Therapists’ Views of Mechanisms of Change in Psychotherapy: A Mixed-Method Approach

Abstract

The question of what works in psychotherapy has been a subject of debate in the recent years, occupying both clinicians and researchers. In this study, we aimed to assess the current perspectives held by clinicians regarding the processes which produce changes in psychotherapy, as well as the predictors of specific views. Licensed therapists (n = 107), consisting mainly of psychodynamically and integratively oriented psychologists, were asked to write in their own words what they think works in psychotherapy. Thematic analysis was employed to assess the main mechanisms of change as perceived by the therapists. Differences in the prevalence of specific themes were assessed using Friedman and Wilcoxon signed-rank tests. Univariate logistic regressions were employed to assess the factors that predict the probability of reporting a specific mechanism of change. The results indicated that the therapeutic bond was the most highly reported mechanism of change, followed by theory-driven mechanisms of change, therapist characteristics, therapist professionalism, and client motivation. Male therapists were more likely to indicate the professionalism as a mechanism of change compared to female therapists. Higher education was associated with lower reports of therapists’ characteristics as the mechanisms of change. These results suggest that therapists acknowledge the importance of the working alliance, and that the perception of the mechanism of change is associated with various factors which comprise therapist orientation. Limitations and directions for future research are discussed.

Promoting Meaning and Recovery for Psychosis: Comparison of Metacognitively-Oriented Psychotherapists and Clinicians in Psychiatric Rehabilitation

“…Therapeutic alliance has long been recognized as an important element of recovery-oriented care for persons with psychosis, is associated with recovery outcomes, 11,35,36 and is recognized by clinicians from qualitative interviews as an important element of psychiatric rehabilitation. 13,14,23 Although the groups both valued the relationship, they were described differently. PR-S clinicians valued a comfortable, supportive relationship with clear roles.…”

“…Much of the research highlights therapeutic alliance as it relates to outcomes and the process of treatment. Aligning with established quantitative research, qualitative research also shows that therapeutic alliance as an important mechanism of change 14 and that meaningful relationships between clinicians, patients, and clinical teams are essential for positive outcomes. 10 Other studies highlight clinicians’ report of the complexities of factors that might influence relationships between the therapeutic alliance, the treatment itself, and perception of outcomes.…”

Supervisees perspectives of challenges and opportunities in cross-cultural implementation of psychodynamically oriented therapy in Israel.

“…An undergraduate student conducted transcriptions for the interview recordings. Training in the Braun and Clarke method was provided by author DTB (Tzur Bitan et al, 2017, 2022) to two independent undergraduate students who undertook the task of coding the themes. Each coder first read and formulated a list of themes.…”

Dyadic Interactions of Treatment-Resistant Schizophrenia Patients Having Followed Virtual Reality Therapy: A Content Analysis

“…The mechanisms establishing the success of a psychotherapy are widely debated [ 2 , 4 ]. Despite the debates, the therapeutic bond between the therapist and the patient is perceived to be a major factor resulting in behavioral, social, or cognitive changes [ 5 , 6 ]. As part of this bond, the notion of transference and countertransference is relevant.…”