Abstract
This mixed method study explored both (1) how changes are made and (2) what encourages the maintenance of change after psychotherapy. Literature has called for further exploration into what helps clients to make and sustain change from their perspectives. While the effectiveness of approaches such as: psychodynamic, cognitive behavioral, and other disorder-specific treatments has been demonstrated broadly, less is known about individual variables, and specifically about how individuals participate in and support their recovery. This study used a mixed method sequential design. Wampold & Imel’s (2015) contextual model was used as a conceptual framework throughout the study. Using secondary data analysis, we used quantitative methods to explore the degree to which clients made and maintained progress using an empirical measure: the OQ-45.2 (using a longitudinal, within subjects design). Fourteen (N = 14) qualitative interviews were reviewed to hear from a sample of former clients about their impressions of what supported their efforts at change and how they maintained these gains 12–18 months post treatment. The findings of the quantitative strand demonstrated clinically meaningful change from pretest to posttest, posttest to follow-up, and from pretest to follow-up with an effect size of d = .5. Qualitative themes emerged within five categories used to describe the findings. These categories included questions asking about: (1) what drives or facilitates change, (2) what participants do to maintain change post-therapy, and (3) what was and was not helpful in their therapy experiences. The findings suggest implications for both practice and policy. Practice implications include the importance of both monitoring client progress and of termination as a distinct phases of therapeutic relationships. Policy implications include the importance of economic and other macro-level variables in supporting or discouraging mental health.