Identifying patient verbal coaching in psychotherapy

According to control-mastery theory (CMT), patients enter therapy with a plan (often unconscious) for how to work on their problems and disconfirm pathogenic beliefs. Patients want therapists to understand their plans and help them master their problems. CMT proposes that patients frequently coach their therapist to get them oriented and attuned to critical aspects of their treatment plan. The theory views patients coaching their therapists as an important part of the therapeutic process. The present study represents the first empirical research on this concept of coaching. It was designed to assess whether trained clinical judges could reliably identify and rate instances of patients coaching their therapists from psychotherapy transcript material. Segments from the beginning sessions of three brief (16-session) psychotherapy cases were presented to clinical judges to rate on the following dimensions: the degree to which a patient communication is coaching; the degree to which a patient communication is intended to help the therapist understand the plan; and the degree to which a patient communication is intended to influence the therapist's behaviour. The results provide empirical evidence that patient coaching communications can be reliably distinguished from non-coaching communications. Moreover, there was consensus among clinical judges on both the degree to which a coaching communication was intended to help the therapist understand the patient's treatment plan, and the degree to which a coaching communication was intended to influence the therapist's behaviour. Further research is necessary to better understand the vicissitudes of this coaching dynamic in therapy.