Psychotherapy Process Research Articles

Adolescents' experiences of psychotherapy following child sexual abuse.

The aim of this study was to explore adolescents' experiences of psychotherapy following sexual abuse, complementing those studies that focus on outcomes and measurement of symptom change across the course of therapy and building on recent studies that focus on the process of psychotherapy for young people who have experienced sexual abuse, from their perspective. Recent reviews have highlighted the need for tailored approaches to therapy. Research is needed that focuses on young people's experiences of therapy to help develop such tailored approaches. In this study, 16 young people aged 15-18 years who were attending specialist sexual violence therapeutic services were interviewed. Using thematic analysis, six themes were identified as reflecting their experiences of therapy following sexual abuse. Young people spoke of not wanting to attend; the importance of choice and not feeling pressured in both initially attending and in how the therapy unfolded; how helpful it was to talk; the centrality of the relationship with their therapist; the benefit of attending a specialist service; how helpful it was when the therapist explained things; and finally, the coping skills they learned in the therapeutic work. A key learning from the study is the importance of respecting young people's autonomy following such violations of trust and psychological integrity. The study highlights how engagement in therapy may be experienced as a re-enactment of an experience that was forced on the young person. Further qualitative research exploring this phenomenon could guide therapists on how to minimise such re-enactments in therapeutic work.

Transference-Focused Psychotherapy for Adolescents with Personality Disorders: A Case Example with a Focus on the Interpretative Process and Transference Analysis

ABSTRACT In this paper, I focus on the nature and functions of the interpretive process in psychotherapy with adolescents with severe personality disorder. I will describe how the interpretive process in transference focused psychotherapy for adolescents provides affective containment and symbolic management of psychological conflict along with a shift toward the predominance of repression-based over primitive defenses. This process leads to a progressive resolution of identity diffusion. I will give illustrations of different phases of the interpretive process.

Discursive angles on the relationship in psychotherapy.

Research on the psychotherapy relationship has been dominated by quantitative-statistical paradigms that focus on relationship elements and their (evidence-based) effectiveness regarding the psychotherapy process. In this mini review, we complement this existing line of research with a discursive-interactional view that focuses on how the relationship is accomplished between therapists and clients. Our review highlights some of the main studies that use micro-analytic, interactional methods to explore relationship construction of the following elements: Affiliation, cooperation (Alignment), empathy and Disaffiliation-Repair. We not only provide a summary of important discursive work that provides a unique lens on how the relationship may be established and maintained, but also suggest that this kind of micro-analytic approach can offer more nuanced conceptualizations of the relationship by showing how different elements work together in a synergistic manner.

Therapists’ and patients’ experiences of using patients’ self-reported data in ongoing psychotherapy processes—A systematic review and meta-analysis of qualitative studies

Objective: Using patient-generated quantitative data in psychotherapy (feedback) appears to enhance treatment outcome, but there is variability in its effect. Different ways and reasons to implement routine outcome measurement might explain such variability. The goal of this review is to address the insufficient knowledge on how these data are used by therapists and patients. Methods: The present study is a systematic review and meta-analysis of qualitative reports of therapists’ and patients’ experiences using patient-generated quantitative data during ongoing psychotherapy. Results: Four main categories of use were identified: (1) uses of patients’ self-reported data as nomothetic/objective markers for assessment, process monitoring, and treatment planning; (2) intrapersonal uses that enhance self-awareness, initiate reflection, and influence patients’ mood or responses; (3) uses that prompt interactional processes by facilitating communication, supporting exploration, creating ownership in patients, changing treatment focus, enhancing therapeutic alliance, or disturbing the psychotherapy process; and (4) patients responding for specific purposes due to uncertainty and interpersonal motives, or strategic responding to achieve a desired result. Conclusion: These results demonstrate that patient-reported data, when used in active psychotherapy, is very clearly not just an objective measurement of client functioning: the inclusion of patient-data has the potential to influence psychotherapy in numerous ways.

Questionnaire for the Perception of Psychotherapy Process by the Psychotherapist (QPPP) - a preliminary presentation of a research tool.

The emotional reactions of therapist in the treatment process constitute the core of therapeutic work, but they are poorly represented in research area. The article presents the results of work on the creation of a new tool the Questionnaire for the Perception of Psychotherapy Process by the Psychotherapist (QPPP). The Questionnaire containing 267 statements assessing cognitive, affective and behavioural reactions of psychotherapists in interaction with a specific patient was uploaded on the website. The link to the website, together with a request to complete the questionnaire, was sent to the members of the Psychotherapeutic Societies. The study involved 159 therapists, working mainly psychodynamically (91.95%). The analysis of basic descriptive statistics of test items and exploratory factor analysis by principal components method with varimax rotation were used. The work resulted in creating a tool consisting of 75 items grouped into 6 scales: Positive cooperation with the patient, Therapist burdened with commitment, Therapist in the centre of negative interest, Therapist with no room for intervention, The overwhelmed/overloaded therapist, The helpless/disengaged therapist. High alpha-Cronbach reliability of all distinguished factors was demonstrated at the level from 0.79 to 0.94. The data analysis also made it possible to create initial sten standards for therapists working in the psychodynamic approach. A tool was developed to assess emotions of therapist in relation to client. QPPP contains generally understandable terminology, independent of the therapist's dominant modality. The questionnaire can have many practical applications - both scientific and clinical.

Emotional change in its "natural habitat": Measuring everyday emotion regulation with passive and active ambulatory assessment methods.

Ambulatory assessment methods have made it possible to study psychological phenomena in real-time, with translational potential for psychotherapy process research. This article uses case example data to demonstrate applications of ambulatory assessment to measuring emotion regulation, a process with relevance across diagnoses and treatment modalities that may be particularly important to measure in situ. Two methods are reviewed: Ecological Momentary Assessment (EMA), which enables self-reported momentary assessments as people go about their days, and the Electronically Activated Recorder (EAR), an unobtrusive naturalistic observation methodology that collects short audio recordings from participants' moment-to-moment environments, capturing an acoustic diary of their social interactions, daily behaviors, and natural daily language use. Using case example data from research applying EMA and EAR methods in the context of adolescent self-injurious thoughts and behaviors, we illustrate how EMA can be used to measure emotion regulation over time and across contexts, and how EAR can assess the behaviors and social-environmental factors that interact with emotion regulation in clinically important ways. We suggest applications of this measurement approach for investigations of clients' emotional change over the course of psychotherapy, as well as potential clinical applications of these methods.

The analysis of the Process of Counselling and Psychotherapy

Today, many of us humans do not realize the importance of socializing, needing other people, medication, and so on. The things mentioned earlier can happen partly because we humans sometimes think that we can and are capable, even though this perception is not always true. In the world of counseling, this is said to be a human being who is KES-T (Effective Daily Life Disturbed). Furthermore, to help people with KES-T, counseling and psychotherapy are professional services that can help people overcome them. If you look at it in general, the process of counseling and psychotherapy is not much different, but if you look more closely, the two have differences in terms of concepts and different objects of practice. The method used in this article is an analysis of literature studies in which the collection of information regarding the counseling and psychotherapy process comes from all types of reading sources, both direct and indirect written sources such as printed or electronic reading sources

Lessons from ten years of psychotherapy process research

Objective: The aim of this review is to systematize and interpret results produced over one decade of Psychotherapy Process Research (2009–2019) in eight journals. Method: It is a Mixed Studies Review of quantitative as well as qualitative primary studies. The analysis of the results of these studies included a descriptive quantitative part and a qualitative part that followed the logic of Qualitative Meta Analysis, categorizing the main results of both types of studies in a bottom-up procedure that generates specific content categories that are synthesized in further steps of a higher level of abstraction, leading to an “interpretive synthesis” presented in a narrative way. Results: The review shows that psychotherapy process research uses a variety of qualitative and quantitative methods, often creating new procedures. Furthermore, the review indicates that the most commonly assessed macroprocess variables are ongoing change, therapeutic relationship (predominantly therapeutic alliance), and therapeutic intervention; while the most extensively studied microprocess variables are change events, difficult episodes (mainly ruptures), and therapeutic intervention. Macrolevel results reveal that the main contents of ongoing change are the building of new meanings and progressive psychological integration; underscore the association of the therapeutic alliance with ongoing change and outcome; and show the complexity of associating intervention with outcome, because different phases of therapy (and problems) need different assessments. Microlevel results indicate that change events impact on ongoing change and outcome; that for ruptures the key fact is their repair; and that therapist communication has an immediate influence on patient communication. Conclusion: Our knowledge regarding relevant aspects of psychotherapy is very fragmented; robust and replicated results are still scarce. Only a few variables have been found to consistently predict outcome across most therapies. Only in the field of alliance research it has been possible to perform meta-analyses that clearly demonstrate the impact of this factor on final outcomes. Despite these limitations, psychotherapy process research is a powerful tool for uncovering change mechanisms and is at present widely implemented. Our conclusion is that, in order to generate useful future knowledge, change mechanisms need to be linked to ongoing change; this, in turn, requires models of change, hopefully of a transtheoretical nature.

Enhancing mental health and well‐being outcomes for psychotherapy and counselling through idiographic analysis: A four‐quadrant approach

AbstractMental health and well‐being outcomes in psychotherapy and counselling have largely been studied through the use of standardised nomothetic measurement. A key limitation is that nomothetic measurement and current statistical analyses do not necessarily capture the outcomes of the complicated and individual psychotherapy processes. There is an increased interest in the use of idiographic patient‐reported outcome measures (I‐PROMs), which are uniquely useful because they may explore areas of importance that are unexplored by nomothetic outcome measures. We argue that to optimise the value of I‐PROMs, it is necessary to consider their contribution alongside standardised nomothetic measures. However, there are important considerations with respect to whether or not I‐PROMs from different clients, or indeed from the same client, can be meaningfully explored at a team/service level, and alongside standardised nomothetic outcomes. We provide worked examples on real client data to show that delineating four quadrants of analysis is important to explore the breadth of information: (a) individual progress on single items, (b) individual progress by aggregated scores, (c) team/service‐level progress by goal item/theme and (d) team/service‐level progress by aggregated scores.

The power (and limits) of the therapeutic relationship: Working alliance, psychiatric distress, and the role of trait emotional intelligence.

The working alliance between therapists and patients is an important factor in the psychotherapy processes. Trait emotional intelligence has also been found to be malleable in treatment and to play a significant role in patient outcomes. The present study investigated how the relationship between measured working alliance and patient symptoms may differ depending on changes in patient trait emotional intelligence capacities. One hundred twenty-nineadults at a community mental health clinic completed self-report measures at thebeginning of treatment, as well as 8 months into treatment. Hierarchical linear regressions were computed to assess the interaction of working alliance and trait emotional intelligence scores on patient symptom scores. Simple slope tests were used to probe significant interactions. Trait emotional intelligence served as a significant moderator on the relationship between working alliance and patient symptoms. Specifically, the relationship between working alliance and patient symptoms was only significant for participants who reported an improvement in trait emotional intelligence over the course of treatment. Results demonstrate that the impact of working alliance on patient symptom outcomes depended on patient improvement in trait emotional intelligence capacities. Such findings emphasize the importance of investigating the nuanced individual factors that impact the ways in which working alliance relates to treatment outcomes.

Primal Familiarity

ABSTRACT This article proposes a concept of primal familiarity, which gives increased importance to a fusion of basic life energy and the everyday happenings in our lives. It expands attention to the vital role that this accentuation of familiarity plays not only in our everyday lives but also in the psychotherapy process and its communal possibilities. It also highlights the concept of ordinary familiarity as a guiding force that illuminates the geography of a lifetime. It expands these principles to create a communal relevance in the form of Life Focus Groups. These groups represent the expansion of ordinary therapeutic practice into the development of lifelong congregations, bringing attention to the nature of living in community, as contrasted with the more personal individual benefits of ordinary psychotherapy. It represents psychotherapy as an heir to religion, and as a force in the communal exploration of the lives people live.

Development of a psychotherapy process prototype for the Real Relationship

Objective The Real Relationship (RR) describes the aspect of the psychotherapy relationship that is based on a genuine connection and a realistic view between patient and therapist. In the current study, we aimed to develop a Psychotherapy Process Q-set (PQS) prototype of the RR to facilitate post-hoc assessment of the RR in psychotherapy session recordings. We also aimed to measure the association between the RR-PQS and current PQS measures of theoretical treatment principles and the working alliance. Method We developed an RR-PQS prototype based on ratings of an ideal RR session by eight RR experts. We assessed the associations between the RR-PQS and existing cognitive behavioral and psychodynamic process prototypes, and seven PQS items known to predict the working alliance. Results RR experts agreed on the ideal RR session ratings to a high degree (ICC = 0.89). The RR-PQS was moderately related to both cognitive behavioral (r = 0.66, p < 0.01), and psychodynamic prototypes (r = 0.56, p < 0.01). PQS items predictive of the working alliance were characteristic of the RR-PQS. Conclusion The RR-PQS prototype appears to behave in theoretically predicted ways and may be a valid measure of the RR.

An initial validation of the Clients’ Experience of Therapy Scale (CETS): assessing the quality of psychotherapy process and outcome from clients’ perspectives

ABSTRACT In studies of psychotherapy, researchers typically rely on symptom-focused measures to assess treatment success. However, good psychotherapy can engage clients in many other transformations–such as, improved relationships, insight, and emotional engagement. In line with research indicating that clients value a distinct set of therapeutic gains, our goal was to develop a measure that assesses the quality of psychotherapy as experienced by clients. Initial items were based upon results from an omnibus meta-analysis of the qualitative literature on clients’ experiences of therapy, lending both construct and face validity. In this initial study, exploratory (Study 1) and confirmatory (Study 2) factor analyses were conducted. The Clients’ Experiences of Therapy Scale (CETS) contains five subscales including 15 questions. It demonstrated strong test-retest reliability and inter-item consistency across diverse demographic groups and psychotherapy orientations. Comparisons with symptom measures suggested that the scale assesses related but distinct constructs. The CETS shows potential to predict client dropout from therapy, correctly classifying 80.0% of cases posthoc. When used in routine outcome monitoring, because the items assess the quality of psychotherapy in relation to in-session process and micro-outcomes, they can provide feedback to therapists, on specific in-session dynamics to change, discuss with clients, or refine in practice.

Developing a prototype for relationship therapy psychoanalysis: an empirical study with the Psychotherapy Process Q-set.

Psychotherapy Process Q-set (PQS) prototype characteristic of psychoanalytic relationship therapy does not yet exist. Experts in psychoanalysis of relationship therapy [from the Italian Society of Psychoanalysis of the Relationship (SIPRe)] used the 100-Item PQS questionnaire to rate an ideal SIPRe therapy. Agreement between rates was high (Cronbach's alpha=0.84). The prototype for SIPRe therapy showed a significant correlation to the psychoanalytic prototype (r=0.68, p<0.000) and to the short expressive-supportive therapy (r=0.69, p<0.000) prototype. Correlations with Cognitive Behavioural Therapy (r=0.28, p<0.005) and Interpersonal Therapy (r=0.22, p<0.031), prototypes were significant, but weaker. The correlation between the two SIPRe samples (junior and expert therapists) was highly significant (Spearman's rho=0.936; p<000).

Subjectivity and Constitution of the Subject in the Cultural-Historical Clinic: An Experience Report

Cultural-Historical Psychology, developed by Lev S. Vygotsky, is a complex theory which responds to contemporary clinical needs, since it considers social relations and subjectivity as a historical process. This experience report aims to point out the clinical paths built and carried out with a patient from the Applied Psychology Service (APS) of a public university in the state of Ceará, during a Cultural-Historical psychotherapy process. All ethical procedures were followed and this study was based on a qualitative perspective in psychology, and also, case study was used as a methodological approach, considering that it allows greater detail and deepening about the studied object. From the studied case and the interventions carried out by the psychologist, changes were noticed in both the patient’s subjective dynamics and his way of life, as a result of the psychotherapeutic mediation on the mentioned approach. Thus, the present article is among the few clinical studies about Cultural-Historical Psychology, adding up to the greater promotion and production in this field.

Changes in group counseling engagement and conflict and growth in emotional cultivation for children and adolescents.

Group climate is an important factor in group counseling and psychotherapy process and outcome research. The current investigation examined group climate changes (from early to late sessions) at the within-group (i.e., group members) and between-group (i.e., group-as-a-whole) levels in predicting changes in group members' emotional cultivation in group counseling. A total of 236 Taiwanese children and adolescents across 41 groups participated in this study. Members' ratings of group climate (i.e., engagement and conflict) were partitioned into within-group and between-group components, and polynomial regression with response surface analysis was used to examine the association between changes in group engagement and conflict (at the member- and group-level) from early to late group sessions on changes in emotional cultivation. Results supported the theoretical hypothesis that when a group-as-a-whole reported increasing engagement from early to late group sessions, relative to other groups (i.e., between-group effect), members of that group experienced greater growth in emotional cultivation. Results also indicated that group members reported greater growth in emotional cultivation when there was consistent and high engagement or consistent and low conflict from early to late group sessions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

In defence of loose ends: Psychotherapy process research in the real world

Understanding what transpires in therapeutic conversations is as complex as the humans who are engaged in them. Inspired by the natural sciences, mainstream research in psychotherapy has taken up a positivist epistemology and strives for quantification and verification to produce evidence of the effectiveness of an approach. This paper explores an alternative foundation for therapeutic practices which has implications for how we do research. First, we present some ideas from process philosophy and dialogical perspectives.. In particular we return to the ideas of Henri Bergson who understood change as consisting of interpenetrated continuous and shifting states. In a next step we briefly look into how such ideas have influenced what is referred to as dialogical practices. Such dialogical practices operate through facilitating polyphonic, diverse perspectives that may mediate change in and through an intersubjective process of becoming. Based on this we take another step and make some suggestions for how we may develop research that enables ways of exploring therapeutic conversations as a multi-voiced, interactional and unfinalized process. We offer by way of example a method by which we attempt to integrate a linguistic theory (Systemic functional linguistics) with the dialogical framework and the ideas of Bergson. This paper considers how process philosophy may offer an alternative to the seeking of certainty that occurs in both psychotherapy research and practice, and ideas for making space for the ‘loose ends’ of the inconsistent and the unknown.

Languages and Psychotherapy: The Effect of Foreign Language on Fear Extinction.

Using a foreign language can influence emotion modulation, but whether different psychotherapy processes would be affected by a foreign language is still unclear. The current study explored the foreign language effect on the extinction of fear. During the conditioning phase, part of the neutral stimuli presented to the participants were associated with a threat, while they performed a countdown task in their native language. In the extinction phase, participants performed the same task either in their native/foreign language and were informed that the threat would no longer appear. We collected self-reports of fear, and pupil dilation and electrodermal activity as physiological measures of arousal. Extinction was successful, indicated by greater self-reported fear and pupil dilation during the threat condition compared to neutral in the conditioning phase, but no significant differences during extinction. Although the foreign language group presented higher arousal, fear extinction occurred regardless of the linguistic context. Fear extinction via verbal instructions is equally effective in a foreign and a native language context. These results indicate that evidence should be continue to be gathered on the role of foreign languages using basic paradigms with clinical applications.

The Method of Resolving Actual Conflict in Five Stages and with Five Capabilities Based on Positive Psychotherapy: The Trust-PHAL Method

The process of positive psychotherapy works to resolve the key, actual and basic conflicts of the clients. Although many practitioners resolve these conflicts in their own way, standard and effective methods are needed. The aim of this study is to investigate the Trust-PHAL Method, which includes resolving actual conflict in five stages with five capabilities. There are five capabilities that we use in this method to resolve actual conflict: trustworthiness, politeness, honesty, achievement, loyalty. In other words, the method can be expressed as Trust (trustworthiness) P (Politeness) H (Honesty)A (Achievement) L(Loyalty). Each capability used is consistent with the five phases of positive psychotherapy. In the study, an example is given of how the Trust-PHAL Method is used in the psychotherapy process.

Transgender and nonbinary patients’ psychotherapy goals: A secondary analysis from a randomized controlled trial

ObjectiveGoal setting is an important factor that contributes to positive outcomes in psychotherapy, yet research has not focused on this particular aspect of process and outcome of psychotherapy for transgender and nonbinary (TNB) patients. MethodsThe present study used secondary data analysis from a pilot randomized controlled trial focused on trans-affirmative therapy for TNB patients (N = 19). The aims of the present study were twofold: 1) gain an in-depth understanding of goals prior to the course of psychotherapy for TNB patients and 2) determine the outcome of goal setting after a 12-session course of psychotherapy with TNB patients. Content analysis and descriptive statistics were used to analyze the data. ResultsResults indicated that the majority (70%) of goals were met at termination. The results also indicated that the majority of goals (73%) were not related to gender. The content analysis revealed that there were five overarching themes regarding the types of goals described by TNB patients: 1) managing mental health symptoms, stress, and distress; 2) developing skills to improve well-being; 3) working on relationships; 4) exploring and understanding of trans identity (gender identity); and 5) orienting towards positive growth and development. Patients’ mean scores indicated that goals focused on developing skills to improve well-being were rated the highest regarding change over the course of 12 sessions of psychotherapy. ConclusionsThis study illuminates the importance of assessing TNB patients’ goals and understanding which goals resulted in the highest amount of self-reported change over 12 sessions of psychotherapy.