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01-03-2018 | Original Paper

Exploring Associations Between Therapy Factors and Post-therapy Development After Naturalistic Psychotherapies

Authors: Vidar Blokhus Ekroll, Michael Helge Rønnestad

Published in: Journal of Contemporary Psychotherapy | Issue 1/2018

Abstract

Earlier research on what contributes to long-term outcome after psychotherapy is scarce and scattered. Responding to this, the current study explores potential associations between therapy factors reported as salient by clients in naturalistic psychotherapy and variation in post-therapy-movement. Material from different codes and categories derived from an earlier content analysis was explored in relation to post-therapy-changes on OQ-45. In the first part of the study, two overarching themes (relational aspects and therapeutic operations) were included in a regression analysis of data from 32 clients. In the second part, more nuanced associations between material from different change- or process categories and post-therapy-movement were explored using data from 20 clients that showed reliable improvement at treatment termination but varied in later development. Reports of material related to relational aspects were recurrently associated with post-therapy improvement. Material suggesting that therapy was experienced as not fully complete (e.g., changes being superficial or wish for more treatment), as well as reports of more positive affect, correlated with later deterioration after improvement at termination. Different processes and changes appreciated by clients during therapy seem to vary as predictors of lasting gains.

Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research and Practice, 16, 252–260.CrossRef

Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17–31.CrossRefPubMed

Cresswell, J. W., & Clark, V. L. P. (2007). Designing and conducting mixed methods research. Thousand Oaks: Sage Publications.

Crits-Christoph, P., Connolly Gibbons, M., & Mukherjee, D. (2013). Process outcome research. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavioral change (6th ed., pp. 298–340). New York, NY: Wiley.

Cuijpers, P. (2016). The future of psychotherapy research: Stop the waste and focus on issues that matter. Epidemiology and Psychiatric Sciences, 25, 291–294.CrossRefPubMed

DeRubeis, R. J., Siegle, G. J., & Hollon, S. D. (2008). Cognitive therapy versus medication for depression: Treatment outcomes and neural mechanisms. Nature Reviews. Neuroscience, 9, 788–796.CrossRefPubMedPubMedCentral

Doss, B. D. (2004). Changing the way we study change in psychotherapy. Clinical Psychology: Science and Practice, 11, 368–386.

Durham, R. C., Chambers, J. A., Power, K. G., Sharp, D. M., Macdonald, R. R., Major, K. A., … Gumley, A. L. (2005). Long-term outcome of cognitive behavior therapy clinical trials in central Scotland. Health Technology Assessment, 9(42), 1–174CrossRefPubMed

Ekroll, V. B., & Rønnestad, M. H. (2016). Processes and changes experienced by clients during and after naturalistic good-outcome therapies conducted by experienced psychotherapists. Psychotherapy Research, 27, 450–468.CrossRefPubMed

Elliott, R., Greenberg, L. S., Watson, J., Timulak, L., & Freire, E. (2013). Research on humanistic-experiential psychotherapies. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavioral change (6th ed., pp. 219–257). New York, NY: Wiley.

Falkenström, F., Grant, J., Broberg, J., & Sandell, R. (2007). Self-analysis and post- termination improvement after psychoanalysis and long-term psychotherapy. Journal of the American Psychoanalytic Association, 55, 629–674.CrossRefPubMed

Glaser, B. G., & Strauss, A. L. (1967/2006). The discovery of grounded theory: Strategies for qualitative research. New Brunswick, NJ: Aldine Transaction.

Heinonen, E., Knekt, P., Jääskeläinen, T., & Lindfors, O. (2014). Therapists’ professional and personal characteristics as predictors of outcome in long-term psychodynamic psychotherapy and psychoanalysis. European Psychiatry, 29, 265–274.CrossRefPubMed

Hersoug, A. G., Høglend, P., Gabbard, G. O., & Lorentzen, S. (2013). The combined predictive effect of patient characteristics and alliance on long-term dynamic and interpersonal functioning after dynamic psychotherapy. Clinical Psychology and Psychotherapy, 20, 297–307.CrossRefPubMed

Høglend, P. (2003). Long-term effects of brief dynamic psychotherapy. Psychotherapy Research, 13, 271–292.CrossRefPubMed

Høglend, P., Dahl, H.-S., Hersoug, A. G., Lorentzen, S., & Perry, J. C. (2011). Long-term effects of transference interpretation in dynamic psychotherapy of personality disorders. European Psychiatry, 26, 419–424.CrossRefPubMed

Hollon, D. H., Stewart, M. O., & Strunk, D. (2006). Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety. Annual Review of Psychology, 57, 285–315.CrossRefPubMed

Imel, Z. E., Malterer, M. B., McKay, K. M., & Wampold, B. E. (2008). A meta-analysis of psychotherapy and medication in unipolar depression and dysthymia. Journal of Affective Disorders, 110, 197–206.CrossRefPubMed

Kivlighan, D. M. III, Goldberg, S. B., Abbas, M., Pace, B. T., Yulisha, N. E., Thomas, J. G., … Wampold, B. E. (2015). The enduring effects of psychodynamic treatments vis- à-vis alternative treatments: A multilevel longitudinal meta-analysis. Clinical Psychology Review, 40, 1–14.CrossRefPubMed

Knekt, P., Lindfors, O., Sares-Jäske, L., Virtala, E., & Härkänen, T. (2013). Randomized trial on the effectiveness of long- and short-term psychotherapy on psychiatric symptoms and working ability during a 5-year follow-up. Nordic Journal of Psychiatry, 67, 59–68.CrossRefPubMed

Lambert, M. J., Burlingame, G. M., Umphress, V., Hansen, N. B., Vermeersch, D. A., Clouse, G. C., & Yanchar, S. C. (1996a). The reliability and validity of the Outcome Questionnaire. Clinical Psychology and Psychotherapy, 3, 249–258.CrossRef

Lambert, M. J., Hansen, N. B., Umphress, V., Lunnen, K., Okiishi, J., Burlingame, G. M., & Reisinger, C. W. (1996b). Administration and scoring manual for the OQ-45.2. East Setauket, NY: American Professional Credentialing Services.

Leichsenring, F., & Leibing, E. (2003). The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: A meta- analysis. American Journal of Psychiatry, 160, 1223-1232-.CrossRef

Leichsenring, F., Salzer, D., Beutler, M., Herpertz, S., Hiller, W., Hoyer, J., … Leibing, E. (2014). Long-term outcome of psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder. American Journal of Psychiatry, 171, 1074–1082.CrossRefPubMed

Liberman, B. L. (1978). The role of mastery in psychotherapy: Maintenance of improvement and prescriptive change. In J. D. Frank, R. Hoehn-Saric, S. D. Imber, B. L. Liberman, & A. R. Stone (Eds.), Effective ingredients of successful psychotherapy. New York: Brunner/Mazel.

Lindgren, A., Werbart, A., & Philips, B. (2010). Long-term outcome and post-treatment effects of psychoanalytic psychotherapy with young adults. Psychology and Psychotherapy: Theory, Research and Practice, 83, 27–43.CrossRef

Lippe, A. L., von der Oddli, H. W., & Halvorsen, M. S. (2014, June). How do highly experienced therapists succeed with ‘difficult-to-treat’ clients? Paper presented at SPR-conference, Copenhagen.

Llewelyn, S. P. (1988). Psychological therapy as viewed by clients and therapists. British Journal of Clinical Psychology, 27, 223–237.CrossRefPubMed

Ludgate, J. W. (2009). Cognitive-behavioral therapy and relapse prevention for depression and anxiety. Sarasota, FL: Professional Resource Press.

Newman, M. G., Castonguay, L. G., Borcovec, T. D., Fisher, A. J., & Nordberg, S. S. (2008). An open trial of integrative therapy for generalized anxiety disorder. Psychotherapy, 45, 135–147.CrossRefPubMedPubMedCentral

Nissen-Lie, H. A., Rønnestad, M. H., Høglend P. A., Havik, O. E., Solbakken O. A., Stiles, T. C., & Monsen, J. T. (2015). Love yourself as a person, doubt yourself as a therapist? Clinical Psychology and Psychotherapy. doi:10.1002/cpp.1977.

Oettingen, G., Mayer, D., & Portnow, S. (2016). Pleasure now, pain later: Positive fantasies about the future predict symptoms of depression. Psychological Science. doi:10.1177/0956797615620783.PubMed

Orlinsky, D. E., & Howard, K. I. (1987). A generic model of psychotherapy. Journal of Integrative and Eclective Psychotherapy, 6, 6–27.

Orlinsky, D. E., Rønnestad, M. H., & Willutzki, U. (2004). Fifty years of psychotherapy process-outcome research: Continuity and change. In M. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (5th ed., pp. 307–389). New York: Wiley.

Paykel, E. S. (2008). Partial remission, residual symptoms, and relapse in depression. Dialogues in Clinical Neuroscience, 10, 431–437.PubMedPubMedCentral

Powers, M. B., Smits, J. A. J., Whitley, D., Bystritsky, A., & Telch, M. J. (2008). The effect of attributional processes concerning medication taking on return of fear. Journal of Consulting and Clinical Psychology, 76, 478–490.CrossRefPubMed

Rønnestad, M. H. (2009). An intensive process-out-come study of the interpersonal aspects of psychotherapy. Application for the Council of Research. Department of Psychology, University of Oslo. Retrieved from http://www.psykologi.uio.no/personer/vit/helgero_linker/process%20_outcome_study.Pdf.

Rønnestad, M. H., Gullestad, S. E., Halvorsen, M., Haavind, H., von der Lippe, A. L., … Reichelt, S. (2014). The outcomes of therapies conducted by highly experienced therapists. Paper presented at SPR-conference, Copenhagen.

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65, 98–109.CrossRefPubMed

Svanborg, C., Wistedt, A. Å., & Svanborg, P. (2008). Long-term outcome of patients with dysthymia and panic disorder: A naturalistic 9-year follow-up study. Nordic Journal of Psychiatry, 62, 17–24.CrossRefPubMed

Tang, T. Z., Derubies, R. J., Hollon, S. D., Amseterdam, J., & Shelton, R. (2007). Sudden gains in cognitive therapy of depression and depression relapse/recurrence. Journal of Consulting and Clinical Psychology, 75, 404–408.CrossRefPubMed

Town, J. M., Diener, M. J., Abbas, A., Leichsenring, F., Driessen, E., & Rabung, S. (2012). A meta-analysis of psychodynamic psychotherapy outcomes: Evaluating the effects of research-specific procedures. Psychotherapy, 49, 276–290.CrossRefPubMed

Ulberg, R., Høglend, P., Marble, A., & Sørbye, Ø (2009). From submission to autonomy: Approaching independent decision making. A single case study in a randomized controlled study of long-term effects of dynamic psychotherapy. American Journal of Psychotherapy, 63, 227–243.PubMed

Umpress, V. J., Lambert, M. J., Smart, D. W., Barlow, S. H., & Clouse, G. (1997). Concurrent and construct validity of the outcome questionnaire. Journal of Psychoeducational Assessment, 15, 40–55.CrossRef

Wampold, B. E. & Imel, Z. E. (2015). The great psychotherapy debate. The evidence for what makes psychotherapy work (2nd ed.). New York: Routledge.

Title: Exploring Associations Between Therapy Factors and Post-therapy Development After Naturalistic Psychotherapies
Authors: Vidar Blokhus Ekroll
Michael Helge Rønnestad
Publication date: 01-03-2018
Publisher: Springer US
Published in: Journal of Contemporary Psychotherapy / Issue 1/2018
Print ISSN: 0022-0116
Electronic ISSN: 1573-3564
DOI: https://doi.org/10.1007/s10879-017-9366-7

At a glance: The STEP trials

Springer Medicine

Exploring Associations Between Therapy Factors and Post-therapy Development After Naturalistic Psychotherapies

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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