THERAPIST S VERBAL BEHAVIOR CODING SYSTEM (TVB-CS) Verbal Behavior Codes: Definitions, Coding Rules and Examples 1

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1 THERAPIST S VERBAL BEHAVIOR CODING SYSTEM (TVB-CS) Verbal Behavior Codes: Definitions, Coding Rules and s 1 Montserrat Montaño-Fidalgo María Xesús Froján-Parga Ana Calero-Elvira Javier Virués-Ortega 1. Discriminative Definition Therapist verbalization followed by a specific verbal or non-verbal response by the client. Specific meaning that client s response is clearly dependent, in terms of content, on the therapist preceding verbalization. Therapist: When did the problem start? Client: Two years ago more or less. Special cases, coding rules, examples and non-examples - A Discriminative code will be assigned even if the client does not show the desired response, as far as the response is relevant, and therefore discriminated by the preceding therapist s verbalization (e.g., request for clarification). Therapist: You're not going to tell me the same thing you said to David, do you? Client: What? Therapist: You told him you have never lied to him Client: No, I won't say that. - A Discriminative code will be assigned anytime the client interrupts the therapist with a verbalization semantically related to whatever the therapist was saying (client's nodding and sentences with no predicate excluded). The putative function identified for the 1 This document is a supporting material for conducting behavioral observation of in-session clinical interaction with the Therapist s Vebal Behavior Coding System (Froján et al. Psicothema 2008;20: , Montaño-Fidalgo et al. in preparation).

2 Therapist s Verbal Behavior Coding System 2 - therapist verbal behavior before the episode will remain with the exception of the utterance immediately before the client intermission Therapist: Like I said, you react to exams in such a way because you have somehow learned that testing situations are aversive (Informative code, with the exception of the last part of the sentence, which is Discriminative). Client: (interrupting) Yeah, but the information in the book you gave me doesn't say exactly that. - If the client interrupts the therapist to say something without any relation in content with whatever the therapist was saying, a Discriminative code will not be assigned. The client s behavior may be discriminated by a private or unknown source of stimulation. Therapist: Like I said, you react to exams in such a way because you have somehow learned that testing situations are aversive (Informative). Client: (interrupting) But wait, before I explain this I want to comment on something else that occurred to me. - Anytime the client interrupts an ongoing verbal function because some element of the therapist s speech discriminates a sudden utterance, a Discriminative code will be assigned starting at the time the client begins to talk. Client and therapist verbalizations can overlap briefly. - For the purposes of coding Discriminative events on the occasions described above, an interruption requires the client breaking in the therapist's speech and the therapist discontinuing an unfinished turn. - Clear episodes of Discriminative events (e.g., a question) may be interspersed with other verbal functions. Interspersed verbal codes will be assigned accordingly. Therapist: Like I said, you are anxious when doing an exam because you've learned that testing situations are aversive. You have been aroused by similar situations in the past (Informative). Do you follow me? (Discriminative). Client: Yes, I do. - Anytime the client assents verbally to whatever the therapist is saying, the therapist s preceding verbalization will not be considered a Discriminative. Client assenting would probably have a reinforcing role for the therapist verbal behavior and therefore is out of the analysis for this study.

3 Therapist s Verbal Behavior Coding System 3 Therapist: Like I said, you are anxious when doing an exam because you've learned that testing situations are aversive. You have been aroused by similar situations in the past. Client: Yeah. Therapist: That is why you now have those reactions every time you take a test (Informative, the code will cover the whole episode). - Exception to the case described above: anytime the client assents to an utterance by the therapist coded as Discriminative whether if client assenting is followed or not by an instance of reinforcement (viz. Reinforcing function). 1 Therapist: Like I said, you are anxious when doing an exam because you've learned that testing situations are aversive. You have been aroused by similar situations in the past (Informative). Am I right? Client: Yes. Therapist: That is why you now have those reactions every time you take a test (Informative). 2 Therapist: Like I said, you are anxious when doing an exam because you've learned that testing situations are aversive. You have been aroused by similar situations in the past (Informative). Am I right? Client: Yes, it always happened to me. Therapist: Exactly! (Reinforcing). That is why you now have those reactions every time you take a test (Informative). - On occasions when the therapist presents a summary of the information collected so far, or describe relevant circumstances before asking a specific question (i.e., Discriminative), the complete verbal episode will be coded as a Discriminative event. However, if in the course of the event is interspersed with explicit technical/clinical information; Informative codes shall be interspersed accordingly. - Anytime the therapist utters a verbal episode other than Discriminative (e.g., Punishing) ending in a full stop and a response by the client follows, a Discriminative episode will not be coded. Although the therapist silence may discriminate the client's verbal behavior, the ongoing verbal code will prevail. - When the therapist asks a question but does not allow enough time for the client to answer, the question will be consider as part of the ongoing verbal code.

4 Therapist s Verbal Behavior Coding System 4 Therapist: But, what are you getting out of this? If you keep going on like this you will feel bad about it, and your relation will continue to deteriorate (Motivational). - In addition, rhetorical questions will not be recorded as Discriminative events, even if the client responds to them. Therapist: What I mean is, if you would have not shown up, what would have been the consequences? Absolutely none (Motivational). Client: Yes, none. - The expression 'Huh? or any equivalent expression will only be coded as a Discriminative when used as a substitute for 'what?' and only if the client responds appropriately. Otherwise, it will be considered as part of the ongoing verbal function. s Client: Let's see how it goes. Therapist: Huh? Client: I said, let's see how everything goes. Therapist: The fact that it is difficult does not mean you cannot get to learn to be calm and handle all these situations, huh? (Motivational). Client: Yes, right. - Therapist-client verbal interaction episodes comprised of sequences of questions, or other forms of information request on the therapist side, will be coded as sequences of Discriminative codes. See specific cases below. 1) Complex client responses (at least one predicative verb). Therapist: Did you think you have reasons...? Client: Yeah, I had motives... Therapist:... reasons to think he was trying to take advantage of you? Client: No. It's just how I felt about it. 2) Fractioned questioning and simple client responses (no predicative verb). Therapist: So, did you tide up the store already? Client: Yes.

5 Therapist s Verbal Behavior Coding System 5 Therapist:... Were you able to get up to date with your administrative work? Client: Yes. Therapist: So setting up the furniture is the only task left, right? Client: That's right. 3) If the therapist provides praise or re-assurance to one of the client's verbalizations during Discriminative sequences a Reinforcing code will be interspersed. Therapist: You think that... Client: If that was the best way to put it? Therapist: Yeah (Reinforcing). Aren't there other alternatives? 4) Several formulations of a given question or the same question partitioned in several utterances due to client's interruptions. Therapist clarifications may be interspersed. 1 Therapist: Do you think there might be another way out from this situation? Client: Yes. Therapist: We need to find a solution to this issue (Informative). Can you think of another way to improve the situation? Client: I could get another job. 2 Therapist: Could you think of some other reason? Let s say... Client: No... Therapist: Can t you think of some other reason for him not calling you? Client: Maybe he just forgot. 5) If customer response is sufficiently developed (including at least one verb of predicative value). Therapist: Could you ask him? Client: Yes, I think so. Therapist: I mean that he may be able to tell you about this, right? Client: Yes, yes, no problem.

6 Therapist s Verbal Behavior Coding System 6 - When the same client's response is presented several times within a given therapist s utterance, only one instance of Discriminative code will be recorded. s Therapist: Could you ask him if... Client: Yes. Therapist: he might be able to help you? Client: Yes, no problem. 2. Reinforcing Definition Therapist verbalization denoting agreement, approval or acceptance of a specific client s behavior. Client: I went out last Friday as you suggested and I had a good time. Therapist: That is great! I am glad to hear it (Reinforcing). Special cases, coding rules, examples and non-examples - If a given verbalization meets criteria for both Discriminative and Reinforcing codes, the former will prevail. - This code does not incorporate events potentially involving negative reinforcement (e.g., verbalizations that alleviate client's discomfort). - During client-therapist verbal interaction, verbal chaining may occur frequently (i.e., a given verbalization serving both discriminative and reinforcing functions). On those occasions, the following disambiguation criteria will be used: 1) On occasions when both functions are believed to operate in close sequence although over distinct verbalizations, putative verbal function codes will be assigned to the appropriate verbalizations (e.g., OK [Reinforcing], tell me [Discriminative]). 2) In all other cases when multiple functions are suspected, the prevailing function will be determine on the basis of its effect over the client's subsequent behavior. Frequent cases of multiple functions may be exclamations (e.g., 'Is that true?', 'Really?'). This rule will be followed even on occasions when the therapist s utterance is apparently aimed at reinforcing the client s behavior (e.g., Great!, well done! ).

7 Therapist s Verbal Behavior Coding System 7 - If subsequent client's behavior would be changed in any way, the Discriminative code will prevail. In other words, we make the assumption that the therapist verbalization discriminated the subsequent client response. Client: Yesterday I did everything you need me to do. Therapist: That's great! Client: Yes, I am quite happy about it. - In the event that no identifiable change on client's behavior is prompted by the relevant verbalization, then a Reinforcing code will be assigned. Namely, we assume that the therapist verbalization had a reinforcing effect but did not discriminate any further responses during that episode. Client: Yesterday I did everything you need me to do. Therapist: That's great! (Reinforcing). Client: I completed the exposure exercise. 3) The therapist repeats several utterances with the same putative function (Reinforcing) (e.g., very good, very good, perfect ). No changes in the subsequent behavior of the client are identifiable. In such cases, if the client talks in between the therapist repetitive comments, a sequence of codes will be recorded. Alternatively, a single code will be assigned if these utterances are produced in sequence with no interruption. - Disambiguation criteria for Discriminative and Reinforcing codes: 1) Discriminative will prevail under the following set of circumstances: - When the subsequent client's verbalizations are significantly changed. Anytime that therapist and client speak at the same time. Client: I started to get nervous because of those feelings... Therapist: You mean you felt your heart beating. You started sweating... Client: Yes, I also felt cold. - When client-therapist verbalizations occur in sequence and the clinician preceding comment has a clear impact, in terms of contents, over the subsequent client verbalization.

8 Therapist s Verbal Behavior Coding System 8 Client: I started to get nervous because I felt those feelings. Therapist: You mean you felt your heart beating. You started sweating... Client: I felt that my heart was beating so fast, I sweat, and I was cold. 2) If any element of the therapist's verbalization repeats in the speech of the client, a Reinforcing code will be assigned only if both verbalizations occurred simultaneously. Otherwise, the therapist behavior will be coded as Discriminative as indicated above. Client: I started to get nervous because I felt those feelings. Therapist: You mean you felt your heart beating. You felt yourself sweating... Client: (simultaneously)... palpitations, sweating... 3) If the client does not take up any element of the preceding verbalization of the clinician a Reinforcing code will be assigned. Client: I started to get nervous because I felt those feelings Therapist: Sure (Reinforcing). Client:... of palpitations, sweating... 4) Anytime the therapist take up an element of a previous client's verbalization during an ongoing Informative, Motivational or Instructional episode we will assign a Reinforcing code will be assigned if: o the therapist verbalizations are significantly changed as a consequence of the preceding verbalizations by the client (overlapping is possible); Therapist: It's like when you're going to the gym... (Informative). Client: Yes, aren't you going on Wednesday? Therapist: Yes (Reinforcing). I hardly go anymore (Informative). o the speech is not altered significantly, but the therapist's verbalization incorporates elements of the preceding comments by the client. If the utterances of both the client and the therapist overlap, a Reinforcing code will not be assigned (whatever ongoing category was assigned right before will continue to prevail).

9 Therapist s Verbal Behavior Coding System 9 1 Therapist: It's like when you're going to the gym... (Informative). Client: Yes, aren't you going on Wednesday? Therapist: Not anymore (Reinforcing). I hardly go anymore (Informative). 2 Therapist: It's like when you're going to the gym... (Informative). Client: Yes, aren't you going on Wednesday? Therapist: (overlapping client's speech)... I hardly go anymore (Informative). - Reinforcing events do not necessary come right after the client's utterance that is aimed to reinforce. On the other hand, the Reinforcing code may follow a sequence of other functions preceding the final Reinforcing episode (e.g., Motivational, Informative). - It should be noted that a given verbalization aimed at being reinforcing (e.g., 'you are doing a great job!'), may be built up on previous verbalizations that actually provide the opportunity to reinforce (e.g., discussion of homework). - Conversational resources used to connect utterances or to provide emphasis to a given verbalization (e.g., 'I see,' 'Yes, but) will not be recorded with a specific code. However, if they are used very emphatically, a Reinforcing code can be assigned. Client: I can't be like her mother who does whatever he commands. Therapist: Of course (Reinforcing), but transitioning to the new circumstances may take him some time (Informative). - If the same conversational resources are used to oppose emphatically to client s previous comments, a Punishing code may be assigned. If the language element is very emphatic although neutral (does not oppose, nor supports client's previous comment), a Motivational code will be assigned. s Client: I can't be like her mother who does whatever he commands. Therapist: Hold on one second! (Punishing). For how long has he been living with his mother and has been accustomed to have her as a servant? Client: Finally, I did go but I was not in the mood at all. Therapist: But look, what might have been the consequences would you have stayed at home? Absolutely none (Motivational). - Unfinished utterances by the therapist incorporating the conversational connectors mentioned above will be coded within the exclusion category (Other).

10 Therapist s Verbal Behavior Coding System 10 s Client: It's not that I don't like peppers... Therapist: Of course, but... (Other). Client:... in fact I love fish with grilled peppers. Therapist: Of course, however... (Other). Therapist:... but I am unable to get home and start cocking. I just fill like having a sandwich. Therapist: Of course, but my point is that if you keep on having those sandwiches it may become difficult to get rid of them later (Motivational). 3. Punishing Definition Therapist verbalization denoting disapproval, refusal or lack of acceptance of client s behavior (including interrupting the client without signs of approval, agreement or acceptance). Therapist: You have been offered a better position. I take it they regard you very highly, right? Client: Nothing out of the ordinary I guess. Therapist: Come on, you have been offer the best position. Do you really think that everybody gets that treatment? (Punishing). Special cases, coding rules, examples and non-examples - A Punishing code will be assigned only on those occasions in which there is an evident disagreement during at least two conversational turns of both the therapist and the client. - A Punishing code will be also assigned anytime the therapist attempts to discontinue or prevent the occurrence of a given verbalization in the client. Client: That's going to be effortful. Therapist: Don t be worried! I am here to help. - Notice that 'Don't worry' may be coded differently depending on the context provided by the previous client's verbalization. - On occasions in which there are reasons to infer that the therapist is trying to extinguish the client's behavior, a Punishing code will not be assigned (e.g., the therapist change

11 Therapist s Verbal Behavior Coding System 11 topics without reinforcing last client's comments; the therapist doesn't show agreement explicitly). Therapist: OK, then. Are you above others in terms of your performance at work? Client: OK. Therapist: What do you mean OK? (Punishing) Are you or are you not? Client: I guess I don't have enough information to say one thing or the other. Therapist: Let's start over. Your boss praised you in a rather remarkable way... (Discriminative, extinction of previous utterances; therapist changed topics). - A Punishing code will be assigned anytime the therapist interrupts the client with a comment opposing to whatever the client just said (no evidence of approval). s Client: What he did was highly disrespectful because... Therapist: Hold on one second (Punishing). What does 'disrespectful' means to you? - Anytime that there is evidence that the verbalization interrupting the client has two concurrent functions (Punishment and any other), the function other than Punishing will be assigned. On those occasions, the Punishing code will be assigned only if there is an element within the utterance that may be particularly punishing. s (two functions with a distinct punishing element) Client: Then, I started to think that he may be dating someone else... Therapist: Hold on one second! (Punishing). What evidence do you actually have to reach at that conclusion? (two functions without a distinct punishing element) Client: Then, I start thinking that he may be with someone else... Therapist: Tell me, what evidence do you actually have to reach at that conclusion? - Punishing events may occur in sequence with discriminative events. As we hypothesize that the Punishing function in those occasions is attempted at redirecting client's verbal behavior, the Punishing code will prevail over the Discriminative code. Specific cases are described below:

12 Therapist s Verbal Behavior Coding System 12 1) Cases in which the Discriminative and Punishing functions come together but associated to distinct elements within the therapist's utterances. In these cases both categories will be coded in sequence (e.g., I strongly disagree [Punishing]. Tell me all about it [Discriminative]). 2) Occasions in which the clinician verbalization stops abruptly a client's sequence of verbal behavior (e.g., no! ). On those occasions a single Punishing code will be recorded. - Refer to the previous section for disambiguation between the Informative and the Punishing codes. - The Punishing does not necessary comes right after the client's utterance that it may be punishing. On the other hand, the Punishing code may follow a complex sequence of other preceding functions (e.g., Motivational, Informative). 4. Informative Definition Therapist verbalization conveying technical or clinical information in a plain-language format. Therapist: That is exactly what happens when someone avoids systematically a feared situation. Emotions get more and more intense and unpleasant towards that situation and coping becomes unbearable. That is the point where you are at. Special cases, coding rules, examples and non-examples - A single Informative code will be assigned anytime the therapist provides information continuously or with minimal interruptions (the topic could be the same or change overtime). Minimal client interruption is allowed taken that it is not reinforced afterwards by the therapist and does not incorporate a predicative verb. However, if the therapist s speech changes as a consequence of an interspersed client response, a Discriminative or Reinforcing code may be recorded. - Short verbalizations operating as conversational connectors (e.g., I have been thinking on a new topic of discussion that you may be interested in ), are not to be confused with Informative events and will be coded within the exclusion code (Others). - A list of broad clinical activities in which Informative codes are prevalent follows: Describing the results of the clinical case conceptualization. Presenting examples to illustrate therapist's points.

13 Therapist s Verbal Behavior Coding System 13 Explaining in-session activities. Clarifying why the client says something, why the therapist is doing something in session, or why a particular strategy is being proposed. Suggesting alternative approaches to a topic of discussion. Providing information on the therapeutic goals and the intervention techniques to be used. Adjusting therapeutic goals. - On occasions in which the therapist shows whether approval/agreement or disapproval/disagreement toward the preceding client's verbalization refer to the following disambiguation directions to avoid confusion between Informative, Reinforcing and Punishing codes. 1) Negative information - Punishing code will be assigned when a clear disapproval/disagreement is presented with no additional accompanying information. Therapist: Do you think you do a good job at work? Client:... Yes. Therapist: That answer is not good enough. You don't seem to be convinced (Punishing). - Anytime a clear disapproval/disagreement is followed by additional information, two codes will be assigned accordingly. Therapist: That answer is not good enough. You don't seem to be convinced (Punishing). I will rephrase the question so you could provide a clearer response (Informative). - On occasions when the therapist may show some extent of disagreement but the comment is basically informative (e.g., clarifications), a single Informative code will be assigned. Therapist: Well, your boss praised you intensively for that, right? Client: Well, I should also know how she interacts with the other employees in order to have the big picture, don't you think? Therapist: Well, she used the word 'exceptional,' so regardless of how highly she thinks of the other employees, your boss said that you are exceptional. That is to say way above the average (Informative).

14 Therapist s Verbal Behavior Coding System 14 2) Similarly, on occasions when the therapist shows some extent of praise but the comments under analysis are basically informative (e.g., clarifications), a single Informative code will be assigned and the Reinforcing code will be discarded. - Sign of agreement/approval with no further informative remarks: use a Reinforcing code. Therapist: So, you are very valuable at work. You have reached the maximum rank. In fact you have requested to be transferred to the international office and your request has been granted! I ll bet you they don't do that with everybody else (Reinforcing, no relevant informative bits are presented). - Approval/agreement plus relevant information: use Reinforcing plus Informative codes. - Presentation of relevant information that is consistent with the client comments: use an Informative code. - Anytime that the therapist seems to take the place of his client and he is trying to model a clinically relevant behavior, an Informative code will be assigned. Therapist: You could say something like: 'Sorry, you know I don't work extra hours. I could get this done tomorrow but I have to leave now' (Informative). Could you try and do the same thing? - On occasions when the therapist plays the role of the client for other purposes the coding rule above shall not be used. s Client: I know what's going to happen. Some day he will ask me to stay extra hours and I will say no. Therapist: Sure, just tell him 'Hey look, I don't do extra hours. I would do anything during my regular schedule, but that is all' (Reinforcing). Client: But I fear that he will ask me over and over again. Therapist: OK, but you already know what to say: 'Sorry, you know I don't work extra hours. I could get this done tomorrow but I have to leave now,' etc (Instructional). - It is important to keep in mind the definition of the Informative code (viz. provide clinical or technical information). Therefore we should avoid using this category as a nonotherwise specified' or exclusion category. The code 'Other' could be used properly for that purpose.

15 Therapist s Verbal Behavior Coding System 15 - In some cases, for instance during cognitive restructuring, we could assign the Informative code for therapist s clarifications. Although these utterances do not convey a specific psychological datum, they may be essential to achieve important therapeutic goals. Therapist: OK, you may have great co-workers (Reinforcing). But the term 'exceptional' would not be used properly if you could use it with everybody, right? (Informative). I understand what you said and you probably have very good coworkers (Reinforcing), but the adjective exceptional lose all meaning you use it with everybody (Informative), right? 4. Motivational Definition Therapist verbalization anticipating the consequences, whether positive or negative, of a client's behavior. Therapist: The best you could do to make him stop calling is not answering his calls. If you do that he will stop eventually (Motivational). However, it's likely that right after you stop answering he would insist in calling you more frequently for a short period of time (Informative). Special cases, coding rules, examples and non-examples - Motivational events are intended at establishing or abating the reinforcing or punishing value of a given consequence. - The Motivational code will be recorded when the therapist describes positive consequences of a clinically relevant behavior (viz., a behavior targeted for acquisition, increase or maintenance). In addition, we will also use a Motivational code for verbalizations referring to the negative consequences of problem behavior. On the other hand, anytime the therapist points out the difficulties entailed by target behaviors we will assign an Informative code. Namely, the informative role prevails over the motivational role. - Disambiguation between Instructional and Motivational functions: 1) If there are distinct sections of an utterance referring to behaviors to be performed by the client and the consequences of such behaviors, Instructional and Motivational codes will be recorded accordingly.

16 Therapist s Verbal Behavior Coding System 16 Therapist: You want to use 'thought stop' anytime you find yourself thinking again (Instructional). You will notice that you feel much better (Motivational). 2) However if the instructional component is minimal and not specific, we will assign the Motivational code only. Therapist: You need to stop thinking. You will feel much better (Motivational). - Disambiguation between Motivational and Informative codes: the Motivational code refers solely to the consequences of behavioral change (or lack of change). Consequences described for other individuals or in general terms: use an Informative code. s Therapist: If you use 'thought stop' you will feel much better (Motivational). Therapist: The 'thought stop' technique improves the affect of the individuals who use it (Informative). - We will also assign a Motivational code to utterances referring to hypothetical courses of action and their consequences (e.g., 'if you resign now if it has occurred to you, things would get even worse'). - We will also assign a Motivational code on occasions when therapist utterances describe the consequences that client's behavior will have on others close to the client. - We will also assign a Motivational code when the therapist refers to the consequences of intermediate clinical goals (achievements that are necessary for a final clinical achievement). - A listing of contents to be coded with the Motivational code follows: Convey that changing is possible. Convey that change is possible while providing unspecific strategies to achieve it. General praise statements not referring to preceding utterances (e.g., you are getting there'). The therapist points out the negative consequences of maladaptive behavior. 5. Instructional Definition

17 Therapist s Verbal Behavior Coding System 17 Therapist verbalization describing specific directions/instructions for the patient to be followed outside the session. The consequences of following such directions don t need to be mentioned. A step-by-step description of instructions is required. Therapist: How about practicing some relaxation during the week? Client: But when I try to relax I start worrying about my husband being with someone else. I start thinking about he not calling. I start thinking that he is sick and tired of me. Therapist: Maybe he is willing to phone but he cannot at the time, or he just forgot or ran out of batteries (Informative). When you experience what you have described I suggest you follow the simple steps for the relaxation exercise we have talked about before: step 1, step 2, etc (Instructional). Special cases, coding rules, examples and non-examples - The Instructional code will be assigned only when clear and direct instructions to be used outside session are presented. 6. Utterances not otherwise specified (Other) Definition This is an exclusion code, and therefore to be assigned to any utterances not meeting any of the definitions and coding rules described above. Special cases, coding rules, examples and non-examples - Within the exclusion category we will include what we could call 'failed discriminative.' Specific cases below. 1) The client interrupts the therapist starting a new speech on his own unaffected by the preceding therapist comments. Therapist: So you were saying that you went to the movies with your friend (Other, failed discriminative). Client: This week I had a hard time cleaning up the house. 2) The therapist presents a discriminative stimulus (e.g., a question) that is ignored by the client.

18 Therapist s Verbal Behavior Coding System 18 Therapist: So you were saying that you went to the movies with your friend (Other, failed discriminative). Client: (silence). Therapist: Sorry, I wonder if you finally got to go with your friend to the movies. - The therapist stops in the middle of a sentence. - The exclusion category will not be assigned on occasions when the client gives an appropriate non-verbal response to the therapist (e.g., nodding, performing an instruction, etc.). - The exclusion category will be assigned anytime that the client interrupts the clinician's verbalization without responding accordingly to whatever the clinician was saying. Note that the idea of appropriate response only applies to the Discriminative code, as for the other codes there is no immediate appropriate response to be observed. 1 Client: I started to get nervous because of those feelings... Therapist: We have talked about this before (Other). Client:... and I left without buying anything. 2 Client: I started to get nervous because of those feelings... Therapist: We have talked before about the relationship between specific situations and emotional reactions (Informative). Client: I had to leave without buying anything. - A list of cases where the exclusion category shall be used is presented below. Verbalizations with no relationship with the clinical process (e.g., 'Sorry, I have to switch off my cell phone'). Loud self-talk (e.g., 'let's see what I have here,' 'let me think of another example'). The therapist is reading aloud the client's self-recording or homework materials. Proper discriminative verbalizations by the therapist that the client ignores.