Psychological change from the inside looking out: a qualitative investigation

Regardless of the type of psychotherapy considered, change is the predominant goal. Psychotherapies differ in their explanations of how change occurs and what it is that needs to change, but pursuing change of something in some way is common. Psychotherapeutic methods, therefore, should be enhanced as knowledge of the change process improves. Furthermore, improving our knowledge about general principles of change may be of greater benefit to psychotherapy than increased knowledge about any particular change technique. This study addresses the questions 'What is psychological change?' and 'How does it occur?' from patients' viewpoints. Answers to these questions were sought using qualitative methodology. At the end of treatment, 27 people were interviewed about their experience of change. Interviews were taped and transcripts analysed using the Framework approach. Change occurred across three domains: feelings, thoughts and actions. Participants described change as both a gradual process and an identifiable moment. In relation to how change occurred, six themes emerged: motivation and readiness, perceived aspects of self, tools and strategies, learning, interaction with the therapist and the relief of talking. Change was experienced in similar ways irrespective of type of treatment. Current stage models of change may not be suited to the explanations of change provided by the participants of this study; the process of insight through reorganization might be a more accurate explanation. Understanding change as a process involving sudden and gradual elements rather than a process occurring through sequential stages could inform the development of more efficacious psychological treatments.