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Dissatisfied psychotherapy patients: A tentative conceptual model grounded in the participants' view
Uppsala County Council, Sweden.
Stockholm University, Faculty of Social Sciences, Department of Psychology.
2012 (English)In: Psychoanalytic Psychotherapy, ISSN 0266-8734, E-ISSN 1474-9734, Vol. 26, no 3, 211-229 p.Article in journal (Refereed) Published
Abstract [en]

Usually, between 5% and 20% of psychotherapy patients are dissatisfied with their treatments. This naturalistic study explores seven clearly dissatisfied patients' view of the therapeutic process and outcome. Interviews at termination of psychoanalytic psychotherapy and at a 1.5-year follow-up were analysed to create a tentative conceptual model of patient dissatisfaction using grounded theory approach. At the core of the model is an experience of abandonment by a therapist felt to be insufficiently flexible, a therapy lacking intensity, and links missing between therapy and everyday life. Dissatisfied patients lacked confidence in their relationship with the therapist, described their therapists in negative terms and concluded that their therapies lacked direction. They wanted more response from the therapist. Paying greater attention to the patient's emerging dissatisfaction may prevent lasting disappointment, unnecessary continuation of fruitless treatment, and probably increase efficiency.

Place, publisher, year, edition, pages
2012. Vol. 26, no 3, 211-229 p.
Keyword [en]
psychoanalytic psychotherapy, process research, grounded theory, dissatisfied patients, young adults
National Category
Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:su:diva-83477DOI: 10.1080/02668734.2012.709536OAI: oai:DiVA.org:su-83477DiVA: diva2:575934
Available from: 2012-12-11 Created: 2012-12-11 Last updated: 2017-08-03Bibliographically approved
In thesis
1. When psychotherapy does not help: ...and when it does: Lessons from young adults' experiences of psychoanalytic psychotherapy
Open this publication in new window or tab >>When psychotherapy does not help: ...and when it does: Lessons from young adults' experiences of psychoanalytic psychotherapy
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The process and outcome of psychoanalytic psychotherapy have been studied for a long time. However, the experiences of patients, particularly in therapies where goals were not met, have not yet been the target of extensive research. Psychoanalytic psychotherapy with young adults might face particular challenges. The overall aim of this thesis was to explore the experiences of young adults in psychoanalytic psychotherapy, with a particular focus on differences between suboptimal therapies and therapies with generally good outcome. The setting was naturalistic, and perspectives of the patient, therapist and observer were combined. Qualitative and quantitative methods were used. Study I explored experiences of psychotherapy process and outcome among seven patients in psychoanalytic psychotherapy, who expressed dissatisfaction. Interviews at termination and 18 months later were analysed using grounded theory and compared to therapist experiences. Patients experienced abandonment with their problems in and after therapy, since therapy according to the patients lacked connections to daily life, as well as flexibility, activity and understanding from the therapist. Therapists presented a different picture of the same therapies, mainly focused on the difficulties of the patients. Study II analysed the experiences of 20 non-improved or deteriorated young adult psychotherapy patients at termination of therapy and 36 months later. Non-improvement and deterioration were calculated based on the reliable change index on self-rating scores. The grounded theory analysis of interviews established spinning one’s wheels as a core category. The relationship to the therapist was described as artificial, although at times helpful. Participants experienced their own activity in life and active components of therapy as helpful, but thought focus in therapy was too much on past experiences. Study III explored the experiences of 17 young adult patients, in psychoanalytic individual or group therapy, overcoming depression. The analysis of interviews from therapy termination and 18 months later indicated that finding an identity and a place in life were perceived as intertwined with symptom relief. Negative experiences included difficulties to change oneself, fear of change, and problems in therapy, such as too little activity on the therapist’s part.

The results were discussed in relation to young adulthood, therapeutic alliance, mentalization, and attachment. The conclusion was expressed in a comprehensive process model of suboptimal therapy with young adults, with suggested ways to prevent such a development. The therapist’s meta-communication and correct assessment of the patient’s mentalization capacity from moment to moment are proposed as crucial. Regarding clinical implications, therapists of young adult patients need to establish meta-communication on therapy progress, as even experienced therapists might be unaware of dissatisfaction or deterioration. Meta-communication could be considered part of the treatment itself, as it may foster mentalization and good outcome. Further, the period of young adulthood entails decisions and developing an adult life, and therapists need to make room for this by active interventions.

Place, publisher, year, edition, pages
Stockholm: Department of Psychology, Stockholm University, 2017
Keyword
young adults, emerging adulthood, psychoanalytic, psychodynamic, psychotherapy, patient perspective, deterioration, dissatisfaction, mixed method, grounded theory, therapeutic alliance
National Category
Applied Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-144399 (URN)978-91-7649-913-9 (ISBN)978-91-7649-914-6 (ISBN)
Public defence
2017-10-20, David Magnussonsalen (U31), Frescati Hagväg 8, Stockholm, 10:00 (English)
Opponent
Supervisors
Available from: 2017-09-27 Created: 2017-06-20 Last updated: 2017-09-05Bibliographically approved

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