Client perceptions of significant events in prescriptive and exploratory periods of individual therapy
Abstract
This study compared the impact of helpful and hindering events, as perceived by 40 clients, in two forms of psychotherapy: an exploratory, relationship‐oriented therapy, and a prescriptive, cognitive/behavioural therapy. All clients received eight sessions of each type of treatment in a crossover design. Events were obtained by self‐report both during and at the end of each period, and content analysed for type of therapeutic impact by three trained raters. Results showed that during treatment the most commonly occurring helpful impacts across both types of treatments were ‘problem solution’, ‘awareness’ and ‘reassurance’, while the most commonly occurring hindering impact was ‘unwanted thoughts’. Similar impacts were reported at the end of each period, with the addition of ‘personal contact’. In addition, it was found that ‘problem solution’ and ‘reassurance’ impacts were more commonly reported in prescriptive treatment, whereas ‘awareness’ and ‘personal contact’ impacts were more prevalent in exploratory treatment. Only the prevalence of ‘unwanted thoughts’ was correlated (negatively) with outcome. Some possible reasons for the lack of correlation between reported impacts and outcome are suggested.
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The Helpful Aspects of Therapy Form (HAT) is an instrument that assesses the most significant events in the therapy.
“The Helpful Aspects of Therapy Form (HAT) [80,81] is an instrument that assesses the most significant events in the therapy.”
From Low-intensity internet-delivered treatment for generalized anxiety symptoms in routine care: protocol for a randomized controlled trial (2014) · cites this paper as [81]
The HAT is an instrument that assesses the most helpful and hindering events in therapy.
“Helpful Aspects of Therapy Form (HAT) [61,62] is an instrument that assesses the most helpful and hindering events in the therapy.”
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“These are similar to in-session outcomes reported from face-to-face studies (Booth, Cushway, & Newness, 1997; Elliott, 1985; Llewelyn, 1988; Llewelyn et al., 1988; Martin & Stelmaczonek, 1988).”
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“However, when Llewelyn et al. (1988) contrasted reports from prescriptive CBT therapy with reports from explorative relation oriented therapy, the latter resembled our findings more than the former.”
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“First, use of this earlier version to rate client perceptions of impact in individual therapy sessions permitted a reliable differentiation of client perceptions of exploratory (psychodynamic) and prescriptive (cognitive-behavioral) therapy cases (Llewelyn, 1985).”
MethodAre client- and therapist-identified significant events related to outcome?: a systematic review
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“Bloom (1954) used an early, and highly structured version of the approach in a classroom setting, and Alger (1969, 1976) identified numerous therapeutic applications for videoplayback.”
MethodQualitative Methods for Routine Outcome Measurement
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“The HAT includes questions such as “Of the events which occurred in this session, which one do you feel was the most helpful or important for you?””
BackgroundInfluentialPsychological functioning in families that blame: from blaming events to theory integration
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“In several studies, Llewelyn and her colleagues explore therapy as seen by clients (Llewelyn and Hume 1979; Llewelyn 1988; Llewelyn et al. 1988).”
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Insight and Outcome in Long-Term Psychotherapies of Depression
Klug, G., Seybert, C., Ratzek, M., Grimm, I., Zimmermann, J., & Huber, D. (2021) · Zeitschrift für psychosomatische Medizin und Psychotherapie · doi:10.13109/zptm.2021.67.oa10 · Cited by 9 · see citing works
Hindering events in psychotherapy: A retrospective account from the client's perspective
Burton, L., & Thériault, A. (2019) · Counselling and Psychotherapy Research · doi:10.1002/capr.12268 · Cited by 9 · see citing works
“Significant events researchers typically use predetermined categorical systems developed by the investigators and/or authors of the study to code client responses for experienced significant events in the therapeutic process (e.g., Gershefski, Arnkoff, Glass, & Elkin, 1996; Levy, Glass, Arnkoff, Gershefski, & Elkin, 1…”
BackgroundClient–counsellor agreement on what happens in counselling
Manthei, R. J. (2007) · British Journal of Guidance and Counselling · doi:10.1080/03069880701419431 · Cited by 10 · see citing works
Cape, J. D. (2001) · Europe PMC (PubMed Central) · Cited by 9 · see citing works
Process Research in the Treatment of Adult Victims of Childhood Sexual Abuse
Hill, C. E., & Alexander, P. C. (1993) · Journal of Interpersonal Violence · doi:10.1177/088626093008003009 · Cited by 9 · see citing works
- Authors
- Llewelyn, S. P., Elliott, R., Shapiro, D. A., Hardy, G., & Firth‐Cozens, J.
- Affiliations
- Dorset HealthCare University NHS Foundation Trust (GB)
- University of Toledo (US)
- University of Sheffield (GB)
- University of Leicester (GB)
- Venue
- British Journal of Clinical Psychology
- Publisher
- Wiley
- Published
- 1988-05
- Volume
- 27
- Issue
- 2
- Pages
- 105-114
- ISSN
- 0144-6657 (ISSN-L)
- 2044-8260
- OpenAlex
- W2021508634
- Cited by
- 164
- References
- 0
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 3 · 2023: 5 · 2022: 1 · 2021: 6 · 2020: 5 · 2019: 6 · 2017: 7 · 2016: 3 · 2015: 5 · 2014: 9 · 2013: 5 · 2012: 6
- FWCI
- 3.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- British Journal of Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Society for Psychotherapy Research
- British Psychological Society
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- individual psychotherapy, cognitive behavioral therapy, problem solutions, awareness, reassurance, intrusive thoughts, personal contact, treatment outcomes, therapeutic impact
- MeSH terms
- Anxiety Disorders, Behavior Therapy, Cognition, Depressive Disorder, Humans, Professional-Patient Relations, Psychoanalytic Therapy, Psychotherapy
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