Clients' perceptions of pivotal moments in couples therapy: A qualitative study on change in therapy

Karen Bischof Helmeke, Purdue University

Abstract

Few qualitative process research studies have been conducted on change processes in couples therapy, and even fewer have focused on the clients' perceptions of change processes. None have focused specifically on sudden change processes, such as pivotal moments. In this qualitative study, three couples shared their perceptions of pivotal moments in marital therapy. Therapy sessions were videotaped, and data were collected immediately after each session via post session questionnaires and again after therapy was completed via two interviews, the first of which utilized a revised version of Interpersonal Process Recall (IPR) (Elliot, 1984) with both spouses present. In the second interview, the therapist was also present, and initial findings were presented to the couple for further feedback and clarification. The accounts of their pivotal moments were analyzed using grounded theory methodology (Glaser & Strauss, 1967), particularly the constant comparative method. The researcher used videotapes and transcripts of each therapy session and both interviews in the analysis, along with client and therapist self-report from each session in the analysis. Findings from this study were: pivotal moments do exist; they averaged about one per session, although they occurred in sessions in which other pivotal moments occurred; spouses to a large degree did not identify similar pivotal moments or when they did, did not give similar accounts for what made it pivotal; the therapist did not identify the same pivotal moments as did the spouses, and yet this did not seem to impede the progress of therapy; the topics being discussed at the time pivotal moments occurred were related to presenting problems; the topic being discussed during a pivotal moment was likely to have been discussed in previous and subsequent sessions; non-pivotal factors, such as therapist characteristics and the use of practical suggestions, were prerequisite for the occurrence of pivotal moments; the pivotal moments were associated with specific discourses or events in therapy; and the change associated with the pivotal moments tended to be cognitive in nature, rather than emotional or behavioral. Implications for future research and clinical practice are discussed.

Degree

Ph.D.

Advisors

Sprenkle, Purdue University.

Subject Area

Psychotherapy|Families & family life|Personal relationships|Sociology|Social work

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