Clients' experience of non‐response to psychological therapy: A qualitative analysis

Abstract

Objective The evidence is that therapy only works for some. This study aimed to explore clients' subjective experience of non‐improvement; specifically how do participants who feel they have not benefitted from psychological therapy describe the experience and make sense of their therapy? Method Eight people from a National Health Service Psychological Therapies Department in the UK who felt their therapy had not resulted in improvement took part in semi‐structured interviews, later analysed using interpretative phenomenological analysis. Results Participants described a process, beginning with their difficulties, negative feelings about themselves, and initial hopes and anxieties for therapy. Once in therapy, participants described overwhelming fears of losing control and being judged. They described attempts to manage this, using self‐censoring and compliance. After therapy, while most could identify some gain, they felt disappointed and that they were having to ‘make do’. The sense of not having succeeded or being sufficiently deserving of further input, in turn, reinforced participants' initial negative self‐beliefs. Conclusion Although participants identified themselves as not having improved through therapy, the accounts suggested more complexity. All participants reported detrimental effects and accounts contained qualified, thoughtful descriptions of these experiences: participants acknowledged some gains, even though they felt that therapy had not met their expectations.

Relationship and Alliance Formation Processes in Psychotherapy: A Dual-Perspective Qualitative Study

“…In this study, overwhelming fear and shame fueled relational distance. Our findings resonate with other qualitative research, confirming that feelings of fear and shame are common during initial sessions and need to be dealt with to successfully reach a real relationship and a collaborative working alliance ( Lavik et al, 2018 ; Radcliffe et al, 2018 ; Kleiven et al, 2020 ). Further, serious ruptures or a lack of relationship became fatal when not addressed, as in dyads 4, 9, and 11.…”

How Does Therapy Harm? A Model of Adverse Process Using Task Analysis in the Meta-Synthesis of Service Users' Experience

“…The literature search preceded the lengthy process of empirical refinement, which preceded the study used as validation, and so is not contemporary. However, there is no reason to believe that people's experiences of therapy have fundamentally altered during this time period; indeed more recent reports confirm that very similar issues continue to be raised (Werbart et al, 2015 ; Radcliffe et al, 2018 ). Our verification results were encouraging, although we did not proceed to the final stage of verification, which would require testing whether the model can distinguish between beneficial and adverse therapies in a new, prospective study.…”

“We Just Did Not Get on”. Young Adults’ Experiences of Unsuccessful Psychodynamic Psychotherapy – A Lack of Meta-Communication and Mentalization?

“…In a rare study of patient experiences of non-improvement, Radcliffe et al (2018) found that patients unfortunately had their negative self-image reinforced by the absent positive effects of therapy. The patients in their study started therapy with negative views of themselves and a fear of what psychotherapy might lead to (such as losing control), which might be understood as a fear of affects and a limited capacity to mentalize.…”