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Outcome research in psychotherapy has proceeded remarkably, and the claim that the effects of psychotherapy are statistically and clinically significant is now well founded empirically. As a result, the focus of psychotherapy research has shifted from the therapy process as a whole to processes of change that necessarily link process to outcome. According to Laurenceau, Hayes, and Feldman (2007), psychotherapy process research addresses three sets of questions: For whom and under what conditions does change occur? (moderators of change). What is the shape of change? (trajectories of change). Why and how is change occurring? (mediators of change).
The processes of therapy can be conceived as a series of outcomes (“little o's”) during ongoing treatment, in contrast to the outcome at termination (“big O”) (Greenberg and Pinsof 1986). Symptoms and maladaptive social functioning, measured continuously during the course of treatment, allow the assessment of outcome as it unfolds. The examination