Sudden gains in clients of psychotherapy trainees: A process and outcome analysis

Sudden gains are abrupt and substantial improvements in psychotherapy outcome between two consecutive therapy sessions. Though psychotherapy outcome studies show that sudden gains occur in a range of clinical settings, no study has determined if they occur in clients of psychotherapy trainees. This study uses the sudden gain criteria of Tang, DeRubeis, Hollon, Amsterdam, and Shelton (2007) to identify sudden gains in outcome data from a university-based psychotherapy training clinic. Moreover, a method is developed to identify gradual gainers in order to provide a more stringent test of sudden gains' treatment benefits. In the second part of this study, raters assessed the differentiability between pregain and control sessions in order to evaluate the validity of the explanation that sudden gains are the result of a single, critical therapy session. Sudden gains are identified in 22% of the sample, which is lower than the results of most sudden gain studies. Gains occurred early in therapy, with a median session of 4, and sudden gainers enjoyed better treatment outcomes than gradual gainers. In addition, the raters experienced difficulty in differentiating pregain and control sessions. Further research is needed to replicate the finding that sudden gains confer treatment advantages relative to gradual gains, as well as to examine the uniqueness of the session prior to gain.