Order and Pattern Formation in Psychotherapy

We use concepts and tools from self-organization theory to analyze the dynamics of psychotherapy processes on an empirical basis. We focus on pattern formation in the therapy system, i.e. the system constituted by the interaction dynamics of therapist and patient. We hypothesize that during psychotherapy patterns tend to emerge in the therapeutic alliance. This hypothesis was tested based on data sets of 28 psychotherapies (10 behavioral, 3 client-centered, 9 heuristic, 6 schema-oriented psychotherapies; 40 to 90 weekly sessions). Patients' and therapists' therapy session records were analyzed (33 variables addressing various aspects of the therapy relationship, of progress within and outside the therapy setting). Multivariate methods were used to test the key hypothesis of self-organization theory, namely the reduction of degrees of freedom of a system. Consistent with our hypothesis, a significant reduction of degrees of freedom was found in the therapeutic alliance. This reduction is found when the initial and the final sessions of the therapies are compared. Correspondingly, our measure of order increased significantly in the course of therapies. Given these results, the explorative question of how this self-organizing property relates to the outcome of therapy was investigated. There is a significant positive relation with various outcome measures, such as: therapist and clients evaluations of success (direct change measures), feelings of guilt, anxiety, social potence, depression (pre-post effect sizes), and others. These results suggest that order and pattern formation are potential predictors of therapy outcome. According to our interpretation, order is a dynamical attribute of the therapeutic alliance, which can be further explored as an essential therapy process variable.