Mediators of Change in Successful Psychotherapy—Patients' Perspectives on Cognitive‐Behavioural, Psychodynamic and Analytic Therapies

ABSTRACT Background Psychotherapy research is increasingly concerned with how psychotherapy is effective and what mediating factors are involved in change processes. Previous attempts to categorise mediators of change have mostly been based on expert opinion and theory. Patients themselves provide unique insights into factors contributing to therapeutic success, as their lived experiences make them experts on mediators of change and reveal processes that may be overlooked by traditional models (e.g., Common Component or Contextual Models). This study aimed to follow a patient‐informed approach to identify and systematise factors mediating change in successful psychotherapy. Methods Semi‐structured interviews were conducted with adult participants up to 2 months after their completion of successful outpatient psychotherapy in cognitive behavioural therapy (CBT), psychodynamic therapy (PDT) and analytic psychotherapy (AP). Patients were asked about their experiences regarding how change was achieved in their psychotherapy (i.e., through which mediating factors). The Consensual Qualitative Research (CQR) approach was used for data analysis. Findings In total, 16 interviews were conducted (CBT: n = 6; PDT: n = 5; AP: n = 5). The identified core ideas were assigned to four main categories: (1) Re‐forming, Awareness, and Processing; (2) Perceiving and Expressing emotions; (3) Relational functions; (4) Solutions or Behavioural options. Applying the CQR‐guidelines, we found notable differences between therapeutic approaches for 15 mediators. Discussion These patient‐informed results extend existing common‐factor and contextual models by highlighting mediators often under‐represented in theory‐driven frameworks, particularly relational experiences. Future studies should further examine the extent to which method‐specific change processes contribute to therapy, as our results indicate some important differences, and to test these findings in larger and more diverse samples.