Processes and changes experienced by clients during and after naturalistic good-outcome therapies conducted by experienced psychotherapists

Abstract

Objective: This study explores processes and changes experienced by clients during and after successful naturalistic therapy conducted by experienced psychotherapists. A taxonomy of content is built and presented, before the prevalence, range, and variation of process— and change categories are explored. Method: Sixteen therapies showing reliable improvement (on OQ-45) at treatment termination and having complete follow-up data up to 3–4 years post therapy were selected for this study. Processes and changes were extracted from clients’ reports of important aspects during therapy and semi-structured interviews from termination and follow-up. A procedure allowing for description, organization, and quantification of this material was developed and followed. Results: The totality of processes and changes (36 categories) reported by clients under and after these therapies are described. The most prevalent of these were exploration and more understanding (from session reports); relational quality and ways of thinking/more understanding (from interviews at termination); therapy process continues and situational changes (from follow-up interviews). Conclusions: Findings suggest that the therapies in this privileged sample are operating through a broad range of processes and changes, with all clients appreciating material from a large share of categories.

Resumo

Objetivo: Este estudo explora processos e mudanças experimentados pelos clientes durante e após terapia naturalista bem sucedida realizada por psicoterapeutas experientes. Uma taxonomia de conteúdo é construída e apresentada, antes da prevalência, intervalo e variação do processo - e as categorias de mudança são exploradas. Método: Dezesseis terapias que mostram mudanças confiáveis ​​(no OQ-45) no término do tratamento e com dados completos de acompanhamento pós-terapia de até 3-4 anos foram selecionadas para este estudo. Os processos e as mudanças foram extraídos dos relatos dos clientes dos aspectos importantes durante a terapia e das entrevistas semi-estruturadas de término e acompanhamento. Foi desenvolvido e seguido um procedimento que permite a descrição, organização e quantificação deste material. Resultados: A totalidade dos processos e mudanças (36 categorias) relatadas pelos clientes durante e após essas terapias são descritas. As mais prevalentes destas foram exploração e mais compreensão (a partir dos relatos de sessão), qualidade relacional e formas de pensar / mais compreensão (a partir das entrevistas no término), e processo de terapia continua e mudanças situacionais (a partir das entrevistas de acompanhamento). Conclusão: os achados sugerem que as terapias nesta amostra privilegiada estão operando por meio de uma ampla gama de processos e mudanças, com todos os clientes apreciando material de uma grande parcela de categorias.

Zusammenfassung

Ziel: Diese Studie exploriert von Klienten erlebte Prozesse und Veränderungen während und nach erfolgreicher naturalistischer Therapie, welche von erfahrenen Psychotherapeuten durchgeführt wurde. Eine Taxonomie der Inhalte wurde erstellt und präsentiert, bevor die Prävalenz, Range und Variation der Prozess- und Veränderungskategorien exploriert wurden. Methode: Sechszehn Therapien, welche reliable Verbesserung (im OQ-45) beim Therapieabschluss und vollständige Follow-up Daten 3-4 Jahre nach der Therapie aufwiesen, wurden für diese Studie ausgewählt. Prozesse und Veränderungen wurden Klientenberichten der wichtigen Aspekte während der Therapie sowie teilstrukturierten Interviews bei Therapieabschluss und Follow-up entnommen. Ein Verfahren zur Beschreibung, Organisation und Quantifizierung dieses Materials wurde entwickelt und angewandt. Ergebnisse: Die Gesamtheit der von Klienten berichteten Prozesse und Veränderungen während und nach diesen Therapien (36 Kategorien) wird beschrieben. Die vorherrschenden Kategorien waren Exploration und Mehr Einsicht (von Sitzungsbögen); Beziehungsqualität und Denkweise/Mehr Einsicht (von Interviews bei Therapieabschluss); Fortführung des Therapieprozesses und Situative Veränderungen (von Follow-up Interviews). Schlussfolgerungen: Die Befunde legen nahe, dass die Therapien in dieser priviligierten Stichprobe durch eine breite Palette von Prozessen und Veränderungen wirken, wobei alle Klienten Inhalte von einem Großteil der Kategorien wahrnahmen.

摘要

目的: 本研究探索案主在與資深心理治療師有成功心理治療工作過程中所經驗的歷程與工作後的改變。建立與呈現有關盛行率、問題範圍與不同歷程的分類系統，以及探索改變的類別。研究方法: 本研究選定之研究對象為16位接受心理治療且在結案時(OQ-45量表)顯示有可靠的進展，並且在治療結束後3-4年有完整追蹤資料的案主。所謂的歷程與改變資料是指從案主在治療過程提供之重要事件的自陳報告，以及結案及後續追蹤時透過半結構訪談中所萃取的資料。研究程序包含發展出描述、組織與量化資料的方式並據以後續執行。結果: 案主所描述在治療過程中與結案後所經驗到的歷程與改變內容共有36類。最常被提及的類別是探索與更加理解(取自晤談歷程); 關係品質與思考方法/更加理解(取自結案後的訪談); 治療歷程持續與情境改變(取自結案後的追蹤訪談)。結論: 以這群特殊樣本所進行的研究顯示心理治療歷程與改變的運作範圍很廣，且所有案主表達感謝的內容涵蓋在極大範圍的分類架構內。

Obiettivo: Questo studio esamina i processi e i cambiamenti sperimentati dai pazienti durante e dopo una terapia naturalistica di successo condotta da psicoterapeuti esperti. E’ stata costruita e presentata una tassonomia di contenuti, prima la prevalenza, la gamma e la variazione del processo – e sono state esplorate le categorie di cambiamento. Metodo: sono state selezionate per questo studio 16 terapie che mostrano un miglioramento affidabile (al OQ-45) alla conclusione del trattamento e che hanno completato i dati di follow-up fino a 3-4 anni al termine della terapia. I processi e i cambiamenti sono stati estratti dai report dei pazienti su aspetti importanti nel corso della terapia e da interviste semi-strutturate alla fine del trattamento e al follow-up. E’ stata elaborata ed applicata una procedura che consente la descrizione, l'organizzazione e la quantificazione di questo materiale. Risultati:vengono descritti tutti i processi e cambiamenti (36 categorie) riportate dai pazienti nel corso e dopo le terapie. Le categorie prevalenti sono state l'esplorazione e la maggior comprensione (dai report di seduta); la qualità relazionale e i modi di pensare / maggiore comprensione (dalle interviste alla fine); i cambiamenti situazionali e continui del processo terapeutico (dalle interviste al follow-up). Conclusioni: i risultati suggeriscono che le terapie in questo campione privilegiato operano attraverso una vasta gamma di processi e cambiamenti, con tutti i pazienti che apprezzano il materiale a partire dalla gran parte delle categorie.

Keywords:

• psychotherapy
• change processes
• client perspective
• content analysis
• long-term effects

Palavras-chave:

• psicoterapia
• processos de mudança
• perspectiva do cliente
• análise de conteúdo
• efeitos de longo prazo

Schlüsselwörter:

• Psychotherapie
• Veränderungsprozesse
• Klientenperspektive
• Inhaltsanalyse
• Langzeiteffekte

關鍵字:

• 心理治療
• 改變歷程
• 案主觀點
• 內容分析
• 長期效果

Parole chiave:

• psicoterapia
• processo di cambiamento
• prospettiva del paziente
• analisi del contenuto
• effetti a lungo termine

Acknowledgement

The study was supported by “The National Program for Integrated Clinical Specialist and PhD-training for Psychologists” in Norway. This program is a joint cooperation between the Universities of Bergen, Oslo, Tromsø, The Norwegian University of Science and Technology (Trondheim), the Regional Health Authorities, and the Norwegian Psychological Association. The program is funded jointly by The Ministry of Education and Research and The Ministry of Health and Care Services. The authors are also thankful for the help of John McLeod and Christopher Lockwood Meyer.

Disclosure Statement

No potential conflict of interest was reported by the authors.

Notes

1 Processes not directly linked to therapy is also present during therapy, but the category is presented here since it is more prevalent after termination.

2 Since the content of this category mainly refers to processes after termination, it is placed and presented here.

3 Processes and changes from the follow-up period were excluded from this part to ease comparison with earlier research.

4 As this also amounts to 50% of the possible values.

Additional information

Funding

This study was supported by “The National Program for Integrated Clinical Specialist and PhD-training for Psychologists” in Norway. This program is a joint cooperation between the Universities of Bergen, Oslo, Tromsø, The Norwegian University of Science and Technology (Trondheim), the Regional Health Authorities, and the Norwegian Psychological Association. The program is funded jointly by The Ministry of Education and Research and The Ministry of Health and Care Services.