A scoping review of studies examining processes of therapeutic change in psychological interventions, covering 778 studies published since 2007, with AI-assisted clustering (GPT-5 nano) used to organize 684 identified processes into thematic clusters.
32 process clusters were identified; the largest cluster — common factors (therapeutic alliance, collaborative processes, interpersonal functioning) — accounted for 20.6% of all investigated processes. The remaining processes were mainly specific CBT-related factors (e.g., cognitive appraisal, belief change). Research focus and volume have not meaningfully changed over the study period.
Scoping reviews do not appraise study quality, so the evidence base behind each process cluster is unvetted. The AI-assisted clustering relied on a single LLM (GPT-5 nano), which may introduce classification bias. Coverage begins in 2007, potentially missing earlier foundational work.
Therapeutic alliance and common factors remain the dominant focus of process research — clinicians can feel confident these constructs are well-studied. However, the field's stagnation suggests that emerging or underexplored mechanisms of change likely lack robust evidence to guide practice refinement.
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