The influence of significant events in conceptualising change during psychotherapy: a systematic review
The aims of this study were to examine current scientific literature on significant events and various other change process concepts in psychotherapy and to explore the influence thereof on conceptualising change during psychotherapy. The objectives were attained by conducting a systematic review in order to identify different themes that flowed from the included literature. An initial search strategy was conducted and yielded 124 studies from which 74 articles were excluded during the screening phase for being either duplications, book reviews or irrelevant. In the critical appraisal phase the full-text articles were evaluated for quality and relevance and a further 25 articles were excluded. Therefore, the final data set consisted of twenty-five studies that were found to be eligible for inclusion by both reviewers. Five overarching themes emerged following the thematic analysis namely: 1) definitions of change process concepts; 2) therapeutic process variables; 3) therapeutic intervention; 4) therapeutic relationship; 5) sequence of change process events. Within these themes, prominent subthemes also emerged. Subthemes that emerged from the first theme, definition of change process concepts, included helpful events, significant events, sudden gains, innovative moments, insight events and hindering events. These yielded important information regarding the definition, type and example of each one of the change process concepts. Findings indicated that the various events may have different functions in psychotherapy and that they are directly or indirectly linked to the outcome. From the second theme, therapeutic process variables, several subthemes arose integrating most components forming part of the practice of therapy including role players, pertaining to client and therapist variables, context including aspects within- and outside of therapy, as well as timing, impact and outcome. Within the theme of therapeutic process variables the findings showed that clients and therapists may differ in their perspectives of what is helpful and hindering in psychotherapy (Timulak, 2010). Furthermore, helpful events could be contained within sessions or happen outside of sessions, and it is possible to identify if psychotherapy will be successful from the first few sessions (McCarthy et al., 2017). The different impacts that helpful events had on the client was emotional, cognitive and an enhanced therapeutic relationship (Timulak, 2010). The third theme, therapeutic intervention, related subthemes inherent in the intervention including cognitive awareness, thought restructuring, emotion experiencing and cognitive disengagement. The fourth theme, therapeutic relationship, centered around the importance of the therapeutic relationship, whereas the fifth theme, sequence of change process events, consisted of three subthemes around the different stages of treatment namely what happens prior to events, mechanisms underlying events and process evolving after the events. The results impart an understanding of the various change process concepts and highlighted the usefulness of significant events in improvement and positive outcomes. The results also show a need for more research into significant events in relation to change in psychotherapy. Thus, further research should elucidate the influence of significant events in relation to psychotherapeutic change. The association between significant events and psychotherapeutic change is important for two reasons, firstly it shows promise by increasing the effectiveness of psychotherapy research, and secondly, it may further enhance the evidence-based nature of clinical practice to the benefit of clients.
- Health Sciences