Processes in psychotherapy: A scoping review with LLM-assisted clustering

Area of Science:

• Clinical Psychology
• Psychotherapy Research
• Treatment Efficacy

Background:

• Clinical psychology shows limited progress in treatment efficacy and intervention refinement.
• Traditionally, common factors like therapeutic alliance and empathy are key to change.
• Understanding processes of change is crucial for advancing psychological science.

Purpose of the Study:

• To systematically survey and analyze research trends on processes of change in psychological interventions.
• To identify and categorize the various processes of therapeutic change investigated in recent literature.
• To assess shifts in research focus and volume concerning therapeutic processes over time.

Main Methods:

• Systematic literature review of 778 studies reporting on 684 processes of therapeutic change since 2007.
• AI-assisted human-in-the-loop clustering procedure for organizing processes.
• Utilized OpenAI's GPT-5 nano model to define 32 distinct process clusters.

Main Results:

• Common factors (therapeutic alliance, collaborative processes, interpersonal functioning) formed the largest cluster (20.6%).
• Specific factors, particularly from cognitive behavioral therapy (cognitive appraisal, belief change), constituted the remaining processes.
• Research focus and study volume on therapeutic processes have remained largely unchanged.

Conclusions:

• Despite recognized needs, research on therapeutic processes has not substantially evolved.
• The predominant focus remains on common factor processes, potentially hindering innovation.
• Further investigation into diverse therapeutic processes is needed to improve treatment efficacy.