The phenomenology of therapeutic change in young people

Abstract

Objective: Research exploring young people’s experiences of therapeutic change has been limited by several factors. Firstly, there is a lack of triangulation of clients’ and therapists’ perspectives alongside outcome measures. Secondly, existing research has over-relied on post-therapy semi-structured interviews that cannot explore the process of change during or between sessions. Thirdly, few studies have considered how developmental differences between young people and adults may affect therapeutic change experiences. These limitations are concerning considering the vulnerability of young people to developing mental health issues. Such a lack of foundational knowledge about therapeutic change may limit the effectiveness of psychotherapy. The present research addressed these limitations and triangulated therapeutic change from the perspectives of clients, therapists, and three client-therapist dyads. In doing so it explored points of convergence and divergence between clients’ and therapists’ perspectives and findings in the adult literature. Additionally, it explored how helpful factors changed throughout therapy and whether several models of adult therapeutic change accurately reflected young people’s therapeutic change experiences. Method: This mixed-methods research utilised two designs to explore therapeutic change in young people aged between 17 and 22 years. Design one consisted of post-therapy semi-structured interviews with three clients and their therapists, alongside data from functioning and distress outcome measures. Interpretative phenomenological analysis (IPA) was used to develop separate themes for clients and therapists. Design two utilised repeated semi-structured interviews with a different three clients and their therapists following the first, then every second subsequent session of therapy. In addition, several outcome and process measures were collected throughout therapy. IPA was used to develop themes for three separate client-therapist dyads. Results: Several important findings emerged from the analysis. Differences were noted in how clients and therapists described both the characteristics of therapeutic change and what was seen as most problematic. While many identified themes of helpful factors that appeared to be similar to those in the adult literature, several differences were noted. Relational factors were particularly important and changes in self-hood reflected a process of returning young people to developmentally normal levels of functioning. Findings also suggested that the pace of therapeutic change was most consistent with the good-enough level of recovery, although some support was also found for dose-effect responses. Furthermore, therapeutic change experiences appeared quite consistent with the tenets of the assimilation model. Conclusions: Therapeutic changes in agency, autonomy, capacity, and motivation enabled young people to perpetuate their own changes post-therapy in a manner that reflected a return to developmentally normal functioning. Therapeutic change was not a homogenous construct, as differences were evident in the perceptions of clients and therapists. Further differences were noted between young people’s experiences of therapeutic change and those described in the adult literature. However, considering the overlap in identified helpful factors, a developmentally sensitive adaptation of adult principles of therapeutic change may still be appropriate when working with young people. These findings highlight that important new knowledge about therapeutic change can be derived through the triangulation of experiences from multiple perspectives and measures. Future research should continue to triangulate therapeutic change experiences in different treatments and problem areas in order to develop a more robust account of the phenomenon of psychological change during therapy.

Date of Award	2018
Original language	English
Supervisor	Debra RICKWOOD (Supervisor), Bruce Stevens (Supervisor) & Tim Carey (Supervisor)