Findings from different areas of psychotherapy research suggest that psychotherapeutic change is complex, involving common factors and various specific change processes. Attention has turned to understanding how psychotherapy works—that is, what are the mechanisms of change of psychotherapy?
This overarching aim of this theses was to examine central mechanisms of change, both common factors and specific change processes (such as emotional and cognitive), in order to acquire a better understanding of how change occurs. The results suggest that patients conceive the therapeutic relationship as consisting of two central components, namely Confidence in the therapist and Confidence in the treatment. In addition to finding a reciprocal association between the two relationship factors and symptom change, they also seem to be associated with distinct pathways of change (i.e., affective and cognitive). Finally, our results suggest that associations between the different aspects of the therapeutic relationship and other change processes vary across treatment orientations, thereby supporting existing notions in the field about the therapeutic relationship as a pantheoretic phenomenon that expresses differently depending on treatment context.