Mental health professionals have long debated what makes effective psychotherapy work. Is it a specific treatment modality, or a set of common factors such as a strong therapeutic relationship?

In this book, J. Scott Fraser argues that both perspectives are correct. His transtheoretical, transdiagnostic framework identifies the process of change that underlies all effective treatments.

From this viewpoint, all client problems boil down to negative, recurring cycles of thought and behavior. The goal of psychotherapy is to disrupt or reverse those cycles.

While successful treatment requires common factors linked with specific interventions, these components must be embedded in a therapeutic rationale that implies a direction for treatment. There are many possible "correct" rationales, so finding the one that best fits the client and therapist is the task of treatment planning.

Fraser uses varied and compelling case examples, featuring different client problems and treatments, to illustrate a common process of change.

Table of Contents




I. Searching for What Works in Psychotherapy

  1. The Evolution From Empirically Supported Therapies to Evidence-Based Practices
  2. Changing Paradigms: What's in a Point of View?
  3. Change
  4. Process and Systems
  5. Context

II. Applying the Process Perspective to Specific Client Problems

  1. Anxiety
  2. Depression
  3. Posttraumatic Stress Disorder
  4. Couple Problems
  5. Family System Problems

III. From Process to Practice

  1. The Process of Change in Clinical Context



About the Author

Author Bio

J. Scott Fraser, PhD, is a clinical psychologist with nearly 40 years of clinical practice, supervision, training, and academic teaching.

He has served as director of internship training, associate dean, and director of clinical training and as professor of clinical psychology in the nationally ranked and pioneering doctoral program at the School of Professional Psychology at Wright State University in Dayton, Ohio. Before that, he was director of a crisis/brief therapy center in a large general hospital setting for 14 years.

He is a Diplomate in Family Therapy through the American Board of Professional Psychology and an approved supervisor in the founders' track of the American Association for Marital and Family Therapy.

Dr. Fraser has presented and trained therapists in the United States, Europe, and Asia, and his recent writing focuses on integrating evidence-based approaches to psychotherapy.

A companion DVD titled The Process of Change in Integrative Psychotherapy, which uses the process model described in this book, is also available from APA in the Systems of Psychotherapy Video Series.

Dr. Fraser coauthored Integrative Families and Systems Treatment (I-FAST): A Strengths-Based Common Factors Approach (2014), which represents the first research-based manual for teaching and practicing a moderated common factors approach to at-risk youth and families in community settings. His related book, coauthored with Andrew D. Solovey, Second-Order Change in Psychotherapy: The Golden Thread That Unifies Effective Treatments (2007), applies this integrative model across all evidence-supported approaches to psychotherapy.

Now serving as emeritus professor, Dr. Fraser continues to write, train, and supervise through these models.

Reviews & Awards

Fraser offers a truly integrative and satisfying approach to the contentious and messy debate over specific treatments versus common factors by focusing on processes that can be linked to unique problems, relationships, and therapeutic situations. Practitioners, trainees, and treatment researchers alike will benefit from reading this engaging and remarkable text.
—Timothy Anderson, PhD
Professor of Psychology, Department of Psychology, Ohio University, Athens

Replete with clinical wisdom, analytic clarity, and scholarly grounding, this volume is a creative tour de force. We will be exploring the implications of Fraser's process orientation to therapy for years to come.
—Kenneth J. Gergen, PhD
Senior Research Professor, Swarthmore College, Swarthmore, PA; author of Relational Being: Beyond Self and Community

In this marvelous book, Fraser synthesizes a lifetime of research on the underlying principles for psychotherapy, culminating in this insightful process-centered view that emphasizes context. Covering a variety of problems ranging from anxiety and depression to couple and family difficulties, the author provides a glimpse into the future of psychotherapy.
—Jay L. Lebow, PhD, ABPP
Senior Scholar and Senior Therapist, Family Institute at Northwestern and Northwestern University, Evanston, IL

This one-of-a-kind therapy training text unifies specific empirically validated psychotherapies, including treatments for mood disorders and interpersonal problems, and fully integrates them with the process of change. It then translates this process into clinical practice. This will be an excellent resource for students who are planning to become counselors.
—Toni Zimmerman, PhD
Professor of Human Development and Family Studies, Colorado State University, Fort Collins

Companion Products