The development of a new Change Process Research approach to psychotherapy
This study aimed to explore change process research (CPR) in psychotherapy and to develop and evaluate a new CPR approach to psychotherapy. An intervention research design was used as the overarching methodology. To achieve the study aim, the researchers initially conducted a systematic review of CPR in the context of psychotherapy to identify critical themes emerging from high-quality and relevant scientific literature. Eight themes were identified and grouped into two clusters, namely research- and practice-related themes, respectively. The research-related themes were: 1) research methodologies in CPR, 2) outcome measures, 3) process measures, and 4) existing CPR approaches, while the practice-related themes were: 1) therapeutic relationship, 2) therapeutic techniques, 3) change concepts, and 4) psychological understanding of the client. These critical themes formed the baseline from which the pilot version of a new CPR approach to psychotherapy was developed, known as the Scientist-Practitioner Approach to Change Process in Psychotherapy (SP-CPP). A design and development methodology was used to develop the SP-CPP. The pilot version of the SP-CPP was critically evaluated by 13 key informants (or experts) who met strict inclusion criteria, after which an amended version of the SP-CPP was developed. Finally, the practical application of the amended version of the SP-CPP was illustrated through a multiple case study design with four clients who presented with anxiety-related difficulties. Two of the clients received cognitive behavioural therapy as evidence-based treatment, while the other two received schema therapy. The write-up of the cases was presented according to the framework provided by the SP-CPP with the clients, psychotherapist, individual supervisor and a reflective team as important role players. The SP-CPP was found to be a useful framework for conceptualising change process for clients from a cognitive behaviour and schema therapy perspective. In addition, it was possible to use the SP-CPP to reflect on the differences in outcomes across the four presented cases. Reasons for differences in outcomes could best be explained by the key change construct and therapy variable sections. In this regard, the client’s readiness to change, cognitive-emotive developmental level (and/or conceptualisation) and the quality of the therapeutic alliance appeared to be the most significant empirical indicators. The study revealed, moreover, that mechanism of change and the client’s response to the use of therapeutic techniques can also play an important part in explaining differences in outcome. Based on the study’s findings, increased collaboration between psychotherapy researchers and practitioners is recommended for empirical studies of CPR in psychotherapy. Such increased collaboration will not only reduce the scientist-practitioner gap but also add to the evidence-based nature of change process in psychotherapy. It is also recommended that the SP-CPP be applied practically with different clients with different presenting problems and who receive treatment from different therapeutic approaches. In addition, the application value of the SP-CPP for couples’, family and group psychotherapy should also be explored. Finally, it is recommended that the SP-CPP be used as an evidence-based framework by psychotherapists with different levels of training, experience and theoretical orientations. The SP-CPP can also be used during supervision of psychotherapists in training. Psychotherapists in practice can use the SP-CPP to further enhance the effectiveness of their clinical practices and to ‘troubleshoot’ or ‘problem-solve’ difficult cases. In this regard, the development of continuous professional development courses on the use of the SP-CPP is strongly recommended. Psychotherapy researchers can use the SP-CPP as a single framework that combines process and outcome research to conceptualise and study CPR in the context of psychotherapy by integrating quantitative and qualitative data from multiple perspectives.
- Health Sciences