Mechanisms of change : a qualitative investigation into the emergence of exits in cognitive analytic therapy

For decades one of the most fundamental questions of psychotherapy research has been whether psychotherapy works. A substantial body of research (e.g. Lambert & Bergin, 1994; Lambert & Ogles, 2004) now allows us to answer this question positively. The next major question concerns the specific psychological mechanisms underlying therapeutic progress. This is also the central focus of the present thesis; both the literature review and the research paper attempt to address the question of how change occurs in therapy, although they do so in two different ways. The literature review looks specifically at one potential mechanism of change, namely the construct of transference and its therapeutic uses. Using a narrative approach, the evidence base behind transference and working in the transference in psychodynamic and non-psychodynamic approaches is examined. First, some evidence for the existence of transference processes is presented, followed by outlining an argument for the therapeutic benefits of working in the transference, in particular when working with people who have more pronounced personality difficulties. The research paper examines how therapeutic change occurs within the framework of Cognitive Analytic Therapy (CAT). In this study, grounded theory methodology was used to investigate the process of the emergence of "exits", a term used in the CAT model to refer to positive changes in therapy. Nine therapist-client dyads were jointly interviewed about their experience of how exits developed and a temporal model of this process was constructed. The results pointed towards the central process of "opening up new perspectives" underlying the development of exits and indicated that distinguishing between "one-off exits" and "planned exits" may be useful. The thesis concludes with personal reflections on and a discussion of advantages and disadvantages of interviewing therapist-client dyads.EThOS - Electronic Theses Online ServiceGBUnited Kingdo