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Quantitative Approaches to Treatment Process, Change Process, and Process-Outcome Research

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Psychotherapy Research

Abstract

To understand how and why psychotherapy works, it is necessary to focus on (both) the process of psychotherapy (i.e., what takes place during the treatment) and the relationship between this process and the outcome of psychotherapy (i.e., the treatment’s clinical effects). In the present chapter, we provide an overview of three main quantitative research strategies that may be differently used to fulfill this aim. These include treatment process research (which investigates what takes place during psychotherapy, regardless of its clinical meaningfulness), change process research (which investigates what takes place during psychotherapy, with regard to its clinical meaningfulness), and process-outcome research (which investigates the relationship between what takes place during psychotherapy and its clinical effects). We first define the process and outcome of psychotherapy; then, for each research approach proposed, we review the research design, data collection, and data analysis issues; finally, we conclude with suggestions for future research.

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Notes

  1. 1.

    Actually, quantitative research may also be described with regard to other aspects that are related to the research methods (e.g., data collection, sampling, and research designs) as well as with reference to the methodological principles that underlie these methods and the philosophical worldviews that are the basis of these methodological principles. However, we believe that, at a very pragmatic and procedural level, considering data analysis is enough to characterize the quantitative approaches to empirical research (see Gelo 2012; Gelo et al. 2008, 2009; Polkinghorne 1983; and Ponterotto 2005 for an articulated discussion; also see Chap. 4).

  2. 2.

    Elaborated with the aim to coherently organize the empirical literature that links the therapeutic process to the outcome (see Sect. 13.3.3 for more details on process-outcome research), it offers a very useful abstract and synthetic representation of what can be considered the main dimensions of the therapeutic process. Beyond this process, the Generic Model of Psychotherapy also encompasses the input (i.e., antecedents of the process) and the output [i.e., the consequences of the process, which include the therapy outcome (see Sect. 13.2.2)] (see Orlinsky 2009 for a detailed overview).

  3. 3.

    Actually, a sixth facet exists, temporal patterns, which was introduced in the fourth edition of the Handbook of Psychotherapy and Behaviour Change. This facet describes a specific way of analyzing one or more process variables and, for this reason, will be introduced later in this chapter (see Sect. 13.3.3.1).

  4. 4.

    It should be noted that the observational instruments used to collect process data at a within-session level actually make use of qualitative text analysis (see Chap. 20 for more details; see Gelo et al. 2012 for a discussion).

  5. 5.

    It should be noted that the term of process research may also be used to refer to any kind of research that focuses on the process, either alone (see Chap. 1 and 9) or with regard to its relationship with the outcome (see Sect. 13.3.3).

  6. 6.

    The term naturalistic is often used to describe the approach used by qualitative research (see Chap. 20).

  7. 7.

    At a very pragmatic level, the difference between an experiment and a quasi-experiment is that in the former case, subjects are randomized to the different conditions, while this is not the case for quasi-experiments. Both include the manipulation of an independent variable.

  8. 8.

    Although experimental research presents higher internal validity (due to the greater control of confounding variables with regard to the investigated cause-effect relationships) and external validity (due to the higher control of sampling procedures that allow the results to be generalized from the sample to the population), non-experimental research presents a higher ecologic validity (which addresses the degree to which we may generalize our results to real-life contexts outside the laboratory) due to being characterized by less strict control. Different researchers, who provide different emphasis on either internal and external validity or ecological validity, will, consequently, prefer to use either an experimental or non-experimental approach.

  9. 9.

    We should stress that this difference is of a more heuristic and theoretical/conceptual nature and does not necessarily have practical implications for the practice of psychotherapy research.

  10. 10.

    In contrast, more complex, mixed-method approaches to CPR, belonging to the so called significant event approache (see Elliott 2010 for an overview; also see Rice and Greenberg 1984), make use of a combination of both theoretical and empirical ways to identify significant events. Prototypical examples of this approach include task analysis (e.g., Greenberg 2007; Pascual-Leone et al. 2009), comprehensive process analysis (e.g., Elliott et al. 1994), and assimilation analysis (Stiles et al. 1990).

  11. 11.

    This work of Safran and Muran (1996) actually represents a more complex design where, prior to the quantitative assessment of the relationship among the variables of interest, a performance model was created following an empirical-rational approach. This is a prototypical example of what Greenberg (2007) calls task analysis.

  12. 12.

    By doing this, these instruments may be ascribed to the significant event approach (Rice and Greenberg 1984; also see Elliott 2010).

  13. 13.

    It should be noted that, beginning with the fourth edition of the handbook, the GMP was enriched with a sixth dimension, temporal patterns. Because these address a specific way of analyzing the process rather than a constitutive conceptual element of it, we will refer to it later when discussing data analysis in POR (see Sect. 13.3.3.3).

  14. 14.

    In contrast to quantitative approaches, in qualitative and/or mixed-method approaches, single-case designs within an interpretative, theory-building framework are used more often (see Stiles 2007; Elliott 2010).

  15. 15.

    To account for these results, a sixth dimension, temporal patterns, was added to the GMP beginning with the fourth edition of the Handbook of Psychotherapy and Behavior Change (Orlinsky et al. 1994, 2004).

  16. 16.

    Dynamic systems theory (DST) has been recently applied to psychotherapy research in order to explain the dynamic nature of clinical processes. A theoretical and methodological account of this is offered in Chap. 10. See Tschacher, Gelo, Koch, & Salvatore (2014) for some empirical applications.

  17. 17.

    MLMs represent a collective group, including, among others, hierarchical linear models, mixed-effects models, random regression models, and growth curve modeling (Tasca and Gallop 2009).

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Acknowledgment

We would like to thank David Orlinsky and Marcello Gallucci for their discussions, which helped to inform the contents of this chapter. However, as the authors, we are solely responsible for the content of this chapter.

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  1. Department of History, Society and Human Studies, University of Salento, Via Stampacchia 45, 73100, Lecce, Italy

    Omar Carlo Gioacchino Gelo

  2. Department of Psychotherapy Science, Sigmund Freud University, Freudplatz 1, 1020, Vienna, Austria

    Omar Carlo Gioacchino Gelo

  3. Animal Research Institute, Via Toledo 148, Napoli, Italy

    Stefano Manzo

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  1. University of Salento, Lecce, Italy, and Sigmund Freud University, Vienna, Austria

    Omar C.G. Gelo

  2. Sigmund Freud University, Vienna, Austria

    Alfred Pritz

  3. Sigmund Freud University, Vienna, Austria

    Bernd Rieken

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Gelo, O.C.G., Manzo, S. (2015). Quantitative Approaches to Treatment Process, Change Process, and Process-Outcome Research. In: Gelo, O., Pritz, A., Rieken, B. (eds) Psychotherapy Research. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1382-0_13

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