Therapy Process, Individual

Therapy Process Defined

In order to understand what constitutes “process,” it is important to distinguish it from other related aspects of therapy, namely, input variables, extratherapy variables, and outcome variables. Input variables refer to therapist demographics, personality, expectations, and theoretical orientations, whereas extratherapy variables refer to personal or world events that clients experience outside the therapeutic interaction. Outcome refers to changes that occur as a result of the therapeutic process (e.g., client satisfaction). While outcome and process may overlap as in the case of client insight or the working alliance, process is concerned with the intra- and interpersonal actions and interactions embedded in patterns of relationships. Specifically, Clara E. Hill and Maureen M. Corbett defined process as the overt and covert thoughts, behaviors, and feelings within psychotherapy sessions that pertain to the therapist and the client and the interaction between the two.

Initial Approaches to Understanding Process

Early attempts to understand process were focused on what therapists do in therapy. As early as the 1920s, Sigmund Freud, Earl F. Zinn, and Percival M. Symonds recorded analytic and nonanalytic interviews to enable content analysis of sessions. In 1938, Frank Robinson started the first process research program in Counseling Psychology at Ohio State University. Session recordings helped identify both overt and covert therapist and client behaviors in therapy (e.g., self-disclosure, self-talk), with focus on therapist patterns across clients (e.g., interpretation, empathy). Carl Rogers's “nondirective therapy” continued to emphasize the therapist's role, identifying specific therapist skills. Although Rogers was opposed to focusing on therapist behaviors, in 1957, Rogers's necessary and sufficient conditions (i.e., empathy, genuineness, and positive regard) became the primary indicators of therapeutic change. The focus on therapists' role in the therapeutic process continued with Robert R. Carkhuff's model that emphasized therapists' skills as important in creating client change. However, he suggested that it was primarily the therapist that was doing something to create change. In 1984, Laura N. Rice and Leslie S. Greenberg suggested a need to examine clients' roles in creating change. At this time, the focus shifted to clients' behaviors and therapists' behaviors were seen as contextual sources of influence (e.g., expertness, attractiveness).

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