Understanding the client's perspective of helpful and hindering events in psychotherapy sessions: A micro‐process approach

Abstract

The purpose of this study was to bridge the methodologies of significant events and micro-process research to gain a better understanding of clients' perceptions of helpful and hindering events in psychotherapy. A total of 16 clients were asked to review a recent psychotherapy session and, while watching, complete a moment-by-moment rating of helpful/hindrance using a dial rating system. They were also asked to describe the most helpful and hindering segments that were rated as such. The moment-by-moment ratings suggest that clients perceive a significant amount of variability within a single session. The qualitative results suggest that clients perceive both specific treatment and common factors techniques as being helpful. Further, some of the same therapist actions were rated as both helpful and hindering, but they differed in the timing and the client's experience of feeling heard and understood versus judged or given advice that was not perceived as relevant to them. These results have important implications for clinical practice.

‘It was me answering my own questions’: Experiences of method of levels therapy amongst people with first‐episode psychosis

“…This is consistent with research showing that the same therapist activities can be experienced as either helping or hindering the process of change, depending on the preferences of the individual (Swift et al . ). Because MOL explicitly focuses on present moment experiences, it is anticipated that therapists using the approach will generally be well placed to detect whether therapy is being experienced as unhelpful, although clearly this is not always possible.…”

Patient activation in psychotherapy interactions: Developing and validating the consultation interactions coding scheme

“…Achieving reliable turn‐by‐turn analysis also allows easier identification of clinically important changes that occur within the session. Such changes can affect outcome and may not be picked up by total score analyses (Swift et al, ). Overall, results suggest that a coding manual and training method has been developed with sufficient clarity, specificity, and reliability to provide a foundation upon which further study of interaction‐level patient activation can be built.…”

“…This paper reports the development of the CICS, which aims to assess whether patient activation can be accurately rated at specific in‐session interactions and whether these ratings correlate with outcomes. This detailed approach accounts for the same type of interaction being viewed as helpful or unhelpful at different points in a session (Swift, Tompkins, & Parkin, ), which is not addressed by more typical total behavior counts or global scores. Patient activation has been assessed within mental health settings (e.g., Green et al, ) and interactions have been rated for activation within diabetes care (Williams et al, ).…”

Agents of change: Understanding the therapeutic processes associated with the helpfulness of therapy for mental health problems with relational agent MYLO

“…21 Investigating therapeutic processes requires a detailed analysis of what happens in therapy, how it is experienced by clients, and why they find it helpful or hindering. [22][23][24][25] Greater transparency regarding precisely how and why digital interventions achieve psychological change is likely to increase user trust, streamline interventions to their key components, and, consequently, increase reach. 18 Transdiagnostic interventions delivered in traditional and computerized formats have been shown to provide equivalent effects to disorder specific interventions of their type 26,27 and offer greater interactivity, flexibility and importantly, scalability.…”