The aim of this study was to describe and gain an understanding of clients' experiences of psychotherapy contracts and processes in cognitive behavioural therapy (CBT) and psychodynamic psychotherapy (PDT). Fourteen participants were interviewed after ending their psychotherapy. To get information richness they were selected with as great a variation as possible in relation to their life context. Qualitative content analysis was used to analyse the descriptions and the significance of the descriptions. Similarities between the two therapy orientations emerged throughout the informants' experiences. These similarities were expressed in the two themes: The creation of a new context and The working method and the cooperation with the psychotherapist made up a whole. The psychotherapy process was described as 'hard work' in a new context, markedly different from the ordinary social context. From the informants' perspective, the creation of a new context offered a possibility to give full attention, together with the psychotherapist, to oneself and to the problems one was grappling with. A salient feature was the informant's responsibility for agreements in the psychotherapy contract, especially in relation to the number of sessions and the creation of cooperation with the psychotherapist. Irrespective of therapy orientation the therapeutic techniques were described as inextricably linked to the cooperation with the psychotherapist. An implication for practice and research from these findings is to give more weight to the influence of cooperation in psychotherapy techniques, irrespective of therapy orientation. Another implication is an awareness that the client's knowledge of her/his difficulties, needs and desire for change, capacity to make an effort and to assume
Attachment theory is an encompassing theory for understanding human reactions to life stressors, such as loss and separation, and interpersonal problems are common reasons for seeking psychotherapy. Psychotherapy may be an opportunity to revise insecure attachment and handle interpersonal problems. This study examined attachment styles and interpersonal problems in a clinical sample of psychotherapy patients (n = 168) at the start of psychotherapy. The main aim was to study how self-reported attachment styles, measured by the Attachment Style Questionnaire (ASQ), correlated with interpersonal problems measured using the Inventory of Interpersonal Problems (IIP). Avoidant-related and anxious-related attachment scales correlated positively to the total IIP scores. Inconsistent with findings in nonclinical samples, specific interpersonal problems in the dominant and affiliative parts of the IIP correlated positively to both the anxious-related and the avoidantrelated attachment scales. The findings imply that a challenge for the therapist at the start of psychotherapy is to balance providing security with encouraging exploration of feelings, thoughts, and behaviour in the patient's interpersonal problems in current relationships. Exploring individual profiles of attachment styles helps to clarify motives in expressed interpersonal problems.
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