Studies in Psychology: Estudios de Psicología

The questions that guide psychotherapy process research are: what changes in psychotherapy? And, how does that change occur? These questions have been present in clinical settings and psychotherapy research for decades, generating a substantial amount of knowledge for the discipline. Based on a questioning of the limitations of traditional psychotherapy research, whose primary focus has been the study of final outcomes of treatment, this area of research has exposed important conceptual and methodological proposals for the study of the process. Despite its long and productive tradition, research into the psychotherapeutic process is currently gathering a new momentum from the growing conviction of the need to focus efforts on studies that can account for the elements, mechanisms and processes associated with change. In this introduction we organize the field of psychotherapy process research, according to its units of analysis — macro- or micro-processes — and the foci on which they are based: content, factors and mechanisms of change. The different ways in which these components are organized are exemplified with the articles included in this monograph. We then give an overview of the most used methods in this field of study, also referring to the studies that report on the application of these methods in this special issue of Studies in Psychology.

The sequences of historical shifts in research foci in psychotherapy are reviewed. Two emerging trends are examined: focus on micro-analysis of small units that exemplify client change; and fine-grained analyses of client-therapists interactions that encapsulate significant therapy events in clinical contexts. Several examples of each of these types of research programmes are described. Based on the apparent evolution of questions that are considered relevant and useful for the better understanding of best clinical practices, some tentative conclusions are offered as to the types of research that will gain prominence in the next generation of inquiries.

The authors provide a process model which captures how successful clients use and develop resources in the process of counselling and psychotherapy and how these are linked to the overall process. The use and gradual development of resources are integrated into the process model, as well as additional meta-categories such as experiencing positive feelings and internal and external actions of the client. The model is based on a qualitative meta-analysis.

Although patients’ expectation about a treatment’s efficacy correlate with beneficial therapy processes and outcomes, scant research addresses patients’ expectation for lasting improvement at treatment’s end. Given the influence of beliefs on psychological functioning, posttreatment outcome expectation reflects an important acute treatment outcome. In this study, we examined patient characteristics, treatment processes and clinical change factors in relation to the posttreatment outcome expectation of 65 depressed outpatients completing group cognitive-behavioural therapy. Less than 1% of variability in posttreatment outcome expectation was due to group effects; thus, we conducted single-level regressions. Patients with less severe baseline depression, higher session 3 outcome expectation, more during-treatment hope and a greater reduction in interpersonal problems reported greater posttreatment outcome expectancy. Various patient characteristics and change factors can help clinicians forecast, and respond to, those patients who will possess stronger or weaker belief in their ability to maintain therapy gains at treatment’s end.

In this research process, Stiles’ assimilation of problematic experiences scale is used to study Olivia’s process of change. The objectives of this study are: first, to describe Olivia’s therapeutically successful assimilation of the problematic experience of fear of dying, treated with brief strategic therapy; and second, to study how that pattern of assimilation unfolded. We can conclude that Olivia assimilated her problematic experience of fear of dying by following a fluctuating and irregular pattern.

The purpose of this study is to understand how psychotherapists perceive the process of change in psychotherapy in children and/or adolescents who have been victims of sexual abuse and the influence therapeutic alliance has on this treatment. A qualitative research study was carried out through 24 in-depth interviews with psychologists, analysed from a narrative analysis framework. The results of this study highlight that the change in psychotherapy is gradual and progressive and develops in different stages: an initial one of connection with the therapeutic space, an intermediate stage of giving new meanings to their abusive experience and a final stage consolidating the changes. In each of these stages, the therapeutic alliance influences in different ways; it is essential in the process of psychotherapeutic change. The implications of these findings for child and adolescent clinical work are stressed by highlighting therapists’ narratives.

A single case study for a psychoanalytic psychotherapy process in a girl and her mother is presented from the perspective of the Object Relations Theory framework. Of interest are the empirical findings of therapeutic change and the effectiveness of the tool using a method created by a team of researchers from a university chair. A qualitative and quantitative analysis of textual observational records of sessions was conducted using codes constructed ad hoc from specific manuals for children and adults. The results of the application of the method are contrasted with results from psychological assessment techniques. Therapeutic change indicators are linked to progress in the processes of symbolization; therapeutic efficacy is recorded when the psychotherapist’s interventions favour symbolization and mentalization processes.

The purpose of this study was to analyse the therapeutic process of a case of couple therapy for depression. The evolution of symptoms, marital satisfaction and therapeutic alliance were evaluated during therapy. Results showed that symptoms followed a specific trajectory where the patient displayed a sudden deterioration towards the end of their therapy but, at follow-up, reached a clinically significant change in both individual and relational measures. The analysis of the process highlighted the association between the couple’s relational pattern and its problematic within-system alliance, as well as the relevance of this association for explaining the trajectory of change. The most useful case management interventions were: (a) fostering a relational formulation of symptoms; and (b) the use of therapy termination as an intervention. Results from this case study support the role of relational mechanisms for the process of change and provide technical alternatives that can be applied in cases at risk of failure.

While the contribution of patients’ perspectives regarding their psychotherapeutic experiences has been widely recognized, some have received less attention from research, as is the case of people with schizophrenia. This paper focuses on the subjective experience of psychotherapy in order to go more in-depth into aspects related to the therapeutic success. A study of multiple cases was carried out which included four patients who participated in semi-structured interviews. Data analysis was performed based on the Grounded Theory. Results show that the process of psychotherapeutic change in people with schizophrenia can be understood as a progressive reintegration of the self into the biographical continuity and they contribute to understanding the meaning that psychotherapy can have for people suffering from schizophrenia.

Depressive symptoms are associated with typical ways of relating to and handling conflict with others. This study empirically analysed the most frequent relational ‘demands’ and ‘offers’ identified in the verbal expressions of depressive patients during the first session, comparing them according to their personality organization (anaclitic vs introjective). The CCRT-LU-S Category System was used to analyse the first session of 27 patients with depressive symptomatology. The results showed that the highest percentage of depressive patients’ interactional components identified were relational ‘offers’, whereas the remainder percentage were relational ‘demands’. At the same time, the highest percentage of those interactional components were verbalized as disharmonious (weakness, withdrawing, unpleasant and fighting) by anaclitic patients, while the highest percentage were verbalized as harmonious (loving or having self-determination) by introjective patients. Implications for clinical relevance of these results are discussed.

Aim: to describe and understand an interrupted psychotherapy of a patient with Borderline Personality Disorder. Method: systematic, naturalistic and exploratory case study of the therapeutic dyad. The Therapeutic Cycles Model (TCM) and the Psychotherapy Process Q-Set (PQS) were the instruments used. Results: according to TCM, the case can be divided into two stages: one with cycles of change and one without cycles of change. According to the PQS, the themes addressed by the dyad were relevant to psychotherapy and related to patient diagnosis. However, the patient seemed to be uncommitted to the therapeutic process and did not rely on the therapist to solve her problems. The therapist’s attitudes were adequate but technical interventions were not prominent. The combination of patient and therapist data assisted in understanding why the psychotherapy was abandoned.

This study examines clients’ and therapists’ verbal communication during psychotherapy, in order to determine its relation to ongoing change and outcome. It replicates previous studies showing the specificity of verbalizations depending on the speaker (client or therapist) and the phase of therapy, adding its relation to change measured at the level of process and final outcome. 7,009 speaking turns of clients and therapists, nested in 139 change episodes, were analysed regarding the use of the five Linguistic Basic Forms included in the Therapeutic Activity Coding System (TACS) through Hierarchical Modelling. Results show that three of these Linguistic Basic Forms — Question, Assertion and Agreement — are related to ongoing change as well as to final outcome.

The purpose of this paper is to describe verbal and nonverbal expressions of mutual regulation between patients and therapists through the analysis of relevant episodes of five psychotherapy processes. Microanalyses of discourse, vocal quality and facial expression of emotions were conducted on both patients and therapists in 67 Episodes of Change and 86 Episodes of Rupture of the Therapeutic Alliance. The analyses were carried out using hierarchical regression, showing that both Episodes of Change and Episodes of Rupture correspond to interactional scenarios where patients and therapists use different forms of speech, vocal qualities and facial expressions that account for specific regulation processes which are coherent with such scenarios.

The nonverbal, implicit and affective regulation process of psychotherapy patients was studied through their facial-affective displays during Confrontation and Withdrawal Ruptures, as well as the evolution of this display throughout therapy. Twenty-six rupture episodes selected from a total of five individual therapeutic processes from different theoretical orientations were analysed using the Facial Action Coding System (FACS), which analyses facial behaviour. The results showed association between expressions of Joy, Social Smile and positive emotional Valence during Withdrawal Ruptures, while Confrontation Ruptures were characterized by patients’ absence of Emotional Valence. The differential characteristics of these variables were associated with stages of therapy. The results are discussed based on the notions of agency and affiliation put into play by patients during events of relational tension.

The objectives of this research study were to validate a Spanish version of The Alliance Negotiation Scale with Mexican patients and contrast relevant variables from the therapy and negotiation of the alliance. The sample was composed of 199 participants of both sexes. Exploratory factor analysis grouped three factors related to the therapeutic alliance negotiation, which are: therapist’s flexibility; therapist’s negotiating stance; and being comfortable expressing negative feelings. This factorial structure differs from the English version. It was found that clients’ sex and age did not influence the negotiation of the alliance, while time in therapy and the reason for attendance did offer differences; it was determined that negotiations depend largely on the therapist being flexible and their negotiating stance during the process.

Our aim is to expose the DLA-N (an integrant of the David Liberman Algorithm), useful for the study of wishes and defenses (and their states) in narratives, and to illustrate its implementation. The instruments are: (1) a grid; (2) instructions to infer defenses and their state; (3) the frequency distribution of wishes in patients’ narratives. As illustrations, three research studies, with objectives, samples and different strategies are exposed. The first one shows the utility of the DLA-N in the determination of, in a case: (a) when and in connection with what or who the patient’s defenses have failed; (b) changes in some of the defenses. In the second research study we apply the DLA-N to a sample of 15 episodes of violence aiming to infer: (a) what were the triggering factors; and (b) the anticipation of the emergence of one of those episodes. In the third research study we apply the DLA-N to three sessions of the same case aiming to discuss the utility of the frequency distribution in evaluating the clinical change.

The study of psychotherapeutic interventions and their link with process and outcome variables has become a popular topic of great interest in psychotherapy research. This paper presents the adaptation into Spanish of the Comparative Psychotherapy Process Scale (CPPS), a 20-item scale that measures the degree to which therapists use Cognitive-Behavioural or Psychoanalytic-Interpersonal interventions. A hundred and one therapists (50 cognitive-behavioural and 51 psychoanalytic) completed the CPPS for the last patient they had treated. In a second sample of 15 patient-therapist dyads, both participants completed the CPPS regarding the same session. The subsequent analyses showed preliminary evidence of reliability (internal consistency and homogeneity) and validity (of construct and criterion) in the adaptation of the CPPS to Spanish. The implications of having a scale of these characteristics in Spanish and future lines of research are discussed.