Something is Different But What or Why is Unclear: Commentary on the Boston Change Process Study Group

The authors from the Boston Change Process Study Group address an observation that is commonly echoed by patient and therapist alike. Both have a sense that something in their therapeutic work together is different, that a change has occurred, but neither can point to a specific moment at which that change seemed evident or to a specific intervention by the therapist or personal insight by the patient. Why this commonplace observation is worthy of closer study is that for years therapists engaged in long-term psychodynamically oriented work or psychoanalysis have pointed in retrospect to such moments as the hallmarks of a deepening treatment process, that is, of patients becoming more engaged and curious about their mental life and/or of the beginning of a fruitful termination phase in which patients actively review and make the treatment progress their own. Sometimes both therapist and patient appreciate nearly simultaneously that a change has occurred, but more commonly one perceives change before the other and often these nodal points are clear to both only in retrospect. The authors propose that clues to the nature of this perception of change can be found in close process study of moment-to-moment interactions between patient and therapist. They are proposing that the perception of change by one or both parties changes the way therapist and patient work in the dyadic interaction of therapy and that these kinds of shifts are important both for therapeutic outcome and for