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Therapeutic realizations are one of five universal, session-level change processes explicated in the Generic Model of Psychotherapy. Realizations refer to session impacts, the moment-to-moment accomplishments that patients experience within sessions. This study establishes the psychometric characteristics and factor structure of a modified patient-rated measure of session-level effects, the Therapeutic Realization Scale-Revised (TRS-R). In addition, it shows the relationship of the TRS-R to treatment process and outcome from the perspective of both patients and therapists. The findings provide support for the TRS-R as a reliable and valid, multidimensional index of session-level treatment effects.

The generic model of psychotherapy is offered as a transtheoretical model of universal change processes. Session 3 change processes are examined in a naturalistic study of dynamic therapy guided by the generic model. Findings replicate and extend earlier work addressing propositions of the generic model in dynamic therapy. Openness and bond contributed to in-session realizations, whereas bond and realizations fostered session progress. Session progress, bond, use of experiential operations, and less frequent use of dynamic interventions contributed to change between Sessions 2 and 4. Discussion outlines a model of change in early dynamic therapy and highlights the usefulness of the generic model for the evaluation of change processes.

This naturalistic study examined effective microprocesses in early sessions of dynamic psychotherapy. A multiple-regression data analytic strategy focused on the proportion of variance accounted for by process variables in session outcome as judged by the patient. This measure of session outcome in early sessions of dynamic therapy was associated with overall treatment outcome. Specific microprocesses differentially emerged as contributors to session progress as therapy proceeded, accounting for 55% of the variance in session 3 and 58% in session 7. Findings are discussed in terms of specific as well as fundamental change processes in early sessions of dynamic psychotherapy. The usefulness of the generic model of psychotherapy for guiding exploratory change process research is also highlighted.