Wednesday, March 31, 2010

Elliott (2010). Psychotherapy Change Process Research: Realizing the Promise

Entry for 31 March 2010:

When I received the Distinguished Research Career Award from the Society for Psychotherapy Research in June 2008, it came with a catch: I had to produce a paper for SPR’s journal, Psychotherapy Research. Paulo Machado asked me in Barcelona shortly after I got the award, giving me what felt at the time like a generous deadline: Aug 1, 2009. I spent months wondering what I should write about; I even sounded Paulo and Clara out about using my long-neglected Adjudicated HSCED paper (Elliott et al., 2009) for this purpose, but was gently reminded that it had to be single-authored.

Somewhere around February or March 2009 I finally realized that the only logical thing was for me to write about Change Process Research (CPR), a topic close to my heart and one that has spanned my research career. By a strange piece of synchronicity, Madison, Wisconsin, provided a 30-year time loop encircling my interest in CPR: At the front end of the time loop, my scientific interest in CPR dates back to a fateful conversation that I had with Les Greenberg in 1977, as we drove to O’Hare Airport after that year’s SPR meeting in Madison, Wisconsin. At the other end of the time loop, I had given a plenary paper on CPR at the 2007 SPR meeting, which was once again in Madison. The Madison 2007 paper became the starting point for my senior career award paper.

Because my writing schedule is generally restricted these days to 20 minutes each morning, work on the paper proceed slowly, as the pressure from Paulo increased to produce the paper, as it turned out, earlier than the original deadline. April and May passed, with the paper being repeatedly pushed aside for other pressing writing projects, including final work on the adjudicated HSCED paper. I had promised Paulo something by the end of June; however, I arrived in Santiago de Chile in late June with only a fraction of the paper drafted.

Then I came down with the H1N1 or Swine Flu, which was pretty awful in itself, but turned out to be gift from heaven as far as my senior career CPR paper was concerned. First, I was quarantined in my hotel room for a week, so I had plenty of time to lay in bed with minimal distractions. Second, the doctor had given a timely dose of Tamiflu, which reduced the flu symptoms enough so that I actually had enough energy to work on the paper. As a result, I wrote most of the paper during the week after the Santiago SPR meeting.

The paper turned out to be a tour de force, a survey of the major approaches to CPR, featuring lots of references and examples. It felt big, and was an odd contrast to my situation at the time, living in the enforced role of an invalid while putting together a grand survey of the key approaches at the core of the most central focus of the psychotherapy research field. Nevertheless, thanks to the H1N1 virus, Tamiflu, and especially to Diane’s patient help, the paper got written and was submitted on the 3rd of July.

See also January 18, 2010 entry on this blog for a previous excerpt from this article: Change Process Research on Relational Depth: The Added Paragraph


Elliott, R. (2010). Psychotherapy Change Process Research: Realizing the Promise. Psychotherapy Research, 20, 123-135.

Abstract: Change process research (CPR) is the study of the processes by which change occurs in psychotherapy, and is a necessary complement to randomized clinical trials and other forms of efficacy research. In this article I describe and evaluate of four types of CPR. The first three are basic designs and include quantitative Process-Outcome, qualitative Helpful Factors, and micro-analytic Sequential Process; the fourth, the Significant Events approach, refers to methods such as Task Analysis and Comprehensive Process Analysis that integrate the first three. The strengths and weaknesses of each design are described and summarized using both causal and practical criteria, as part of an overall argument for systematic methodological pluralism.

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