Psychodynamic psychotherapy for depression: Illuminating processes of change using a time-series design

This study examined the process of change in the early stages of psychodynamic psychotherapy for three patients with Major Depressive Disorder (MDD). The three patients were in once-weekly psychotherapy at a university-based psychological clinic with supervised master’s level therapists in a clinical psychology doctoral training program. Subjective well-being and symptoms were monitored daily throughout treatment (consisting of 9, 12, and 13 sessions). Based on theory-driven models of therapeutic change (Phase Model of change: Howard, et al., 1986; Howard, et al., 1993), improvement in subjective well-being ought to occur early in therapy and prior to improvement in diagnosis-specific symptoms. Six phase-specific outcome patterns were defined (18 across the three patients) that ought to obtain according to the Phase Model of therapeutic change. Time-series analyses were applied to test whether the improvement realized in each case unfolded in the pattern predicted by theory. It did not, neither on a case-by-case basis, nor when all cases were taken together. Only 4 of the 18 conditions were satisfied. Though the findings are in no way definitive, the pattern of improvement in these three cases did not conform to that predicted by the Phase Model of therapeutic change. The current study provides an important methodological template for examining the process of change in psychotherapy using a time-series design.