Intrepid Pursuit of the Essential Ingredients of Psychotherapy

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This article elaborates on Doss's (this issue) call for a programmatic psychotherapy change research that unveils the specific mechanisms inherent in the in-session and extratherapy client changes occurring over the course of a therapy. To accomplish this new agenda, both “process” and “outcome” investigators must formulate some clear conceptualization of the dependent variables of psychotherapy—both in and outside therapy, both proximate and remote—and their theoretical interrelationships. Dismantling the essential ingredients of any of the field's available psychotherapy “packages” requires explanation of each client change that results from a particular “miniature” intervention, and how that change is related to subsequent changes from other miniature interventions, across the entire course of therapy. For each miniature intervention researchers need to demonstrate also the level of expertise and the specific patient-therapist relationship context required for its successful execution. The field can profit from a new kind of “process diagnosis” for psychotherapy research, one that specifies and measures “process signs” (observable cues, markers, indicators) of a patient's distinctive set of in-session maladaptive behaviors, behaviors that can be ameliorated with an optimum sequence of tailored miniature interventions.

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