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Capturing and studying the moments in psychotherapy that clients find most important can help us understand more about how psychotherapy works, what the curative ingredients are, and by what processes they are mediated. Qualitative research in this area has, so far, mainly focused on describing, and categorizing clients’ experiences of important factors and events. The methods employed to analyse the data have been rather limited in variation and are usually based on a realist epistemology, according to which data are basically treated as reflections of the clients’ actual experiences. This entails a risk of overlooking and obscuring other aspects of therapy and the therapy process that are equally important to explore, for example the microprocesses of interaction within important events, or how clients’ accounts of their experiences are shaped and limited by the context in which they are produced. The overall aim of this licentiate thesis was to explore client-identified important events in psychotherapy with a focus on studying therapy talk and talk about therapy from a social constructionist point of view, which would allow a closer exploration of the understudied areas mentioned above. In Study I, Conversation Analysis was used to explore the interaction taking place between seven client-therapist dyads in 16 client-identified important events collected from their third sessions. The analysis identified that 12 of the events contained clients’ expressions of disagreement. Three different ways that the therapists handled the disagreement were discerned: The first, and most common, way was to orient to the client’s cues of disagreement by inviting the client to elaborate on his or her point of view and to establish a shared understanding acceptable to both participants. The second way was to orient to the client’s disagreement cues but define the therapist’s own point view as more relevant than the client’s, and the third way was a single case in which the therapist did not in any way orient to the client’s disagreement cues. In Study II, two qualitative methods based on different epistemologies were used to analyse the same set of eight clients’ accounts of 18 important events. The aim was to first identify what types of events clients describe as important, and then explore how their accounts of these events were contextually shaped and  organized, and the consequences of this. The first analysis, a content analysis, yielded descriptions of five different types of events, which were similar to the ones found in previous research on important events. The second analysis, a discourse analysis, demonstrated how clients’ accounts were not only influenced by the participants’ ability to accurately remember and report their experience, but also by what was sayable within the context of the research interview. In conclusion, the two studies demonstrate how qualitative methods based on a socialconstructive perspective can contribute to our understanding of clientidentified important events by highlighting and describing participants’ use of language in interaction, and its forms and  functions within therapy sessions and in research interviews. The findings point out the need to broaden the range of qualitative methods used in psychotherapy research in general and indicate the potential value of methods like CA and DA to psychotherapy process research and research on important events in particular.

Currently, there is a limited understanding of change mechanisms across all treatment approaches for eating disorders (ED), particularly with regard to group psychotherapy. This presents one of the major obstacles in the development of more effective treatments. The purpose of this study was to extend current understanding of therapeutic processes in group psychotherapy for bulimic disorders. Thirty-one women were randomly assigned to either 16-weeks of Emotion-Focused Therapy (EFT) or Motivation/Education and Skill Building (M/ESB) as part another study at a participating outpatient ED program. The goals of this study were to: (1) evaluate the relationship between in-session processes; (2) compare these processes between two group treatments; (3) examine in-session differences as a function of client activity in group EFT; (4) and identify a pathway to change. As expected, the findings demonstrated that mid therapy emotional arousal was associated with higher levels of insight, and an increase in insight overtime was associated with an increase in therapeutic alliance. Arousal was not positively correlated with alliance. There was a significant interaction between group treatment x time: clients in EFT reported gains in insight overtime, as measured by post-session change measure, whereas clients’ scores in M/ESB did not change over the course of psychotherapy. Alliance increased significantly over the course of therapy in both groups. Contrary to expectations, clients in the EFT group did not report higher levels of arousal compared to the M/ESB group. The limited sample size in the control group precludes firm conclusions about group comparisons. When examining client activity within EFT, the results demonstrated that clients that were actively engaged in the chair-tasks reported higher post-session change scores, arousal, and alliance compared to when they were in the observing role; however, there was a significant upward trend on post-session change scores regardless of the client role. The pathway to change was partially supported: the observer-rated degree of resolution scores predicted a third of variance in post-session change scores; controlling for pre-treatment outcome scores, post-session change scores predicted variance at the outcome on several EDI-3 subscales. These preliminary findings are discussed in the context of psychotherapy process literature, highlighting limitations and future directions.

Currently, there is a limited understanding of change mechanisms across all treatment approaches for eating disorders (ED), particularly with regard to group psychotherapy. This presents one of the major obstacles in the development of more effective treatments. The purpose of this study was to extend current understanding of therapeutic processes in group psychotherapy for bulimic disorders. Thirty-one women were randomly assigned to either 16-weeks of Emotion-Focused Therapy (EFT) or Motivation/Education and Skill Building (M/ESB) as part another study at a participating outpatient ED program. The goals of this study were to: (1) evaluate the relationship between in-session processes; (2) compare these processes between two group treatments; (3) examine in-session differences as a function of client activity in group EFT; (4) and identify a pathway to change. As expected, the findings demonstrated that mid therapy emotional arousal was associated with higher levels of insight, and an increase in insight overtime was associated with an increase in therapeutic alliance. Arousal was not positively correlated with alliance. There was a significant interaction between group treatment x time: clients in EFT reported gains in insight overtime, as measured by post-session change measure, whereas clients’ scores in M/ESB did not change over the course of psychotherapy. Alliance increased significantly over the course of therapy in both groups. Contrary to expectations, clients in the EFT group did not report higher levels of arousal compared to the M/ESB group. The limited sample size in the control group precludes firm conclusions about group comparisons. When examining client activity within EFT, the results demonstrated that clients that were actively engaged in the chair-tasks reported higher post-session change scores, arousal, and alliance compared to when they were in the observing role; however, there was a significant upward trend on post-session change scores regardless of the client role. The pathway to change was partially supported: the observer-rated degree of resolution scores predicted a third of variance in post-session change scores; controlling for pre-treatment outcome scores, post-session change scores predicted variance at the outcome on several EDI-3 subscales. These preliminary findings are discussed in the context of psychotherapy process literature, highlighting limitations and future directions.

Thesis (Ph. D.)--Miami University, Dept. of Psychology, 2006. / Title from second page of PDF document. Includes bibliographical references (p. 201-210).

Thesis (M.A.)--Miami University, Dept. of Psychology, 2004. / Title from first page of PDF document. Includes bibliographical references (p. 37-46).

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