Psychotherapeutic process from the psychotherapist’s perspective

Abstract

Process research began with therapistreported case studies describing therapeutic practice but conflating data and analysis. Audio recordings of therapy shifted the focus towards a third-party perspective, avoiding previous bias but marginalising therapy participants who alone can supply first-hand reports of the process. Today, both patients’ and therapists’ experiences remain underrated. We seek to redress the balance, highlighting empirical studies of the therapist’s perspective on process that avoid the limitations of early case study research. Our review starts with the broadest perspective on therapists’ experience, using data from a large international study. Analysing self-reports of specific aspects of process experience yielded two dimensions, Healing and Stressful Involvement, leading to distinct patterns of work experience. The subsequent section affords a sharper focus, using observations within sessions gathered through structured questionnaires, particularly the Therapy Session Report. Completed by both therapists and patients, it allows progressively complex stages of analysing experience, from describing specific facets, via constructing individual profiles from latent patterns, to generating conjoint dimensions, characterising a therapist-patient dyad. Finally, we exemplify a close-up view by examining therapeutic difficulties, an aspect of therapists’ process experience particularly relevant for clinical practice and supervision. Qualitative and quantitative studies have yielded distinct dimensions, individual profiles, and markers for problematic processes. At all levels we demonstrate the feasibility of moving from therapists’ experience-near reports of process to empirically derived dimensions transcending what is accessible to self-awareness, thereby facilitating reflective practice. Investigating process in terms congruent with therapists’ own experience helps close the gap between research and practice.