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Psychol Psychother. 2017 Sep;90(3):264-278. doi: 10.1111/papt.12108. Epub 2016 Oct 15.

Therapeutic conversations: Therapists' use of observational language contributes to optimal therapeutic outcomes.

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School of Psychology & Counselling, Queensland University of Technology, Brisbane, Queensland, Australia.



Reflexivity is the process of critically examining one's own experience. Emerging literature suggests that reflexivity is a positive predictor of outcomes in psychotherapy. However, limited research has been conducted regarding therapists' use of reflexivity as a therapeutic technique. In particular, we have a limited understanding of how therapists use language to initiate reflexive conversations. This study investigates the characteristics of therapist language that elicit reflexivity focused on internal and external processes.


Therapeutic outcomes of 42 trainee-therapists who provided psychotherapy to 173 clients were tracked with the OQ-45.2 with the view of identifying client-trainee-therapist dyads (CTTDs) with the best and poorest outcomes. Six best outcome and six poorest outcome CTTDs were identified. Thirty-six therapy transcripts were initially coded with the Narrative Process Coding System to identify each Narrative Process Mode (NPM). Sixty external, internal, and reflexive NPMs (N = 180 NPMs) were randomly selected across all therapy transcripts for the best outcome group and the same number for the poorest outcome group. The Narrative Initiating Language Element Coding Manual, developed for this study, was used to code therapists' use of language to initiate each NPM.


Therapists belonging to the best outcome group utilized more observational language to initiate internal and reflexive NPMs. Therapists belonging to the poorest outcome group evidenced high proportions of questioning language to elicit each NPM.


Examining how therapists use language to elicit NPMs provides further insight as to how therapeutic language may contribute to successful therapeutic outcomes.


Reflexive therapeutic conversations characterized by a greater use of observational language were associated with positive therapeutic outcomes. Therapeutic conversations characterized by a high proportion of questioning language were associated with poorer therapeutic outcomes. Supervisors of trainee-therapists have a key role in coaching supervisees to use language that contributes to client treatment outcomes.


Narrative Process Model; OQ-45.2; reflexive language; reflexivity; therapist language; trainee-therapists

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