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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) [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]
In the citing paper
“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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“This has been established through client reports of critical incidents, significant or positive moments and helpful events (Bedi et al., 2005; Castonguay et al., 2010; Elliott, 1985, Levit et al., 2006; Llewelyn et al., 1988; Timulak and Lietaer, 2011); known as the ‘events paradigm’.”
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“In fact, I would argue that the Helpful Aspects of Therapy Form and the Change Interview, both described below, should be used more often as vehicles for enabling mental health service users to have their voice heard.”
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“…about their counselling and counsellor, and, of course, solving their problems (Bovraian & Fine, 2000; Boyhan, 1996; Jinks, 1999; BCremer & Gesten, 2003; Llewelyn et al., 1988 McDonald & Webb, 1998; Paulson et al., 1999; Tracey & Dundon, 1988; Wilcox-66 Matthew et al., 1997; Wivell & Webb, 1995).”
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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).”
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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.”
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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?””
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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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“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…”
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Metadata
- 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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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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