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Change processes underlying 'good outcome' : a qualitative study on recovered and improved patients’ experiences in psychotherapy for major depression

Melissa De Smet (UGent) , Reitske Meganck (UGent) , Femke Truijens (UGent) , Rosa De Geest (UGent) , Shana Cornelis (UGent) , Ufuoma Angelica Norman (UGent) and Mattias Desmet (UGent)
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Abstract
Aim: Exploring change processes underlying "good outcome" in psychotherapy for major depression. We examined the perspectives of patients who "recovered" and "improved" (Jacobson & Truax) following time-limited CBT and PDT. Method: In the context of an RCT on the treatment of major depression, patients were selected based on their pre-post outcome scores on the BDI-II: we selected 28 patients who recovered and 19 who improved in terms of depressive symptoms. A grounded theory analysis was conducted on post-therapy client change interviews, resulting in an integrative conceptual model. Results: According to recovered and improved patients, change follows from an interaction between therapy, therapist, patient, and extra-therapeutic context. Both helping and hindering influences were mentioned within all four influencing factors. Differences between recovered and improved patients point at the role of patients' agency and patients' internal and external obstacles. However, patients marked as "improved" described heterogeneous experiences. CBT- and PDT-specific experiences were also observed, although our findings suggest the possible role of therapist-related influences. Conclusion: From patients' perspectives, various change processes underlie "good outcome" that do not necessarily imply an "all good process". This supports a holistic, multidimensional conceptualization of change processes in psychotherapy and calls for more fine-grained mixed-methods process-outcome research.
Keywords
process research, outcome research, qualitative research methods, cognitive behaviour therapy, psychoanalytic, psychodynamic therapy, CLIENTS, THERAPY, METAANALYSIS, PERSONALITY, REMISSION, ALLIANCE, EVENTS, ADULTS, SCALE

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MLA
De Smet, Melissa, et al. “Change Processes Underlying ‘good Outcome’ : A Qualitative Study on Recovered and Improved Patients’ Experiences in Psychotherapy for Major Depression.” PSYCHOTHERAPY RESEARCH, 2020.
APA
De Smet, M., Meganck, R., Truijens, F., De Geest, R., Cornelis, S., Norman, U. A., & Desmet, M. (2020). Change processes underlying “good outcome’ : a qualitative study on recovered and improved patients” experiences in psychotherapy for major depression. PSYCHOTHERAPY RESEARCH.
Chicago author-date
De Smet, Melissa, Reitske Meganck, Femke Truijens, Rosa De Geest, Shana Cornelis, Ufuoma Angelica Norman, and Mattias Desmet. 2020. “Change Processes Underlying ‘good Outcome’ : A Qualitative Study on Recovered and Improved Patients’ Experiences in Psychotherapy for Major Depression.” PSYCHOTHERAPY RESEARCH.
Chicago author-date (all authors)
De Smet, Melissa, Reitske Meganck, Femke Truijens, Rosa De Geest, Shana Cornelis, Ufuoma Angelica Norman, and Mattias Desmet. 2020. “Change Processes Underlying ‘good Outcome’ : A Qualitative Study on Recovered and Improved Patients’ Experiences in Psychotherapy for Major Depression.” PSYCHOTHERAPY RESEARCH.
Vancouver
1.
De Smet M, Meganck R, Truijens F, De Geest R, Cornelis S, Norman UA, et al. Change processes underlying “good outcome’ : a qualitative study on recovered and improved patients” experiences in psychotherapy for major depression. PSYCHOTHERAPY RESEARCH. 2020;
IEEE
[1]
M. De Smet et al., “Change processes underlying ‘good outcome’ : a qualitative study on recovered and improved patients’ experiences in psychotherapy for major depression,” PSYCHOTHERAPY RESEARCH, 2020.
@article{8653750,
  abstract     = {Aim: Exploring change processes underlying "good outcome" in psychotherapy for major depression. We examined the perspectives of patients who "recovered" and "improved" (Jacobson & Truax) following time-limited CBT and PDT. Method: In the context of an RCT on the treatment of major depression, patients were selected based on their pre-post outcome scores on the BDI-II: we selected 28 patients who recovered and 19 who improved in terms of depressive symptoms. A grounded theory analysis was conducted on post-therapy client change interviews, resulting in an integrative conceptual model. Results: According to recovered and improved patients, change follows from an interaction between therapy, therapist, patient, and extra-therapeutic context. Both helping and hindering influences were mentioned within all four influencing factors. Differences between recovered and improved patients point at the role of patients' agency and patients' internal and external obstacles. However, patients marked as "improved" described heterogeneous experiences. CBT- and PDT-specific experiences were also observed, although our findings suggest the possible role of therapist-related influences. Conclusion: From patients' perspectives, various change processes underlie "good outcome" that do not necessarily imply an "all good process". This supports a holistic, multidimensional conceptualization of change processes in psychotherapy and calls for more fine-grained mixed-methods process-outcome research.},
  author       = {De Smet, Melissa and Meganck, Reitske and Truijens, Femke and De Geest, Rosa and Cornelis, Shana and Norman, Ufuoma Angelica and Desmet, Mattias},
  issn         = {1050-3307},
  journal      = {PSYCHOTHERAPY RESEARCH},
  keywords     = {process research,outcome research,qualitative research methods,cognitive behaviour therapy,psychoanalytic,psychodynamic therapy,CLIENTS,THERAPY,METAANALYSIS,PERSONALITY,REMISSION,ALLIANCE,EVENTS,ADULTS,SCALE},
  language     = {eng},
  pages        = {17},
  title        = {Change processes underlying 'good outcome' : a qualitative study on recovered and improved patients’ experiences in psychotherapy for major depression},
  url          = {http://dx.doi.org/10.1080/10503307.2020.1722329},
  year         = {2020},
}

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