An Introduction to Change in Psychotherapy: Moderators, Course of Change, and Change Mechanisms

This overview addresses for whom and under what conditions psychotherapy produces change, the course of change over sessions, and why change happens. Specifically, the most confirmed moderators are pretreatment symptoms level, readiness for change, assertiveness, agency, defense maturity, quality of object relationships, mentalization, and interpersonal functioning. Regarding the course of change, processual models better describe change than stage ones, capturing its nonlinear and time-embedded nature. Moreover, trajectories of change describe different classes of change by clients (i.e., from three to five) and might be helpful feedback for clinicians. Furthermore, the most confirmed change mechanisms in literature for individual psychotherapy are insight, affective awareness, reflective functioning, externalizing difficulties, self-talk, coping, emotion regulation, the reappraisal of threat, fear extinction, change of interpersonal cognitions/avoidance, compensatory skills, mood regulation expectancies, diet habits, and self-efficacy. Conversely, emotional closeness, couple satisfaction, blamer softening, family functioning, and parental competence are confirmed mechanisms for couple/family psychotherapy. Finally, transversal mechanisms common to many approaches should not be considered equal to common factors, such as alliance, emotional regulation, and insight.