ABSTRACT
The patient’s reluctant submission was captured through a code of Sulking & Scurrying. In contrast, during the AFT phase, when the
patient experienced a similar apprehension about therapy tasks, the therapist metacommunicated the following: “I’m getting the sense that this feels really difficult. Almost like I’m asking you to face what you fear the most.” This utterance, coded as therapist Disclosing & Expressing, was not dominating of the other as in the previous example. The patient did not submit or display self-focused hostility as in the previous example, but rather disclosed her experience
in a friendly and autonomous way, which was coded as Disclosing & Expressing: “Yeah… I don’t know… it is like, I can hold onto the fact that I know that it’ll be helpful, but it really is tough for me.” Finally, while we did not find that therapists in the
CBT phases were more likely to display hostile interpersonal process than they did in AFT, we did find more evidence of hostile patient interpersonal process in CBT phases. However, it is possible that the therapist dominance seen in CBT (as in the clinical example above) represents a subtle form of hostility that is difficult to detect using the SASB,
which requires that codes be made purely based on observable behavior. It was not uncommon for therapists in the AFT phases to retrospectively report in supervision groups that they had been experiencing subtle feelings of frustration and irritation towards their patients during CBT phases of treatment that they had not discussed extensively with their CBT supervisors. It is possible that such feelings had been leaking out in the form of subtle nonverbal manifestations of hostility which were sensed at some level by their patients, thus contributing to their tendency towards hostility (albeit of a self-focused or intransitive nature). It is worth noting that these patients did not show
the type of other-focused hostility (Belittling & Blaming,Attacking&Rejecting, Ignoring&Rejecting that has been found to be associated with poor outcome (e.g., Henry et al., 1986, 1990). However, bothWalling Off & Distancing and Sulking & Scurrying acts are still forms of hostile patient interpersonal process that are associated with poor outcome (Henry et al., 1986, 1990). In this respect, it is important to bear in mind that the distinction between hostility coded on the selffocused versus the other-focused surfaces of the SASB is not one of intensity, but rather one of directionality. In other words, hostile interpersonal behavior coded on the other-focus surface is directed at the therapist, whereas hostility on the self-focused surface of the SASB tends to be less direct (examples will be given in the final discussion). Another way of looking at it is that this self-focused form of hostility is more likely to manifest as what we have termed a withdrawal rupture, in which the patient moves away from the therapist, than a confrontation rupture, in which the patient moves against the therapist. Again, this is not surprising given this particular population of patients.
