Wolfgang Tschacher, University of Bern, Bern, Switzerland
Christian Scheier, University of Bern, Bern, Switzerland
Klaus Grawe, University of Bern, Bern, Switzerland

Abstract: In an empirical analysis of the dynamics of psychotherapy processes, concepts and tools from self-organization theory are applied. Our focus is on pattern formation in the 'therapy system', i.e. the system constituted by the interaction dynamics of therapist and patient. The hypothesis of pattern formation explored is based on data sets of 28 psychotherapy courses (10 behavioral, 3 client-centered, 9 heuristic, 6 schema-oriented; 40 to 90 weekly sessions). Patients' and therapists' therapy session records are analyzed (33 variables addressing various aspects of the therapeutic relationship, of progress within and outside the therapy setting). Multivariate methods are implemented to test the key hypothesis of self-organization theory, namely the reduction of degrees of freedom of a system. Consistent with this hypothesis, a significant reduction of degrees of freedom is found when the initial and final sessions of the therapies are compared. Correspondingly, 'Landsberg order' increased significantly in the course of therapies. Given these findings, the explorative question of how this self-organizing property relates to therapy outcome is investigated. We find a significant positive association with various outcome measures, such as: therapist's and client's evaluations of success (direct change measures), feelings of guilt, anxiety, social potence, depression (pre-post effect sizes), and others. These results suggest that order is related to therapy outcome. In our interpretation, order is a dynamical attribute of the therapeutic alliance to be considered as a promising therapy process variable.

Keywords: psychotherapy process, self-organization, process-outcome research, entropy, pattern formation