The main aim of the adherence coding group at the Brief is to monitor the lab therapists’ compliance with certain specified treatment modalities. Adherence data is used to provide feedback to active therapists about their compliance to a given modality, as well as to inform research projects which rely on the extent to which specific treatments techniques are administered. The coding protocol identifies 36 techniques “specific” to three different treatment modalities, and 8 techniques reflective of “common factors” found across treatment types. The “specific” treatment items encompass Cognitive-Behavioral Therapy (CBT), Alliance-Focused Therapy, and Brief Analytic Psychotherapy, respectively.
The coherence coding group is part of the attachment initiative at the Brief. Its aim is to understand and assess the way people change in psychotherapeutic treatment. Through this initiative, we conceive of the therapist as a quasi-attachment figure, whose relationship with the patient can serve as an agent of change. Irrespective of the quality of the patient-therapist relationship, when the therapy goes well and has worked, patients should have formed a real relationship with therapists, which they would be able to discuss in an open and coherent manner. Since one aspect of coherence is the ability to collaborate with interviewers, a coherence measure also indicates patients’ capacity for relating to others. When patients develop secure attachments to their therapists, they may use the security found in the therapeutic alliance to modify earlier established insecure working models.
Drawing from Humanistic and Experiential theories, the experiencing scale examines the individual's ability to verbalize their inner felt awareness of themselves including personal reactions and sense of self. Lower scores on the scale are characterized as descriptions of external events in an impersonal and detached manner. Moving up the scale, the individual's personal perspective and reaction to events become clearer. Higher levels on the scale indicate purposeful exploration of feelings and personal reactions where emergent levels of experiencing serve as referents for problem resolution and understanding. Currently, the scale is being applied to therapist data at the Brief Psychotherapy Research Program to examine the relationship between therapists' capacity for experientially grounded reflection and various outcome and process variables.
The reflective functioning coding group utilizes a coding system that has been designed to measure patient and therapist mentalization. Mentalization is the ability to envision the mental states of other people, thereby understanding the thoughts and feelings that motivate them. Rooted in attachment research, the reflective functioning measure was originally designed to rate Adult Attachment Interviews. Its focus on the developmental significance of mental states and interpersonal process make it useful in understanding research material drawn from interviews probing the therapeutic relationship.
The SASB, or Structural Analysis of Social Behavior coding group looks at interpersonal process as it emerges in the here-and-now of psychotherapy sessions. We are currently using the SASB to examine how interpersonal process may change with the implementation of Alliance Focused Training as an adjunct to Cognitive Behavior Therapy (CBT) for patients with Cluster C personality disorders at Beth Israel Medical Center. As therapists gain awareness of in-session process and ruptures in the therapeutic alliance, we expect their interpersonal behaviors to change. In the context of a treatment for individuals with Cluster C personality disorders, this may include therapists non-defensively acknowledging their own contributions to ruptures and facilitating patients’ self-assertion and expression. Following SASB’s roots in interpersonal theory, we expect a complementary change in patients, such that they begin to assert and disclose more and defer to therapists less.