Abstract
Earlier research on what contributes to long-term outcome after psychotherapy is scarce and scattered. Responding to this, the current study explores potential associations between therapy factors reported as salient by clients in naturalistic psychotherapy and variation in post-therapy-movement. Material from different codes and categories derived from an earlier content analysis was explored in relation to post-therapy-changes on OQ-45. In the first part of the study, two overarching themes (relational aspects and therapeutic operations) were included in a regression analysis of data from 32 clients. In the second part, more nuanced associations between material from different change- or process categories and post-therapy-movement were explored using data from 20 clients that showed reliable improvement at treatment termination but varied in later development. Reports of material related to relational aspects were recurrently associated with post-therapy improvement. Material suggesting that therapy was experienced as not fully complete (e.g., changes being superficial or wish for more treatment), as well as reports of more positive affect, correlated with later deterioration after improvement at termination. Different processes and changes appreciated by clients during therapy seem to vary as predictors of lasting gains.
Similar content being viewed by others
References
Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research and Practice, 16, 252–260.
Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17–31.
Cresswell, J. W., & Clark, V. L. P. (2007). Designing and conducting mixed methods research. Thousand Oaks: Sage Publications.
Crits-Christoph, P., Connolly Gibbons, M., & Mukherjee, D. (2013). Process outcome research. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavioral change (6th ed., pp. 298–340). New York, NY: Wiley.
Cuijpers, P. (2016). The future of psychotherapy research: Stop the waste and focus on issues that matter. Epidemiology and Psychiatric Sciences, 25, 291–294.
DeRubeis, R. J., Siegle, G. J., & Hollon, S. D. (2008). Cognitive therapy versus medication for depression: Treatment outcomes and neural mechanisms. Nature Reviews. Neuroscience, 9, 788–796.
Doss, B. D. (2004). Changing the way we study change in psychotherapy. Clinical Psychology: Science and Practice, 11, 368–386.
Durham, R. C., Chambers, J. A., Power, K. G., Sharp, D. M., Macdonald, R. R., Major, K. A., … Gumley, A. L. (2005). Long-term outcome of cognitive behavior therapy clinical trials in central Scotland. Health Technology Assessment, 9(42), 1–174
Ekroll, V. B., & Rønnestad, M. H. (2016). Processes and changes experienced by clients during and after naturalistic good-outcome therapies conducted by experienced psychotherapists. Psychotherapy Research, 27, 450–468.
Elliott, R., Greenberg, L. S., Watson, J., Timulak, L., & Freire, E. (2013). Research on humanistic-experiential psychotherapies. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavioral change (6th ed., pp. 219–257). New York, NY: Wiley.
Falkenström, F., Grant, J., Broberg, J., & Sandell, R. (2007). Self-analysis and post- termination improvement after psychoanalysis and long-term psychotherapy. Journal of the American Psychoanalytic Association, 55, 629–674.
Glaser, B. G., & Strauss, A. L. (1967/2006). The discovery of grounded theory: Strategies for qualitative research. New Brunswick, NJ: Aldine Transaction.
Heinonen, E., Knekt, P., Jääskeläinen, T., & Lindfors, O. (2014). Therapists’ professional and personal characteristics as predictors of outcome in long-term psychodynamic psychotherapy and psychoanalysis. European Psychiatry, 29, 265–274.
Hersoug, A. G., Høglend, P., Gabbard, G. O., & Lorentzen, S. (2013). The combined predictive effect of patient characteristics and alliance on long-term dynamic and interpersonal functioning after dynamic psychotherapy. Clinical Psychology and Psychotherapy, 20, 297–307.
Høglend, P. (2003). Long-term effects of brief dynamic psychotherapy. Psychotherapy Research, 13, 271–292.
Høglend, P., Dahl, H.-S., Hersoug, A. G., Lorentzen, S., & Perry, J. C. (2011). Long-term effects of transference interpretation in dynamic psychotherapy of personality disorders. European Psychiatry, 26, 419–424.
Hollon, D. H., Stewart, M. O., & Strunk, D. (2006). Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety. Annual Review of Psychology, 57, 285–315.
Imel, Z. E., Malterer, M. B., McKay, K. M., & Wampold, B. E. (2008). A meta-analysis of psychotherapy and medication in unipolar depression and dysthymia. Journal of Affective Disorders, 110, 197–206.
Kivlighan, D. M. III, Goldberg, S. B., Abbas, M., Pace, B. T., Yulisha, N. E., Thomas, J. G., … Wampold, B. E. (2015). The enduring effects of psychodynamic treatments vis- à-vis alternative treatments: A multilevel longitudinal meta-analysis. Clinical Psychology Review, 40, 1–14.
Knekt, P., Lindfors, O., Sares-Jäske, L., Virtala, E., & Härkänen, T. (2013). Randomized trial on the effectiveness of long- and short-term psychotherapy on psychiatric symptoms and working ability during a 5-year follow-up. Nordic Journal of Psychiatry, 67, 59–68.
Lambert, M. J., Burlingame, G. M., Umphress, V., Hansen, N. B., Vermeersch, D. A., Clouse, G. C., & Yanchar, S. C. (1996a). The reliability and validity of the Outcome Questionnaire. Clinical Psychology and Psychotherapy, 3, 249–258.
Lambert, M. J., Hansen, N. B., Umphress, V., Lunnen, K., Okiishi, J., Burlingame, G. M., & Reisinger, C. W. (1996b). Administration and scoring manual for the OQ-45.2. East Setauket, NY: American Professional Credentialing Services.
Leichsenring, F., & Leibing, E. (2003). The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: A meta- analysis. American Journal of Psychiatry, 160, 1223-1232-.
Leichsenring, F., Salzer, D., Beutler, M., Herpertz, S., Hiller, W., Hoyer, J., … Leibing, E. (2014). Long-term outcome of psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder. American Journal of Psychiatry, 171, 1074–1082.
Liberman, B. L. (1978). The role of mastery in psychotherapy: Maintenance of improvement and prescriptive change. In J. D. Frank, R. Hoehn-Saric, S. D. Imber, B. L. Liberman, & A. R. Stone (Eds.), Effective ingredients of successful psychotherapy. New York: Brunner/Mazel.
Lindgren, A., Werbart, A., & Philips, B. (2010). Long-term outcome and post-treatment effects of psychoanalytic psychotherapy with young adults. Psychology and Psychotherapy: Theory, Research and Practice, 83, 27–43.
Lippe, A. L., von der Oddli, H. W., & Halvorsen, M. S. (2014, June). How do highly experienced therapists succeed with ‘difficult-to-treat’ clients? Paper presented at SPR-conference, Copenhagen.
Llewelyn, S. P. (1988). Psychological therapy as viewed by clients and therapists. British Journal of Clinical Psychology, 27, 223–237.
Ludgate, J. W. (2009). Cognitive-behavioral therapy and relapse prevention for depression and anxiety. Sarasota, FL: Professional Resource Press.
Newman, M. G., Castonguay, L. G., Borcovec, T. D., Fisher, A. J., & Nordberg, S. S. (2008). An open trial of integrative therapy for generalized anxiety disorder. Psychotherapy, 45, 135–147.
Nissen-Lie, H. A., Rønnestad, M. H., Høglend P. A., Havik, O. E., Solbakken O. A., Stiles, T. C., & Monsen, J. T. (2015). Love yourself as a person, doubt yourself as a therapist? Clinical Psychology and Psychotherapy. doi:10.1002/cpp.1977.
Oettingen, G., Mayer, D., & Portnow, S. (2016). Pleasure now, pain later: Positive fantasies about the future predict symptoms of depression. Psychological Science. doi:10.1177/0956797615620783.
Orlinsky, D. E., & Howard, K. I. (1987). A generic model of psychotherapy. Journal of Integrative and Eclective Psychotherapy, 6, 6–27.
Orlinsky, D. E., Rønnestad, M. H., & Willutzki, U. (2004). Fifty years of psychotherapy process-outcome research: Continuity and change. In M. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (5th ed., pp. 307–389). New York: Wiley.
Paykel, E. S. (2008). Partial remission, residual symptoms, and relapse in depression. Dialogues in Clinical Neuroscience, 10, 431–437.
Powers, M. B., Smits, J. A. J., Whitley, D., Bystritsky, A., & Telch, M. J. (2008). The effect of attributional processes concerning medication taking on return of fear. Journal of Consulting and Clinical Psychology, 76, 478–490.
Rønnestad, M. H. (2009). An intensive process-out-come study of the interpersonal aspects of psychotherapy. Application for the Council of Research. Department of Psychology, University of Oslo. Retrieved from http://www.psykologi.uio.no/personer/vit/helgero_linker/process%20_outcome_study.Pdf.
Rønnestad, M. H., Gullestad, S. E., Halvorsen, M., Haavind, H., von der Lippe, A. L., … Reichelt, S. (2014). The outcomes of therapies conducted by highly experienced therapists. Paper presented at SPR-conference, Copenhagen.
Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65, 98–109.
Svanborg, C., Wistedt, A. Å., & Svanborg, P. (2008). Long-term outcome of patients with dysthymia and panic disorder: A naturalistic 9-year follow-up study. Nordic Journal of Psychiatry, 62, 17–24.
Tang, T. Z., Derubies, R. J., Hollon, S. D., Amseterdam, J., & Shelton, R. (2007). Sudden gains in cognitive therapy of depression and depression relapse/recurrence. Journal of Consulting and Clinical Psychology, 75, 404–408.
Town, J. M., Diener, M. J., Abbas, A., Leichsenring, F., Driessen, E., & Rabung, S. (2012). A meta-analysis of psychodynamic psychotherapy outcomes: Evaluating the effects of research-specific procedures. Psychotherapy, 49, 276–290.
Ulberg, R., Høglend, P., Marble, A., & Sørbye, Ø (2009). From submission to autonomy: Approaching independent decision making. A single case study in a randomized controlled study of long-term effects of dynamic psychotherapy. American Journal of Psychotherapy, 63, 227–243.
Umpress, V. J., Lambert, M. J., Smart, D. W., Barlow, S. H., & Clouse, G. (1997). Concurrent and construct validity of the outcome questionnaire. Journal of Psychoeducational Assessment, 15, 40–55.
Wampold, B. E. & Imel, Z. E. (2015). The great psychotherapy debate. The evidence for what makes psychotherapy work (2nd ed.). New York: Routledge.
Acknowledgements
This study was supported by “The National Program for Integrated Clinical Specialist and PhD-training for Psychologists” in Norway. This program is a joint cooperation between the Universities of Bergen, Oslo, Tromsø, The Norwegian University of Science and Technology (Trondheim), the Regional Health Authorities, and the Norwegian Psychological Association. The program is funded jointly by The Ministry of Education and Research and The Ministry of Health and Care Services.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosure
The authors have no financial interest or benefit arising from the direct applications of this research.
Rights and permissions
About this article
Cite this article
Ekroll, V.B., Rønnestad, M.H. Exploring Associations Between Therapy Factors and Post-therapy Development After Naturalistic Psychotherapies. J Contemp Psychother 48, 15–25 (2018). https://doi.org/10.1007/s10879-017-9366-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10879-017-9366-7