A model of the psychotherapeutic process : The client-centred approach
The problem of how individual psychotherapy stimulates the
improvement of people who are experiencing anxiety disorder is
the focus of this thesis. It is observed that a wide range of
treatments are offered to such patients, that the therapies are
typically based on different theories and that practitioners
usually claim that their methods of intervention are effective.
The possibility that only a few of these models are valid is
explored by examining the outcome literature (Chapter 2). This
evidence suggests that the vast majority of therapies produce
some change and implies that there may be factors and processes
that occur across treatment contexts.
One model which specifies "common factors" and a "common
process" is Rogers" theory of psychotherapy. This theory is
described in Chapter 3 and predicts that the 'more empathic,
congruent and unconditionally positive patients perceive their
therapists to be the more they improve. In Chapter 4 it was
found that studies in which the patients! perceptions of these
qualities were measured offer some support for Rogers' theory.
On the basis of a speculative discussion of how this theory may
explain the results of a process-outcome literature review it
was concluded that other factors may stimulate a reduction in
anxiety via the process proposed by Rogers. This theory of
change was developed so that it could be operationalised
(Chapter 5). It is characterised as an increase in the
"sharpness" and "extent" of the client's conscious awareness of
(a) their anxiety, (b) its environmental causes, (c) their intrinsic reactions to the anxiety provoking situations and (d)
plans for putting their insights to practical use. It was
hypothesised that the Rogerian therapist variables would
stimulate this process and lead to a reduction in anxiety.
In the first study of 16 patients undergoing individual
treatment for anxiety disorder (Chapters 6 and 7), the
hypotheses that therapy would lead to increases in awareness of
the four domains just described and significant reductions in
anxiety were supported. The predicted inverse relationships
between process and outcome were also found. However~ the
Rogerian therapist variables did not predict improvement.
In the second study (Chapters 8 and 9) the hypotheses were
not supported, which included the finding that the treatment
was not effective. It was argued that this data did not
constitute a fair test of the model. However, it ~ found
that differences in awareness of the nfour areasn in an
untreated group of people predicted the severity of their
anxiety disorder. Other processes of change were detected in
both the treatment and control groups and it is recommended
that the very early stages of therapy are studied.
Further analyses (Chapter 10) revealed that the two
therapists who participated only in the first study produced
more improvement than the other therapists and tended to have
patients who were more anxious. Further examination of the
data suggested that this differential success could not be
explained by the type of techniques used. It was suggested
that the therapist's degree of confrontation, their timing and the match between their model and the patient's problem may
determine the success of treatment.
It is concluded that effective psychotherapy has been
shown to stimulate a therapeutic process which is characterised
by the model developed in this thesis. It is proposed that the
reason why the Rogerian therapist qualities nonetheless failed
to stimulate improvement is because the therapists in the
present studies might have been less open about their
perceptions of their patients during therapy than those in the
literature (Chapter 11).
It is suggested that future research should aim to
identify the "non-Rogerian" therapist qualities which stimulate
the process described in Chapter 5. More generally it is
argued that there is a need to develop and test other
"factor-process-outcome" models with specific samples of
patients. It seems time to become less partisan and more
concerned with developing the theoretical basis with which we
can understand personal change.