Helpful and hindering events in psychotherapy: A practice research network study

Louis G. Castonguay, James F. Boswell, Sanno E. Zack, Sally Baker, Mary A. Boutselis, Nancy R. Chiswick, Diana D. Damer, Neal A. Hemmelstein, Jeffrey S. Jackson, Marolyn Morford, Stephen A. Ragusea, J. Gowen Roper, Catherine Spayd, Tara Weiszer, Thomas D. Borkovec, Martin Grosse Holtforth

Research output: Contribution to journalArticlepeer-review

105 Scopus citations


This paper presents the findings of a psychotherapy process study conducted within the Pennsylvania Psychological Association Practice Research Network (PPA-PRN). The investigation was the product of a long-term collaborative effort, both in terms of the study design and implementation, between experienced clinicians of various theoretical orientations and full-time psychotherapy researchers. Based on a relatively large sample of clients seen in independent practice settings, close to 1,500 therapeutic events (described by clients and therapists as being particularly helpful or hindering) were collected. These events were coded by three independent observers using a therapy content analysis system. Among the findings, both clients and therapists perceived the fostering of self-awareness as being particularly helpful. The results also point to the importance of paying careful attention to the therapeutic alliance and other significant interpersonal relationships. The merits and difficulties of conducting scientifically rigorous and clinically relevant studies in naturalistic contexts are also discussed.

Original languageEnglish (US)
Pages (from-to)327-344
Number of pages18
Issue number3
StatePublished - Sep 2010

All Science Journal Classification (ASJC) codes

  • Clinical Psychology
  • Psychiatry and Mental health


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