In psychotherapy, client responses to individual therapy sessions have long been considered a key factor in determining the success of therapy. These reactions range from feelings of relief and discovery of new perspectives on self or relationships to negative experiences such as emotional overload or feelings of failure. Previous research has focused on individual client experiences in psychotherapy, and their effects on the overall therapeutic process from a qualitative perspective. However, the study, which also involved researchers from INPSY/Center for Psychotherapy Research, used a dynamic network model to explore how different client responses to therapy sessions relate to each other and how they influence each other over time.
Study authors Tomáš Řiháček and Michaela Ladmanová from INPSY/Center for Psychotherapy Research collaborated with colleagues Robert Elliott from the University of Glasgow and Jesse Owen from the University of Denver. They decided to use longitudinal network models to investigate how clients' responses to therapy sessions influence and predict future course and progress in psychotherapy. Their research focused on the initial stages of therapy, specifically on clients' reactions during the first five sessions. The authors combined data from three research samples, one of which included clients with post-traumatic stress disorder and the other two covered outpatients. The researchers then analyzed how the individual responses interacted with each other over time and predicted the course of therapy. In total, 123 clients were included in the research and were treated using emotion-focused therapy (EFT).
Distancing from one's own thoughts and new self-discoveries as key responses
Several key findings emerged from the research. One of the most interesting was that distancing from one's own thoughts, feelings or memories, considered a negative factor in the previous study, played a positive role in the first sessions. This result suggests that short-term emotional distancing can help clients to cope with challenging emotional situations that may arise, for example, during a therapy session. However, according to the authors, this is a complex construct that may have a positive impact in certain conditions, but longer-term distancing may lead to a disconnection from one's own emotions and thus may hinder emotional processing.
Another key finding was that the new self-discoveries that clients experience in therapy is related to a number of other positive responses. This construct refers to moments in therapy when clients become aware of new aspects of themselves, their past, or their current behavior. For example, clients seem to make better use of new insights about other people when accompanied by a new or altered view of self. At the same time, this response may mediate relationships between other positive responses in psychotherapy. New self-discoveries thus serve as an important "bridge" that allows clients to better process other therapeutic moments and contribute to progress in therapy. On the other hand, the sense of involvement in therapy, which the authors expected to be a key factor for progress, played a rather marginal role in the overall dynamics of reactions.
Research findings suggest that network modelling is a promising approach to analysing psychotherapeutic processes, as it provides new insights into the interconnectedness of complex client responses in individual sessions. At the same time, this study shows that a more detailed understanding of how clients respond to therapy sessions can provide valuable insights not only for clinical practice but also for further research aimed at improving therapeutic approaches. However, the authors mention that one important limitation of the study is that they only focused on the first five sessions, which prevents generalisation of the results to later stages of therapy. Therefore, the researchers recommend that future research should further investigate the role of distancing and other responses in different phases of therapy and should focus on exploring these responses in more depth, particularly in relation to different types of clients and in specific contexts.
Translated with DeepL.com (free version)
Recommended citation:
Řiháček, T., Elliott, R., Owen, J., & Ladmanová, M. (2024). The structure and dynamics of client session reactions: An exploratory longitudinal network analysis. Journal of Psychotherapy Integration, 34(2), 174–189. https://doi.org/10.1037/int0000331
