From mistakes to mastery: An idiographic microanalytical study comparing processes related to effective and ineffective outcomes in behavioral interventions

The field of psychotherapy research increasingly recognizes the need for idiographic studies linking process of change to outcomes. However, investigations have typically focused on successful outcomes alone, neglecting the analysis of specific behaviors connected to treatment failure. This study aims to link process to both effective and ineffective outcomes. By examining 80 psychotherapy sessions across 13 cases with a mixed-method approach, a turn-by-turn conversational analysis was carried out. After detecting different levels of effectiveness following a multiple baseline design, sequential analysis and intra- and inter-case comparisons were performed. The results indicated that while differential reinforcement of target behavior was found to be related to both successful and unsuccessful outcomes, the defining characteristics of effective sessions were the preciseness of specific strategies and the predominance of appetitive over aversive stimulation throughout the intervention. These findings revealed that splitting units into linear relations to analyze psychotherapeutic interaction might be insufficient. Instead, addressing not only the presence but also the absence and concurrence of covariation associated with the events of interest could be a determining factor in unveiling the processes leading to different outcomes in psychotherapy.