The ups and downs of psychotherapy: Sudden gains and sudden losses identified with session reports

Abstract

Psychotherapy does not always follow a linear path. The present study explores the frequency of sudden gains and losses during the course of outpatient psychotherapy. The sample includes 1500 patients treated at three different outpatient centers. The patients were 57.4% female, and suffered primarily from anxiety and depressive disorders. Progress was measured by session reports. Significant sudden shifts in both directions were prevalent for 28.9% of the patients. Patients with early sudden gains showed the highest effect sizes and patients with sudden losses showed the smallest at the end of treatment. The therapeutic relationship was significantly better after the sudden gain sessions. Results suggest further investigation of the occurrence of sudden gains in relation to early response as well as further exploration of sudden losses during the course of treatment with respect to differential patterns of change and outcome.

Research on psychotherapy integration: Building on the past, looking to the future

“…Furthermore, we predict that a recent shift in clinical training will take a stronger hold in the near future: Outcome monitoring (Lambert, 2010;Lutz, Böhnke, & Köck, 2011;Lutz et al, 2013). Whereas traditional clinical training programs have focused predominantly on techniques and/or relational aspects of therapy, this new development comes with a stronger attention giving to individual client change (as measured by psychometric information) and with the provision of "on-time" feedback during the course of the treatment process-especially when patients do not make progress (Lambert, 2010).…”

Rapid Recovery with an Effective Therapist: A Comment on Hansen, Lambert, and Vlass

“…Early sudden gains reliably predict better outcomes than later sudden gains (Bentall, Fisher, Kelly, Bromley, & Hawksworth, 1989;Kelly et al, 2005;Lutz et al, 2013), emphasizing the need to more closely study very early gains to see if this adds predictive power.…”

Prozessfeedback in der Psychotherapie

“…B. Lutz et al 2013) oder passagere Krisen in der therapeutischen Beziehung ("crisis-repair sequences", z. B.…”

“…B. im Rahmen von Studien zum "ecological ambulatory assessment" im Abstand von wenigen Stunden, "time-sampling") oder bei Auftreten bestimmter Ereignisse (z. B. Stresserfahrungen, "event sampling"; EbnerPriemer und Trull 2009; Myin-Germeys et al 2003), oder -wie in Psychotherapiestudien üblich -im Rahmen von Therapiesitzungen (Lambert et al 2005;Lutz et al 2013). Eine dritte Strömung besteht im zunehmenden Interesse an der Funktionsweise komplexer, nichtlinearer Systeme (Gelo und Salvatore 2016;Haken und Schiepek 2006;Strunk und Schiepek 2006).…”