Sudden Gains and Sudden Losses in the Clients of a "Supershrink": 10 Case Studies
Keywords:sudden gains, rapid response, rapid responders, therapy outcome, working alliance, off-track, sudden loss, therapist factors, interpretative phenomenology, mixed methods, supershrink, outcome questionnaire (OQ-45), case studies, clinical cases
Sudden gain or sudden loss in psychotherapy is a statistically exceptional decrease or increase, respectively, in a client's symptoms and distress between two treatment sessions. In psychotherapy research, such sudden gains have been found to be strong predictors of outcome at termination and follow-up. To obtain further in-depth knowledge of the nature and process of sudden gains, this article presents qualitative and quantitative case studies of the clients of a clinical psychologist who is a private practitioner, Erigoni Vlass (the third author). Vlass's caseload presented numerous examples of this phenomenon—she had a sudden-gain base rate over five times higher than the established rate for similar types of clients (and a sudden-loss rate one third less than expected)—classifying her as a "supershrink" (Okiishi, Lambert, Nielsen, & Ogles, 2003). Specifically, a randomized sample of five of Vlass's sudden-gain clients and five of her sudden-loss clients were selected and their results compared with quantitative and qualitative data collected at two-year-plus follow-up. The quantitative results indicated, consistent with previous research, that the sudden-gains clients made dramatic improvements in reducing distress and increasing functioning, while the sudden-loss clients showed little such improvement. Also, a statistically significant higher overall working alliance was found in the sudden-gain as compared to the sudden-loss clients. The qualitative results supported the quantitative results, providing rich, narrative details of how the clients experienced the process and impact of the therapy. The article concludes with a discussion of the distinctive aspects of the results, including the role of the therapist as an outcome variable; the uneven rate of change reflected in the sudden gain/sudden loss phenomena; and the ability of a supershrink therapist like Vlass to achieve dramatically positive results—as measured over two years after the end of therapy—in an average of little more than four therapy sessions.
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