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Mediators of Change in Successful Psychotherapy—Patients' Perspectives on Cognitive‐Behavioural, Psychodynamic and Analytic Therapies.

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Title: Mediators of Change in Successful Psychotherapy—Patients' Perspectives on Cognitive‐Behavioural, Psychodynamic and Analytic Therapies.
Authors: Reuter, Laurence (AUTHOR), Klapprott, Felix (AUTHOR), Wulf, Sabine (AUTHOR), Frey, Lisa (AUTHOR), Nitzsche, Anne (AUTHOR), Gumz, Antje (AUTHOR)
Source: Counselling & Psychotherapy Research. Jun2026, Vol. 26 Issue 2, p1-15. 15p.
Subjects: Psychotherapy, Psychotherapy patients, Health literacy, Psychodynamic psychotherapy, Therapeutics, Academic medical centers, Research funding, Interviewing, Questionnaires, Behavior, Treatment effectiveness, Emotions, Functional status, Descriptive statistics, Experience, Attitude (Psychology), Research methodology, Social skills, Cognitive therapy, Health outcome assessment, Patients' attitudes, Psychosocial factors
Geographic Terms: Germany
Abstract: Background: Psychotherapy research is increasingly concerned with how psychotherapy is effective and what mediating factors are involved in change processes. Previous attempts to categorise mediators of change have mostly been based on expert opinion and theory. Patients themselves provide unique insights into factors contributing to therapeutic success, as their lived experiences make them experts on mediators of change and reveal processes that may be overlooked by traditional models (e.g., Common Component or Contextual Models). This study aimed to follow a patient‐informed approach to identify and systematise factors mediating change in successful psychotherapy. Methods: Semi‐structured interviews were conducted with adult participants up to 2 months after their completion of successful outpatient psychotherapy in cognitive behavioural therapy (CBT), psychodynamic therapy (PDT) and analytic psychotherapy (AP). Patients were asked about their experiences regarding how change was achieved in their psychotherapy (i.e., through which mediating factors). The Consensual Qualitative Research (CQR) approach was used for data analysis. Findings: In total, 16 interviews were conducted (CBT: n = 6; PDT: n = 5; AP: n = 5). The identified core ideas were assigned to four main categories: (1) Re‐forming, Awareness, and Processing; (2) Perceiving and Expressing emotions; (3) Relational functions; (4) Solutions or Behavioural options. Applying the CQR‐guidelines, we found notable differences between therapeutic approaches for 15 mediators. Discussion: These patient‐informed results extend existing common‐factor and contextual models by highlighting mediators often under‐represented in theory‐driven frameworks, particularly relational experiences. Future studies should further examine the extent to which method‐specific change processes contribute to therapy, as our results indicate some important differences, and to test these findings in larger and more diverse samples. Implications for Practice: Integrating multiple perspectives: Building on observed differences between patient and therapist perspectives, future research should further explore how both parties perceive mediators of change and the extent to which they assign importance to them.Broadening the concept of relational mediators: The differentiated ways in which patients described relational functions suggest a high sensitivity to interpersonal dynamics in therapy. Rather than focusing solely on pragmatic dimensions of the therapeutic alliance (e.g., goals, tasks, formal bond), it may be useful to further investigate the variety of these fundamental relational processes and how they contribute to change.Reflective use of mediators in practice and training: The identified mediators may offer a helpful framework for therapists to reflect on their clinical approach and to consider whether certain change processes are being underutilised. Integrating these findings into psychotherapy training could help raise awareness of diverse change mechanisms and support more individualised treatment planning. Implication for Policy and Society: The findings suggest that change in psychotherapy may result from individual constellations of mediators within each patient–therapist dyad. Therapeutic approaches that allow for flexible tailoring to individual needs may be particularly valuable. Future research might explore how therapeutic processes can be more precisely adapted to specific mediators of change in order to inform the development of more personalised treatment strategies. [ABSTRACT FROM AUTHOR]
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Database: Psychology and Behavioral Sciences Collection
Description
Abstract:Background: Psychotherapy research is increasingly concerned with how psychotherapy is effective and what mediating factors are involved in change processes. Previous attempts to categorise mediators of change have mostly been based on expert opinion and theory. Patients themselves provide unique insights into factors contributing to therapeutic success, as their lived experiences make them experts on mediators of change and reveal processes that may be overlooked by traditional models (e.g., Common Component or Contextual Models). This study aimed to follow a patient‐informed approach to identify and systematise factors mediating change in successful psychotherapy. Methods: Semi‐structured interviews were conducted with adult participants up to 2 months after their completion of successful outpatient psychotherapy in cognitive behavioural therapy (CBT), psychodynamic therapy (PDT) and analytic psychotherapy (AP). Patients were asked about their experiences regarding how change was achieved in their psychotherapy (i.e., through which mediating factors). The Consensual Qualitative Research (CQR) approach was used for data analysis. Findings: In total, 16 interviews were conducted (CBT: n = 6; PDT: n = 5; AP: n = 5). The identified core ideas were assigned to four main categories: (1) Re‐forming, Awareness, and Processing; (2) Perceiving and Expressing emotions; (3) Relational functions; (4) Solutions or Behavioural options. Applying the CQR‐guidelines, we found notable differences between therapeutic approaches for 15 mediators. Discussion: These patient‐informed results extend existing common‐factor and contextual models by highlighting mediators often under‐represented in theory‐driven frameworks, particularly relational experiences. Future studies should further examine the extent to which method‐specific change processes contribute to therapy, as our results indicate some important differences, and to test these findings in larger and more diverse samples. Implications for Practice: Integrating multiple perspectives: Building on observed differences between patient and therapist perspectives, future research should further explore how both parties perceive mediators of change and the extent to which they assign importance to them.Broadening the concept of relational mediators: The differentiated ways in which patients described relational functions suggest a high sensitivity to interpersonal dynamics in therapy. Rather than focusing solely on pragmatic dimensions of the therapeutic alliance (e.g., goals, tasks, formal bond), it may be useful to further investigate the variety of these fundamental relational processes and how they contribute to change.Reflective use of mediators in practice and training: The identified mediators may offer a helpful framework for therapists to reflect on their clinical approach and to consider whether certain change processes are being underutilised. Integrating these findings into psychotherapy training could help raise awareness of diverse change mechanisms and support more individualised treatment planning. Implication for Policy and Society: The findings suggest that change in psychotherapy may result from individual constellations of mediators within each patient–therapist dyad. Therapeutic approaches that allow for flexible tailoring to individual needs may be particularly valuable. Future research might explore how therapeutic processes can be more precisely adapted to specific mediators of change in order to inform the development of more personalised treatment strategies. [ABSTRACT FROM AUTHOR]
ISSN:14733145
DOI:10.1002/capr.70117