THERAPIST IMMEDIACY IN BRIEF PSYCHOTHERAPY: CASE STUDY I LAURA B. KASPER, CLARA E. HILL, AND DENNIS M. KIVLIGHAN JR. University of Maryland The authors examined immediacy (i.e., discussions about the here-and-now therapeutic relationship) in a 12- session case of individual interpersonal psychotherapy. Therapist immediacy during immediacy events most often focused on parallels between external relationships and the therapy relation- ship, encouraging expression of imme- diate feelings, processing termination, therapist expressing disappointment/ sadness/hurt and inquiring about the client’s reactions. Client involvement was slightly higher before and after than during immediacy events. On the positive side, therapist immediacy seemed to help the client express her immediate feelings about the therapist more openly, feel closer to the thera- pist, and become less defended. On the negative side, the client felt somewhat awkward and pressured when the ther- apist used immediacy. Limitations and implications for practice and research are discussed. Keywords: immediacy, therapeutic rela- tionship, psychotherapy process Therapist immediacy, which we defined as dis- closures within the therapy session of how the therapist is feeling about the client, him- or her- self in relation to the client, or about the therapy relationship (Hill, 2004), involves discussing and processing what occurs in the here-and-now client–therapist relationship. Terms that other in- terpersonal theorists have used for this therapist intervention are metacommunication (Kiesler, 1988) and talking in the here-and-now about the here-and-now (Yalom, 1995, 2002). Interper- sonal theorists (e.g., Cashdan, 1988; Kiesler, 1988, 1996; Safran & Muran, 2000; Teyber, 2006; Yalom, 1995, 2002) have suggested that clients reenact with their therapists the interpersonal conflicts that brought them into therapy. If thera- pists can use immediacy with clients to openly discuss these conflicts in the therapeutic relation- ship, clients can become aware of and change these interpersonal patterns, Thus, working immediately with the therapeutic relationship can help clients have a corrective emotional experience and change both internally and interpersonally. Psychoanalytic therapists also work with the therapeutic relationship, particularly by interpret- ing and resolving the client (patient) transference. To describe the therapist (analyst) behavior, they use terms such as transference interpretation (Ho- glend, Johnsson, Marble, Bogwald, & Amlo, 2007; Malan, 1976; Strupp & Binder, 1984), in- terpretation of the here-and-now transference (Gill, 1984), working in the moment (Greenson, 1967), and countertransference disclosures (i.e., a form of “clinical honesty that focuses on the Laura B. Kasper and Dennis M. Kivlighan Jr., Counseling and Personnel Services, College of Education, University of Maryland; Clara E. Hill, Department of Psychology, Univer- sity of Maryland. This study was part of a dissertation completed by Laura B. Kasper under the direction of Clara E. Hill. Laura Kasper is now at the University Counseling Center at The George Washington University, Washington D.C. We acknowledge and thank the client and the therapist who volunteered to participate in this study. We would also like to thank the dissertation committee (Ruth Fassinger, Charles J. Gelso, Sharon Spiegel, and Hedwig Teglasi), the research assistants (Tabatha Cuadra, Liz Erlich, Nidhi Gupta, Stacy Klienman, Arlette Ngoubene, and Kristen Waldemayer), and Sarah Knox (for reading a draft of the manuscript). This study was presented at the Mid-Atlantic meeting of the Society for Psychotherapy Research, October 15, 2005, at St. Mary’s College, St. Mary’s City, Maryland. Correspondence regarding this article should be ad- dressed to Clara E. Hill, Department of Psychology, Uni- versity of Maryland, College Park, MD 20742. E-mail: hill@psyc.umd.edu Psychotherapy Theory, Research, Practice, Training Copyright 2008 by the American Psychological Association 2008, Vol. 45, No. 3, 281–297 0033-3204/08/$12.00 DOI: 10.1037/a0013305 281