Research on change processes is needed to help explain how psychotherapy produces change. To explain processes of change it will be important to measure three types of outcomes-immediate, intermediate, and final-and three levels of process-speech act, episode, and relationship. Emphasis will need to be placed on specifying different types of in-session change episodes and the intermediate outcomes they produce. The assumption that all processes have the same meaning (regardless of context) needs to be dropped, and a context-sensitive process research needs to be developed. Speech acts need to be viewed in the context of the types of episodes in which they occur, and episodes need to be viewed in the context of the type of relationship in which they occur. This approach would result in the use of a battery of process instruments to measure process patterns in context and to relate these to outcome. Research on the process of psychotherapy has yielded some interesting findings (Orlinsky & Howard, 1978) but has not led to the type of understanding and explanations of psychotherapy that the field has needed. A basic problem with most of the process research is its lack of attention to context (Elliott, 1983a; Rice & Greenberg, 1974, 1984). Rather than assuming that any given process has equal significance or a similar meaning at any point in therapy, it is important to segment therapy into different therapeutic episodes or events in order to understand process in the context of clinically meaningful units. One of the most important criteria for selecting episodes for study is whether or not they represent the process of change. A focus on processes of change serves to transcend the dichotomy between process and outcome that has previously hindered the field (Kiesler, 1983). In studying the process of change, both beginning points and endpoints are taken into account, as well as the form of the function between these points. With processes of change as the focus of investigation, the emphasis is not on studying what is going on in therapy (process research) nor only on the comparison of two measurement points before and after therapy (efficacy research) but rather on identifying, describing, explaining, and predicting the effects of the processes that bring about therapeutic change over the entire course of therapy (Greenberg, 1982, in press). Outcome In studying the process of change it is possible to measure three types of patient outcomes or changes over the course of therapy, namely, immediate outcomes, intermediate outcomes, and ultimate (or final) outcomes (Greenberg, 1982, in press; Pinsof, 1981). An immediate outcome or impact is that change that The author wishes to acknowledge the support of Social Sciences and Humanities Research Council of Canada Grants 410-80-0210 and 410-84-0135. Recognition is due D. Kiesler for the term change process research.
