First- and Second-Order Change: Implications for Rationalist and Constructivist Cognitive Therapies

Inquiry into the nature and process of change is fundamental to the domains of counseling and psychotherapy. Particularly relevant to counselors is an understanding of the distinction between first- and second-order change. This article clarifies the distinction and suggests a relationship between these two types of change and Mahoney's (1988) recent metatheoretical contrast between rationalist and constructivist approaches to counseling. Specifically, it is proposed that rationalist approaches are guided by first-order assumptions about change whereas constructivist approaches are based on second-order principles and processes. Within this context, a number of implications for the counseling practitioner are discussed.     

Virginia Satir's Process of Change

SUMMARY

This article describes Virginia Satir's theoretical base out of which grows the theory and practice of her process of change in psychotherapy. Her theory is set in a context of other psychothcrupeulic theories and is described with case examples of application. Virginia's process of change is applied to individual, couple and family therapy particularly its application to cultural change is discussed.     

Exploring How Parents Make Sense of Change in Parent-Child Psychotherapy

Understanding how change occurs in psychotherapy is imperative in informing clinical practice. Increasing attention has been given to the role that qualitative research could play in enhancing our understanding of therapeutic change. Although quantitative research suggests that parent-child psychotherapy is effective in facilitating change, no research to date has focused on how parents make sense of their change experience. In this study, interpretative phenomenological analysis was used to analyze semi-structured interviews of eight parents who had completed parent-child psychotherapy about their understanding of change. Five master themes emerged that encapsulated participants’ understanding of change. These included constructing a survivor narrative, the experience of being understood enabling further understanding, adjusting expectations and practicing acceptance, and feeling empowered to relinquish control. The final theme summarized how despite psychotherapy being conceptualized as a “precious” resource, there was a sense that its limitations could negatively impact participant’s well-being.     

Integrating clients' moment‐to‐moment ratings into psychotherapy research: A novel approach

Counselling and psychotherapy researchers have considerably advanced the field's understanding of psychotherapy processes and how they relate to treatment outcomes. Despite these advances, little is known about the client's perspective of changes in psychotherapy processes that occur throughout a given session (i.e. micro‐processes). To address this gap, this article describes the novel application of methods that assess participants' moment‐to‐moment ratings to psychotherapy research. This method entails recording psychotherapy session content that clients and other potential raters (e.g. therapists, researchers) later review while simultaneously providing continuous ratings of psychotherapy processes (e.g. helpfulness, alliance). In addition, moment‐to‐moment ratings can facilitate significant events research by prompting researchers to elicit client feedback about the moments that are rated the most and least positively. However, few studies have used these methods in the context of psychotherapy research. Studies incorporating these methods may yield findings that advance psychotherapy research, training efforts and clinical practice. For example, studies may examine how the magnitude and timing of clients' moment‐to‐moment ratings of psychotherapy processes are associated with treatment outcomes, therapist ratings and physiological processes (e.g. heart rate variability). Trainee therapists and their supervisors may also use clients' moment‐to‐moment ratings to facilitate attunement to verbal and non‐verbal indicators of moments perceived more positively and negatively. Last, these methods can produce findings that are highly relevant to clinical practice, where therapists routinely navigate fluctuations in psychotherapy processes (e.g. alliance ruptures) that can be assessed using moment‐to‐moment ratings.     

The construction of emotional experience: State‐related emotional awareness and its application to psychotherapy research and practice

The cognitive–developmental theory of ‘levels of emotional awareness’ (LEA) addresses an individual's capacity to experience and express emotion, a capacity highly relevant to psychotherapy. Previous papers on LEA and psychotherapy addressed the aspect of LEA theory pertaining to the ‘trait’ (i.e. enduring) aspects of an individual's emotional functioning over time. LEA theory also applies to the construction of emotional experience at any given moment, in which levels emerge or disappear in a process of microgenetic construction as a function of arousal and other variables. This state‐related perspective is supported by recent research showing that people vary in their LEA from moment to moment. Momentary changes in LEA correspond to the variations in lived experience that occur in relationships, including the therapy relationship, and provide the context for corrective emotional experiences that promote change. In this paper, the construction of emotional experience at different levels of organisation is discussed separately in relation to clients and therapists. Key phenomena relevant to psychotherapy include the transition from bodily sensations to specific differentiated emotional feelings, the ability to be aware of multiple feelings that may be contradictory or counter‐intuitive, and the appreciation of how complex combinations of feelings may differ in self and other. This perspective adds to the literature on how the integration of emotion and cognition contributes to change in psychotherapy. The clinical and research implications of this perspective are discussed.     

The role of the body as the medium in child psychotherapy: snapshots of therapy with an 11-year-old,severely abused,multiply placed girl

In Victoria, Australia, children with a history of abuse and severe attachment difficulties, and who have experienced multiple carers and placements, have been traditionally viewed by mental health services as unsuitable for psychoanalytic psychotherapy. A number of factors, including the lack of integrated, long-term case planning; unstable residential placement; and the belief that psychotherapeutic treatment will be of an extended duration, have influenced the decision not to provide individual psychotherapy for these children. Currently, the movement within mental health services is towards responsive and briefer treatment models. The child psychotherapist is challenged to re-think theory, technique and practice. This paper identifies contextual constraints that have led to these children being precluded from accessing psychotherapy. An alternative model of intervention is discussed and illustrated with clinical material. The contributions of Alvarez, Trevarthen, Schore and other writers are drawn on to underpin the clinical work. This model involves a change in technique and role and the use of a time-limited intervention. Intrinsic to the model is the understanding of the child's psycho-biological experience of trauma and disrupted attachment. The child's experiences are conveyed in the pre-verbal, gestural domain to enable history to be given voice.     

The Future of Psychotherapy and the Expanding Universe or Michael J. Mahoney

Human Change Processes (Mahoney, 1991) is an attempt to set experiential psychotherapy on a scientific basis. The first tow-thirds of the book, based on an extensive survey of diverse scientific and scholarly literatures, argues fairly convincingly for a conception of human beings in which attachment, subjectivity, emergent and unconscious mental processes-especially regarding the self-and emotionality are central to human development and psychotherapeutic change. The book's last part, a discussion of experiential psychotherapy, based largely on clinical experience and intuition, is vague on important points of psychotherapeutic procedure ad process and is less convincing. The disjunction between the scientific discussion of psychology and the non-scientific discussion of psychotherapy is the book's major flaw. Nevertheless, the book is important as an attempt to synthesize a psychotherapy that is at once humanistic and scientifically informed.     

Using the Delphi Technique: Experience from the world of counselling and psychotherapy

Background: Delphi studies have been popular in the health and social care domain for some time, particularly within nursing. They are used to elicit views and opinions from experts in the field on specific topics, without the need for face‐to‐face interviews. Focus: This paper brings Delphi methodology to the attention of potential researchers in the counselling and psychotherapy field, who may not have previously considered Delphi methodology, describing the researcher's experience of using a Delphi study through the media of electronic mail, and incorporating participant feedback. Aims: To discuss the advantages and disadvantages, as well as the complexities and limitations of the Delphi methodology. I will outline previous recommendations from Delphi researchers and offer further suggestions based on my experience of completing a Delphi study.     

Self-Confrontation and Confrontation With Another as Determinants of Long-Term Value Change1

An experiment was carried out to determine whether attempts to change values would be less successful under conditions of confrontation with a significant other than under conditions of private self-confrontation. Rokeach's value change procedure was used to induce self-dissatisfaction in two experimcntal groups, one under anonymous conditions and the other under non-anonymous, face-to-face interaction with the experimenter. The rcsults confirm previously reported findings that significant long-term changes in values can be brought about by inducing feelings of self-dissatisfaction about contradictions within one's value-attitude system. The findings also showed that changes in equality and freedom 8 to 9 weeks after the experiment were equally great under both anonymous and non-anonymous conditions compared with a control condition. The results are discussed especially in relation to their practical implications for psychotherapy.     

Change process in systemic therapy: A qualitative investigation

This study addresses the process of therapeutic change in individuals who received systemic therapy. This study is an exploratory qualitative study based on the client's perceptions and therapeutic experiences. The sample included 10 clients who had completed their therapy with systemic therapists. The method used for the collection of the data was semi‐structured interviews (Change Interview; Elliott, Slatick, & Urman, 2001). The interviews were analysed using grounded theory analysis. The results showed that both specific and common factors in therapy function in a co‐occurring mode, hence suggesting a synergy effect between common factors and specific techniques or therapist factors in psychotherapy. The core category ‘experience of therapeutic change, within the secure frame of therapy, is a process of deconstructing and reconstructing the house you live in: Yourself’ emerged based on self‐exploration and self‐discovery and is then discussed in a theoretical constructivist framework. Implications for research on the issue of the process of therapeutic change are discussed.     

Second-Order Change in Marriage and Family Therapy: A Web-Based Modified Delphi Study

Second-order change is a central concept in Marriage and Family Therapy, but still remains poorly operationalized. We conducted a web-based modified Delphi study with 31 established faculty members currently teaching in COAMFTE-accredited Master's and Doctoral programs in the United States and in Canada to identify consensus regarding second-order change concepts, clinical operationalization, evaluation, and teaching principles. Numerous exemplars of first and second-order change were generated, but consensus on most items was low. Consensus was highest for pedagogy and low regarding concepts and clinical examples of first-order change and evaluation of second-order change. Results suggest clearer definitions and better measurement of systemic change are needed.     

Psychotherapy research: an interplay between inner and outer and a succession of meanings

Psychotherapy research is a rapidly developing area of study that aims to explore the integration of inner and outer conditions of an individual’s experience, the interplay between subjective and objective, as well as between individual and collective. Questions regarding a more integrative view and qualitative research in psychotherapy are discussed in the paper. The author introduces some ideas from the studies on psychotherapy effectiveness that were done at Vilnius University by a group of researchers who work in the ‘Centre for research on the psychodynamics of personality’. Clinical psychologists who hold a doctorate degree or who are in doctoral studies in the Department of Psychology at Vilnius University are members of this research group. The subjective understanding about healing episodes and the development of depth premises were the main tasks of these studies. Among other methods, the researchers used the drawing a picture of a healing moment and telling a psychotherapy story recalled by the client to collect data. Two examples of drawing a picture of a healing moment and one example of telling a therapy story are analyzed in the paper. The themes of subjective experience of renewal in psychotherapy as well as the multiplicity of experience and results in psychotherapy are discussed in the paper with case illustrations. This study showed that drawing a picture opens one more dimension of reflection and that it can be an appropriate tool for developing individual narratives as well. Authoring and re‐authoring one’s life narrative is accepted as part of a productive therapy as well as discovering one’s inner authorship. The ability to follow a succession of meanings, as well as a connection to nature and culture could be one of the ways of actualizing an integrative view in psychotherapy research.     

Saudi therapists' lived experience of self-awareness

Self-awareness and self-reflection in psychotherapeutic processes have been critical components for effective counselling and psychotherapy. However, little qualitative research in Saudi Arabia has been conducted that aims to explore the therapist's subjective experiences of the self in their professional work. Therefore, the purpose of this phenomenological study was to understand the therapist's self-awareness within psychotherapy, by focusing on the therapist's lived experience of self-awareness and exploring how therapists recognise themselves as an integral component of the therapeutic relationship. Semi-structured interviews were conducted with six experienced and accredited psychologists with at least three years of clinical experience, and the qualitative data were analysed using interpretative phenomenological analysis (IPA). Five superordinate themes emerged from the data; that is, development of the professional self, use of self, self-oriented, supervision and experience. This study provides an understanding of the therapist's self in psychotherapy, as it shows that self-awareness is important for therapists to manage their feelings, thoughts and behaviours in meeting with clients and that it is a valuable resource for a therapist to become aware of and reflect upon the process within oneself. This understanding is integrated into the training programmes in counselling psychology, especially in the areas of self-awareness and personal development.     

Clinical Experiences in Conducting Cognitive-Behavioral Therapy for Social Phobia

Several authors have identified a disconnect between psychotherapy research, including research on cognitive behavioral therapy (CBT), and real-world psychotherapy practice. This disconnect has several negative consequences, potentially including less-than-optimal practice standards as well as a lack of input from practicing psychotherapists on how research can be improved and made more relevant in their day-to-day clinical work. As part of an ongoing effort to engage practicing psychotherapists in a feedback loop with psychotherapy researchers, this study reports the results of a survey of CBT therapists who have used CBT in the treatment of social phobia (SP). The survey was designed primarily to document how often certain potential problems, identified by expert researchers and CBT manuals, actually act as barriers to successful treatment when CBT is employed in nonresearch environments. The participants were 276 psychotherapists responding to email, online, and print advertisements completing the online survey. Participants varied considerably in psychotherapy experience, work environment, experience in using CBT for SP, and in some ways varied in their usual CBT techniques when treating SP. Among the most prominent barriers identified by many of the participants were patient motivation, comorbidity, logistical problems (especially with exposures), patient resistance, and severity and chronicity of SP symptoms. These findings may be useful for psychotherapy researchers as areas for potential study. The results may also suggest topics requiring clinical guidelines, innovations within CBT, and dissemination of successful techniques to address the barriers identified here.     

The Value of Research Methods in Psychotherapy Research: A Reply to the Commentary of Dr Norton

Norton's commentary on our article has prompted us to think further about the purpose of psychotherapy research. We agree with his suggestion that researchers have much work to do to understand when and for whom interventions are most efficacious. We hope that our field will make progress in this regard. In this reply, we further describe why we believe careful attention to research methods, such as those highlighted in our article, is key to making progress in psychotherapy research.     

The Edge of Chaos: Enactment,Disruption, and Emergence in Group Psychotherapy

The author outlines his approach to the theory and practice of group psychotherapy. The emphasis is on therapy by the group rather than therapy in the group. The therapist's task is to help the group itself become the agent of change. The group is conceived as being composed of many multiple selves. The process of group psychotherapy unfolds through enactments that involve the whole group and the group therapist entering into the grip of repetitive and unmentalized self-states. These enactments are resolved when the group members, with the therapist's help and containment, can access alternative self-states that allow for new and unformulated experience to emerge. This dialectical movement between the rigid “familiar chaos” of enactment and the reflective and related working through is compared to the dynamic systems theory articulation of the tension between rigidity and chaos captured by Kauffman's notion that “life exists at the edge of chaos.” A group session is described that involves a painful enactment. It illustrates how the therapist allows the enactment to unfold by holding and containing intense affect and how the group members are helped to find their own meaning and new experience in interaction with each other.     

The Psychotherapeutic Utility of the Five-Factor Model of Personality: A Clinician's Experience

This article summarizes experience using the five-factor model of personality, operationalized by the NEO Personality Inventory (NEO-PI), to facilitate psychotherapy treatment with 119 private-practice, outpatient, psychotherapy patients and their family members over a period of 2 years. Trait theories such as the five-factor model implicitly challenge the premises of much clinical theory, yet they can be useful to clinicians, as they provide a detailed, accurate portrait of the client's needs, feelings, proximate motives, and interpersonal style. I suggest that: Neuroticism (N) influences the intensity and duration of the patient's distress, Extraversion (E) influences the patient's enthusiasm for treatment, Openness (O) influences the patient's reactions to the therapist's interventions, Agreeableness (A) influences the patient's reaction to the person of the therapist, and Conscientiousness (C) influences the patient's willingness to do the work of psychotherapy. Fundamental questions raised by the five-factor model about the nature of psychopathology and psychotherapy are discussed.     

Perceptions of psychotherapy trainees of psychotherapy research

Aims: The research‐practice gap and lack of engagement with research by trainees and qualified therapists is a widely discussed issue amongst psychotherapy researchers. The present study investigates the perceptions of psychotherapy trainees of psychotherapy research and explores what would encourage them to participate in research. Method: Two focus groups of 16 trainees in total were conducted at two separate psychotherapy training institutes to explore trainees’ attitudes and perceptions. Data was analysed using Braun and Clarke's (2006) thematic analysis. Results: Three superordinate themes emerged: negative perception of research; recognition of the importance of research; and what would be needed to facilitate engagement in research. Discussion: The results suggest that interest in and willingness to participate in research exists, however it is necessary for negative perceptions about research to be addressed and for researchers to design projects which are supportive of participants.     

Common principles of psychotherapeutic change: patterns of use

ABSTRACT

Many authors have proposed the existence of common principles of counselling and psychotherapeutic change. However, little is known about how practitioners use these change principles. A sample of 373 Czech psychotherapists and counsellors participated in an online survey and rated their use of 10 psychotherapy change principles in their practice over the previous year. The frequency of the use of the 10 change principles is reported. Furthermore, three principal components of the change principles were identified: exploration, acceptance, and understanding of clients’ experience; attending to clients’ own resources; and furnishing clients with new skills and advice. The use of these components was mainly associated with the practitioner's theoretical orientation. The implications of the component structure for psychotherapist and counsellor training and practice are discussed.