Reverie and Psychotherapeutic Technique: Public Surveys on Therapist Attention, Understanding, and the Therapeutic Alliance

Abstract

Reverie, or a therapist’s daydreaming during therapy, is theorized to represent an aspect of transference-countertransference that provides a unique opportunity for attending to the experience of clients. However, the processes that underlie using reverie might affect the therapeutic alliance through perceived therapist inattention and understanding. Consequently, it is unclear whether this classical psychoanalytic technique is applicable to modern psychotherapy in which the therapist and client face one another. To maximize experimental control and avoid the need to violate the confidentiality of real therapy clients, vignettes were used to study how the processes that underlie the use of reverie could affect the therapeutic alliance. Specifically, participants completed an online survey that involved multiple steps. First, the participants read a brief description of a therapist and client and rated their therapeutic alliance using the Working Alliance Inventory – Short Form C bond scale. Next, they read one of four brief session transcripts between the therapist and client that were randomly assigned and represented the presence and absence of therapist attention and understanding as processes that underlie using and ignoring reverie. Then, the participants rated the therapeutic alliance using the Working Alliance Inventory Form C bond scale. Finally, participants completed a manipulation check and demographic questionnaire. After establishing that the manipulation was effective, statistical analyses revealed that the levels of therapist attention and understanding affected ratings on the therapeutic alliance for the clinical vignettes. Furthermore, the effect size for the condition of therapist understanding was larger than the effect size for the condition of therapist attention, meaning that ratings on the therapeutic alliance for the four session transcripts differed. These results imply that the processes underlying the use and ignoring of reverie might affect the therapeutic alliance. Also, the positive impact of understanding client experience could help partially offset the negative impact of therapist distraction while using reverie during therapy. This pattern is consistent with theories on reverie suggesting that using reverie for attending to the experience of clients might produce better outcomes than ignoring it when therapists are daydreaming during therapy.