Helpful and meaningful aspects of a psychoeducational programme to treat complex dissociative disorders: a qualitative approach

Purpose: Complex dissociative disorders (CDDs) are prevalent among psychotherapy clients, and research suggests carefully paced treatment for CDDs is helpful. The purpose of the present study is to qualitatively explore helpful and meaningful aspects of the TOP DD Network programme, a web-based adjunctive psychoeducational programme for the psychotherapeutic treatment of clients with CDDs.Methods: TOP DD Network programme participants (88 clients and 113 therapists) identified helpful and meaningful aspects of their participation in response to two open textbox questions. Framework analysis was used to qualitatively analyze client and therapist responses.Findings: Participants found the TOP DD Network programme helpful and meaningful in nuanced ways. Three themes were created: (1) Components of the Programme (subthemes: content, structure), (2) Change-Facilitating Processes (subthemes: heightened human connection, receiving external empathy and compassion, contributing to something bigger, improved therapeutic work and relationship), and (3) Outcomes (subthemes: insight, increased hope, self-compassion, increased safety and functioning). The most emphasized theme was components of the programme, which captured its content and structure.Conclusion: Clients and therapists in the TOP DD Network programme described the programme's components and processes as helpfully facilitating positive outcomes in the treatment of CDDs. Therapists may consider integrating the components and processes in the programme into their practice with clients with CDDs.

Perception, experience and use of moments of change - a qualitative investigation

Objectives: In psychotherapeutic change processes, in addition to gradual changes, specific single special moments are described as a starting point for change. We investigated the perception of these moments of change (CMs) from the patient's perspective: What does each patient perceive and experience in a CM? Methods: A qualitative, explorative study of CMs was conducted by means of semi-structured questionnaires as well as qualitative interviews with patients (n = 12). Grounded theory was used for the analysis. Results: CMs were noticed by an "explicit mode of perception" based on physical, emotional and cognitive aspects. In addition, we found a "transcending mode of experience" that involved changes in consciousness and self-experience. CMs showed a "specific transformative pattern" and were preserved as "experience anchors". Conclusions: The intensification of consciousness, transformation of self-experience, and intense prototypical experience of a change process appeared particularly impressive. With the help of CMs, access could be gained to an embodied and implicit experience, which could subsequently be symbolised and used as an "experience anchor". This could be useful especially for the treatment of psychosomatic patients.

Kann die Psychoanalyse noch aus ihren Krisen lernen?

Mit dem neuen Psychotherapeutengesetz ist eine ernste Lage für die Psychoanalyse entstanden. Auf die eine Gefahr, die technologische Medizinalisierung (Buchholz 2017b, c; Buchholz und Kächele 2019), wurde häufig verwiesen. Eine wachsende Abhängigkeit von der klinischen Psychologie (Slunecko 2021) ist noch wenig gesehen. Wie kann sich die Psychoanalyse behaupten? Vorgeschlagen wird, sich verstärkt Fragen nach a) Ausbildung therapeutischer Persönlichkeiten, b) stärkerer lebensweltlicher Kontextualisierung und c) weit größerer Aufmerksamkeit der originalen Stimme der Patienten in Theorie und Kasuistik zu widmen. Loyalität gegenüber Theorie-Traditionen löst keine Probleme. Sie blockiert Umweltsensitivität und erzeugt Rückzug in Selbstbeschäftigung und beunruhigenden Mangel an Irritierbarkeit. Die viel zu loyale Bindung an Theorietraditionen, an lehranalytische Aus- und Vorbilder, supervisorische Praktiken und an fragliche Behandlungsregeln wehrt die Irritation ab, deren Bewältigung zentrale Aufgabe wäre, und entmutigt die nächste Generation. Dazu am Schluss Vorschläge.

The Effectiveness of Emotion Regulation Therapy for Adolescent Females With Nonsuicidal Self-Injury Disorder: A Mixed-Method Study

Given the prevalence and consequences of the nonsuicidal self-injury disorder (NSSID) among adolescents, this study aimed to analyze the effectiveness of emotion regulation therapy (ERT) among adolescents with NSSID. The present study is an after-trial, mixed-method intervention design. Six participants completed questionnaires at baseline, during their treatment, and follow-up. In-depth interviews were made after the intervention. The quantitative findings were consistent with the pattern of the qualitative findings that prominently supported the treatment efficiency concerning the difficulties in emotion regulation. The research findings indicated that ERT had a positive effect on adolescents with NSSID.

Psychotherapeutic change in children and adolescents who have been sexually abused: a model from participants’ perspectives

Change in psychotherapy research in cases of child sexual abuse (CSA) has mainly emerged from a symptomatologic view, which needs to be complemented by a subjective perspective of change. Thus, this article aim is to describe different outcomes and stages of change during psychotherapy in children and adolescents who have been sexually abused, from the subjective perspectives of those involved in the process. A longitudinal qualitative study was developed. Qualitative interviews were conducted at different moments of the psychotherapeutic process (at around 6 months of therapy, 12 months and at the end of therapy) with 28 children and adolescents aged 6 to 17, with their caregivers and therapists. All children and adolescents attended and then completed psychotherapy due to sexual abuse in natural settings, in public specialized centres in Santiago, Chile. Sexual abuse occurred mainly in an intrafamilial context or by acquaintances. Data analysis was conducted using narrative analysis. Three stages of therapy were identified: i) settling into therapy; ii) approaching CSA; and iii) healing from abuse. Three different outcomes of psychotherapeutic change were also identified: i) protective and psychosocial changes; ii) changes related to diminishing the effects of abuse; and iii) changes related to healing from abuse. Psychosocial characteristics of the cases and features of the therapeutic process are described in each group. The outcomes of change and the stages of therapy are interrelated in a dynamic and gradual process where change is linked with the case’s psychosocial characteristics and the features of the therapeutic process. Results allowed the authors to situate the voices of the participants within a proposed model of psychotherapeutic change for CSA, with clinical practical implications.

Learning from mothers who received focused parent-infant psychotherapy for the treatment of their child's regulatory disorders

OBJECTIVE

Gaining a deeper understanding of how focused parent-infant psychotherapy (fPIP) works by asking mothers about their experiences.

METHOD

Purposeful sampling was used to select participants who before had participated in an RCT on fPIP. Nine mothers of infants with early regulatory disorders who had received fPIP were interviewed. Eight cases received full-protocol treatment, one case was a treatment drop-out. Semi-structured interviews were audio-recorded, transcribed verbatim and analyzed applying grounded theory methodology.

RESULTS

Seven major categories evolved: (1) engaging in therapy while maintaining autonomy, (2) relating to an emotionally responsive therapist and resolving ruptures, (3) involvement of partners in therapy facilitates multiple perspectives, (4) understanding the meaning of the child's signals and increasing acceptance of difficult behaviors, (5) feeling supported by advice that is attuned to the families' needs, (6) insight into parental contributions to the child's problems and (7) feeling strengthened as a mother and recognizing one's own needs.

CONCLUSION

Findings highlight which aspects of fPIP mothers find most helpful and most challenging. Aspects that compromised the change process seemed related to the specific needs of this population and therapeutic setting. The results may guide therapists and inspire future development in interventions for treating infant regulatory disorders.

Finding a Common Ground: Therapist Responsiveness to Male Clients Who Have Acted Violently Against Their Female Partner

Men in treatment for intimate partner violence (IPV) do often present with problem formulations that do not fit the therapeutic endeavor of personal change and may, therefore, challenge therapists in their effort to build an alliance. However, the therapist's initial contributions are also likely to influence whether the client finds it worthwhile to become involved in a working alliance. In a qualitative study of the in-session interactions between experienced therapists and men in IPV individual therapy, we looked for variations in therapist responsiveness to the client's initial invitations to identify whether and, eventually, how the two parties were able to reach common ground for working together. We studied therapist-client interactions in 20 therapy cases, including 10 completed cases with good outcomes and 10 dropout cases. Two sessions during the early phase of the therapy and the final session were audiotaped and transcribed verbatim. The transcriptions were analyzed following the guidelines of constructivist grounded theory. The analysis revealed three interactional patterns: co-creative exploration, pull-avoid repetitions, and tiptoeing softly around, each of which was associated with a distinctive set of therapist strategies. Clients participating in the co-creative pattern appeared to experience the most successful treatment. Our findings suggest that a model of therapist responses to client invitations is valuable for the conceptualization of the therapeutic alliance during the early sessions of psychotherapy. The findings also highlight the importance of clarifying and expanding upon the client's personal experience with his abuse to form a viable working alliance.

Parenthood-Lost and Found: Exploring Parents' Experiences of Receiving a Program in Emotion Focused Skills Training

Background

Parents play a crucial role in the development, maintenance, and deterioration of child difficulties. Emotion focused skills training (EFST) targets parents’ capacity to provide their child with emotion-oriented skills in order to promote good child mental health. Few qualitative studies have specifically investigated parents’ experiences of receiving such programs.

Objective

This study aimed to explore how parents experience working with their own and their child’s emotions undergoing a short-term program in EFST; in particular, changes in their experience of being a parent and in everyday life are reported.

Method

Semi-structured in-depth qualitative interviews were conducted with 14 parents who had completed a short-term EFST program (2-day group training and 6 h of supervision). Interview transcripts were analyzed using a reflexive thematic analysis approach.

Results

A total of 14 parents (40% men, four couples, Mage = 39.5, SD = 4.4) participated in the study. Our analysis resulted in the following three themes: (1) “Coming home” as a parent, with the following subthemes: (a) New ways of being with their child and (b) Parents’ painful inner world; (2) Reclaiming parenthood—applying new tools and learning in challenging situations; and (3) This is us—changing the heart of the story. The first theme was related to the descriptions of the changes that emerged in parents’ inner lives, the second revolved around the employment of their skills intuitively and creatively based on what was required by the challenging situations, and the third theme referred to new discoveries on family dynamics.

Conclusion

Parents’ experiences of having wisdom and calmness inside them (being) and doing parenting differently, as well as the changed perspectives of the family (living), resonate with the theoretical ground of emotion-focused therapy (EFT). The findings also indicate that therapists should be aware of potential parental distress when working in view of changing unpleasant emotions in such skill-based programs.

Recognizing oneself in the encounter with others: Meaningful moments in systemic therapy for social anxiety disorder in the eyes of patients and their therapists after the end of therapy

OBJECTIVE

The objective of this study is to characterize and describe meaningful moments in the context of systemic psychotherapy, from the point of view of patients and their therapists, after the end of therapy. The therapy studied is a manualized, monitored systemic therapy for social anxiety disorder.

METHOD

Semi-structured follow-up interviews were conducted separately with five patients and their therapists (N = 10). Methodological triangulation was used: Grounded theory was used to code the transcripts as described by Charmaz. Then the passages of the selected code "meaningful moment" were evaluated using thematic comparison, in line with Meuser & Nagel.

FINDINGS

Three categories involving meaningful moments were identified: (1) meeting other patients in group therapy session, (2) therapeutic resource orientation and (3) recognizing oneself in a diagnosis or pattern of behaviour. These categories emerged as contexts related to the occurrence of meaningful moments from a subjective perspective.

DISCUSSION

Meaningful moments seem to be consistently related to the therapist input and to specific interventions or settings, both from the perspective of the patients and the therapists. Two tandems each described a coincident moment. One central aspect of all 14 moments is that the patients and therapists described patients being able to acquire another outlook on themselves.

Getting to Know the Inner Self. Exploratory Study of Identity Oriented Psychotrauma Therapy-Experiences and Value From Multiple Perspectives

Early trauma and failures in attachment attunement can affect future relational patterns, health and well-being. The processing of trauma, especially complex trauma, through adequate interventions may help integrate traumatic experiences, enhance health and quality of life. Despite years of clinical practice with Identity oriented psychotrauma therapy (IoPT), there is a lack of scientific research on the subject. Objective: The study's aim was to explore the experiences and value of IoPT for persons with experiences of IoPT, whether as a therapist, client, representative and/or observer. Methods: The study has an explorative, qualitative design. Data collection through individual in-depth interviews and focus groups with 20 participants and data analysis were inspired by grounded theory. Results: The results showed an exploratory process of self-discovery and self-development, Getting to know the inner self, to which all categories were interrelated through their contribution to the process. The findings shed light on the experiences and tangible value of IoPT for the participants from the perspectives of client, therapist, representative and observer. These perspectives were intertwined and illuminated in terms of their contribution to the process. Conclusion: IoPT seems to have transformative potential in terms of a self-exploratory journey from multiple perspectives. The need for effective treatments to enhance health and prevent further ill health in persons affected by complex trauma motivates the exploration of novel treatment approaches and formats to support clients toward health enhancing strategies. Further quantitative and qualitative research is motivated to enhance our understanding of the workings and value of IoPT for self-development, health and quality of life.

Patient-appraised beneficial moments during inpatient psychiatric treatment

BACKGROUND

Psychiatric inpatients receive a multidisciplinary treatment approach, covering psychiatry, nursing, occupational therapy, and psychology. Research findings reveal that the effectiveness of any treatment is associated with three types of factors: specific (e.g., treatment techniques), common (e.g., clinician-patient relationship, patients' expectations) and extra-therapeutic. However, there is little published research on the factors and events which inpatients themselves consider to be beneficial ('beneficial moments').

METHODS

Inpatients (N = 107) of a psychiatric clinic completed a questionnaire to elicit their appraisal of beneficial moments. A qualitative content analysis was applied. The coding procedure was conducted independently by two authors.

RESULTS

Self-appraised beneficial moments were found in five areas: therapy-specific components (number of quotations, N = 204), positive relationships (N = 140), clinical setting and environment (N = 52), inpatients' new insights (N = 36), and factors unrelated to either therapy or the clinic (N = 30). In total, 44% of the quotations were related to specific factors, 49% to common factors, and 7% to extra-therapeutic factors.

CONCLUSIONS

Inpatients judge both specific and common factors as crucial for the therapeutic benefit they gain during their stay at the clinic. Our results differ from meta-analytical findings, where the impact of specific factors on symptom improvement has shown to be much smaller (i.e., 17%) than appraised by patients in our study (i.e., 44%). Our study underlines the importance of a patient-centred care approach as well as shared decision making and patient-clinician communication. For clinical practice, knowledge of inpatients' perspectives on beneficial moments is crucial in order to reinforce precisely these therapeutic components.

"You Feel They Have a Heart and Are Not Afraid to Show It": Exploring How Clients Experience the Therapeutic Relationship in Emotion-Focused Therapy

Background: The therapeutic relationship is regarded as an important source of change in emotion-focused therapy (EFT) (Greenberg, 2014; Watson, 2018), but few qualitative studies have specifically investigated how clients experience the role of the relationship in EFT. Aim: The purpose of the present study was to explore what clients experienced as helpful or hindering aspects of the therapeutic relationship when undergoing EFT for depression, anxiety, and severe self-criticism. Methods: We interviewed 18 clients after a clinical trial of time-limited EFT, to explore their experiences of the relationship with their therapist during treatment. The interviews were analyzed using hermeneutic-phenomenological thematic analysis (Braun and Clarke, 2006; Binder et al., 2012). Results: We identified four main themes: (1) Forming a trusting relationship or finding it hard to connect, (2) Collaborating and struggling to find new ways to relate to painful feelings, (3) Alliance ruptures and needs for repair when working with distressing emotions, and (4) The significance of new relational experiences. Conclusion: Clients described therapists' genuineness and the establishment of trust in the relationship as important preconditions to open up to vulnerability and painful feelings, and engaging fully in specific EFT interventions. The findings also indicate that the therapists need to be mindful of different client preferences and monitor potential alliance ruptures when working to change distressing emotions in therapy.

Common therapeutic strategies in psychological treatments for medically unexplained somatic symptoms

Objective: Medically unexplained somatic symptoms (MUSS) represent a frequent complaint in health care services. While psychological treatments have demonstrated some effect in patients with MUSS, further progress may be achieved by a synthesis of clinical strategies used in diverse treatment models. The aim of this study was to identify clinical strategies shared across multiple psychological treatments intended for the treatment of adult patients with MUSS. Method: Descriptions of psychological treatments for patients with MUSS were searched in the PsycINFO, PsycARTICLES, and Medline databases and manually. N = 135 resources met inclusion criteria and were subjected to qualitative analysis. Results: Similarities across treatments were captured in 8 broad categories and 18 subcategories that covered aspects of the therapeutic relationship, specific skills (bodily, emotional, and relational) for patients to develop, search for the meaning of symptoms, and the orientation on life beyond symptoms. Conclusions: Despite the differences in technique, it was possible to identify common therapeutic strategies in psychological treatments for patients with MUSS. These overarching treatment strategies, many of which have already obtained empirical support, may inspire further research and the development of comprehensive treatments with enhanced efficacy. Limitations of the present study include the lack of focus on specific syndromes.

How Does Therapy Harm? A Model of Adverse Process Using Task Analysis in the Meta-Synthesis of Service Users' Experience

Background: Despite repeated discussion of treatment safety, there remains little quantitative research directly addressing the potential of therapy to harm. In contrast, there are numerous sources of qualitative evidence on clients' negative experience of psychotherapy, which they report as harmful. Objective: To derive a model of process factors potentially leading to negative or harmful effects of therapy, from the clients' perspective, based on a systematic narrative synthesis of evidence on negative experiences and effects of psychotherapy from (a) qualitative research findings and (b) participants' testimony. Method: We adapted Greenberg (2007) task analysis as a discovery-oriented method for the systematic synthesis of qualitative research and service user testimony. A rational model of adverse processes in psychotherapy was empirically refined in two separate analyses, which were then compared and incorporated into a rational-empirical model. This was then validated against an independent qualitative study of negative effects. Results: Over 90% of the themes in the rational-empirical model were supported in the validation study. Contextual issues, such as lack of cultural validity and therapy options together with unmet client expectations fed into negative therapeutic processes (e.g., unresolved alliance ruptures). These involved a range of unhelpful therapist behaviors (e.g., rigidity, over-control, lack of knowledge) associated with clients feeling disempowered, silenced, or devalued. These were coupled with issues of power and blame. Conclusions: Task analysis can be adapted to extract meaning from large quantities of qualitative data, in different formats. The service user perspective reveals there are potentially harmful factors at each stage of the therapy journey which require remedial action. Implications of these findings for practice improvement are discussed.

How to conduct a qualitative meta-analysis: Tailoring methods to enhance methodological integrity

Although qualitative research has long been of interest in the field of psychology, meta-analyses of qualitative literatures (sometimes called meta-syntheses) are still quite rare. Like quantitative meta-analyses, these methods function to aggregate findings and identify patterns across primary studies, but their aims, procedures, and methodological considerations may vary.

OBJECTIVE

This paper explains the function of qualitative meta-analyses and their methodological development. Recommendations have broad relevance but are framed with an eye toward their use in psychotherapy research. Rather than arguing for the adoption of any single meta-method, this paper advocates for considering how procedures can best be selected and adapted to enhance a meta-study's methodological integrity.

METHOD

Through the paper, recommendations are provided to help researchers identify procedures that can best serve their studies' specific goals. Meta-analysts are encouraged to consider the methodological integrity of their studies in relation to central research processes, including identifying a set of primary research studies, transforming primary findings into initial units of data for a meta-analysis, developing categories or themes, and communicating findings.

CONCLUSION

The paper provides guidance for researchers who desire to tailor meta-analytic methods to meet their particular goals while enhancing the rigor of their research.

CBT for Pediatric Migraine: A Qualitative Study of Patient and Parent Experience

OBJECTIVE

The goal of this study was to determine which cognitive behavioral therapy (CBT-HA) treatment components pediatric headache patient stakeholders would report to be most helpful and essential to reducing headache frequency and related disability to develop a streamlined, less burdensome treatment package that would be more accessible to patients and families.

BACKGROUND

Pediatric migraine is a prevalent and disabling condition. CBT-HA has been shown to reduce headache frequency and related disability, but may not be readily available or accepted by many migraine sufferers due to treatment burden entailed. Research is needed to determine systematic ways of reducing barriers to CBT-HA.

METHODS

Qualitative interviews were conducted with 10 patients and 9 of their parents who had undergone CBT-HA. Interviews were analyzed using an inductive thematic analysis approach based upon modified grounded theory. Patients were 13-17.5 years of age (M = 15.4, SD = 1.63) and had undergone CBT-HA ∼1-2 years prior to participating in the study.

RESULTS

Overall, patients and their parents reported that CBT-HA was helpful in reducing headache frequency and related disability. Although patients provided mixed reports on the effectiveness of different CBT-HA skills, the majority of patients indicated that the mind and body relaxation skills of CBT-HA (deep breathing, progressive muscle relaxation, and activity pacing in particular) were the most helpful and most frequently used skills. Patients and parents also generally reported that treatment was easy to learn, and noted at least some aspect of treatment was enjoyable.

CONCLUSIONS

Results from these qualitative interviews indicate that mind and body CBT-HA relaxation skills emerged as popular and effective based on patient and parent report. Future research examining the effectiveness of streamlined pediatric migraine nonpharmacological interventions should include these patient-preferred skills.

Significant Events Identified by Clients Engaged in Existential Psychotherapy: A Descriptive Phenomenological Exploration

This research focuses on the descriptions of significant events experienced in the context of existential psychotherapy as described by five clients. The results include a set of eidetic dimensions in which the human relationship stands out as being particularly meaningful. Clients considered the therapy process to be significant for a number of different reasons, ranging from the development of the capacity to cope with difficulties to a basic sense of increased self-understanding. Significant events in therapy are sometimes preceded by tensions between the therapist and the client, which, in turn, promote turning points and breakthroughs in the therapeutic relationship. The results also seem to corroborate the affect and interdependence of the relational dimensions of psychotherapy, such as common factors, and more specific ingredients, such as the techniques used by the therapist. However, the experience of significant events is multifaceted and dynamic, and only a holistic perspective would seem to do justice to the complexity of these interrelated phenomena. Implications for practice and research are discussed.

Client Perceptions of Helpfulness in Therapy: a Novel Video-Rating Methodology for Examining Process Variables at Brief Intervals During a Single Session

BACKGROUND

The value of clients' reports of their experiences in therapy is widely recognized, yet quantitative methodology has rarely been used to measure clients' self-reported perceptions of what is helpful over a single session.

AIMS

A video-rating method using was developed to gather data at brief intervals using process measures of client perceived experience and standardized measures of working alliance (Session Rating Scale; SRS). Data were collected over the course of a single video-recorded session of cognitive therapy (Method of Levels Therapy; Carey, 2006; Mansell et al., 2012). We examined the acceptability and feasibility of the methodology and tested the concurrent validity of the measure by utilizing theory-led constructs.

METHOD

Eighteen therapy sessions were video-recorded and clients each rated a 20-minute session of therapy at two-minute intervals using repeated measures. A multi-level analysis was used to test for correlations between perceived levels of helpfulness and client process variables.

RESULTS

The design proved to be feasible. Concurrent validity was borne out through high correlations between constructs. A multi-level regression examined the independent contributions of client process variables to client perceived helpfulness. Client perceived control (b = 0.39, 95% CI .05 to 0.73), the ability to talk freely (b = 0.30, SE = 0.11, 95% CI .09 to 0.51) and therapist approach (b = 0.31, SE = 0.14, 95% CI .04 to 0.57) predicted client-rated helpfulness.

CONCLUSIONS

We identify a feasible and acceptable method for studying continuous measures of helpfulness and their psychological correlates during a single therapy session.

Symptom Reduction Without Remoralization: A Randomized, Waiting-List Controlled Study Aimed at Separating Two Beneficial Psychotherapy Outcome Effects

OBJECTIVE

Treatment effects in psychotherapy outcome research are generally based on the reduction of symptoms. Standard inclusion of other beneficial treatment effects such as remoralization (increase of hope, self-efficacy, well-being) might lead to more elaborate findings in the field of psychotherapy. On the other hand, it is also possible that symptom reduction and remoralization always go hand in hand in the experience of patients. The present study sought to experimentally test this assumption.

METHOD

A total of 78 patients suffering from panic disorder were randomly assigned to brief remoralization treatment, brief exposure treatment, or waiting list (WL).

RESULTS

Both treatments increased remoralization and both reduced symptoms of panic disorder as compared to WL.

CONCLUSION

It is unlikely that patients experience remoralization without symptom reduction or symptom reduction without remoralization. These findings do not favor the assumption that conclusions within psychotherapy outcome research are flawed because of its heavy reliance on measurements of symptom reduction.

Assimilation, reflexivity, and therapist responsiveness in group psychotherapy for social phobia: A case study

OBJECTIVE

This case study examined reflexivity and the assimilation of problematic experiences, especially its progress within and between the Assimilation of Problematic Experiences Scale (APES) Stages 2-3, in group psychotherapy for social phobia.

METHOD

The data consisted of all of one client's turns expressing the two voices of her main problematic experience in 12 sessions, and all replies by the therapist in direct connection to them. The client's utterances were rated on the APES.

RESULTS

A detailed analysis of 13 conversational passages revealed that progress in assimilation happened only when the client took a reflexive stance towards her inner experience or outer actions. There were a few instances when she took a reflexive stance, but no progress in assimilation could be noted. A qualitative analysis of three conversational episodes showed how therapist responsiveness facilitated the client's increased reflexivity and progress in assimilation.

CONCLUSIONS

Reflexivity appears to be a necessary condition for progress in assimilation both at APES Stages 2 and 3, but the model should recognize that reflexivity can appear in diverse forms and at different levels. Therapist responsiveness and sensitivity to the client's assimilation process is crucial for a successful transition from Stage 2 to Stage 3.

Client experiences of motivational interviewing: An interpersonal process recall study

OBJECTIVES

To explore clients' experience of the therapy process in motivational interviewing (MI) for alcohol abuse.

DESIGN

A qualitative study using grounded theory.

METHODS

Interviews with nine clients were conducted using interpersonal process recall (IPR), a methodology which utilizes a video recording as a cue to aid memory recall. Clients watched a videotape of their MI session and were asked to identify and describe the important moments in the therapy session. The transcribed interviews were then analysed using grounded theory.

RESULTS

A single session of MI is seen by the clients in this study as a complex interpersonal interaction between client and therapist, which impacts on the client's cognitive and affective intrapersonal processes.

CONCLUSIONS

The themes which emerged partly confirm processes of MI previously hypothesized to be important, but also highlight the importance of factors common to all therapeutic approaches.

PRACTITIONER POINTS

The aspects of therapy which clients in this study felt were important are similar to those hypothesized to underlie the effectiveness of MI, including a non-confrontational approach, affirmation, and developing discrepancies between beliefs and behaviour. These were embedded in aspects common to all therapies, including the qualities of the therapist and the therapeutic relationship. Client's perspectives on therapeutic processes are an important area of research, and IPR is a particularly suitable method.

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

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.

Helpful aspects of metacognitive therapy and cognitive behaviour therapy for depression: a qualitative study

Six clients in cognitive behaviour therapy (CBT) or metacognitive therapy (MCT) were interviewed about their experiences of therapy with a focus on helpful elements. Clients in both CBT and MCT mentioned the positive and informal relationship with the therapist as helpful. However, while clients in both therapies emphasized insight into the causes of depression and modification of negative maintenance patterns as helpful, the understanding of depression and the remedies for the condition differed. Clients in CBT focused on previous negative experiences as the cause of present maintenance patterns and mentioned changing negative thought patterns as helpful. Clients in MCT stated that the realization that rumination was their key problem and that they could choose not to engage in negative thinking had been crucial. Furthermore, clients in CBT tended to describe increased personal strength and self-confidence as the main gain from therapy, whereas MCT clients mentioned improved ways of coping with thoughts or problems. The importance attributed by the clients to technical factors differs from previous qualitative studies conducted across various therapeutic approaches, which have typically concluded that common therapeutic factors are more important than specific factors. It does, however, correspond with conclusions from other qualitative studies focusing explicitly on CBT.

Therapeutic Cycles Model (TCM): instrumento de avaliação do processo psicoterapêutico

O objetivo deste trabalho foi apresentar a versão brasileira do Therapeutic Cycles Model (TCM) a partir da análise de uma sessão de um processo de psicoterapia psicanalítica. O TCM é um método de análise de textos por computador que identifica os momentos-chave no discurso de paciente, psicoterapeuta, ou de ambos, em interação. As análises são feitas com o auxílio de um software (Cycles Model), que dispõe de listas de palavras de tom emocional e de abstrações, permitindo a classificação do texto em duas categorias: conteúdo emocional e cognitivo das verbalizações na sessão. Buscou-se ilustrar uma possibilidade de utilização do TCM a partir de uma sessão de psicoterapia. A análise exploratória dos conteúdos verbalizados pela dupla, paciente e psicoterapeuta, a partir dos ciclos terapêuticos demonstrou que esse instrumento contribui na identificação de momentos clinicamente significativos do discurso do paciente em sessões individuais. Sendo assim, o TCM pode ser mais uma ferramenta para compreender o processo terapêutico e, com isso, auxiliar o psicoterapeuta em sua prática.

Critical Secret Disclosure in Psychotherapy With Korean Clients

Korean clients who had completed counseling in Korea and viewed the therapy as successful were interviewed about critical secret disclosure during their therapy. In-depth interviews along with grounded theory-informed analyses in a methodological hermeneutic framework revealed that many Korean clients reported that despite initial fears and needing to test their counselors, sharing their secrets was a powerful experience that deepened their connection to their counselor, facilitated positive life changes, and enhanced their relationships with others. We present a hierarchy of categories that explains the meaning and process of critical secret disclosure in therapy. The results are discussed in the context of Korean culture and how these findings can inform therapy with Korean clients.

A meaningful struggle: trauma clients' experiences with an inclusive stabilization group approach

The present study explores how trauma clients experience participation in an inclusive stabilization group approach. Upon completion of treatment, all 31 clients from six stabilization groups for women were invited to participate in a qualitative post-therapy interview study. Thirteen clients consented to participate. All interviews were carried out by a team of three health-care workers shortly after completion of treatment. Five main themes were identified: Dreading and Hoping-Preparing for Participation; Tuning in and Staying Put; Meeting Other Trauma Survivors; Acquiring a Stabilizing Ballast; and Being Receptive to Change. Participating in the stabilization group was experienced as demanding, while also providing new and helpful experiences. Participants emphasized the importance of being receptive to help in order to benefit from treatment.