An integrative mechanistic account of psychological distress, therapeutic change and recovery: The Perceptual Control Theory approach

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Abstract

The exact nature and mechanisms of psychological change within psychological disorders remain unknown. This review aims to use a psychological framework known as Perceptual Control Theory (Powers, 1973, 2005; Powers, Clark, & McFarland, 1960) to integrate the diverse literature within psychotherapy research. The core principles of Perceptual Control Theory are explained, and key domains of psychotherapy are considered to explore how well they converge with these principles. The quantitative and qualitative empirical literature on the process of psychological change is reviewed to examine how it fits with predictions based on Perceptual Control Theory. Furthermore, the prerequisites for psychological change; client qualities, therapist qualities, the therapeutic alliance and the shifting of awareness, are also considered to examine their consistency within a Perceptual Control Theory account. Finally the strengths and limitations of a Perceptual Control Theory account in explaining the mechanism of psychological change are considered.

Section snippets

Perceptual Control Theory

Perceptual Control Theory is a self-regulatory framework based on control system engineering which provides an integrative theoretical account of human behaviour. It has informed the development of contemporary self-regulatory approaches within psychology (Carver & Scheier, 1982, Karoly, 1993, Vancouver, 2005). The theoretical principles of PCT can be applied across both normal psychological functioning and across a range of psychological disorders. For PCT, there are four key principles of

Explanations of change in a selection of psychological theories

With the considerable proliferation in the number of psychotherapies designed to initiate change in those who seek psychotherapeutic assistance, there are now countless approaches to psychotherapy. Nevertheless, over the last fifty years, some key approaches have emerged. This review selects the most prevalent therapies within health services: psychodynamic therapy, cognitive behavioural therapy including its most recent ‘third’ wave developments, motivational interviewing and client-centred

Explaining empirical findings concerning the processes of change

In summary, PCT proposes the following stages of psychological change:

  • 1)

    the client is aware of losing control over key aspects of their life (‘error’ is increased).

  • 2)

    the client becomes increasingly aware of the conflicted goal systems that are causing lack of control.

  • 3)

    reorganisation of the higher level systems occurs on a trial-and-error basis.

  • 4)

    over time, the systems eventually reorganise in a way that reduces conflict and the clients experience an improvement in the overall control of their life and

Evidence for factors involved in psychotherapeutic change

It is important to consider what is known about the kind of therapeutic environment that facilitates psychotherapeutic change, and whether this fits with the principles of PCT. The following section will highlight the prerequisites for psychotherapeutic change drawn partly from client-centred therapy (Rogers, 1957), and in turn consider them within a PCT account.

Strengths and limitations of a PCT approach

PCT is a psychological theory that is based on functional mechanisms known to operate within technology that utilises control engineering. Therefore, it provides a truly mechanistic account of how change occurs, rather being descriptive in nature. In utilising control engineering terms, rather like the use of latin terms in the biological sciences, it allows the precise operationalised definition of its components in contrast to psychological terms, such as ‘attitudes’, ‘insight’ and ‘beliefs’

Summary and conclusions

Perceptual Control Theory has been introduced as an explanatory framework for psychological change. The key principles of the theory – control, hierarchical organisation, conflict and reorganisation – were explained alongside several contemporary psychotherapies and their theoretical foundations. Each psychotherapeutic approach, despite superficial differences, provided an account that was consistent with the psychological principles of PCT. In particular, the importance of the reorganisation

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