Patients' and Therapists' Actions on the Precipice of Change: Session Processes Before Sudden Gains and Sudden Losses

• Published in: Journal of psychotherapy integration 2021-09, Vol.31 (3), p.238-256
• Main Authors: Schilling, Viola N. L. S., Boyle, Kaitlyn S., Rubel, Julian A., Flückiger, Christoph, Zimmermann, Dirk, Lutz, Wolfgang
• Format: Article
• Language: English
• Subjects: Cognitive Behavior Therapy; Female; Human; Integrative Psychotherapy; Male; Outpatient; Psychotherapeutic Processes; Therapeutic Alliance; Treatment
• ISSN: 1053-0479; 1573-3696
• DOI: 10.1037/int0000242

In the present study, sessions prior to sudden gains, sudden losses, and neutral control sessions were examined regarding the processes of change resource activation, problem actuation and therapeutic alliance. With respect to these change processes, we examined whether pregain, preloss, and neutral sessions are distinguishable by particular patterns. For the current project, videos of 30 pregain, 29 preloss, and 30 neutral control sessions from n = 89 patients receiving integrative cognitive-behavioral therapy were rated minute-by-minute using Resource-Oriented Microprocess Analysis. The sample was drawn from a total of N = 365 patients, who had completed treatment or who had attended at least 20 sessions of therapy between the years of 2007 and 2011. Discriminant function and survival analyses as well as a binary logistic regression analysis were performed to identify patterns and timing of change processes associated with session types (gains, losses, and neutral sessions). The three session types differed with regard to patterns of resource activation and problem actuation. No difference concerning therapeutic alliance was found. The findings may help future studies to generate new hypotheses regarding processes that are involved in the occurrence of sudden changes. Acciones de los pacientes y los terapeutas en el precipicio de cambio: Procesos de sesión antes de ganancias y pérdidas repentinasEn el presente estudio, las sesiones previas a las ganancias repentinas, las pérdidas repentinas, y sesiones de control neutral se examinaron con respecto a los procesos de activación de los recursos de cambio, problema de activación y la alianza terapéutica. Con respecto a estos procesos de cambio, examinamos si las sesiones de pre-ganancia, pre-pérdida y sesiones neutrales se distinguen por patrones particulares. Para el proyecto actual, los videos de 30 pre-ganancia, 29 pre-pérdida, y 30 sesiones de control neutral de n 89 pacientes que recibieron terapia cognitivo-conductual integrativa fueron clasificadas minuto-a-minuto usando el análisis de microprocesos orientados a recursos (Resource-Oriented Microprocess Analysis). La muestra fue extraída de un total de N 365 pacientes, que habían completado el tratamiento o que habían asistió a por lo menos 20 sesiones de terapia entre los años 2007 y 2011. Análisis de función discriminante y de supervivencia, así como un análisis de regresión logística binaria se realizaron para identificar los patrones y sincronizaci