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Sudden gain or sudden loss in psychotherapy is a statistically exceptional decrease or increase, respectively, in a client's symptoms and distress between two treatment sessions. In psychotherapy research, such sudden gains have been found to be strong predictors of outcome at termination and follow-up. To obtain further in-depth knowledge of the nature and process of sudden gains, this article presents qualitative and quantitative case studies of the clients of a clinical psychologist who is a private practitioner, Erigoni Vlass (the third author). Vlass's caseload presented numerous examples of this phenomenon—she had a sudden-gain base rate over five times higher than the established rate for similar types of clients (and a sudden-loss rate one third less than expected)—classifying her as a "supershrink" (Okiishi, Lambert, Nielsen, & Ogles, 2003). Specifically, a randomized sample of five of Vlass's sudden-gain clients and five of her sudden-loss clients were selected and their results compared with quantitative and qualitative data collected at two-year-plus follow-up. The quantitative results indicated, consistent with previous research, that the sudden-gains clients made dramatic improvements in reducing distress and increasing functioning, while the sudden-loss clients showed little such improvement. Also, a statistically significant higher overall working alliance was found in the sudden-gain as compared to the sudden-loss clients. The qualitative results supported the quantitative results, providing rich, narrative details of how the clients experienced the process and impact of the therapy. The article concludes with a discussion of the distinctive aspects of the results, including the role of the therapist as an outcome variable; the uneven rate of change reflected in the sudden gain/sudden loss phenomena; and the ability of a supershrink therapist like Vlass to achieve dramatically positive results—as measured over two years after the end of therapy—in an average of little more than four therapy sessions.

Sudden Gains and Sudden Losses in the Clients of a "Supershrink": 10 Case Studies