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Therapists of Nonimproved Patients Looking Back on Their Work
Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.ORCID iD: 0000-0003-0859-1012
2017 (English)Conference paper, Oral presentation only (Other academic)
Abstract [en]

Aim: Despite clear evidence that about 5 to 10% of patients deteriorate and 35 to 40% does not improve in psychotherapy, nonimproved cases are seldom scrutinized. The therapists’ experiences of their work with nonimproved patients might be a rich source of clinically relevant knowledge. Our study explores therapists’ experiences of therapeutic process in unsuccessful cases of psychoanalytic psychotherapy with young adults. Method: A two-stage, mixed-method design was used. Nonimproved cases were identified according to the criterion of reliable and clinically significant change in self-rated symptoms. Transcripts of 16 therapist interviews (8 pretreatment and 8 at termination) were analyzed applying Grounded Theory methodology. Results: A tentative conceptual process model was constructed around the core category Having Half of the Patient in Therapy. Initially, the therapists experienced collaboration as stimulating, at the same time as the therapeutic relationship was marked by distance. At termination negative processes predominated: the patient reacted with aversion to closeness and the therapist experienced struggle and loss of control in therapy. The therapists described therapy outcome as favorable in form of increased insight and alleviated problems, while core problems remained. Discussion: This split picture was interpreted as a sign of a pseudo-process emerging when the therapist allies herself with the patient’s capable and seemingly well-functioning parts. The therapists’ experiences could be compared to the nonimproved patients’ descriptions of “spinning one’s wheels” in therapy. The therapists seem not to have succeeded in adjusting their technique to their patients’ problems, despite their attempts to meta-communicate.

Place, publisher, year, edition, pages
2017.
Keywords [en]
psychoanalytic/psychodynamic therapy, long term psychotherapy, outcome research, process research, mixed-methods, therapist perspective, negative processes
National Category
Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:su:diva-150196OAI: oai:DiVA.org:su-150196DiVA, id: diva2:1165814
Conference
Society for Psychotherapy Research at the Society for Psychotherapy Research, 48th Annual International Meeting, Toronto, Canada, June 21-24, 2017
Available from: 2017-12-13 Created: 2017-12-13 Last updated: 2022-02-28Bibliographically approved

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Werbart, Andrzej

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CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf