Psychotherapy change process research : realizing the promise

Change process research (CPR) is the study of the processes by which change occurs in psychotherapy, and is a necessary complement to randomized clinical trials and other forms of efficacy research. In this article I describe and evaluate of four types of CPR. The first three are basic designs and include quantitative Process-Outcome, qualitative Helpful Factors, and micro-analytic Sequential Process; the fourth, the Significant Events approach, refers to methods such as Task Analysis and Comprehensive Process Analysis that integrate the first three. The strengths and weaknesses of each design are described and summarized using both causal and practical criteria, as part of an overall argument for systematic methodological pluralism

From psychotherapist to supervisor

This study is a part of an ongoing research project examining group supervision in psychotherapy. The study was performed in a postgraduate training program for prospective supervisors. The two-year supervisor training program included theory seminars as well as group supervision of the prospective supervisor’s supervision of a trainee who had a patient in psychotherapy. The training program was based on psychoanalytic theory and the psychotherapy conducted was psychoanalytically oriented. Supervisees´ and supervisors´ experiences of the learning process, supervision format in group and supervisor styles were explored in semi-structured interviews. Both supervisees and supervisors emphasized the importance of a specific training program for psychotherapists who intend to work as supervisors. The didactic aspects of supervision were pointed out. The group format was experienced as particularly suitable for this training level. The “super-supervisor’s” style was important as a role model for the supervisors in training

Doing research on the effectiveness of psychotherapy and psychotherapy training: a person-centered/experiential perspective

In this article, we present a framework for selecting instruments for evaluating psychotherapy and psychotherapy training from a person-centered and experiential psychotherapy (PCEP) perspective. The protocol is divided into eight therapy measurement domains, consisting of four research themes (therapy outcome, therapy process, client predictors, training outcome) and two levels (general/pan-theoretical concepts vs. treatment specific/PCEP-oriented concepts). This research protocol provides recommendations about what to measure, encouraging collaboration across different training sites, while still allowing flexibility for individual centers. Minimum and systematic case study data collection designs are described: Minimum designs are appropriate for use in private practice settings with one's own clients; systematic case-study designs can be used for student case-presentation requirements or for publication. The framework and research protocols described are part of an emerging international research project involving private and public training centers in several countries

Qualitative Research Interviews

After presenting a brief overview of the complexity of the qualitative interviewing process used by psychotherapy researchers, the authors discuss some of the major ideas that psychotherapy researchers using such interviews must consider both before and during the interview process. They then offer thoughts regarding approaches to strengthen qualitative interviews themselves

Revisiting 'What works for whom?' A qualitative framework for evaluating clinical effectiveness in child psychotherapy

This paper describes a framework for evaluating the effectiveness of child psychotherapy used by child psychotherapists in an inner city Child and Adolescent Mental Health Service (CAMHS). The Hopes and Expectations for Treatment Approach (HETA) involves using the assessment for psychotherapy that normally precedes treatment to derive a baseline from which to generate a set of hopes/expectations as regards the effects of the treatment on the part of parents and the psychotherapist, to be revisited one year after the start of the psychotherapy and/or at its completion. The Strength and Difficulties Questionnaire, for parents and schools, was also administered before and after the treatment. The characteristics of the first 30 children referred for psychotherapy over a particular time period are described. Of the first 15 children in this group to complete one year of individual psychotherapy, all showed change or significant change in the areas concerning parents' and therapists' hopes at the end-of-year review, as rated by parents and psychotherapists. A case of a child with conduct disorder is used to describe how the assessment generated a psychoanalytic formulation, how the therapist's understanding was fed back to the parents, and how the parents' and therapist's hopes and expectations were derived and recorded. This case illustrates powerfully the impact of trauma in the parents' backgrounds on the internal world of the child, and how the method provides a useful bridge between parent and child work. Feedback from the psychotherapists, the parents and the referrers using the framework is reviewed, and in conclusion the paper argues for the framework's value in promoting good practice in the treatment and management of complex cases and in enhancing awareness of the nature and scope of the psychotherapy process

The Use of Dreams in Modern Psychotherapy

We review theories of dream work. We also review the empirical research about how dreams are used in psychotherapy, as well as the process and outcome of different models of dream work. Finally, we review how dream content can be used to understand client, the role of culture in dream work, client and therapist dreams about each other, and training therapists to do dream work

Change processes underlying 'good outcome' : a qualitative study on recovered and improved patients’ experiences in psychotherapy for major depression

Aim: Exploring change processes underlying "good outcome" in psychotherapy for major depression. We examined the perspectives of patients who "recovered" and "improved" (Jacobson & Truax) following time-limited CBT and PDT. Method: In the context of an RCT on the treatment of major depression, patients were selected based on their pre-post outcome scores on the BDI-II: we selected 28 patients who recovered and 19 who improved in terms of depressive symptoms. A grounded theory analysis was conducted on post-therapy client change interviews, resulting in an integrative conceptual model. Results: According to recovered and improved patients, change follows from an interaction between therapy, therapist, patient, and extra-therapeutic context. Both helping and hindering influences were mentioned within all four influencing factors. Differences between recovered and improved patients point at the role of patients' agency and patients' internal and external obstacles. However, patients marked as "improved" described heterogeneous experiences. CBT- and PDT-specific experiences were also observed, although our findings suggest the possible role of therapist-related influences. Conclusion: From patients' perspectives, various change processes underlie "good outcome" that do not necessarily imply an "all good process". This supports a holistic, multidimensional conceptualization of change processes in psychotherapy and calls for more fine-grained mixed-methods process-outcome research

Developing the adjudicated case study method

In this commentary we discuss Miller’s Panel of Psychological Inquiry (PPI) and Bohart’s Research Jury method approaches to the development of the adjudicated case study method, as represented by the papers assembled for this issue of Pragmatic Case Studies in Psychotherapy. In our view, the case studies presented here demonstrate the rapidly developing potential offered by this approach for psychotherapy research and reveal many parallels to recent research using the Hermeneutic Single Case Efficacy Design (HSCED) model. In our view, each of the three models has taken significant steps forward in adapting particular aspects of the legal process as viable psychotherapy research procedures. In this commentary we summarize the HSCED method, then take readers through the issues of the sources of the evidence used; ways in which that evidence is tested; claims, burden and standard of proof; and the handling of the adjudication process itself. We conclude with recommendations for further development of adjudicated case study methods

Metacognition as a predictor of improvements in personality disorders

Personality Disorders (PDs) are particularly hard to treat and treatment drop-out rates are high. Several authors have agreed that psychotherapy is more successful when it focuses on the core of personality pathology. For this reason, therapists dealing with PDs need to understand the psychopathological variables that characterize this pathology and exactly what contributes to maintaining psychopathological processes. Moreover, several authors have noted that one key problem that characterizes all PDs is an impairment in understanding mental states - here termed metacognition - which could also be responsible for therapy failures. Unfortunately, a limited number of studies have investigated the role of mentalization in the process of change during psychotherapy. In this paper, we assume that poor metacognition corresponds to a core element of the general pathology of personality, impacts a series of clinical variables, generates symptoms and interpersonal problems, and causes treatment to be slower and less effective. We explored whether changes in metacognition predicted an improvement among different psychopathological variables characterizing PDs; 193 outpatients were treated at the Third Center of Cognitive Psychotherapy in Rome, Italy, and followed a structured path tailored for the different psychopathological variables that emerged from a comprehensive psychodiagnostic assessment that considered patients' symptoms, metacognitive abilities, interpersonal relationships, personality psychopathology, and global functioning. The measurements were repeated after a year of treatment. The results showed that changes in metacognitive abilities predicted improvements in the analyzed variable

A clinical heritage of empirical research. In memory of Jeremy Safran

This is Part II of a special issue, Research in Psychotherapy: Psychopathology, Process and Outcome, dedicated in memory of our colleague Jeremy Safran (Part I was published in April 2019). All of the contributions (theoretical papers, clinical cases, qualitative and quantitative studies) presented in this second part of the special issue focus on the topic of ruptures and resolutions in the therapeutic alliance. Each paper demonstrates a unique approach, perspective, and methodology