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Title: A model of the psychotherapeutic process : The client-centred approach
Author: Colter, R. A.
Awarding Body: University of Sussex
Current Institution: University of Sussex
Date of Award: 1983
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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.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Psychology Psychology