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Originalia

Identifikation und Aufklärung von Veränderungssprüngen im individuellen Psychotherapieverlauf

Published Online:January 21, 2009https://doi.org/10.1026/1616-3443.38.1.13

Abstract

Zusammenfassung.Theoretischer Hintergrund: Die Identifikation diskontinuierlicher Veränderungen im Psychotherapieverlauf sowie deren Erklärung sind Gegenstand der modernen Psychotherapieforschung, welche die patientenorientierte Forschung sowie die Evaluation von Behandlungsfortschritt vorsieht. Fragestellungen: Ziel der vorliegenden Studie ist die Aufklärung möglicher Ursachen für Veränderungssprünge in positive und negative Richtung im Therapieprozess, welche als Sudden Gains und Sudden Losses definiert sind, sowie deren Zusammenhang zum Therapieerfolg. Methode: Mikroprozessanalytisch werden 128 kritische Sudden Gain- und Loss-Sitzungen hinsichtlich Prozessparametern wie therapeutischen Techniken, allgemeinen Wirkfaktoren, u.a. das interpersonale Verhalten der Therapeuten, aber auch außertherapeutische Elemente untersucht. Resultate: Die Analyse der kritischen Therapiesitzungen vor einem Sudden Gain oder Loss ergab, dass sich diese Sitzungstypen qualitativ voneinander unterscheiden und, wie in der bisherigen Forschung bestätigt, kognitive Veränderungen, interpersonale Aspekte der Therapeuten, die therapeutische Beziehung, der emotionale Status der Patienten und außertherapeutische Faktoren Einfluss nehmen. Schlussfolgerung: Die Bedeutung von diskontinuierlichen, insbesondere negativen, Therapieverläufen kann erfolgreich anhand mikroprozessanalytischer Methodik aufgezeigt werden.


Identification and clarification of sudden gains and sudden losses in individual psychotherapy courses

Abstract.Theoretical background: The identification and prediction of individual discontinuous paths of change is of the highest importance in psychotherapy research which aims at following patient-oriented research and evaluating treatment success. Objective: The aim of the study is the exposure of possible causes of sudden gains and sudden losses as well as their relation to therapy outcome. Method: 128 sudden gain, sudden loss as well as neutral sessions were analysed using a microprocess strategy. Therapy sessions were analysed in respect of identifying specific factors and common factors as well as extratherapeutic influences. Results: Sudden gain and sudden loss sessions differ qualitatively as regards cognitive changes, interpersonal aspects of the therapists, therapeutic relationship, emotional status of the client, and extratherapeutic factors. Discussion: The implication of discontinuous, especially negative, therapy courses can be uncovered sucessfully by microprocess analysis and is discussed regarding specific and unspecific process variables.

Literatur

  • Andrusyna, T. , Luborsky, L. , Pham, T. , Tang, T. Z. (2006). The mechanisms of sudden gains in supportive-expressive therapy for depression. Psychotherapy Research, 16 (5), 526–535. First citation in articleCrossref, Google Scholar

  • Barkham, M. , Margison, F. , Leach, C. , Lucock, M. , Mellor-Clark, J. , Evans, C. et al. (2001). Service profiling and out-comes benchmarking using CORE-OM: Towards practice-based evidence in the psychological therapies. Journal of Consulting and Clinical Psychology, 69 (2), 184–196. First citation in articleCrossref, Google Scholar

  • Barkham, M. , Stiles, W. B. , Shapiro, D. A. (1993). The shape of change in psychotherapy: Longitudinal assessment of personal problems. Journal of Consulting and Clinical Psychology, 61 (4), 667–677. First citation in articleCrossref, Google Scholar

  • Bortz, J. , Lienert, G. A. , Boehnke, K. (2000). Verteilungsfreie Methoden in der Biostatistik. Berlin: Springer. First citation in articleCrossref, Google Scholar

  • Busch, A. M. , Kanter, J. W. , Landes, S. J. , Kohlenberg, R. J. (2006). Sudden gains and outcome: A broader temporal analysis of cognitive therapy for depression. Behavior Therapy, 37, 61–68. First citation in articleCrossref, Google Scholar

  • Comninos, A. , Grenyer, B. F. S. (2007). The influence of interpersonal factors on the speed of recovery from major depression. Psychotherapy Research, 17 (2), 239–249. First citation in articleCrossref, Google Scholar

  • Davies, L. , Leach, C. , Lucock, M. , Stiles, W. B. , Iveson, S. , Barkham, M. (2006). Therapists’ recall of early sudden gains in routine clinical practice. Psychology and Psychotherapy: Theory, Research & Practice, 79 (1), 107–114. First citation in articleCrossref, Google Scholar

  • DeLongis, A. , Coyne, J. C. , Dakof, G. , Folkmann, S. , Lazarus, R. S. (1982). Relationsship of daily hassles, uplifts, and major life events to health status. Health Psychology, 1, 119–136. First citation in articleCrossref, Google Scholar

  • Finch, A. E. , Lambert, M. J. , Schaalje, B. G. (2001). Psychotherapy quality control: The statistical generation of expected recovery curves for integration into anearly warning system. Clinical Psychology and Psychotherapy, 8, 231–242. First citation in articleCrossref, Google Scholar

  • Frank, J. D. (1973). Persuasion and healing (2nd ed.). Baltimore: John Hopkins University Press. First citation in articleGoogle Scholar

  • Gaynor, S. T. , Weersing, V. R. , Kolko, D. J. , Birmaher, B. , Heo, J. , Brent, D. A. (2003). The prevalence and impact of large sudden improvements during adolescent therapy for depression: A comparison across cognitive-behavioral, family, and supportive therapy. Journal of Consulting and Clinical Psychology, 71 (2), 386–393. First citation in articleCrossref, Google Scholar

  • Goldman, R. N. , Greenberg, L. S. , Pos, A. E. (2005). Depth of emotional experience and outcome. Psychotherapy Research, 15 (3), 248–260. First citation in articleCrossref, Google Scholar

  • Grawe, K. (1998). Psychologische Therapie. Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Grawe, K. (2004). Neuropsychotherapie. Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Grawe, K. , Braun, U. (1994). Qualitätskontrolle in der Psychotherapiepraxis. Zeitschrift für Klinische Psychologie, 23, 242–267. First citation in articleGoogle Scholar

  • Greenberg, R. P. , Constantino, M. J. , Bruce, N. (2006). Are patient expectations still relevant for psychotherapy process and outcome? Clinical Psychology Review, 26 (6), 657–678. First citation in articleCrossref, Google Scholar

  • Haas, E. , Hill, R. D. , Lambert, M. J. , Morrell, B. (2002). Do early responders to psychotherapy maintain treatment gains. Journal of Clinical Psychology, 58 (9), 1157–1172. First citation in articleCrossref, Google Scholar

  • Hardy, G. E. , Cahill, J. , Stiles, W. B. , Ispan, C. , Macaskill, N. , Barkham, M. (2005). Sudden gains in cognitive therapy for depression: A replication and extension. Journal of Consulting and Clinical Psychology, 73 (1), 59–67. First citation in articleCrossref, Google Scholar

  • Harkness, K. L. , Monroe, S. M. (2006). Severe melancholic depression is more vulnerable than non-melancholic depression to minor precipitating life events. Journal of Affective Disorders, 91, 257– 263. First citation in articleCrossref, Google Scholar

  • Hayes, A. M. , Beevers, C. G. , Feldman, G. C. , Laurenceau, J. P. , Perlman, C. (2005). Avoidance and processing as predictors of symptom change and positive growth in an integrative therapy for depression. International Journal of Behavioral Medicine, 12 (2), 111–122. First citation in articleCrossref, Google Scholar

  • Howard, K. I. , Lueger, R. J. , Maling, M. S. , Martinovich, Z. (1993). A phase model of psychotherapy outcome: Causal mediation of change. Journal of Consulting and Clinical Psychology, 61 (4), 678–685. First citation in articleCrossref, Google Scholar

  • Ilardi, S. S. , Craighead, W. E. (1999). Rapid early response, cognitive modification, and nonspecific factors in cognitive behavior therapy for depression: A reply to Tang and DeRubeis. Clinical Psychology: Science and practice, 6, 295–299. First citation in articleCrossref, Google Scholar

  • Jacobson, N. S. , Truax, P. (1991). Clinical Significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19. First citation in articleCrossref, Google Scholar

  • Kanfer, F. H. , Reinecker, H. , Schmelzer, D. (2000). Selbstmanagement-Therapie. Ein Lehrbuch für die klinsiche Praxis (3. Aufl.). Heidelberg, Berlin, New York: Springer. First citation in articleGoogle Scholar

  • Lambert, M. J. (2007). Presidential address: What we have learned from a decade of research aimed at improving psychotherapy outcome in routine care. Psychotherapy Research, 17 (1), 1–14. First citation in articleCrossref, Google Scholar

  • Lutz, W. (2002). Patient-focused psychotherapy research and individual treatment progress as scientific groundwork for an empirical based clinical practice. Psychotherapy Research, 12, 251–273. First citation in articleCrossref, Google Scholar

  • Lutz, W. , Leach, C. , Barkham, M. , Lucock, M. , Stiles, W. B. , Evans, C. , Noble, R. , Iverson, S. (2005). Predicting change for individual psychotherapy clients on the basis of their nearest neighbors. Journal of Consulting and Clinical Psychology, 73 (5), 904–913. First citation in articleCrossref, Google Scholar

  • Lutz, W. , Stulz, N. , Smart, D. W. , Lambert, M. J. (2007). Die Identifikation früher Veränderungsmuster in der ambulanten Psychotherapie. Zeitschrift für Klinische Psychologie und Psychotherapie, 36, 93–104. First citation in articleLink, Google Scholar

  • Lutz, W. , Tholen, S. , Kosfelder, J. , Tschitsaz, A. , Schürch, E. , Stulz, E. (2005). Evaluation und störungsspezifische Rückmeldung des therapeutischen Fortschritts in der Psychotherapie. Verhaltenstherapie, 15, 168–175. First citation in articleCrossref, Google Scholar

  • Lutz, W. , Tschitsaz, A. (2007). Plötzliche Gewinne und Verluste im Behandlungsverlauf von Angststörungen, depressiven und komorbiden Störungen. Zeitschrift für Klinische Psychologie und Psychotherapie, 36, 298–308. First citation in articleLink, Google Scholar

  • Meng, X. , Rosenthal, R. , Rubin, D. B. (1992). Comparing correlated correlation coefficients. Psychological Bulletin, 111 (1), 172–175. First citation in articleCrossref, Google Scholar

  • Najavits, L. M. , Strupp, H. H. (1994). Differences in the effectiveness of psychodynamic therapists: A process-outcome study. Psychotherapy, 31, 114–123. First citation in articleCrossref, Google Scholar

  • Pham, T. , Tang, T. Z. (2006). Sudden gains – When do they occur? Paper presented at the Association for Behavioral and Cognitive Therapies (ABCT), Chicago, USA. First citation in articleGoogle Scholar

  • Sachs, L. (1997). Angewandte Statistik – Anwendung statistischer Methoden. Berlin: Springer. First citation in articleCrossref, Google Scholar

  • Schulte, D. (1996). Therapieplanung. Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Schulte, D. , Eifert, G. H. (2002). What to do when manuals fail? The dual model of psychotherapy. Clinical Psychology: Science and practice, 9, 312–328. First citation in articleCrossref, Google Scholar

  • Stiles, W. B. , Leach, C. , Barkham, M. , Lucock, M. , Iveson, S. , Shapiro, D. A. , Iveson, M. , Hardy, G. E. (2003). Early sudden gains in psychotherapy under routine clinic conditions: Practice-based evidence. Journal of Consulting and Clinical Psychology, 71, 14–21. First citation in articleCrossref, Google Scholar

  • Tang, T. Z. , Bebermann, R. , DeRubeis, R. , Pham, T. (2005). Cognitive Changes, Critical Sessions, and Sudden Gains in Cognitive-Behavioral Therapy for Depression. Journal of Consulting and Clinical Psychology, 73, 168–172. First citation in articleCrossref, Google Scholar

  • Tang, T. Z. , DeRubeis, R. J. (1999). Sudden gains and critical sessions in cognitive-behavioral therapy for depression. Journal of Consulting and Clinical Psychology, 6, 894–904. First citation in articleCrossref, Google Scholar

  • Teasdale, J. D. , Moore, R. G. , Hayhurst, H. , Pope, M. , Williams, S. , Segal, Z. V. (2002). Metacognitive Awareness and Prevention of Relapse in Depression: Empirical Evidence. Journal of Consulting & Clinical Psychology, 70 (2), 275–287. First citation in articleCrossref, Google Scholar

  • Thompson, M. , Thompson, L. , Ghallager-Thompson, D. (1995). Linear and nonlinear changes in mood between psychotherapy sessions: Implications for treatment outcome and relapse risk. Psychotherapy Research, 5 (4), 327–336. First citation in articleCrossref, Google Scholar

  • Tschitsaz-Stucki, A. (2007). Diskontinuitäten im individuellen Psychotherapieverlauf – Identifikation und Aufklärung von Veränderungssprüngen. Universität Bern: Unveröffentlichte Dissertation. First citation in articleGoogle Scholar

  • Tschitsaz, E. , Lutz, W. (2007). MEPI. Manual zur Erfassung therapeutischer Prozesse und Interventionen. Bern: Selbstverlag. First citation in articleGoogle Scholar

  • Vittengl, J. R. , Jarrett, R. B. , Clark, L. A. (2005). Validity of Sudden gains in acute phase treatment of depression. Journal of Consulting and Clinical Psychology, 73 (1), 173–182. First citation in articleCrossref, Google Scholar

  • Wise, E. A. (2003). Psychotherapy outcome and satisfaction: Methods applied to intensicve outpatient programming in a private practice setting. Psychotherapy: Theory, Research Practice, Training, 40 (3), 203–214. First citation in articleCrossref, Google Scholar