The process of change in psychotherapy for depression: helping clients to reformulate the problem

Abstract

There is increasing interest in mental health nurses delivering structured short-term evidence-based psychotherapies such as cognitive behavioural therapy (CBT) and interpersonal psychotherapy (IPT); however, while there is evidence of the efficacy of psychotherapy for depression, there is limited understanding of the treatment processes. Data were drawn from audio tapes of CBT and IPT sessions for treatment of depression. The transcripts of the initial, middle and final psychotherapy sessions of 40 clients were analysed. A thematic analysis was conducted to identify what was occurring in the sessions, how the client was describing psychotherapy and how the client was describing improvement or lack of improvement in depressive symptoms. There were differences in descriptions of therapy and the experience of depression between clients who responded and those who did not respond to therapy that were related to improvement in symptoms but not to the specific therapy. These differences were in the client's engagement with the language of therapy, sense of optimism about the particular model of psychotherapy, ability to examine their own role in the problem and desire to engage with new ways of being in their lives. Clients who responded to CBT or IPT had flexibility to develop new ways of thinking and acting, the ability to accept responsibility for their role in the identified problem and were willing to risk change.

The development of a change model of “exits” during cognitive analytic therapy for the treatment of depression

“…For example, the importance of therapists scaffolding around nascent change has been previously highlighted across both cognitive behavioural therapy and psychodynamic psychotherapy (Göstas, Wiberg, Neander, & Kjellin, 2012). Crowe et al (2012) have emphasised that clients need to reformulate their depression in order to be able to change, and in the current study, the SDR grounded the exits in the client's formulation. Explicitly labelling exits on the SDR was a key therapeutic activity, and research on planning clinically effective between-session work has emphasised the utility of writing change strategies down (Helbig & Fehm, 2004).…”

A content analysis of client e-mails in guided internet-based cognitive behavior therapy for depression

“…Indeed, the therapeutic process has been shown to manifest itself in both clients' speech in the context of face-to-face treatment (Crowe et al, 2012) and in text in internet therapy when therapist and client correspondence is analyzed ( Van der Zanden et al, 2014, Dirkse et al, in press). In a study on therapist behavior in ICBT for GAD, Paxling and coworkers (2013) analyzed close to 500 e-mails from three online therapists providing support to patients with generalized anxiety disorder.…”

Effect of a brief training program based on cognitive behavioral therapy in improving work performance: A randomized controlled trial

“…Cognitive flexibility involves the acceptance of difficult situations to make them controllable and the ability to perceive life events and the behavior of others from multiple points of view 6) , two tasks that can be improved through CBT. For example, repairing a subject's dysfunctional cognition might improve their flexibility regarding a new way of thinking and action 11,12) , help them accept their role in a problem, find more solutions for the problem, and take action appropriate to a given situation 37) . In a study of healthy subjects, groups who had low-level cognitive restructuring tended to have low-level cognitive flex-ibility 38) .…”