Pathways towards different long-term outcomes after naturalistic psychotherapy.

This study suggests some potential pathways leading towards maintained gains or further growth versus deterioration after naturalistic psychotherapy with experienced clinicians. This is explored in a way that transcends specific theoretical orientations. Sixteen therapies, all showing reliable improvement on Outcome Questionnaire 45.2 (OQ-45) at treatment termination but varying in later post-therapy development, were included in this study. Building on previous content and correlational analyses, individual cases were explored qualitatively in search for developmental patterns of potential relevance for long-term outcome. Patterns re-emerging across several cases were described in light of the OQ-45 trajectories of clients providing them. Six pathways, associated with different long-term outcomes, emerged. Four of these, "Reflective route towards regulation of affects," "Gaining autonomy through a secure holding relationship," "Opening up as a new relational/emotional experience," and "Lasting acceptance of «reality»," re-emerged in clients showing maintained/growing treatment effects. Two pathways, entitled "Residual problems grow and overshadow progress" and "Core problems remain beneath superficial change," seemed linked to deterioration after termination of therapy. We suggest the former pathways as some possible routes towards enduring good outcome, and the latter as some patterns to avoid when trying to secure therapy gains will not be only temporary.