A Model of Therapeutic Action Grounded in the Patients' View of Curative and Hindering Factors in Psychoanalytic Psychotherapy.

Abstract

The patients' view of curative and hindering factors in psychoanalytic psychotherapy was explored, starting from conducting the Private Theories Interview with 22 young adult patients at termination of their therapies. A tentative theoretical model of therapeutic action was constructed using grounded theory methodology. Talking About Oneself, Having a Special Place and Relationship, and Exploring Together With the Therapist were perceived as curative factors by the patients, leading to therapeutic impacts such as New Relational Experiences and Expanding Self-Awareness. Hindering aspects included experiencing that Talking Is Difficult and that Something Was Missing in therapy, interacting with negative impacts such as Self-Knowledge Is Not Enough and Experiencing Mismatch. Methodological issues, the question of common versus specific factors, and im-plications for clinical practice are discussed.

Developing Pluralistic Practice in Counselling and Psychotherapy: Using What the Client Knows

“…However, if a client who believed in the value of "avoidant" coping strategies stayed in therapy long enough, what seemed to happen was that the therapist and the client were eventually able to find ways in which they could work collaboratively and effectively, even though each of them was operating from a different set of basic assumptions about what was helpful. Nevertheless, despite the resourcefulness of their therapists in being able to form a bridge between their contrasting knowledge bases, at least some of these clients reached the end of therapy with a sense that "something had been missing" (Lilliengren & Werbart, 2005), even though the therapy as a whole had been beneficial. McLeod 55…”

“…An important set of qualitative studies has investigated client knowledge through exploring "ideas of cure" in clients receiving psychoanalytic psychotherapy (Lilliengren & Werbart, 2005;Philips, Werbart, Wennberg, & Schubert, 2007). In one study, young adults who were referred for psychoanalytic psychotherapy were invited to take part in pre-therapy interviews around their ideas of how therapy might help them .…”

“…The programme of research conducted by Lilliengren and Werbart (2005) and has begun the task of mapping the contours of client knowledge about therapy, and the ways in which client knowledge can have an impact on the course of therapy. However, their research does not address the question of whether clients whose ideas about what is helpful are different from the ideas held by their therapists, eventually come to adopt their therapists' beliefs, or whether successful outcomes are due to the capacity of the therapist to implement a flexible approach that accommodates these differences.…”

“…Nevertheless, despite the resourcefulness of their therapists in being able to form a bridge between their contrasting knowledge bases, at least some of these clients reached the end of therapy with a sense that "something had been missing" (Lilliengren & Werbart, 2005), even though the therapy as a whole had been beneficial. McLeod 55The programme of research conducted by Lilliengren and Werbart (2005) and has begun the task of mapping the contours of client knowledge about therapy, and the ways in which client knowledge can have an impact on the course of therapy. However, their research does not address the question of whether clients whose ideas about what is helpful are different from the ideas held by their therapists, eventually come to adopt their therapists' beliefs, or whether successful outcomes are due to the capacity of the therapist to implement a flexible approach that accommodates these differences.…”

“…One of the themes that has emerged from several qualitative studies is that over the course of therapy, some clients become aware that what they are being offered is not right for them, and reach the end of therapy with a feeling of disappointment or "something was missing". For example,Nilsson, Svensson, Sandell, and Clinton (2007) found that some clients were disappointed with the CBT therapy they had received because what they felt they had needed was to just talk about their difficulties and make sense of their relationships, whereas disappointed clients who had received psychodynamic therapy reported that they wanted more practical advice and ideas about how to cope.An important set of qualitative studies has investigated client knowledge through exploring "ideas of cure" in clients receiving psychoanalytic psychotherapy (Lilliengren & Werbart, 2005;Philips, Werbart, Wennberg, & Schubert, 2007). In one study, young adults who were referred for psychoanalytic psychotherapy were invited to take part in pre-therapy interviews around their ideas of how therapy might help them .…”