title: Trajectories of Change in Psychotherapy.
abstract: OBJECTIVE
  The current study used multilevel growth mixture modeling to ascertain groups of patients who had similar trajectories in their psychological functioning over the course of short-term treatment.
  
  
  METHODS
  A total of 10,854 clients completed a measure of psychological functioning before each session. Psychological functioning was measured by the Behavioral Health Measure, which is an index of well-being, symptoms, and life-functioning. Clients who attended 5 to 25 sessions at 46 different university/college counseling centers and one community mental health center were included in this study. Client diagnoses and the specific treatment approaches were not known.
  
  
  RESULTS
  A 3-class solution was a good fit to the data. Clients in classes 1 and 3 had moderate severity in their initial psychological functioning scores, and clients in class 2 had more distressed psychological functioning scores. The trajectory for clients in class 1 was typified by early initial change, followed by a plateau, and then another gain in psychological functioning later in treatment. The trajectory for clients in class 2 demonstrated an initial decrease in functioning, followed by a rapid increase, and then a plateau. Last, the clients in class 3 had a steady increase of psychological functioning, in a more linear manner.
  
  
  CONCLUSIONS
  The trajectories of change for clients are diverse, and they can ebb and flow more than traditional dose-effect and good-enough level models may suggest.
authors.affiliation: University of Denver.
authors.forename: Jesse
authors.initials: J
authors.lastname: Owen
authors.affiliation: University of Louisville.
authors.forename: Jill
authors.initials: J
authors.lastname: Adelson
authors.affiliation: 3University of Wisconsin, Madison.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Budge
authors.affiliation: University of Wisconsin, Madison, Modum Bad Clinic, Norway.
authors.forename: Bruce
authors.initials: B
authors.lastname: Wampold
authors.affiliation: University of Evansville.
authors.forename: Mark
authors.initials: M
authors.lastname: Kopta
authors.affiliation: University of Massachusetts, Boston.
authors.forename: T
authors.initials: T
authors.lastname: Minami
authors.affiliation: International Center for Clinical Excellence.
authors.forename: Scott
authors.initials: S
authors.lastname: Miller
mesh_terms: D003155:Community Mental Health Centers; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy*; D055361:Multilevel Analysis; D011613:Psychotherapy / Q000706:statistics & numerical data*; D057566:Self Report; D016896:Treatment Outcome; D014495:Universities
keywords: dose effect; good-enough level; growth mixture modeling; therapy outcomes