Background: The value of clients’ reports of their experiences in therapy is widely recognized, yet quantitative methodology has rarely been used to measure clients’ self-reported perceptions of what is helpful over a single session. Aims: A video-rating method using was developed to gather data at brief intervals using process measures of client perceived experience and standardized measures of working alliance (Session Rating Scale; SRS). Data were collected over the course of a single video-recorded session of cognitive therapy (Method of Levels Therapy; Carey, 2006; Mansell et al., 2012). We examined the acceptability and feasibility of the methodology and tested the concurrent validity of the measure by utilizing theory-led constructs. Method: Eighteen therapy sessions were video-recorded and clients each rated a 20-minute session of therapy at two-minute intervals using repeated measures. A multi-level analysis was used to test for correlations between perceived levels of helpfulness and client process variables. Results: The design proved to be feasible. Concurrent validity was borne out through high correlations between constructs. A multi-level regression examined the independent contributions of client process variables to client perceived helpfulness. Client perceived control (b = 0.39, 95% CI .05 to 0.73), the ability to talk freely (b = 0.30, SE = 0.11, 95% CI .09 to 0.51) and therapist approach (b = 0.31, SE = 0.14, 95% CI .04 to 0.57) predicted client-rated helpfulness. Conclusions: We identify a feasible and acceptable method for studying continuous measures of helpfulness and their psychological correlates during a single therapy session.

Background: Computerized self-help that has an interactive, conversational format holds several advantages, such as flexibility across presenting problems and ease of use. We designed a new program called MYLO that utilizes the principles of Method of Levels (MOL) therapy - based upon Perceptual Control Theory (PCT). Aims: We tested the efficacy of MYLO, tested whether the psychological change mechanisms described by PCT mediated its efficacy, and evaluated effects of client expectancy. Method: Forty-eight student participants were randomly assigned to MYLO or a comparison program ELIZA. Participants discussed a problem they were currently experiencing with their assigned program and completed measures of distress, resolution and expectancy preintervention, postintervention and at 2-week follow-up. Results: MYLO and ELIZA were associated with reductions in distress, depression, anxiety and stress. MYLO was considered more helpful and led to greater problem resolution. The psychological change processes predicted higher ratings of MYLO's helpfulness and reductions in distress. Positive expectancies towards computer-based problem solving correlated with MYLO's perceived helpfulness and greater problem resolution, and this was partly mediated by the psychological change processes identified. Conclusions: The findings provide provisional support for the acceptability of the MYLO program in a non-clinical sample although its efficacy as an innovative computer-based aid to problem solving remains unclear. Nevertheless, the findings provide tentative early support for the mechanisms of psychological change identified within PCT and highlight the importance of client expectations on predicting engagement in computer-based self-help.