Interactive dynamics among therapist interventions, therapeutic alliance and metacognition in the early stages of the psychotherapeutic process †

Clinical or Methodological Significance of this article: From a methodological standpoint, the originality of the present study lies in the combination of an interactionist approach, which conceives process factors as interrelated dimensions interacting in non-additive and often nonlinear ways, with analyses at both micro- and macro-analytic levels (i.e., sequential and mediation analyses). From a theoretical standpoint, findings of the present study indicate that specific therapist's interventions are related to specific levels of the therapeutic alliance (i.e., positive, neutral and negative), hence providing crucial insights into the clinical understanding of the psychotherapy process.