If you want to get ahead, get a sequence of general strategies : integrative decision making in real-world psychoterapy

Abstract

The purpose of this dissertation was to analyse equivalent therapist's strategyrelated operations and patient's strategy-related change processes as they unfold and relate along the psychotherapeutic process as practiced in real world settings. Ideally, in order to optimize therapeutic responsiveness and effectiveness, therapist´s operations and patient´s processing abilities should proceed in tandem. Processing capacity was conceptualized as the productive use, by the patient, of strategy-related change processes or general psychological processes underlying skilful means to resolve life challenges. There were two research phases, both set within the framework of Paradigmatic Complementarity. The cross-sectional study used self-report data from therapists in real world practice, while the longitudinal study used observed data from 129 videotaped sessions of four patients of a single therapist. The findings from both studies suggest it is relevant to consider the sequencing of general strategies as a phase-by-phase map of the therapeutic process. First, strategyrelated therapist's operations and patient's change processes can be operationalized in a equivalent format and measured with acceptable reliability, for psychotherapy as practiced in the real-world. Second, the time patients need to show high levels of strategy-related change processes suggests general processing capacities take months to build up, rendering it less a moment-by-moment process. Third, strategy-related patient change seems to unfold sequentially according to a sequence of 3, 5 or 7 dimensions, thus providing sequential maps of intermediate outcomes before hitting termination. Fourth, these intermediate outcomes, predict changes in final outcome, making unique contributions over and above the therapeutic alliance, rendering them good enough vi candidates to stand as mechanisms of change common to any approach. Fifth and finally, decision-making by the therapist can be responsive to this macro developmental sequence influencing its unfolding and being influenced by it. Limitations and implications for real-world essentially integrative psychotherapy theory, research, practice and training are then discussed.

The purpose of this dissertation was to analyse equivalent therapist's strategyrelated operations and patient's strategy-related change processes as they unfold and relate along the psychotherapeutic process as practiced in real world settings. Ideally, in order to optimize therapeutic responsiveness and effectiveness, therapist´s operations and patient´s processing abilities should proceed in tandem. Processing capacity was conceptualized as the productive use, by the patient, of strategy-related change processes or general psychological processes underlying skilful means to resolve life challenges. There were two research phases, both set within the framework of Paradigmatic Complementarity. The cross-sectional study used self-report data from therapists in real world practice, while the longitudinal study used observed data from 129 videotaped sessions of four patients of a single therapist. The findings from both studies suggest it is relevant to consider the sequencing of general strategies as a phase-by-phase map of the therapeutic process. First, strategyrelated therapist's operations and patient's change processes can be operationalized in a equivalent format and measured with acceptable reliability, for psychotherapy as practiced in the real-world. Second, the time patients need to show high levels of strategy-related change processes suggests general processing capacities take months to build up, rendering it less a moment-by-moment process. Third, strategy-related patient change seems to unfold sequentially according to a sequence of 3, 5 or 7 dimensions, thus providing sequential maps of intermediate outcomes before hitting termination. Fourth, these intermediate outcomes, predict changes in final outcome, making unique contributions over and above the therapeutic alliance, rendering them good enough candidates to stand as mechanisms of change common to any approach. Fifth and finally, decision-making by the therapist can be responsive to this macro developmental sequence influencing its unfolding and being influenced by it. Limitations and implications for real-world essentially integrative psychotherapy theory, research, practice and training are then discussed.