A phase model of psychotherapy outcome: Causal mediation of change.

Abstract

A 3-phase model of psychotherapy outcome is proposed that entails progressive improvement of subjectively experienced well-being, reduction in symptomatology, and enhancement of life functioning. The model also predicts that movement into a later phase of treatment depends on whether progress has been made in an earlier phase. Thus, clinical improvement in subjective well-being potentiates symptomatic improvement, and clinical reduction in symptomatic distress potentiates life-functioning improvement. A large sample of psychotherapy patients provided self-reports of subjective well-being, symptomatic distress, and life functioning before beginning individual psychotherapy and after Sessions 2, 4, and 17 when possible. Changes in well-being, symptomatic distress, and life functioning means over this period were consistent with the 3-phase model. Measures of patient status on these 3 variables were converted into dichotomous improvement-nonimprovement scores between intake and each of Sessions 2, 4, and 17. An analysis of 2 x 2 cross-classification tables generated from these dichotomous measures suggested that improvement in well-being precedes and is a probabilistically necessary condition for reduction in symptomatic distress and that symptomatic improvement precedes and is a probabilistically necessary condition for improvement in life functioning.

Participation Patterns Among Mexican–American Parents Enrolled in a Universal Intervention and Their Association with Child Externalizing Outcomes

“…A reasonable expectation is children of parents who attend less frequently will have worse outcomes than will children of parents who attend more frequently. However, consistent with treatment literature suggesting clients may prematurely end treatment because they are satisfied with progress (Howard, Lueger, Maling, & Martinovich, 1993), perhaps some parents stop attending because they observe positive behavioral changes in their child and feel they have reaped all potential intervention benefits.…”

Investigation of the Phase Model of Psychotherapy Across Therapeutic Orientations: Are Different Approaches Actually All That Different?

“…Given the need for comprehensive explanations of the process of psychotherapy, a number of theoretical models have been proposed. The most notable and relevant for the current study is the phase model of psychotherapy (Howard, Lueger, Maling & Martinovich, 1993). Before expanding upon the relevance and importance of this model, it is important to provide some background and context to the formulation of the phase model of psychotherapy.…”

“…Essentially, this concept can be summarized by highlighting the importance of the therapist demonstrating their ability to help the client early in psychotherapy and is thus akin to the establishment of hope or remoralization described in the phase model. The phase following remoralization is known as remediation and is primarily concerned with the abatement and lessening of symptoms or direct manifestations of the client's current distress and life problems (Howard et al, 1993). This phase has been varyingly conceptualized as the period during which cognitive and interpersonal strategies are utilized to enhance functioning and ameliorate distress (Schwartz, 1997;Stulz & Lutz, 2007).…”

“…Each of these models has contributed to the understanding of the mechanisms underlying the process of therapy, however the most notable and relevant model for the current study is the phase model of psychotherapy (Howard, Lueger, Maling & Martinovich, 1993) The Phase Model…”

“…The phase model of psychotherapy (Howard et al, 1993) posits that individuals move through three sequential phases during successful psychotherapy: remoralization, remediation and rehabilitation. The first of these phases, remoralization, refers to an increase in the individual's subjective feelings of hope that psychotherapy will be of assistance in overcoming present difficulties.…”