How do people change during psychotherapy – the clients’ perspective

Presumably the goal of psychotherapy is some kind of psychological change for the better, but what is that change and how does it happen? Psychological models refer to such things as 'stages of change' and assimilation, but few researchers have sought the views of clients who have undergone therapy.

Tim Carey and colleagues conducted loosely structured, hour-long interviews with 18 women and 9 men who had completed an average of six sessions of cognitive-based psychotherapy (either Method of Levels or CBT) for conditions like depression, anxiety or addiction.

The 22 participants who said they had changed during therapy were unable to come up with a definition of psychological change, but they described their experience in terms of acceptance, behavioural changes, new beginnings and a return to positive emotional states.

Accounts of when change occurred tended to be paradoxical – the participants talked of a gradual process that occurred at an identifiable moment. "It was gradual but the realisation was sudden,' one client said.

Many of the participants could remember the exact moment they became aware a change had occurred: "I could actually hear it," one participant said; others spoke of their surroundings: "I was in the pool with my husband."

The clients' descriptions of how change occurred fell into six themes: motivation and readiness ("I was desperate to get back to my old self"); tools and strategies ("It's the changes in behaviour that I learned"); learning ("I would take a lot of stuff home to read about assertiveness"); interaction with therapist ("…they don't judge your character or think they know you"); perceived aspects of self ("I am a strong person mentally"); and the relief of talking ("Let me get everything out, let me relieve myself of everything").

The researchers said that while many of these insights are not new – for example they point to factors identified as crucial by psychologists like the importance of the therapeutic alliance and readiness to change – what is new is that "these descriptions have come from the people experiencing the change rather than other sources, and the descriptions were not guided by assumptions about any particular stages of change model."

References

Carey, T.A., Carey, M., Stalker, K., Mullan, R.J., Murray, L.K. & Spratt, M.B. (2007). Psychological change from the inside looking out: A qualitative investigation. Counselling and Psychotherapy Research, 7, 178-187.