Events In Psychotherapy Research Articles

Positive events in psychotherapy: What do adolescents and young adults say is helpful?

Background The significant challenge in adolescent and young adult therapy lies in the fact that research in this field does not provide many clinical indications. This study addresses domains contributing to the establishment and sustenance of engagement, satisfaction, and progress among adolescents and young adults in their treatment by delving into the impact of events that, from the perspective of clients, have positively influenced their therapeutic process. Methods Employing a qualitative research approach, we conducted semi-structured interviews with 13 adolescents and young adults undergoing therapy, recounting positive and constructive events during their treatment. Results A structured thematic analysis revealed six primary domains of positive events: events linked to the management of the setting, events shaping the definition of therapy goals, occurrences tied to the therapist’s active role, collaborative events between therapists and clients, and events associated with both clients’ external and internal worlds. Conclusions The findings suggest that working with adolescents shares similarities with psychotherapy involving adult clients but demands specific attention to adolescents and young adults’ families, surrounding environment, and rapidly changing needs.

Hindering events in psychotherapy with adolescents: A retrospective investigation of patients' recollection

AbstractBackgroundAdolescents often drop out of psychotherapy, with research indicating that almost half of adolescents abandon therapy prematurely. Authors have recommended that, in order to increase engagement and prevent dropout, it is important for clinicians to manage and maintain the therapeutic setting and the relationship.ObjectiveThis study was designed to investigate the impact of events that hinder the therapeutic alliance in psychotherapy with adolescents, with attention to the adolescents' experiences of these events, how such events were managed within the therapeutic relationship and consequences for the course of treatment.MethodsSemi‐structured interviews were conducted with adolescents and young adults who experienced negative events during their treatment.ResultsFollowing a structured thematic analysis, four main domains of hindering events were identified: (a) the nature of problems; (b) subjective experience; (c) response to the events; and (d) consequences of these events.ConclusionWhile there were some similarities between hindering events in adult psychotherapy and that undertaken with adolescents, findings indicate that working with adolescents presents specific challenges associated with limited independence that is typical of this stage of life, and this has implications for clinical practice.

Adverse events in psychotherapy randomized controlled trials: A systematic review

Objective: Although evidence for benefits of psychotherapy is substantial, less is known about potential harm. Therefore, we systematically summarized randomized controlled trials (RCTs) to compile evidence-based data on the frequency and characteristics of adverse events (AEs) of psychotherapy. Method: This systematic review of result publications is based on a review of harm consideration in psychotherapy study protocols. Results: On the basis of 115 study protocols, 85 RCTs with 126 psychotherapy and 61 control conditions were eligible for inclusion. The sample consisted of 14,420 participants with the most common mental disorders. Harmful events, e.g., AEs, number of individuals with symptom deterioration, were explicitly reported in 60% of the studies. Conceptualization, recording, and reporting of AEs were heterogeneous. For most reported AEs, the association to study treatment remained unclear. Conclusions: Because the AE recording approaches of the individual studies differed substantially, results could only be compared to a limited extent. Consistent with other findings, this review demonstrates that AEs can be expected to affect more than one in ten participants. Serious AEs occurred more than in one in 21 participants in psychotherapy RCTs. To allow a balanced risk/benefit evaluation of psychotherapy, systematic harm monitoring and reporting should become standard in psychotherapy RCTs.

Pitfalls and Opportunities of the Therapist’s Metacommunication: A Self-determination Perspective

Psychotherapy research identifies alliance ruptures and their resolutions as significant events in psychotherapy, influencing outcome. However, we know little about the process how such events influence outcomes, only assuming if clients stay in therapy that the rupture was resolved, and the outcome will be positive. The purpose of this paper is to problematize this assumption against the backdrop of self-determination theory, introducing motivation and relational positioning as relevant theoretical concepts for understanding rupture resolution and the effect on outcome. A therapeutic transcript demonstrating best practice for alliance rupture resolution in a brief integrative therapy is critically examined, calling the attention of both clinicians and researchers to the risk of prescribing and blindly following techniques during therapeutic impasses. Our analysis of metacommunication demonstrates how the therapist’s use of a certain technique for resolving threats to the therapeutic alliance can lead to the client’s external motivation and compliance, negatively influencing therapeutic outcome. Focusing on the therapist’s relational positioning we present two alternative courses of therapeutic action, ‘mindfulness in action’ and ‘embracing the patient’s ambivalence’, for supporting the client’s autonomous motivation for the therapy process.

Adverse events in cognitive behavioral therapy and relaxation training for children and adolescents with obsessive-compulsive disorder: A mixed methods study and analysis plan for the TECTO trial

BackgroundKnowledge on adverse events in psychotherapy for youth with OCD is sparse. No official guidelines exist for defining or monitoring adverse events in psychotherapy. Recent recommendations call for more qualitative and quantitative assessment of adverse events in psychotherapy trials. This mixed methods study aims to expand knowledge on adverse events in psychotherapy for youth with OCD. MethodsThis is an analysis plan for a convergent mixed methods study within a randomized clinical trial (the TECTO trial). We include at least 128 youth aged 8–17 years with obsessive-compulsive disorder (OCD). Participants are randomized to either family-based cognitive behavioral therapy (FCBT) or family-based psychoeducation and relaxation training (FPRT). Adverse events are monitored quantitatively with the Negative Effects Questionnaire. Furthermore, we assess psychiatric symptoms, global functioning, quality of life, and family factors to investigate predictors for adverse events. We conduct semi-structured qualitative interviews with all youths and their parents on their experience of adverse events in FCBT or FPRT. For the mixed methods analysis, we will merge 1) a qualitative content analysis with descriptive statistics comparing the types, frequencies, and severity of adverse events; 2) a qualitative content analysis of the perceived causes for adverse events with prediction models for adverse events; and 3) a thematic analysis of the participants’ treatment evaluation with a correlational analysis of adverse events and OCD severity. DiscussionThe in-depth mixed methods analysis can inform 1) safer and more effective psychotherapy for OCD; 2) instruments and guidelines for monitoring adverse events; and 3) patient information on potential adverse events. The main limitation is risk of missing data. Trial registrationClinicalTrials.gov identifier: NCT03595098. Registered on July 23, 2018.

Systematic review: Exploring the monitoring and reporting of unwanted events in psychotherapy trials for anorexia nervosa.

If a psychotherapeutic intervention has the capacity to produce positive change, the "deterioration effect" theory holds that it must also have the potential for negative effects. However, the definition, measurement, and reporting of unwanted events in psychotherapy is a topic of ongoing discussion. At present this area is under-explored in interventions for anorexia nervosa (AN), a severe mental illness associated with high medical and psychiatric risks. The aim of this article was to undertake a systematic review of published randomized controlled trials (RCTs) evaluating psychotherapeutic interventions for AN, and to assess how unwanted events were defined, monitored, and reported alongside the trial's key findings. Using a systematic review methodology, this article identified 23 RCTs through database searches meeting eligibility criteria. Results are presented using a narrative summary approach. Unwanted event reporting varied widely, both regarding definitions of key unwanted events (such as non-compliance or symptom deterioration) and in the amount of detail captured in each paper. The review identified two key issues: firstly, a lack of consistent definitions and unclear causality made it difficult to distinguish between unwanted events, and adverse events caused by the interventions. Secondly, it highlighted the difficulty of defining unwanted events where different studies have different populations and goals. Recommendations are made around how the area of defining, monitoring, and reporting unwanted events in RCTs for AN can be taken forward. Whilst psychotherapies can be effective in treating mental health conditions, negative or unwanted events can sometimes occur. This review explored how RCTs examining psychotherapy for AN report how they monitor the safety of participants, and how they report unwanted events. We found that the reporting was often inconsistent or hard to interpret, and we have made recommendations for how this can be improved in the future.

Jungian psychotherapy, spirituality, and synchronicity: Theory, applications, and evidence base.

The aim of this article is to give an introduction to the theoretical model of Jungian psychotherapy (JP) and the role of spirituality in it, with a special focus on the concept of synchronicity (meaningful coincidences), by which the application of a spiritual viewpoint in JP will be exemplified. The paper gives an overview of the empirical studies of the effectiveness of JP and then focuses on the results of an empirical study on the occurrence of synchronistic events in psychotherapy and how they are integrated in the therapeutic process. JP can be called the prototype of a spiritually integrated psychotherapy, since Jung was the first in the development of psychotherapy who put a strong emphasis on a spiritual perspective and who succeeded to integrate spirituality into his psychotherapy approach with a coherent theoretical model in the background. Moreover, Jung's psychology became a major reference point for many other spiritual psychotherapy approaches which developed in the twentieth century. Regarding the studies on the effectiveness of JP it can be said that there is some empirical support pointing to the effectiveness of JP, but there is a strong need for further research, especially with randomized controlled trial designs. The paper presents the results of a study investigating how psychotherapists integrate synchronistic experiences and make use of these to support the therapeutic process. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Client-Identified Impacts of Helpful and Hindering Events in Psychotherapy: A Qualitative Meta-analysis

Objective Understanding the client perspective is important for the provision of psychotherapy. The significant events paradigm, within which clients report on the most significant events of a therapy session immediately after the session, represents a useful means to explore clients’ in-session experience. Method The aim of this study was to investigate what types of client-identified impacts are reported in qualitative studies on helpful and hindering events in psychotherapy. Seventeen primary studies focusing on client-identified helpful and hindering events were identified through database searches and subsequent manual searches. The data were subjected to qualitative meta-analysis. Results The descriptions of event impacts were classified into 12 helpful (e.g., gaining a new perspective on the self; feeling heard, understood, and accepted; and feeling engaged in the therapeutic process) and eight hindering (e.g., lacking guidance from the therapist and feeling emotionally overwhelmed) impact meta-categories. Conclusion The findings provide an update to a previous meta-analysis by identifying several new categories of helpful event impacts and by categorizing hindering event impacts.

Hindering events in psychotherapy: A retrospective account from the client's perspective

AbstractBackgroundHindering events in the therapeutic process have been associated with client dissatisfaction, disagreements in therapy, and premature withdrawal from the therapeutic process. However, hindering events in therapy have not been extensively researched from the client's perspective and lack subjective details on how these events are experienced in therapy.AimsThis study explored how hindering events are experienced by clients and their influence on the therapeutic process and outcome from the client's perspective.MethodNine individuals who previously attended therapy and experienced hindering events were interviewed using an in‐depth semi‐structured interview protocol created by the authors. Data were analysed using structured thematic analysis.ResultsFour major themes emerged, each containing themes and sub‐themes to further expand on client experiences: (a) identified hindering events (felt mistreated by therapist, distracted/inattentive therapist, perceived clinical mistakes, tensions from the management of the therapeutic frame); (b) subjective experience of the event (negative emotional experience, making sense of the event, parallel personal dynamics); (c) response to the event (client response/decision to continue or end therapy, reaction to discontinuing therapy); and (d) handling/addressing the event (not handled/addressed, handled/addressed, interest in handling/addressing event, reasons given for not addressing/handling event). Results from this study contribute to the further understanding of client experiences of hindering events that occur in therapy as well as how these events influence therapeutic processes and outcomes.ConclusionThe study adds nuance to the scholarly work that informs client experiences of negative events in therapy. Implications for therapeutic organisations, therapists/counsellors, and educators are discussed.

Significant therapy events with clients with intellectual disabilities

PurposeThe purpose of this paper is to explore significant events in psychotherapy with clients with intellectual disabilities (IDs).Design/methodology/approachFour therapy dyads, each consisting of one client and one therapist, were recruited. Following the brief structured recall procedure (Elliott and Shapiro, 1988), semi-structured interviews focused on helpful events in psychotherapy, using video of particular sessions as a stimulus to help prompt recall of that session.FindingsUsing interpretative phenomenological analysis, five super-ordinate themes were identified: “The Uniqueness of the Therapeutic Relationship”; “Using adaptations to Express Emotions”; “Client Behaviour/Therapist Behaviour”; “Hope and Paternalism”; and “Meaning-Making”. The results provide additional evidence that significant therapy events occur for clients with IDs. Furthermore, the research enabled insights to be gained about the process of therapy for this client group and for exploration of therapeutic factors that may be involved in facilitating a significant therapy event.Research limitations/implicationsThis study highlights the need for therapists to work in such a way as to facilitate significant events in therapy. Whilst this study was a necessary first step, owing to the non-existence of research in this area, the sample size and qualitative design may limit any wider generalisation of the findings.Originality/valueSignificant events have not previously been explored in psychotherapy with clients with IDs. This research could therefore make an important contribution to our understanding of the process of psychotherapy for this client group.

Understanding the client's perspective of helpful and hindering events in psychotherapy sessions: A micro-process approach.

The purpose of this study was to bridge the methodologies of significant events and micro-process research to gain a better understanding of clients' perceptions of helpful and hindering events in psychotherapy. A total of 16 clients were asked to review a recent psychotherapy session and, while watching, complete a moment-by-moment rating of helpful/hindrance using a dial rating system. They were also asked to describe the most helpful and hindering segments that were rated as such. The moment-by-moment ratings suggest that clients perceive a significant amount of variability within a single session. The qualitative results suggest that clients perceive both specific treatment and common factors techniques as being helpful. Further, some of the same therapist actions were rated as both helpful and hindering, but they differed in the timing and the client's experience of feeling heard and understood versus judged or given advice that was not perceived as relevant to them. These results have important implications for clinical practice.

Revisiting a meta-analysis of helpful aspects of therapy in a community counselling service

ABSTRACTThis small scale mixed methods study examines helpful events in a community counselling setting, categorising impacts of events according to Timulak’s [(2007). Identifying core categories of client-identified impact of helpful events in psychotherapy: A qualitative meta-analysis. Psychotherapy Research, 17, 305–314] meta-synthesis of significant events research. Comparisons were made between the types of impacts reported as helpful by clients receiving cognitive behavioural therapy (CBT) or relational integrative counselling. Seventy-five clients identified 291 significant events on 216 Helpful Aspects of Therapy (HAT) forms. The findings broadly reflect all nine impacts identified by Timulak (2007). The study also suggests that a potential new category, ‘voicing’ may exist. Differences between the types of impacts reported as helpful by clients in CBT and integrative therapy showed a higher percentage of CBT clients reporting ‘behavioural change/problem solution’, ‘reassurance’ and ‘client involvement’ as helpful. Differences in other categories were not statistically significant.

Review of Task Analysis Research of Significant Events in Psychotherapy

Task analysis is a process and outcome research method in psychotherapy proposed by Greenberg (1975). This method is intended to a) check the efficacy of a specific technique as applied to a certain in-session event; b) clarify the elements and the process that makes such an intervention effective; c) assess how much the solution of that event contributes to the overall treatment success. The task-analyzed interventions are described at a micro-process level, which facilitates reliable training and the practice of effective techniques applied to a wide range of key events of the psychotherapeutic process. GOAL: To compile and organize all tasks analyzed to date in order to facilitate access to this training and practice resource. METHOD: Literature review of task analysis research programs carried out to date. RESULTS: Thirty-seven task analysis research programs analyzing significant events from the perspective of several psychotherapy models and settings were found. Only five of these have been completed to date, but twenty-six have produced effective intervention models. CONCLUSIONS: Although task analysis is a very expensive psychotherapy research method, it generates highly valuable resources for practice and training in psychotherapy. Every task analysis which has completed the discovery phase produce a refined and empirically supported intervention model.

Qualitative meta-analysis of insight events in psychotherapy

Purpose: This study reports on a qualitative meta-analysis examining the phenomenon of insight into psychotherapy. Method: Studies (n = 7, covering 15 insight events of 15 clients) were selected that examined significant events in psychotherapy leading to insight using session recordings and Interpersonal Process Recall interviews with clients and therapists. A conceptual organization of the data using a matrix grid consisting of three domains according to data origin (client process, therapist process, and their interaction) and three domains according to events’ sequence (context, event and key intervention, and impact) was established. Results: Key processes were identified that lead to insight events in psychotherapy. Two distinct types of events according to their main impacts as reported by the clients were identified: Painful/Poignant Insight where clients realized something that was painful, often evoking feelings of sadness or undifferentiated upset containing sadness and hurt; and Self-Asserting/Empowering Insight that led to an impact characterized by a sense of self-assertion and empowerment on the client’s part. A reasonably good alliance and vulnerability on the client’s part represent the context for insight events as does the client’s quest for self-understanding. The therapists’ key interventions in the event leading to poignant/painful insight contain either empathic reflection or collaborative interpretation. In empowerment/self-assertive insight events the therapists offer supportive, validating reframing promoting positive experience. In both types of events the therapist and the client work on consolidating insight. In some events, therapists emphasized cognitive or problem solution focused impacts, while clients emphasized emotional impacts. Some events contained emotional avoidance on the part of the client or therapist thus not realizing the full potential of the event.

The prevalence and characteristics of relational depth events in psychotherapy

We introduce two complementary measures of relational depth, defined as a state of profound contact and engagement between client and therapist. Using an internet-based survey of client and therapist accounts (n=342), judges rated relational depth as present in over a third of significant therapy event descriptions. Participants also completed the Relational Depth Inventory (RDI), for which we report reliability, validity and factor structure. Relational depth events were more likely to occur in the presence of strong therapeutic alliance, and with female participants, but client or therapist role and therapy duration were not related to relational depth content or RDI. RDI items for connectedness, love, respect and intimacy were most strongly associated with relational depth content.

Significant events in psychotherapy: An update of research findings.

Significant events research represents a specific approach to studying client-identified important moments in the therapy process. The current study provides an overview of the significant events research conducted, the methodology used together with findings and implications. PsychInfo database was searched with keywords such as significant events, important events, significant moments, important moments, and counselling or psychotherapy. The references of the selected studies were also searched. This process led to the identification of 41 primary studies that used client-identified significant event(s) as a main or secondary focus of the study. These were consequently reviewed with regard to their methodology and findings. The findings are presented according to type of study conducted. The impacts of helpful events reported by clients are focused on contributions to therapeutic relationship and to in-session outcomes. Hindering events focus on some client disappointment with the therapist or therapy. The group therapy modality highlighted additional helpful impacts (like learning from others). Perspectives on what is significant in therapy differ between clients and therapists. The intensive qualitative studies reviewed confirm that the processes involved in significant events are complex and ambiguous. Studies show that the helpful events may also contain many hindering elements and that specific events are deeply contextually embedded in the preceding events of therapy. Some studies suggest that helpful significant events are therapeutically productive although this may need to be established further. Specific intensive studies show that the clients' perceptions in therapy may differ dramatically from that of the therapist. Furthermore, the relational and emotional aspects of significant moments may be more important for the clients than the cognitive aspects of therapy which are frequently stressed by therapists.

Helpful and hindering events in psychotherapy: A practice research network study.

This paper presents the findings of a psychotherapy process study conducted within the Pennsylvania Psychological Association Practice Research Network (PPA-PRN). The investigation was the product of a long-term collaborative effort, both in terms of the study design and implementation, between experienced clinicians of various theoretical orientations and full-time psychotherapy researchers. Based on a relatively large sample of clients seen in independent practice settings, close to 1,500 therapeutic events (described by clients and therapists as being particularly helpful or hindering) were collected. These events were coded by three independent observers using a therapy content analysis system. Among the findings, both clients and therapists perceived the fostering of self-awareness as being particularly helpful. The results also point to the importance of paying careful attention to the therapeutic alliance and other significant interpersonal relationships. The merits and difficulties of conducting scientifically rigorous and clinically relevant studies in naturalistic contexts are also discussed.

Client-identified important events in psychotherapy: Interactional structures and practices

This study describes interactional structures and practices in client-identified important events in psychotherapy sessions. Twelve of 16 events from seven client–therapist dyads were found to contain disagreement. A turn-by-turn investigation using conversation analysis displayed three different ways that therapists used to handle disagreement. The first was to orient to the client's disagreement cues by inviting the client to elaborate his or her point and to establish a shared understanding. The second was to orient to the client's disagreement cues but define the therapist's point of view as more relevant to the project at hand. The third was a single case where the therapist did not orient to the client's disagreement cues. The results suggest that disagreement patterns may be an interesting focus for further exploration of microprocesses within therapy sessions.

Identifying core categories of client-identified impact of helpful events in psychotherapy: A qualitative meta-analysis

A growing number of psychotherapy studies using qualitative approaches to research call for the cumulative assessment of findings. Although summaries of qualitative research studies have been published in psychotherapy research literature, the cumulative assessment of findings emerging from qualitative psychotherapy studies investigating the same research topic has not yet been attempted using empirical analysis. This study explores, through an application of meta-analytical procedures that result in a rigorous secondary analysis of primary qualitative findings, the kinds of impacts that clients identify as helpful. Findings from qualitative studies focusing on client-identified impacts of helpful significant events are analyzed. The qualitative descriptive–interpretative analysis is conducted in an exploratory manner for selected studies. The preliminary results of the qualitative meta-analysis are presented, together with the assessment of utility, possibilities, and shortcomings of the explored method.

The missed session: A neglected aspect of psychodynamic psychotherapy.

Missed sessions, whether initiated by the patient, therapist, or nature, are events in psychotherapy, not non-events. When appropriately handled, missed sessions provide valuable opportunities for therapeutic exploration. A clear cancellation policy, discussed early in therapy, offers a frame within