Using interpersonal process recall to compare patients’ accounts of resistance in two psychotherapies for generalized anxiety disorder

Abstract

In a trial examining whether cognitive-behavioral therapy (CBT) could be improved by integrating motivational interviewing (MI) to target resistance, MI-CBT outperformed CBT over 12-month follow-up (Westra, Constantino, & Antony, 2016). Given that effectively addressing resistance is both a theoretically and an empirically supported mechanism of MI's additive effect, we explored qualitatively patients' experience of resistance, possibly as a function of treatment. For 5 patients from each treatment who exhibited early in-session change ambivalence, and thus were at risk for later resistance, we conducted interpersonal process recall interviews after a session. Transcripts were analyzed with grounded theory and consensual qualitative research. A salient contrast in patient narratives was a sense of compliance engendered in standard CBT versus connection in MI-CBT. Yet both narratives supported the superordinate category of resistance as an interpersonal process triggered by patient perceptions of therapist beliefs and behaviors. Findings contribute to the conceptualization of resistance from patients' first-hand accounts.

Clients’ own perspectives on psychotherapy outcomes and their mechanisms.

“…With respect to related therapist actions, clients have indicated that they benefit when therapists listen, affirm, validate, empathize, reassure, demonstrate positive regard, and convey acceptance. Additionally, clients have expressed that therapists collaborating with them on the goals and tasks of therapy and granting them autonomy over the treatment's direction is helpful (e.g., Levitt et al, 2016;Morrison et al, 2017). These findings corroborate the robust quantitative literature that links similar researcher-or therapist-constructed factors, including the higher quality alliance (Flückiger et al, 2018) and goal consensus or collaboration (Tryon et al, 2018) with adaptive treatment outcomes.…”

Determinants of psychotherapy outcome expectations: Qualitative accounts from socially anxious college students

“…Data were extracted and analysed using a combination of grounded theory analysis (GTA; Glaser, 1978;Glaser & Strauss, 1967) and consensual qualitative research methods (CQR; Hill, 2012), a hybrid approach used in other qualitative studies of psychotherapy constructs (e.g. Morrison et al, 2017;Westra et al, 2010). As was done in these studies, this blended method allowed us to take advantage of the open coding of grounded theory, while using CQR methods to obtain multiple perspectives on the data.…”

Premature termination of the unified protocol for the transdiagnostic treatment of emotional disorders: The role of ambivalence towards change

“…Research suggests that ambivalence levels are higher at the beginning of therapy and in most of the cases are essential to initiate the process of change (Button et al, 2014; Miller & Rollnick, 2002; Morrison et al, 2017; Oliveira et al, 2021). However, a decrease in ambivalence has been observed in recovered clients, while unchanged clients tended to experience the same levels of ambivalence throughout treatment (Braga et al, 2019; Braga, Ribeiro, et al, 2018).…”