Psychotherapy Research

In response to the extensive research that demonstrates equivalence across major psychotherapy orientations, I have worked to shed light upon those psychotherapy experiences that undergird change across therapy approaches. In this programmatic line of mixed methods research, I have studied common factors such as emotion, responsiveness, significant moments, and silence within psychotherapy.

My work develops empirically-based principles for practice that guide clinicians towards making clinical decisions at critical points within session dynamics. It centers clients' internal experiences and therapists' intentional processes of shaping attuned interventions in relation to common processes.

Throughout this work, I pay particular attention to clients' experiences within the therapy process. Although clients are estimated to contribute more variance within analyses of outcome than factors such as the psychotherapy orientation or the therapist, their experiences and theories of change are rarely considered and much of the history of psychotherapy research has focused sharply on therapists' theories of change. In contrast, my work draws attention to the agentic role of clients as they intentionally make decisions about their engagement in change processes. It points out how clients can hide their concerns, fears, insights, or decisions and can exert control over the therapy session without comment. I utilize critical, constructivist, and humanistic approaches to research to emphasize the need to empower clients to develop strategies that are appropriate for their own interpersonal and cultural contexts.

Within this body of work, I developed the Pausing Inventory Categorization System, which is a process measure that is uniquely empirically grounded in clients' experiences of moments in the session that are so powerful that they interrupt speech. It is based in qualitative research on clients’ experiences and has evidence of both client-rater and inter-rater reliability, an empirically derived sampling system, cross-cultural validity, and has been associated with outcome in research using both efficacy and effectiveness databases. Notably, I have promoted a strategy for forming sets of empirically-based principles grounded in qualitative research that guide therapists' decision making related to critical issues common across therapy orientations and important to clients. This work has made accessible clients’ internal experiences and therapists' unspoken intentions to guide therapists to better conceptualize and respond at decisional points within their sessions.

Most recently, I have been working with collaborators to create principles to guide psychotherapy process based upon meta-analyses of qualitative literatures. We have examined issues such as therapist responsiveness (Wu & Levitt, 2020), clients experiences in session (Levitt, Somerville & Surace, 2016), and therapist' experiences (in process). Qualitative meta-analytic reviews of the therapy literature advances psychotherapy by developing a rich understanding of the internal experience of clients or the intentional processes of the therapist in session, rather than viewing clients from a primarily medical or symptom-based perspective.

Example articles

Levitt, H. M., Pomerville, A. & Surace, F. I. (2016). A qualitative meta-analysis examining clients’ experiences of psychotherapy: A new agenda. Psychological Bulletin, 142(8), 801-830. http://dx.doi.org/10.1037/bul0000057

Levitt, H. M. & Piazza-Bonin, E. (2017).The professionalization and training of psychologists: The place of clinical wisdom. Psychotherapy Research, 27(2), 127-142.http://dx.doi.org/10.1080/10503307.2015.1090034