Susan Llewelyn

ASSIMILATION OF PROBLEMATIC EXPERIENCES BY CLIENTS IN PSYCHOTHERAPY

DAVID A. SHAPIRO AND GILLIAN HARDYMRC/ESRC Social and Applied Psychology UnitUniversity of SheffieldIn successful psychotherapy,problematic experiences (threatening orpainful thoughts, feelings, memories,etc.) are gradually assimilated intoschemata that are introduced by thetherapist or developed in the therapist-client interaction by modification of oldschemata. As it is assimilated, aproblematic experience passes throughpredictable stages. The client movesfrom being oblivious, to experiencingthe content as acutely painful, then asless distressing, merely puzzling, thenunderstood, and finally as confidentlymastered.

Process research in understanding and applying psychological therapies

OBJECTIVES Research on the process of psychological therapy aims to demonstrate how therapy works, partly to increase understanding, but primarily to increase effectiveness by pointing to the crucial ingredients which effect change. This paper aims to demonstrate some of the reasons why process research should be undertaken in the attempt to increase therapeutic effectiveness. METHODS A model of scientific inquiry suggests three broad types of process research: (1) studies which describe behaviours and processes occurring within therapy sessions (exploratory studies); (2) studies which investigate the links between specific psychotherapy processes and treatment outcome (hypothesis testing); (3) studies which examine the links between specific psychotherapy processes and theories of change (theory development). Using this typology, we describe key aspects of process research: what it is; what has been studied; the limitations of existing research. RESULTS Descriptive studies have deepened understanding of the therapeutic process; however, a large number of reliable process-outcome links have been hard to establish. Comparative studies have been rare. Studies which are linked to models of change and which attempt to track therapist responsiveness are more complex and have been more promising. Most studies are beset by methodological difficulties. CONCLUSIONS There are a number of promising future research possibilities and methods. Despite methodological challenges, the field is developing and research is encouraging. We argue that process research has a significant place in advancing our understanding of the complexity of therapeutic change, and hence in facilitating theory development and effective therapeutic interventions.

Alliance ruptures and rupture resolution in cognitivebehavior therapy: A preliminary task analysis

Abstract An initial ideal, rational model of alliance rupture and rupture resolution provided by cognitive–behavioral therapy (CBT) experts was assessed and compared with empirical observations of ruptures and their resolution in two cases of successful CBT. The initial rational model emphasized nondefensive acknowledgment and exploration of the rupture. Results indicated differences between what therapists think they should do to resolve ruptures and what they actually do and suggested that the rational model should be expanded to emphasize client validation and empowerment. Therapists’ ability to attend to ruptures emerged as an important clinical skill.

Therapist and client processes affecting assimilation and outcome in brief psychotherapy

Abstract Therapist focus, client experiencing, and client negative self-statements were examined in relation to both assimilation and treatment outcome based on the analysis of session transcripts from eight clients, four of whom received cognitive–behavioral (CB) and four who received psychodynamic–interpersonal (PI) therapy for depression. Two clients of each therapy type reported significant improvement, whereas two of each remained unchanged. Results showed that PI therapists focused more on constructing meaning than did CB therapists, especially when outcome was good. Good outcome in CB was associated with less focus on creating meaning. Compared with CB clients, PI clients had higher levels of experiencing, which was also linked to increasing assimilation. Good outcome was associated with fewer negative self-statements in both therapies, although it was only linked with assimilation in CB.

Helpful aspects of bereavement support for adults following an expected death: volunteers' and bereaved people's perspectives.

Helpful and unhelpful aspects of bereavement support were investigated from the perspectives of 24 bereaved adults and their volunteer bereavement support workers. Most commonly reported themes were the provision of hope and reassurance, and the opportunity for continued sharing and support. Significantly more clients than volunteers reported provision of information, and talking to someone outside their social network as helpful, and both groups scored higher on helpfulness ratings than comparative groups of psychotherapists and clients. Clients’ grieving styles and the quality of the helping relationship were also related to what was seen as helpful.

Process–outcome studies.

If the effectiveness of psychotherapy is to increase, we need to understand exactly what processes lead to better client outcomes. This is the core challenge and potential contribution of process–outcome research in clinical psychology. In this chapter, we provide a succinct overview of process–outcome as a research approach. Even 10 years ago it was estimated that more than 2,000 process–outcome studies had been published (Orlinsky, Ronnestad, & Willutzki, 2004). Several comprehensive reviews of this literature have already been published (e.g., Crits-Christoph, Gibbons, & Mukherjee, 2013; Gibbons et al., 2002; Orlinsky et al., 2004), so in this chapter we draw on these works and a number of other reviews. Our focus is primarily on psychotherapy, but readers will see that the same methods and principles are also applicable across the wider discipline of clinical psychology.