Locating Nodal Moments Within Psychotherapy Sessions: A Mixed-Methods Study Using a Computerized Measure and Therapist Comments.

A computerized linguistic measure, the Weighted Referential Activity Dictionary (WRAD), was applied to locate nodal turns of speech in psychotherapy, defined here as significant moments of patient emotional communication that are likely to reveal important themes. Two published demonstration sessions conducted by a senior clinician, who made extensive comments on this material, were utilized to illustrate the method. The WRAD, defined in the context of referential process theory, was developed and has been validated as assessing the vividness and immediacy of language. Segments of patient speech (turns of speech) were classified based on WRAD level and sufficient length. The themes of the therapist's clinical comments concerning high WRAD segments were coded using a category system developed for this study, and were compared to themes of comments for the remaining segments. Results showed a significant difference in the therapist's comments between the two groups of segments using Fisher's exact test. In particular, the therapist's comments on the nodal turns showed more focus on the emotional effects of the patient's utterances on him, as well as identification of unexpected disclosures in these utterances. The implications and limitations of this method are discussed.