Conceptions and Perceptions of Psychotherapy in the Eyes of Therapists and their Patients: Longitudinal Analysis by the Faceted Action System Theory (FAST)1

Author(s): Amir Ezrachi, Samuel Shye.

Fifty-four pairs of patients and their psychotherapists were interviewed individually at three time points during therapy, exploring their expectations and perceptions of the therapy in which they were engaged. Depicting therapy as a Faceted Action System, variables were classified into four functioning modes representing: Implied therapy contract, Therapy interactions, Management of external factors, and Therapy outcome. Multivariate analysis of the data by Faceted SSA yielded conceptual maps representing the structure and progression of participants' expectation from therapy, as well as their perceptions of it. Findings revealed that with time, therapists' expectation-maps shifted from the archetypal systemic pattern towards a variation closer to that of their patients, interpreting some integrative-mode (internal) variables, such as therapist interventions, as playing an adaptive-mode (external) role. As therapy extended to eight months, patients completely re-structured their original conceptualization, exhibiting an astonishing pattern dominated by highly differentiated integrative mode, underscoring the profound significance patients attributed to the patient-therapist relationship. Cognitive maps revealed a parallel shift with respect to perceptions of actual therapy. Implications of the findings are explored, resulting in a new, empirically supported systemic interpretation of the therapeutic endeavor. The study illustrates the unique advantage of pictorial representations of complex multivariate data for gaining insights into the psychotherapeutic endeavor, and into the relational approach to psychotherapy, in particular.