This study explored both how changes are made and what encourages the maintenance of change after psychotherapy, from the perspective of a sample of former clients, using a mixed methods sequential design. Wampold & Imel's (2015) contextual model was used as a conceptual framework. Using secondary data analysis, quantitative analysis was used to explore the degree to which clients made and maintained progress from pretest to post test and 12 to 18 month follow-up. Fourteen interviews were used to hear from former clients about their impressions of what supported their efforts at change and how they maintained these gains post treatment. The findings of the quantitative strand demonstrated clinically meaningful change from pretest to follow-up, using a 1 x 3 repeated measures ANOVA. Qualitative themes emerged in response to questions asking about: what facilitates change, what participants do to maintain changes, and what characterized clinical relationships that did and did not go well.