Some methodological and statistical issues in the study of change processes in psychotherapy (original) (raw)
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Counselling and Psychotherapy Research
Objective: Current approaches of routine outcome monitoring (session-by-session measures) expect that trajectories of change should move on a standard track. Patients moving out of standard tracks are assumed to be at risk of deterioration. From a nonlinear dynamic systems perspective, there is not any assumption regarding a supposed standard track a patient should follow. Individual trajectories should be more complex than averaged tracks, highly individual, and characterised by pattern transitions. Method: We tested if high-frequency (daily) trajectories of change are moving on standard tracks, if there are different complexity levels of high-versus low-frequency time series, if 'not on track' dynamics will be correlated with poor outcome and if complexity peaks representing the critical instabilities of a process will be correlated with the outcome. The patients included in the data analysis (N = 88) used the Therapy Process Questionnaire (TPQ) for daily self-assessments and the ICD-10based Symptom Rating (ISR) for outcome evaluation. Results: High-frequency trajectories are not running on standard tracks and are not necessarily correlated with poor outcome. Locally increased complexity may be associated with good outcome. Conclusion: It may be useful to move beyond the concept of standard tracks and expected treatment outcomes. Routine feedback procedures should use the information that is given by the nonlinear dynamics of multiple change criteria. K E Y W O R D S dynamic complexity, nonlinear dynamic systems, on track versus. not on track, processoutcome research, psychotherapy feedback This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Journal of Consulting and Clinical Psychology, 1996
- present a provocative argument that the yield of process research has been minimal because of researchers' overreliance on the drug metaphor and its corollary, the correlational design. Although Stiles and Shapiro raise excellent points regarding the possible misinterpretations of correlational research, their conclusion that the process-outcome correlation paradigm is flawed and has outlived its usefulness is questioned. The basic thesis is that Stiles and Shapiro did not provide a fair test of the correlation paradigm. The process variables used to test the paradigm do not have the strong theoretical and empirical grounding necessary to support the assumption that they should be related to outcome. In this article, examples are described, of programmatic process research that has used the correlation paradigm, along with other methods of inquiry, to advance the understanding of how change occurs and to improve treatment efficacy. It is contended that the correlational method is one useful tool of discovery and that it has contributed significantly to the advancement of the field when the process variables studied are grounded in solid theory and research.
In 1984, Jacobson, Follette, and Revenstorf defined clinically significant change as the extent to which therapy moves someone outside the range of the dysfunctional population or within the range of the functional population. In the present article, ways of operatmnalizing this definition are described, and examples are used to show how clients can be categorized on the basis of this definition. A reliable change index (RC) is also proposed to determine whether the magnitude of change for a given client is statistically reliable. The inclusion of the RC leads to a twofold criterion for clinically significant change.
Different lens or different picture? Comparing methods of defining dramatic change in psychotherapy
Psychotherapy research : journal of the Society for Psychotherapy Research, 2016
Differing methodologies that identify dramatic change in psychotherapy have been thought to be capturing similar phenomena. We compared three methods-percentage improvement-50% (PI-50), rapid response (RR), and sudden gains (SG)-to identify similarities and differences between these approaches. Using a large database (n = 11,764) from a western university counseling center, we examined client characteristics (including initial severity and number of sessions in a course of treatment) and treatment outcomes (including overall change and meeting clinically significant criteria) using the Outcome Questionnaire-45. Approximately 47% of clients (n = 5516) met criteria for one or more of the dramatic change definitions examined. Only 498 clients (3.7%) met criteria for all three methods, while 1349 (11.5%) met criteria for only one; RR identified the most clients (41.9%) and SG identified the fewest (4.9%). All definitions were associated with higher rates of clinically significant change...
Clinical Psychology Review, 2007
The study of discontinuities and nonlinear change has been a fruitful endeavor across the sciences, as these shifts can provide a window into the organization of complex systems and the processes that are associated with transition. A common assumption in psychotherapy research has been that change is gradual and linear. The research designs and statistics used to study change often reflect this assumption, but some recent research reveals other patterns of change. We briefly review relevant literature on dynamical systems theory and on life transition and post-traumatic growth to highlight the significance of nonlinear and discontinuous change across areas of psychology. We describe recent applications of these ideas and methods to the study of change in psychotherapy and encourage their use to complement more traditional clinical trial designs. Some change can be gradual and incremental, but many systems in nature show periods of turbulence and instability, with dramatic changes or growth spurts. Ilya Prigogine, a Nobel laureate known for his theory of dissipative structures in chemistry, argues that instabilities play an important role in transformation and that "most of reality, instead of being orderly, stable, and equilibrial, is seething and bubbling with change, disorder, and process" (Prigogine & Stengers, 1984, p. xv). The study of discontinuities has been a fruitful endeavor across the sciences, as these shifts can provide a window into the organization of a system and the processes that are associated with transition.
Focus on Change: Implications for the Understanding and Evaluation of Psychological Interventions
PSYCHOLOGIA, 2013
Within psychotherapy research traditions there are two cultures. One group of investigators, emphasizing the commonalities inherent in different schools of therapy and recognizing the extreme variability across clients and therapists, focuses on the interpersonal and emotional interactions between client and therapist as the agency of change in client well-being. The other, characterized by the cognitivebehavioral approach and supporting the empirically-supported treatment movement, focuses on the replicable procedures and techniques designed for and tailored to symptom change within specific syndromes. Both approaches are now drawing together by virtue of the growing recognition that all therapy can be represented as the arrangement of social and psychological experiences that facilitate change. We discuss some implications of this change model and describe some of the complexities of the changes that take place within the course of psychotherapy. Some broad principles of change are suggested and related concepts, such as meansends relationships, response interrelationships, and practical and psychological barriers to change are briefly outlined. The value of monitoring change in clients, a long-standing tradition in behavior therapy, is argued, with one additional twist proposed, namely the monitoring of client experiences and actions that themselves facilitate change, regardless of the targeted problem area.