Context matters: Leveraging therapists' session evaluations to optimize technical adjustments and enhance client outcomes.

Abstract

Operationalizing technical flexibility as session-to-session adjustments in therapist techniques, this study explored the context-dependent aspects of its effects on treatment outcomes. Specifically, we focused on how session-to-session adjustments in therapist techniques have different influences on subsequent client outcomes depending on the therapist-rated quality of the previous session. We used data collected from 3,970 sessions conducted by 17 doctoral student therapists in a university clinic, where 132 adult community clients received individual psychodynamic psychotherapy. The extents of session-to-session technique adjustment were measured by Euclidean distance scores representing the difference between techniques (i.e., explore, insight, and action skills) used in two adjacent sessions. Dynamic structural equation modeling was used to examine temporal relationships among client-rated therapist technical adjustments, therapist-rated previous session quality, and client functioning. When therapists evaluated their previous sessions as lower than usual in quality, moderate adjustments were associated with worse-than-usual client functioning in the current week, compared to sticking to previous techniques or making significant adjustments. When the therapist-rated previous session quality as higher than usual, more technical adjustments from the previous sessions were associated with better current week client functioning. The implications and limitations of the present study were discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).