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Objective: This paper highlights the facilitation of dyadic synchrony as a core psychotherapist skill that occurs at the non-verbal level and underlies many other therapeutic methods. We define dyadic synchrony, differentiate it from similar constructs, and provide an excerpt illustrating dyadic synchrony in a psychotherapy session. Method: We then present a systematic review of 17 studies that have examined the associations between dyadic synchrony and psychotherapy outcomes. We also conduct a meta-analysis of 8 studies that examined whether there is more synchrony between clients and therapists than would be expected by chance. Results: Weighted box score analysis revealed that the overall association of synchrony and proximal as well as distal outcomes was neutral to mildly positive. The results of the meta-analysis indicated that real client-therapist dyad pairs exhibited synchronized behavioral patterns to a much greater extent than a sample of randomly paired people who did not actually speak. Conclusion: Our discussion revolves around how synchrony can be facilitated in a beneficial way, as well as situations in which it may not be beneficial. We conclude with training implications and therapeutic practices.

Supportive counseling skills like empathy and active listening are critical ingredients of all psychotherapies, but most research relies on client or therapist reports of the treatment process. This study utilized machine-learning models trained to evaluate counseling skills to evaluate supportive skill use in 3,917 session recordings. We analyzed overall skill use and variation in practice patterns using a series of mixed effects models. On average, therapists scored moderately high on observer-rated empathy (i.e., 3.8 out of 5), 3.3% of the therapists' utterances in a session were open questions, and 12.9% of their utterances were reflections. However, there were substantial differences in skill use across therapists as well as across clients within-therapist caseloads. These findings highlight the substantial variability in the process of counseling that clients may experience when they access psychotherapy. We discuss findings in the context of both the need for therapists to be responsive and flexible with their clients, but also potential costs related to the lack of a more uniform experience of care. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A computerized linguistic measure, the Weighted Referential Activity Dictionary (WRAD), was applied to locate nodal turns of speech in psychotherapy, defined here as significant moments of patient emotional communication that are likely to reveal important themes. Two published demonstration sessions conducted by a senior clinician, who made extensive comments on this material, were utilized to illustrate the method. The WRAD, defined in the context of referential process theory, was developed and has been validated as assessing the vividness and immediacy of language. Segments of patient speech (turns of speech) were classified based on WRAD level and sufficient length. The themes of the therapist's clinical comments concerning high WRAD segments were coded using a category system developed for this study, and were compared to themes of comments for the remaining segments. Results showed a significant difference in the therapist's comments between the two groups of segments using Fisher's exact test. In particular, the therapist's comments on the nodal turns showed more focus on the emotional effects of the patient's utterances on him, as well as identification of unexpected disclosures in these utterances. The implications and limitations of this method are discussed.