PSY343 - 9. The Change Process / Process of Change Flashcards
Background
Change process research studies how ppl change over course of therapy process
change process: therapeutic activities, variables, interactions that leads to change patterns/trajectories that characterize change
Phase Model Change
phase model change: states that in psychotherapy, clients go through 3 sequential phases of recovery:
Remoralization – general sense of well-being improves,
leading to increased hope
Phase Model Change
lifting of morale - hope for aid - Jerome Franks - expectation
very early on by session 4
Phase Model Change
Remediation – resolution of symptoms or problems that led client to seek treatment
using more effective coping skills
2nd + third month of treatment
Phase Model Change
Rehabilitation – improved functioning
increased insight + practicing of coping skills
5th-6th month
took longer to achieve
Phase Model Change
relying on remaining in therapy
phase may take longer
doesn’t take into account to relapse
change process is more complicated than sequencial model
Phase Model Change
- Research designs + statistics used to study change often assume that change is gradual + linear
- In psychotherapy we often see dramatic change following periods of turbulence or instability (i.e., discontinuous, nonlinear change)
Phase Model Change
based on measurement - limitations of statistics
RCTs often assume gradual change
measure baseline, then measure post treatment
process-outcome relationship is often non-linear
therapeutic relationship ruptures - V shape can also predict good outcome
Phase Model Change
therapist interpretations in psychoanalysis - client may grasp or have difficulty in grasping interpretations
possible more dysfunctional may require more interpretations
Phase Model Change
for some clients more interpretations leads to poor outcomes
may be missing that they are simultaneously building a better relationship
we have to look at how change variables is negotiated over time
Change Process in Psychotherapy
CBT for depression context, but replicated for other therapies + populations
Three types of discontinuous change have been identified to predict symptom improvement:
• Sudden gains - large improvement during a single between-session interval that does not reverse
sudden gains: large jump within 2 sessions
Change Process in Psychotherapy
• Rapid response - substantial decrease in symptoms early in treatment, which then level off
insight + problem solving skills
happens for some ppl
Change Process in Psychotherapy
30% of depression patients which accounted for 50% of overall improvement
didn’t differentiate ppl at end of treatment - no statistical diff betw these ppl and those who didn’t experience it
predicted outcome at 18 months posttreatment
contributes to longer term benefits
Change Process in Psychotherapy
Symptom spike - brief period of symptom exacerbation followed by decrease
opposite of rapid response
exposure therapy - spike in anxiety
Change Process in Psychotherapy
neurotic transference - as we start uncovering neurotic patterns - surfacing problems leads to spike in anxiety
important transition points that reveal how they might want to interact with clients
Change Process in Psychotherapy
nonspecific but representative client groups
looking at individual trajectories and clusters within them
5-25 sessions
Owen et al. (2015) – Analyzed post-session questionnaires of 10,854 clients + identified 3 distinct trajectories of change:
Change Process in Psychotherapy
“Early + Late Change” - early initial change, followed by
plateau, + another gain in psychological functioning later in treatment
early + late - most clients
Change Process in Psychotherapy
improvements in first 5 sessions
relatively no change until session 11 then more improvement
no change periods - something may be happening there
Change Process in Psychotherapy
“Worse Before Better” - initial decrease in functioning,
followed by rapid increase, + then plateau
worse: 5% of sample, not common
significantly more baseline distress
Change Process in Psychotherapy
“Slow + Steady Change” – steady increase in functioning
slow and steady: 20% - gradual linear change
nonresponders - no improvement - tend to drop out of treatment
Nonlinear Change in Psychotherapy
importance of destabilization of system which leads to eventual change
Critical fluctuations – periods of disturbance + fluctuation in system followed by change
Challenges to status quo (baseline) => Sudden disturbance + increased variability (transition) => System reorganization (change)
Nonlinear Change in Psychotherapy
fluctuations: when there’s a challenge to status quo, often too great for system to assimilate, increase in variability which coalese back into new system
we first see chaos
Nonlinear Change in Psychotherapy
Gestalt - assimilation + accommodation
open to new info + exploration for more adaptive system
when current state is destabalized, open to new ways synthesis and establishing a new system
process can often feel chaotic
Nonlinear Change in Psychotherapy
Example of nonlinear change in case of trauma:
Traumatic events + major life challenges cause significant emotional distress, which can lead to postraumatic growth
trauma: post-traumatic growth in immediate aftermath - PTSD
Nonlinear Change in Psychotherapy
for some once trauma is resolved, once symptoms dissipates, baseline functioning
new engagement in life
period of decompensation, then followed by change + improvement
Nonlinear Change in Psychotherapy
Therapy introduces a variety of interventions to interrupt, challenge + destabilize old patterns, which increases likelihood of nonlinear change
Nonlinear Change in Psychotherapy
Studying nonlinear change requires:
Multiple assessments over time to understand what
facilitates /inhibits change
examination of individual trajectories of variables rather than group averages
Nonlinear Change in Psychotherapy
many approaches can destabilize thoughts, patterns, feelings which leads to change
requires that we measure it properly to understand how it works + individual trajectories
Why does this matter?
Providing clients with education about patterns of therapeutic change can help them better prepare for + navigate treatment
Why does this matter?
Lack of knowledge about patterns of change may lead to
premature termination from therapy due to:
Client expectations that initial improvement is sign of recovery
if clients know turbulations occur, can not freak out over it
Why does this matter?
protect from drop out - be more patient, change will occur
part of therapist process as well
prevent therapist from giving up or refer someone out - might not be beneficial
Why does this matter?
Clients may expect linear pattern of progression + get
discouraged when therapy is difficult or setbacks are encountered
Improve research + our understanding of how change takes places
Studying the Process of Change
In-session processes – “active ingredients” or therapeutic
activities hypothesized to promote therapeutic change over course of treatment
Studying the Process of Change
measuring components
active process variables
immediate outcome - impact of in session
Studying the Process of Change
increase empathy = better relationship
Immediate outcomes – change that is evident in session as result of specific interventions of therapeutic interaction
resolution to marker and task
Studying the Process of Change
Intermediate outcomes – changes in targeted attitudes or
behaviours measured over course of treatments
captures change in behaviours + symptoms
Studying the Process of Change
Final outcomes – changes measured at end of treatment
final outcome - symptom measure
*To provide a complete picture of change process, outcomes at all 3 points need to be related to each other
Summary
Change in psychotherapy often nonlinear
Essential to understand diff patterns + trajectories of change AND how change occurs
Change process = process of change
Summary
helpful in conceptualizing change process
methods on differentiating treatment deterioration and part of change process
