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This paper presents a collaboration between a clinician (C.M.J.) and a research team (W.B., B.M., and S.M.) to address the question: At an operational level, what happens in the special form of conversation that is psychotherapy? How can we study, beyond a priori lenses of psychoanalytic models, what we are actually doing when we engage in this process? How can we capture from the linear flow of conversation, the simultaneous, complex, active, interwoven, dimensional emotion schemas that words can only point toward? To address the question, we first present the need for new approaches in the current climate within the clinical and research communities. Next, we address the challenges for clinicians and researchers by using multiple code theory and derived linguistic measures that offer an objective view of the processes of subjectivity. We then apply the research methods to the clinical data to illustrate the yield of the collaborative effort—a yield that captures the connection between the linear flow of words and the arousal, verbal expression, and reflection/integration of emotion schemas without the usual filters of psychoanalytic models of process and change. The project illustrates the critical value of clinicians' perspectives to guide researchers and encourages clinicians to participate in research to advance our field. For researchers, this project represents a "fourth generation" of process research that includes the criteria of video-recorded, transcribed data; the clinician's report of their experience; a theory of how emotion-laden meaning and motivations (emotion schemas) are expressed in the therapeutic conversation; and reliable, valid measures to capture and represent those processes; and that encourages researchers to access the rich contributions of clinicians' understanding. The implication for clinical practice is a new way to look beyond the lens of psychoanalytic models into what is actually unfolding in real time. [ABSTRACT FROM AUTHOR]

Introduction: Process notes contain unique information concerning core elements of a psychodynamic treatment. These elements may be both conscious and unconscious for the author. One element for study is the tendency to which a therapist writes about providing either supportive or expressive interventions. This study sought to establish a method of systematically and reliably identifying the records of therapists' interventions as supportive or expressive. Methods: Three early-career clinicians were trained in the use of a process note intervention rating scale constructed specifically for this study. Quantitative statistical analyses assessed the scale's reliability and internal consistency. Results: Interrater reliability analysis determined at a p of 0.005 a Fleiss's kappa of 0.24 and an intraclass correlation coefficient of 0.264, suggesting a low but statistically significant reliability between the raters. A Cronbach's alpha of 0.67 and a McDonald's omega of 0.53 suggested questionable internal consistency. Discussion: Early-career clinicians can reliably code the manifestations of interventions in psychodynamic process notes as supportive or expressive. Future studies may improve the reliability and internal consistency of the scale, add measures of interpretation content, and evaluate these data in relation to other core elements of process notes, such as the author's emotional engagement as manifested in language measures and clinical outcome. [ABSTRACT FROM AUTHOR]