A 15-Year Progress Report on the Presence of Humanistic/Existential Psychology Principles in Mental Health Outcome Measurement: Thematic Discourse and Summative Content Analyses

Fifteen years ago, Pfaffenberger (2006) applied five implicit paradigmatic assumptions identified by Slife of the dominant positivistic medical model paradigm—hedonism, universalism, atomism, materialism, and objectivism—to psychotherapy outcome research and its practice implications. Her applied theoretical essay revealed critical issues involving hidden power and privilege dynamics therein. Furthermore, Levitt et al.’s (2005) research examined nine then-common outcome instruments to determine the extent to which their item content reflected humanistic psychology principles in nine domains derived from the authors’ systematic review and thematic analysis of the humanistic literature. Their content analysis revealed that the majority of those domains were inadequately represented. In this article, using thematic discourse analysis (aka latent thematic analysis), I first identify how the philosophical and political assumptions summarized by Pfaffenberger are apparent in three outcome instruments that are commonly used in U.S. community mental health settings today: the Adult Needs and Strengths Assessment, the Ohio Mental Health Consumer Outcomes System, and the DSM-5 assessment measures. As part of my analysis, I contrast paradigmatic assumptions of the medical model with those of humanistic/existential psychology as a basis for contextualizing and understanding the implications of measurement-based care as articulated through the two discourses. Then, second, based on a summative content analysis of the three instruments, I report on the progress that both has been and remains to be made in their item content since Levitt et al. noted the general dearth of humanistic principles in mental health outcome measurement. Suggestions for future research and instrument development are discussed.

Change processes underlying "good outcome": A qualitative study on recovered and improved patients' experiences in psychotherapy for major depression

Aim: Exploring change processes underlying "good outcome" in psychotherapy for major depression. We examined the perspectives of patients who "recovered" and "improved" (Jacobson & Truax) following time-limited CBT and PDT. Method: In the context of an RCT on the treatment of major depression, patients were selected based on their pre-post outcome scores on the BDI-II: we selected 28 patients who recovered and 19 who improved in terms of depressive symptoms. A grounded theory analysis was conducted on post-therapy client change interviews, resulting in an integrative conceptual model. Results: According to recovered and improved patients, change follows from an interaction between therapy, therapist, patient, and extra-therapeutic context. Both helping and hindering influences were mentioned within all four influencing factors. Differences between recovered and improved patients point at the role of patients' agency and patients' internal and external obstacles. However, patients marked as "improved" described heterogeneous experiences. CBT- and PDT-specific experiences were also observed, although our findings suggest the possible role of therapist-related influences. Conclusion: From patients' perspectives, various change processes underlie "good outcome" that do not necessarily imply an "all good process". This supports a holistic, multidimensional conceptualization of change processes in psychotherapy and calls for more fine-grained mixed-methods process-outcome research.

Understanding Long-term Outcome from the Patients' Perspective: A Mixed Methods Naturalistic Study on Inpatient Psychotherapy

OBJECTIVE

The complex phenomenon of psychotherapy outcome requires further conceptual and methodological developments that facilitate clinically meaningful research findings. In this study, we rely on an idiosyncratic and process-oriented understanding of treatment effects in order to investigate long-term outcome. A conceptual model of long-term outcome is presented that comprises both a taxonomy of change and explanatory factors.

METHOD

A mixed methods naturalistic study was conducted in an inpatient psychotherapy setting. Long-term quantitative outcome data are complemented with a data-driven thematic analysis of interviews with 22 participants, five to six years after ending inpatient psychotherapy.

RESULTS

Long-term outcome findings show improved well-being for the majority of former patients and this until five to six years after treatment. From the patients' perspectives, long-term changes can be situated on different interrelated existential levels: reconnection to others and (the meaning of) life, a revelation, an altered self, life changes, and altered expectations and ideas about recovery and treatment. The complex interplay of the person, the therapy centre, the outside world and the evolution over time helped explain the experienced changes and individual differences.

CONCLUSION

The findings support the value of an idiosyncratic and process-oriented understanding of outcome and recovery as well as substantiate the importance of multiple methods and perspectives when studying the effects of psychotherapy.

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.

An Existential Perspective on Death Anxiety, Retirement, and Related Research Problems

Les auteurs discutent des aspects de l’existentialisme se rapportant à l’existence et de l’anxiété sur la mort (AM). Le facticité de l’existence, l’être-avec-les autres, l’influence sur la motivation de l’inéluctabilité de la mort, la quête de sens, profitant de la vie au maximum en acceptant responsabilité de sa propre vie, et la capacité de faire face à l’isolement existentiel sont tous compris dans cette discussion. Une difficulté importante c’est de séparer AM de l’anxiété de l’objet. On trouve que les corrélations entre l’âge, le sexe et AM sont variables. On discute des problèmes de personnalité et de l’orientation du rôle dans la transition vers la retraite, ainsi que la notion de Erikson de la « générativité » en tant qu’expression de l’énergie et le but de la quarantaine. Considération des problèmes méthodologiques et linguistiques dans la recherche d’AM sont discutés. En conclusion, cet article suggère des méthodologies qualitatives comme un moyen interpersonnel d’exploration d’AM dans le contexte de la psychothérapie et du services de conseil.

Humanistic psychotherapy research 1990-2015: from methodological innovation to evidence-supported treatment outcomes and beyond

OBJECTIVE

Over the past 25 years, humanistic psychotherapy (HP) researchers have actively contributed to the development and implementation of innovative practice-informed research measures and coding systems.

METHOD

Qualitative and quantitative research findings, including meta-analyses, support the identification of HP approaches as evidence-based treatments for a variety of psychological conditions.

RESULTS

Implications for future psychotherapy research, training, and practice are discussed in terms of addressing the persistent disjunction between significant HP research productivity and relatively low support for HP approaches in university-based clinical training programs, funding agencies, and government-supported clinical guidelines.

CONCLUSION

Finally, specific recommendations are provided to further enhance and expand the impact of HP research for clinical training programs and the development of treatment guidelines.

The Abiding Nature of Empathic Connections: A 10-Year Follow-up Study

This qualitative study explores the enduring impact of the therapeutic encounter. Participants, who had engaged in therapeutic relationships 10 years previously and endorsed empathy as a catalyst for personal growth, were invited to reflect on their experiences and to articulate ways in which the relationships have continued to shape their ongoing development. Two predominant themes emerged: therapeutic relationship as a foundation for change, and affirmation/enhancement of personal agency, which was characterized by inter- and intrapersonal self-efficacy and by emotional regulation. This study confirms the abiding nature of personal growth well beyond the therapeutic encounter. Ten years later, participants continue to credit the therapeutic relationship as the basis for their personal growth.