Trajectories of Change in Psychotherapy

Owen, Jesse; Adelson, Jill L.; Budge, Stephanie L.; Wampold, Bruce E.; Kopta, Mark; Minami, Takuya; Miller, Scott D.

doi:10.1002/jclp.22191

Cited by 81 publications

(92 citation statements)

References 31 publications

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“…Research comparing stepped with usual or stratified‐care models has reported differential benefits of stepped‐care models which are likely influenced by service quality (Bower & Gilbody, ; Firth, Barkham, & Kellett, ; van Straten et al, ), a finding which may have been replicated here. Assuming the psychotherapeutic dose‐effect literature is accurate (Owen et al, ), clinical outcomes may have been affected by a higher level of engagement at Service A, in keeping with previous findings (Clark et al, ).…”

Section: Discussionsupporting

confidence: 80%

A naturalistic pilot study assessing the impact of assessment pathways and intake methods within Improving Access to Psychological Therapies services

Steen

Hemmings²,

Foster³

et al. 2019

Couns and Psychother Res

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Fast access pathways characterise many Improving Access to Psychological Therapy (IAPT) services, allowing them to see increasing numbers of referrals year on year. At the same time, emerging research is highlighting potential care inefficiencies, including early treatment disengagement, inappropriate treatment allocation, less than optimal clinical outcomes, and repeat referrals. Integrating more stratified models based on in‐depth and comprehensive assessment techniques which include some therapeutic input could help better target interventions. This could lead to improved engagement and clinical outcomes, while also providing enough therapeutic support to those attending one session only. This pilot study assesses the impact of assessment pathways and intake methods involving a 90‐min face‐to‐face therapeutic consultation, compared with a 45‐min over‐the‐phone assessment session across two IAPT providers in the south of England, and three assessment pathways involving elements of either method and service. Using an observational analysis of routinely collected data across 12 months, intake scores, attendance data and clinical measures of reliable recovery and improvement were considered. The comparisons of intake method reported no significant differences when both services were included; however, there were significant differences in treatment effect sizes and session attendance on an assessment pathway basis. Where assessment sessions were delivered, there was a higher rate of disengagement between sessions one and two, indicating increased attrition. Based on the initial findings and supporting literature, there appears to great promise in exploring pathway modelling and intake processes within IAPT services.

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Section: Discussionsupporting

confidence: 80%

A naturalistic pilot study assessing the impact of assessment pathways and intake methods within Improving Access to Psychological Therapies services

Steen

Hemmings²,

Foster³

et al. 2019

Couns and Psychother Res

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show abstract

“…Beyond this significant problem, there were few attempts to capture more complex forms of change in mechanisms or outcomes (Tryon 2005). Sudden gains are observed in PTSS treatment (Aderka et al 2011;Krüger et al 2014), and beneficial change in psychotherapy overall seems to cluster at the start and towards the end of treatment (Owen et al 2015), suggesting uneven change trajectories.…”

Section: Methodological Issues In Included Studiesmentioning

confidence: 99%

Mechanisms of change in psychological interventions for posttraumatic stress symptoms: A systematic review with recommendations

Kangaslampi

Peltonen

2019

Curr Psychol

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Psychological interventions can alleviate posttraumatic stress symptoms (PTSS). However, further development of treatment approaches calls for understanding the mechanisms of change through which diverse interventions affect PTSS. We systematically searched the literature for controlled studies of mechanisms of change in psychological interventions for PTSS. We aimed to detect all empirically studied mechanisms and evaluate the level of evidence for their role in the alleviation of PTSS. We identified 34 studies, of which nine were among children. We found evidence for improvements in maladaptive posttraumatic cognitions as a general mechanism of change involved in diverse interventions, among both adults and children. We also found some preliminary evidence for increases in mindfulness as a mechanism of change in mindfulness-and spiritually-oriented interventions among adults. We found scant, mixed empirical evidence for other mechanisms of change. Notably, studies on changes in traumatic memories as a mechanism of change were lacking, despite clinical emphasis on their importance. A major limitation across reviewed studies was that most could not establish temporal order of changes in mechanisms and PTSS. Including thorough analyses of mechanisms of change beyond cognitions in all future trials and improving the reporting of findings would aid the development and implementation of even more effective interventions.

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“…In this paper, we bring together three threads in the psychotherapy outcome literature, that of trajectories of change (Owen et al, ), practice‐based research (Henton, ), and contemporary relational psychotherapy (CRP; e.g., DeYoung, ). In doing so, we address the need to examine the effectiveness of psychodynamic treatment beyond the efficacy evidence offered by randomized clinical trials (RCTs; Fonagy, ), and we respond to calls for theory‐driven research on psychoanalytic therapies by testing a theoretical premise of CRP (Luyten, Blatt, & Mayes, ).…”

Section: Introductionmentioning

confidence: 99%

Latent trajectories of change for clients at a psychodynamic training clinic

et al. 2019

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Objective Employing practice‐based research methods, we addressed the need to examine the effectiveness of psychodynamic treatment as a supplement to the efficacy evidence offered by randomized clinical trials. Method We used person‐centered analyses to generate latent subgroups of clients (N = 118; M age = 40.92; 53.4% female; 81.4% Caucasian; 80.5% heterosexual) receiving contemporary relational psychotherapy (CRP) at a psychodynamic community mental health training clinic. Results Subgroups of clients reported a change in depression, social conflict, and anxiety symptomatology, and overall life satisfaction, depicted by significant quadratic growth curves. Findings also offered exploratory support for a theoretical proposition from CRP that improved relational functioning would correspond to improved affect dysregulation and overall life satisfaction. Conclusion Clinical and training implications highlight the need to distinguish subgroups of “responders” and “nonresponders” to inform treatment.

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Trajectories of Change in Psychotherapy

Abstract: The trajectories of change for clients are diverse, and they can ebb and flow more than traditional dose-effect and good-enough level models may suggest.

Cited by 81 publications

References 31 publications

A naturalistic pilot study assessing the impact of assessment pathways and intake methods within Improving Access to Psychological Therapies services

A naturalistic pilot study assessing the impact of assessment pathways and intake methods within Improving Access to Psychological Therapies services

Mechanisms of change in psychological interventions for posttraumatic stress symptoms: A systematic review with recommendations

Latent trajectories of change for clients at a psychodynamic training clinic

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