"Take a Sad Song and Make It Better": What Makes an Interpretation Growth Facilitating for the Patient?

Interpretations are considered to be an important active ingredient in psychodynamic treatment. Research shows mixed results regarding the empirical utility of interpretations, and continuing efforts are needed to investigate what makes interpretations helpful and effective. Our aim was to examine what allows an interpretation to facilitate growth, promoting the flourishing of the patient. We developed a coding system for evaluating the growth-facilitating elements of interpretation (GFI). The GFI is based on 3 scales: the optimal context for implementing the interpretation, the extent to which the interpretation includes positive regard and collaboration, and instills hope, and the immediate results of the interpretation. The GFI was used in a case study of a patient receiving supportive-expressive psychotherapy for depression. Analyses examined between-sessions and within-session processes. The integration of findings from the between-sessions and within-session analyses suggests that growth-facilitating techniques, manifest in growing positive regard, collaboration, and instilling hope, resulted in better outcomes, as reflected in the patient's new associations, mood, and self-esteem, as well as in alliance, attachment to the therapist, and reduction of depressive symptoms. The present study demonstrates the benefits of integrating the psychodynamic perspective with that of positive psychology, for building interpretations that facilitate hope, growth, and flourishing. The GFI shows promise both for psychotherapy research and clinical practice and helps bridge the gap between the two. Clinical Impact Statement Question: This study explored the question: What allows a psychodynamic interpretation to facilitate growth for the patient? Findings: Analysis of a case study suggests that interpretations that were delivered with growth-facilitating techniques, manifest in growing positive regard, collaboration, and instilling hope, resulted in better immediate outcomes. Meaning: Clinicians are recommended to deliver interpretations in a manner that empowers patients and builds on their strengths in order to promote growth, relational maturity, and flourishing. Next Steps: Further studies are needed to explore these suggestions with larger data.