title: Associations between therapy skills and patient experiences of change processes in cognitive behavioral therapy for psychosis.
abstract: Despite the promising findings in relation to the efficacy of cognitive behavioral therapy for psychosis (CBTp), little attention has been paid to the therapy skills necessary to deliver CBTp and to the influence of such skills on processes underlying therapeutic change. Our study investigated the associations between general and technical therapy skills and patient experiences of change processes in CBTp. The study sample consisted of 79 patients with psychotic disorders who had undergone CBTp. We randomly selected one tape-recorded therapy session from each of the cases. General and technical therapy skills were assessed by the Cognitive Therapy Scale for Psychosis. The Bern Post Session Report for Patients was applied to measure patient experiences of general change processes in the sense of Grawe's psychological therapy. General skills, such as feedback and understanding, explained 23% of the variance of patients' self-esteem experience, but up to 10% of the variance of mastery, clarification, and contentment experiences. The technical skill of guided discovery consistently showed negative associations with patients' alliance, contentment, and control experiences. The study points to the importance of general therapy skills for patient experiences of change processes in CBTp. Some technical skills, however, could detrimentally affect the therapeutic relationship.
authors.affiliation: University of Tuebingen, Department of Psychiatry and Psychotherapy, Germany. Electronic address: andreas.wittorf@med.uni-tuebingen.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Wittorf
authors.forename: Ute E
authors.initials: UE
authors.lastname: Jakobi-Malterre
authors.forename: Silke
authors.initials: S
authors.lastname: Beulen
authors.forename: Andreas
authors.initials: A
authors.lastname: Bechdolf
authors.forename: Bernhard W
authors.initials: BW
authors.lastname: Müller
authors.forename: Gudrun
authors.initials: G
authors.lastname: Sartory
authors.forename: Michael
authors.initials: M
authors.lastname: Wagner
authors.forename: Georg
authors.initials: G
authors.lastname: Wiedemann
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Wölwer
authors.forename: Jutta
authors.initials: J
authors.lastname: Herrlich
authors.forename: Stefan
authors.initials: S
authors.lastname: Klingberg
mesh_terms: D000328:Adult; D000339:Affect; D000368:Aged; D001288:Attention; D002983:Clinical Competence; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D012044:Regression Analysis; D016896:Treatment Outcome
keywords: Change processes; Cognitive behavioral therapy; Psychotherapy process research; Schizophrenia; Therapy skills