Clients', therapists', and observers' agreement on the amount, temporal location, and content of psychotherapeutic change and its relation to outcome

Abstract

Clients', therapists', and observers' identification of change was studied in 27 therapeutic processes, and agreement on the amount, temporal location, and content of change was related to outcome. Results show that clients reported more changes in successful therapies. Client–therapist temporal match of change moments was low irrespective of outcome. Results from all three perspectives were consistent in that manifestation of new behaviors and emotions was the most representative content of change among all therapies. Meanwhile, client–therapist agreement on the frequency of grouped change indicators reported was associated with positive outcome, whereas client–observer agreement was related to negative outcome. Therapists and observers agreed in both successful and nonsuccessful therapies. The relationship between agreement and therapeutic outcome is discussed in relation to each dimension of analysis.

Abstract

Abstract

Sono stati studiati i clienti ,i terapeuti e gli osservatori per individuare in 27 processi terapeutici, il cambiamento, l'accordo sul compenso, l'ubicazione temporale e il contenuto del cambiamento legato all'esito. I risultati mostrano che i clienti segnalano più cambiamenti nelle terapie con buon esito. La relazione tarapeuta - paziente in relazione allo spazio in cui avviene porta pochi momenti di cambiamento a prescindere del risultato. I risultati di tutti e tre i punti di vista sono stati coerenti in quanto manifestazione di nuovi comportamenti .Le emozioni sono state quelle che cambiano di più fra tutte le terapie. L'accordo terapeuta-paziente rispetto al cambiamento è stata associata ad esito positivo, mentre accordo cliente-osservatore era collegato ad esito negativo. Terapeuti e osservatori concordato sia sul successo sia sul non successo delle terapie. Il rapporto tra accordo e risultato terapeutico è discusso in relazione a ciascuna dimensione di analisi.

Abstract

Die Identifizierung von Veränderung durch Klienten, Therapeuten und Beobachter wurde anhand 27 therapeutischer Prozesse untersucht. Übereinstimmung der Höhe, der zeitlichen Anordnung und des Inhalts der Veränderung stand im Zusammenhang mit dem Therapieergebnis. Die Ergebnisse zeigen, dass Klienten mehr Veränderungen in erfolgreichen Therapien berichteten. Die Klienten-Therapeuten-Anpassung bzgl. des zeitlichen Auftretens der Veränderungsmomente war gering, unabhängig vom Therapieergebnis. Ergebnisse aller drei Perspektiven waren konsistent darin, dass die Manifestation neuer Verhaltensweisen und Emotionen die häufigste Inhaltsrepräsentation der Veränderung über alle Therapien hinweg, war. Klienten-Therapeuten-Übereinstimmung über die Häufigkeit gruppierter Veränderungsindikatoren, die berichtet wurden, hing mit positiven Therapieergebnis zusammen, wohingegen Klienten-Beobachter-Übereinstimmung mit negativem Therapieergebnis zusammenhing. Therapeuten und Beobachter stimmten sowohl bei erfolgreichen als auch bei nicht erfolgreichen Therapien überein. Der Zusammenhang zwischen Übereinstimmung und Therapieergebnis wird in Hinsicht auf alle Analysedimensionen diskutiert.

Keywords:

• change moments
• change content
• participants' recall
• convergence
• therapeutic outcome

Acknowledgements

This study was supported by funds from the Chilean Fondo Nacional de Desarrollo Cient?fico y Technolygio (FONDECYT, National Fund for Scientific and Technological Development) through Projects 1060768 and 1080136.

Notes

1. Of the 27 clients interviewed, two from a drug abuse group therapy, one from a family therapy, and one from a couple's therapy were interviewed between 8 and 15 months after therapy termination because of difficulties in contacting them. In the case of one of the individual psychodynamic therapies, follow-up interviews of client and therapist were repeated to complement initial information that could not be analyzed as a result of audiotape malfunctions.