Process Of Therapeutic Change Research Articles

Innovative approaches to exploring processes of change in counseling psychology: Insights and principles for future research.

In recent years, innovative approaches have been implemented in counseling and psychotherapy research, creating new and exciting interdisciplinary subfields. The findings that emerged from the implementation of these approaches demonstrate their potential to deepen our understanding of therapeutic change. This article serves as an introduction to the "Innovative Approaches to Exploring Processes of Change in Counseling Psychology" special issue. The special issue includes articles representing several of the most promising approaches. Each article seeks to serve as a sourcebook for implementing a given approach in counseling research, in such areas as the assessment of coregulation processes, language processing, physiology, motion synchrony, event-related potentials, hormonal measures, and sociometric signals captured by a badge. The studies included in this special issue represent some of the most promising pathways for future studies and provide valuable resources for researchers, as well as clinicians interested in implementing such approaches and/or being educated consumers of empirical findings based on such approaches. This introduction synthesizes the articles in the special issue and proposes a list of guidelines for conducting and consuming research that implements new approaches for studying the process of therapeutic change. We believe that we are not far from the day when these approaches will be instrumental in everyday counseling practice, where they can assist therapists and patients in their collaborative efforts to reduce suffering and increase thriving. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Metacognitive and Mentalization Based Concepts and Treatment Models: Implications for Child and Adolescent Psychiatry

Metacognitive and Mentalization Based Concepts and Treatment Models: Implications for Child and Adolescent Psychiatry The aim of this article is to provide a survey of metacognitive and mentalization-based therapeutic approaches and possible applications in the field of child and adolescent psychiatry. Firstly areas of metacognition are described and the concept of mentalization is introduced. Next, the treatments Mentalization Based Treatment (MBT), Metacognitive Interpersonal Therapy (MIT) and Metacognitive Therapy (MCT) are presented. Treatment models, theoretical backgrounds, the most important treatment steps, and typical interventions are explained. The treatment modalities are discussed concerning their conceptual similarities and differences as well as their applications in child and adolescent psychiatry. Finally the treatments are subsumed under the aspect of therapeutic change processes. An outlook for an integrative approach matching the level of metacognitive competency is given.

Treatment Manuals, Single-Subject Designs, and Evidence-Based Practice: A Clinical Behavior Analytic Perspective

Empirical support of procedures linked to processes of therapeutic change is emerging as an alternative foundation for evidence-based treatment development and selection in clinical psychology, in particular within cognitive-behavioral practice. Single-subject designs conducted with treatment manuals have contributed to the existing evidentiary base of research-supported treatment packages organized around psychiatric diagnoses, but as a rule have not been afforded the same status as randomized clinical trials. From a clinical behavior analytic perspective, single-subject experiments may be positioned to proportionately contribute more to emerging evidence-based practice that is itself more process focused, in particular if at least two recommended adjustments are made in how they are conducted. The first of these is to maximize efficacy and minimize rigidity in developing treatment manuals by creating them in a post-hoc rather than a-priori manner and with an emphasis on therapeutic procedures linked to specific processes. The second recommendation is that clinical behavior analysts routinely collect repeated process as well as outcome measures in conducting single-subject research.

Processes of therapeutic change: Results from the Cornell-Penn Study of Psychotherapies for Panic Disorder.

To examine process of changes in two distinct psychotherapies-cognitive-behavioral therapy (CBT) and Panic-Focused Psychodynamic Psychotherapy (PFPP). Two hypothesized processes of change-misinterpretation of bodily sensations and Panic Specific Reflective Function (PSRF)-were tested in the CBT and PFPP arms of the Cornell-Penn Study of Psychotherapies for Panic Disorder. The Brief Bodily Sensations Interpretation Questionnaire (BBSIQ) measures misinterpretation of bodily sensations-a focus of CBT interventions. PSRF, a target of PFPP, assesses the capacity to reflect on the underlying meaning of panic symptoms. A sample of 138 patients (37.7% men, 72.56% Whites, and 16.7% Latinx) with primary Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) panic disorder were included in the present analyses. Mixed effects models tested the effects of early change in BBSIQ and PSRF (intake through Week 5) on subsequent change in the Panic Disorder Severity Scale (PDSS; Week 5 through termination). Early change on both PSRF and BBSIQ predicted subsequent change in panic severity across the two treatments. As predicted, PSRF changed more in PFPP than in CBT, but, contrary to expectation, BBSIQ showed comparable changes in both groups. Counterintuitively, CBT patients benefited more in terms of panic symptom improvement when their PSRF improved than did PFPP patients. This is the first demonstration of general processes of change (PSRF and BBSIQ) across psychotherapies for panic disorder, suggesting that to the extent patients change their beliefs about the meaning of panic, their panic symptoms improve in time-limited, panic-focused psychotherapies. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Therapeutic change processes in school-based counselling: the perspectives of students and counsellors in Hong Kong

ABSTRACT School-based counselling is an effective intervention for psychological distress in adolescents, but little is known about the processes leading to a therapeutic change in a Chinese sociocultural context. Twenty-five Chinese senior secondary school students and eight school counsellors in Hong Kong were interviewed, and the data were analysed thematically within a critical realist paradigm. Three change processes were developed: new ways of thinking, developing better relationships and experiencing positive emotions. The study's findings were broadly consistent with previous research into school-based counselling in Western contexts but not consistent with previous studies carried out with adult Chinese clients. Counselling in schools has the potential to deliver significant benefits to adolescents in Hong Kong.

Agents of change: Understanding the therapeutic processes associated with the helpfulness of therapy for mental health problems with relational agent MYLO.

ObjectiveTo understand the therapeutic processes associated with the helpfulness of an online relational agent intervention, Manage Your Life Online (MYLO).MethodsFifteen participants experiencing a mental health related problem used Manage Your Life Online for 2 weeks. At follow-up, the participants each identified two helpful and two unhelpful questions posed by Manage Your Life Online within a single intervention session. Qualitative interviews were conducted and analyzed using thematic and content analysis to gain insight into the process of therapy with Manage Your Life Online.ResultsMYLO appeared acceptable to participants with a range of presenting problems. Questions enabling free expression, increased awareness, and new insights were key to a helpful intervention. The findings were consistent with the core processes of therapeutic change, according to Perceptual Control Theory, a unifying theory of psychological distress. Questions that elicited intense emotions, were repetitive, confusing, or inappropriate were identified as unhelpful and were associated with disengagement or loss of faith in Manage Your Life Online.ConclusionsThe findings provide insight into the likely core therapy processes experienced as helpful or hindering and outlines further ways to optimize acceptability of Manage Your Life Online.

Change processes related to long-term outcomes in eating disorders with childhood trauma: An explorative qualitative study.

To date, eating disorder (ED) treatments are lacking for ED patients with psychiatric sequelae of childhood trauma, and successful outcomes are scarce. Therefore, the aim of this study was to explore therapeutic change processes from a patient perspective in relation to good versus poor long-term ED outcome at 1-year follow-up. Outcome categories were based on clinician assessment of ED behavior and diagnoses, body mass index, and Eating Disorder Examination Questionnaire scores. Eleven White, cisgendered female ED patients with childhood trauma were interviewed after a 3-month inpatient treatment: data was analyzed with elements from grounded theory and interpretative phenomenological analysis. The qualitative analysis rendered change-related descriptions (9 subcategories) and obstacles to change (6 subcategories), and 3 process-related domains differentiated good from poor long-term outcome: trauma exposure (4 subcategories), patient agency (6 subcategories), and patient-therapist dynamics (3 subcategories). First, sensory and emotional trauma exposure in good outcome informants was contrasted with avoiding or not addressing trauma and body in poor outcome informants. Second, promotion of patient agency while receiving support in the good outcome group was contrasted to an orientation toward others' needs, distrust in own abilities, and difficulties showing vulnerability in the poor outcome group. Third, poor outcome informants described either a distanced or immersed/idealizing relationship to their therapist, as opposed to more balanced between self-assertion and vulnerability in good outcome informants. Our findings raise new hypotheses that trauma work, fostering patient agency, and focusing on relational dynamics in patient-therapist dyad may be important in producing enduring ED outcomes for these patients. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Towards text mining therapeutic change: A systematic review of text-based methods for Therapeutic Change Process Research.

Therapeutic Change Process Research (TCPR) connects within-therapeutic change processes to outcomes. The labour intensity of qualitative methods limit their use to small scale studies. Automated text-analyses (e.g. text mining) provide means for analysing large scale text patterns. We aimed to provide an overview of the frequently used qualitative text-based TCPR methods and assess the extent to which these methods are reliable and valid, and have potential for automation. We systematically reviewed PsycINFO, Scopus, and Web of Science to identify articles concerning change processes and text or language. We evaluated the reliability and validity based on replicability, the availability of code books, training data and inter-rater reliability, and evaluated the potential for automation based on the example- and rule-based approach. From 318 articles we identified four often used methods: Innovative Moments Coding Scheme, the Narrative Process Coding Scheme, Assimilation of Problematic Experiences Scale, and Conversation Analysis. The reliability and validity of the first three is sufficient to hold promise for automation. While some text features (content, grammar) lend themselves for automation through a rule-based approach, it should be possible to automate higher order constructs (e.g. schemas) when sufficient annotated data for an example-based approach are available.

Clarificar para Otro: Seis Prácticas Conversacionales Generativas de Cambio Terapéutico desde la Teoría del Cambio Subjetivo

Drawing from the theory of subjective change in psychotherapy, this theory-building case study examines one successful therapeutic change process. The study characterizes conversational micro-practices featuring in segments of conversation theoretically linked to therapeutic change called change episodes (CE), containing three types of observable generic indicators of change: input, process, and output. For this study the 16 CE containing indicators of the second level (process) were examined. Six conversational practices involving six therapeutic assumptions are presented as a result of the study, which were consequential in discursively accomplishing preferred self-references (PSR) within CE related to process. Given that generating a “subjective theory” about the client’s own change process emerges as a byproduct of conversationally clarifying PSR for and with the therapist (i.e., intersubjective validation), this study contributes further specifying the theory of subjective change.

Change process in systemic therapy: A qualitative investigation

AbstractThis study addresses the process of therapeutic change in individuals who received systemic therapy. This study is an exploratory qualitative study based on the client's perceptions and therapeutic experiences. The sample included 10 clients who had completed their therapy with systemic therapists. The method used for the collection of the data was semi‐structured interviews (Change Interview; Elliott, Slatick, & Urman, 2001). The interviews were analysed using grounded theory analysis. The results showed that both specific and common factors in therapy function in a co‐occurring mode, hence suggesting a synergy effect between common factors and specific techniques or therapist factors in psychotherapy. The core category ‘experience of therapeutic change, within the secure frame of therapy, is a process of deconstructing and reconstructing the house you live in: Yourself’ emerged based on self‐exploration and self‐discovery and is then discussed in a theoretical constructivist framework. Implications for research on the issue of the process of therapeutic change are discussed.

Therapeutic change processes link and clarify targets and outcomes.

Therapeutic change processes link and clarify targets and outcomes.

Understanding Therapeutic Change Process Research Through Multilevel Modeling and Text Mining.

Online interventions hold great potential for Therapeutic Change Process Research (TCPR), a field that aims to relate in-therapeutic change processes to the outcomes of interventions. Online a client is treated essentially through the language their counsellor uses, therefore the verbal interaction contains many important ingredients that bring about change. TCPR faces two challenges: how to derive meaningful change processes from texts, and secondly, how to assess these complex, varied, and multi-layered processes? We advocate the use text mining and multi-level models (MLMs): the former offers tools and methods to discovers patterns in texts; the latter can analyse these change processes as outcomes that vary at multiple levels. We (re-)used the data from Lamers et al. (2015) because it includes outcomes and the complete online intervention for clients with mild depressive symptoms. We used text mining to obtain basic text-variables from e-mails, that we analyzed through MLMs. We found that we could relate outcomes of interventions to variables containing text-information. We conclude that we can indeed bridge text mining and MLMs for TCPR as it was possible to relate text-information (obtained through text mining) to multi-leveled TCPR outcomes (using a MLM). Text mining can be helpful to obtain change processes, which is also the main challenge for TCPR. We showed how MLMs and text mining can be combined, but our proposition leaves open how to obtain the most relevant textual operationalization of TCPR concepts. That requires interdisciplinary collaboration and discussion. The future does look bright: based on our proof-of-concept study we conclude that MLMs and text mining can indeed advance TCPR.

Pathways to Improving Mental Health in Compassion-Focused Therapy: Self-Reassurance, Self-Criticism and Affect as Mediators of Change.

Objective: The working mechanisms of compassion-focused therapy (CFT) remain understudied. Drawing on the theoretical model underlying CFT, we examined four putative working mechanisms – self-reassurance, self-criticism, positive/negative affect – in relation to changes in well-being and psychological distress.Methods: Data of a waitlist randomised controlled trial (N = 242) investigating the effectiveness of a self-help CFT-intervention in a non-clinical sample were analysed. Using single and multiple mediation models, we assessed if changes in self-reassurance, self-criticism and positive/negative affect during the intervention (3-month interval) mediated changes in well-being and depressive/anxiety symptoms from baseline to follow-up (6-month interval) compared to the waitlist condition.Results: For each outcome, single analyses revealed that the effects of CFT were significantly mediated by self-reassurance and self-criticism. The mediating role of affect differed across outcomes. In combined models, self-reassurance emerged as a significant mediator for well-being and anxiety symptoms. Additionally, positive and negative affect were found significant mediators of the effects on depressive and anxiety symptoms, respectively.Conclusion: This study provides preliminary empirical evidence that CFT operates through cultivating self-reassurance, reducing self-criticism and regulating positive and negative affect in a non-clinical sample. To advance the development of CFT, further exploration of therapeutic change processes and their interplay is needed.

Clients' experience of change: An exploration of the influence of reformulation tools in cognitive analytic therapy.

Case formulation is considered important in both the development of the therapeutic relationship and in starting the process of therapeutic change. Cognitive analytic therapy (CAT) describes the developmental origins and maintenance of a client's problems in both written (reformulation letter) and diagrammatic form (sequential diagrammatic reformulation). This study aimed to investigate the effects of these reformulation tools on insight and symptom change. A small-N repeated measures design was employed with quantitative and qualitative measures collected from six therapist/client dyads. Participating therapists kept a record of their delivery of CAT reformulation tools. Participating clients completed the insight subscale of the Self-Reflection and Insight Scale every fourth session and the Clinical Outcomes in Routine Evaluation-10 every session. Qualitative data from client change interviews regarding their experiences of CAT and attributions of change was explored using template analysis. Participants demonstrated improvements (symptom reduction and insight increases) over the course of the intervention. Administration of reformulation tools did not consistently result in significant changes on insight and symptom measures. However, the tools were identified by participants as leading to insight and emotional change within the context of a good therapeutic relationship. These findings suggest that a genuine therapeutic relationship is an important change mechanism operating through, and strengthened by, CAT-specific tools.

Exploring the Vicissitudes of Safety and Danger in Psychoanalysis: Developing Trust Through Mutual Engagement

ABSTRACTOne of the essential features of a therapeutic change process is the ability to establish, within the therapeutic relationship, a sense of safety from which patients can engage and explore the many issues that bring them into therapy. Efforts to gain our patients’ trust so that they feel safe enough to expose their vulnerabilities and engage in a healing process remain at the center of the analytic enterprise, no matter the theoretical position of the therapist. In fact, in an otherwise diverse and sometimes fractious psychoanalytic field, the importance of safety is one of the few areas of near consensus. In our approach, we acknowledge the intersubjective nature of all relational experience and appreciate the powerful processes of mutual influence that reverberate between the analytic couple. As we see it, clinical engagement requires both partners to take risks, tolerate a sense of danger, learn to trust each other, and seek emotional safety through connection and understanding. In this article, we explore a number of perspectives related to building and restoring a shared sense of safety despite what we consider to be the necessary, inherent dangers of psychoanalytic engagement. We include two clinical vignettes that elaborate our views more fully.

Una Extensión del Concepto de Regla y su Aplicación a la Terapia Psicológica

Providing and following rules has been considered an important factor in the effectiveness of psychological treatments; however, a conceptual clarification is needed of what is meant by issuing or following a rule and its application in the clinical setting. Based on a review of the original concept of rule-governed behavior, our purpose was to extend the definition of this behavior oriented to the clinical process. This definition allows its identification and study moment by moment throughout the therapeutic process. The extension of this definition can help us to identify the al role of rules in clinical change and the variables involved that contribute to the understanding of clinical phenomena such as generalization. The findings that emerge from the study of rules from this perspective could increase the information on the therapeutic change process and, therefore, contribute to the improvement of clinical practice.

How do high-risk young adult prisoners with emerging personality disorders describe the process of change in therapy?

PurposeThe purpose of this paper is to investigate the views of young adult prisoners with emerging personality disorders (PDs), who were assessed as posing a high risk of causing serious harm to others, on the process of therapeutic change in a non-residential treatment service in a UK young offender institute. The treatment model utilises an integrated approach, specifically adapted for the developmental needs of young adults and combining therapies for PD with offence focussed interventions and regular keywork.Design/methodology/approachIn total, 13 participants, who had completed at least one year of therapy, were interviewed about their perspectives about what, if any, change had occurred and how any reported change had taken place. The interviews were transcribed verbatim and analysed via thematic analysis.FindingsAll participants described having made positive therapeutic change. Three overarching change themes were identified: mentalisation of others, self-knowledge and adaptive coping. Relationships with staff were described as the key mechanism through which change was achieved. Specific treatment interventions were mentioned infrequently, although keywork and generic individual therapy and groupwork sessions were also described as drivers to change.Originality/valueThe findings suggest the possibility of positive therapeutic outcomes for this complex service user group. They also suggest that the domains of change and associated mechanisms may be similar to those reported for other service user groups and in other settings.

Ideas of the change process: family and therapist perspectives on systemic psychotherapy for children with conduct disorder

AbstractThis report is based on a small‐scale qualitative study exploring therapist and client perspectives on the therapeutic change process in home‐based family therapy for children with conduct disorder. The study consisted of focus group discussions with therapists, interviews with client families and audiotaped therapy sessions. The findings suggested that home‐based therapy (home visits) was effective in improving hard‐to‐reach clients’ access to help, resources, and opportunities, as well as the therapists’ access to invaluable information about their clients. Home‐based therapy also helped the therapists to develop professionally, making it possible for them and their clients to engage in different power relationships, which were seen by both parties as one of the principal motivating forces and important aspects of the change process. In addition, exploring clients’ perspectives appeared to be useful.Practitioner points The process of engaging with hard‐to‐reach families starts in the context of specific therapist‐client power relationships with the therapist encouraging the family to take charge Home‐based therapy is useful for children with conduct disorder Home‐based therapy provides children, family and therapists with information, resources, opportunities and good access, which are not always available in customary clinical settings

Talking Cure Models: A Framework of Analysis.

Psychotherapy is commonly described as a “talking cure,” a treatment method that operates through linguistic action and interaction. The operative specifics of therapeutic language use, however, are insufficiently understood, mainly due to a multitude of disparate approaches that advance different notions of what “talking” means and what “cure” implies in the respective context. Accordingly, a clarification of the basic theoretical structure of “talking cure models,” i.e., models that describe therapeutic processes with a focus on language use, is a desideratum of language-oriented psychotherapy research. Against this background the present paper suggests a theoretical framework of analysis which distinguishes four basic components of “talking cure models”: (1) a foundational theory (which suggests how linguistic activity can affect and transform human experience), (2) an experiential problem state (which defines the problem or pathology of the patient), (3) a curative linguistic activity (which defines linguistic activities that are supposed to effectuate a curative transformation of the experiential problem state), and (4) a change mechanism (which defines the processes and effects involved in such transformations). The purpose of the framework is to establish a terminological foundation that allows for systematically reconstructing basic properties and operative mechanisms of “talking cure models.” To demonstrate the applicability and utility of the framework, five distinct “talking cure models” which spell out the details of curative “talking” processes in terms of (1) catharsis, (2) symbolization, (3) narrative, (4) metaphor, and (5) neurocognitive inhibition are introduced and discussed in terms of the framework components. In summary, we hope that our framework will prove useful for the objective of clarifying the theoretical underpinnings of language-oriented psychotherapy research and help to establish a more comprehensive understanding of how curative language use contributes to the process of therapeutic change.

A Case Study on Child-Centered Play Therapy for a Child with ADHD and ODD: Focusing on the Change of Play Theme at Stage

Objective This study was aimed to enhance of the effects of child-centered play therapy and the process of therapeutic change in a child with ADHD and ODD by examining the process of play therapy and the change of play themes at stages. Methods The participant was a first-grade boy in primary school who was diagnosed with ADHD and ODD. The researcher directly conducted 62 sessions of child-centered play therapy once per week for 1 year and 5 months. Results First, the child’s aggressive and rebellious behavior decreased, and self-control and social situations adjusted accordingly through the child-centered play therapy. Second, looking at the changes of play theme at stage, the play themes of controlling and safety and exploration and mastery were mainly performed in the intimacy formation stage. The play theme of power and aggression increased significantly in the aggressive stage, and the play themes of family and nurturing and power and aggression increased in the degenerative stage. Finally, power and aggression decreased and family and nurturing and controlling and safety increased in the end stage Conclusion The effectiveness of child-centered play therapy was confirmed for a child with ADHD and ODD. By analyzing the play themes at stages of play therapy, certain patterns of change were identified. Keywords: ADHD (Attention Deficit Hyperactivity Disorder), ODD (Oppositional Defiant Disorder), child-centered play therapy, play theme