of their ISE; review the themes within an existing measure of ISE; explore the associations between aspects of therapist ISE and alliance for a series of UK therapists; and gain explanatory qualitative feedback to contextualise quantitative findings. Method: The research project employed a three stage mixed method design. Phase one comprised exploratory qualitative interviews of UK therapists about their ISE, analysed using a semantic level Thematic Analysis (Braun & Clarke, 2006). Phase two comprised a series of single case time series analysis designs where therapists completed a measure of their ISE and alliance weekly over the course of therapy. Phase three comprised explanatory deductive qualitative interviews about phase two findings. Results: ISE may be instrumental for therapy; ISE can be spontaneous or planned, may affect in-session processes and may impact on therapist wellbeing. Intersession thoughts were associated with problem solving, re-experiencing aspects of therapy and internal reflection. Positive emotional ISE preceded increases in alliance ratings. Negative emotional ISE and alliance were bi-directionally negatively associated within the sample. Explanatory phase three themes suggest ISE as an indicator of need for intervention (E.g. supervision), transference of patient difficulties and to help therapy progress. Conclusion: Therapist ISE may be conceptualised as ‘unfinished business’ and appears to relate to emotional processing of in-session content in the form of right brain activation (Kahneman’s system 1) or instrumental problem solving and reflection in the form of left brain processing (Kahneman’s system 2). ISE may hold implications for the therapeutic relationship, in-session processes and therapist wellbeing. ISE appears to be an important process variable linked to the therapeutic alliance and warrants further exploration in the form of patient/therapist dyads, exploration of ISE across therapy phases and the association to patient outcomes and therapist wellbeing