Order and Pattern Formation in Psychotherapy
W. Tschacher, C. Scheier & K. Grawe
We use concepts and tools from self-organization theory to analyze
the dynamics of psychotherapy processes on an empirical basis.
We focus on pattern formation in the therapy system, i.e. the
system constituted by the interaction dynamics of therapist and
patient. We hypothesize that during psychotherapy patterns tend
to emerge in the therapeutic alliance. This hypothesis was tested
based on data sets of 28 psychotherapies (10 behavioral, 3 client-centered,
9 heuristic, 6 schema-oriented psychotherapies; 40 to 90 weekly
sessions). Patients' and therapists' therapy session records were
analyzed (33 variables addressing various aspects of the therapy
relationship, of progress within and outside the therapy setting).
Multivariate methods were used to test the key hypothesis of self-organization
theory, namely the reduction of degrees of freedom of a system.
Consistent with our hypothesis, a significant reduction of degrees
of freedom was found in the therapeutic alliance. This reduction
is found when the initial and the final sessions of the therapies
are compared. Correspondingly, our measure of order increased
significantly in the course of therapies. Given these results,
the explorative question of how this self-organizing property
relates to the outcome of therapy was investigated. There is a
significant positive relation with various outcome measures, such
as: therapist and clients evaluations of success (direct change
measures), feelings of guilt, anxiety, social potence, depression
(pre-post effect sizes), and others. These results suggest that
order and pattern formation are potential predictors of therapy
outcome. According to our interpretation, order is a dynamical
attribute of the therapeutic alliance, which can be further explored
as an essential therapy process variable.
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