"It was like having half of the patient in therapy": Therapists of nonimproved patients looking back on their work

• Published in: Psychotherapy research 2019-10, Vol.29 (7), p.894-907
• Main Authors: Werbart, Andrzej, von Below, Camilla, Engqvist, Karin, Lind, Sofia
• Format: Article
• Language: English
• Subjects: Analytical psychotherapy; Clinical significance; Closeness; grounded theory; long term psychotherapy; Loss of control; negative processes; outcome research; Patients; perspectiva do terapeuta; pesquisa de processo; pesquisa de resultados; process research; processi negativi; processos negativos; prospettiva del terapeuta; psicoterapia a lungo termine; psicoterapia de longo prazo; Psychoanalysis; psychoanalytic/psychodynamic therapy; Psychology; Psychotherapy; psykologi; ricerca di processo; ricerca sui risultati; Self evaluation; teoria fundamentada; terapia psicanalítica / psicodinâmica; terapia psicoanalitica / psicodinamica; Termination; Therapeutic alliances; therapist perspective; Therapists; Therapy; Treatment methods; Young adults; 成效研究; 歷程研究; 治療師觀點; 精神分析/精神動力治療; 紮根理論; 負向歷程; 長期心理治療
• ISSN: 1050-3307; 1468-4381; 1468-4381
• DOI: 10.1080/10503307.2018.1453621

Objective: To explore therapists' experiences of therapeutic process in psychoanalytic psychotherapy with nonimproved young adults. Method: Eight nonimproved cases were identified according to the criterion of reliable and clinically significant change in self-rated symptoms. Transcripts of therapist interviews (8 at baseline 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 mitigated problems, while core problems remained. Conclusions: This split picture was interpreted as a sign of a pseudo-process emerging when the therapist one-sidedly allied herself with the patient's capable and seemingly well-functioning parts. The therapists' experiences could be compared to the nonimproved patients' "spinning one's wheels" in therapy. The therapists seem not to have succeeded in adjusting their technique to their patients' core problems, despite attempts to meta-communicate.