Pathways to affect-discourse integration: the role of gestural interaction in change episodes in a case of focal teletherapy at a university mental health service

This systematic single-case study aims to articulate the gestural-affective interaction and verbal exchange between patient and therapist during episodes of representational change in a depressed young adult consulting at a university health service. Dynamic Interpersonal Therapy sessions conducted in a virtual setting were coded with the Generic Change Indicators System to identify Change Episodes, which were later processed with the Face Reader Recognition Software to observe their gestural-affective correlates. The data was analyzed under an emergent Thematic Analysis. Four implicit relational transactions were identified as relevant milestones to account for the patient process of affect/discourse integration: Balance, Discernment, Marking and Synchrony. The results show the ability of the therapeutic relationship to act as a resonant affective device, enabling the connection of discourse with the emotional domain, contributing with the elaboration of the Interpersonal Affective Focus and increasing the patient’s affective flexibility. The gestural-affective therapeutic interaction works as a relational context that enables the co-construction of what is traditionally understood as insight.