Dissatisfied psychotherapy patients: A tentative conceptual model grounded in the participants' view

Below, Camilla von; Werbart, Andrzej

doi:10.1080/02668734.2012.709536

Cited by 28 publications

(34 citation statements)

References 46 publications

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“…It would be valuable if future research could identify other trajectories of failed therapy and investigate the relative prevalence of each pattern in different therapy settings and client groups. The present study adds to the conclusions of von Below and Werbart () in observing that clients were aware of pivotal moments when they realised that the therapy they were receiving was unhelpful for them.…”

Section: Discussionsupporting

confidence: 64%

“…There was a sense of loss at having shared intimate personal details with their therapist and then realising that they could not undo that sharing. Although based in a rather different sample, these themes are similar to the sense of emotional abandonment that emerged in the von Below and Werbart () study of dissatisfaction in clients receiving long‐term psychoanalytic psychotherapy in the context of the state‐funded healthcare system in Sweden. The similarities suggest that both studies have identified a distinctive pattern of therapeutic failure that may occur on a regular basis.…”

Section: Discussionmentioning

confidence: 71%

“…Some therapist interventions and attitudes may be experienced as temporarily harmful or hindering, in the sense of interrupting the flow of therapy (Henkelman & Paulson, 2006;Paulson, Everall, & Stuart, 2001) but without resulting in lasting damage. A more significant level of harm has been observed in studies that have documented the experiences of clients who complete therapy but remain dissatisfied and disappointed at the end of treatment because they believe that they would have done better if they had seen a different type of therapist (Nilsson, Svensson, Sandell, & Clinton, 2007;von Below & Werbart, 2012). The harm in these instances can be understood in terms of wasted time or lost opportunity.…”

mentioning

confidence: 99%

“…The theme of destructive use of therapist power runs through many client accounts of experiences of having been harmed or damaged by therapy (Armsworth, 1990;Bates, 2006;Dale et al, 1998;Frenken & van Stolk, 1990). In a study of clients who had reported that their therapy had not been helpful, von Below and Werbart (2012) found that dissatisfaction was associated with two main factors. Clients believed that the therapy approach to which they had been exposed was not relevant to their needs.…”

mentioning

confidence: 99%

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‘It was almost like the opposite of what I needed’: A qualitative exploration of client experiences of unhelpful therapy

Bowie

McLeod

2016

Couns and Psychother Res

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Background The issue of unhelpful and harmful therapy outcome has received an increasing amount of attention within the research literature in recent years. However, little research exists on the client's perspective of what constitutes unhelpful therapy. Aim The aim of this study was to explore clients’ experiences of unhelpful therapy. Method Semi‐structured interviews were carried out with ten therapists who, as clients, experienced unhelpful therapy. Interview transcripts were analysed using interpretative phenomenological analysis. Findings Participants recounted therapy episodes characterised by an absence of negotiation, collaboration and care; pivotal moments when they knew that they would not return; and ongoing negative effects. Conclusions The findings of this study have implications for training and strategies for supporting clients who have been harmed by therapy.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 71%

mentioning

confidence: 99%

mentioning

confidence: 99%

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‘It was almost like the opposite of what I needed’: A qualitative exploration of client experiences of unhelpful therapy

Bowie

McLeod

2016

Couns and Psychother Res

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“…badly timed or misdirected interventions may have caused the client to experience the therapist as lacking warmth and understanding. Similar findings were reported in a recent study of seven dissatisfied patients' views of the therapeutic process and outcome (von Below & Werbart, 2012). Patients did not describe one single factor or incident as a starting point for their dissatisfaction and they did not distinguish between the therapist's intervention and what was perceived as flews in the therapist's personality.…”

Section: Hindering Factorssupporting

confidence: 69%

Therapy talk and talk about therapy : Client-identified important events in psychotherapy

Viklund¹

2014

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Capturing and studying the moments in psychotherapy that clients find most important can help us understand more about how psychotherapy works, what the curative ingredients are, and by what processes they are mediated. Qualitative research in this area has, so far, mainly focused on describing, and categorizing clients' experiences of important factors and events. The methods employed to analyse the data have been rather limited in variation and are usually based on a realist epistemology, according to which data are basically treated as reflections of the clients' actual experiences. This entails a risk of overlooking and obscuring other aspects of therapy and the therapy process that are equally important to explore, for example the microprocesses of interaction within important events, or how clients' accounts of their experiences are shaped and limited by the context in which they are produced. The overall aim of this licentiate thesis was to explore client-identified important events in psychotherapy with a focus on studying therapy talk and talk about therapy from a social constructionist point of view, which would allow a closer exploration of the understudied areas mentioned above.In Study I, Conversation Analysis was used to explore the interaction taking place between seven client-therapist dyads in 16 client-identified important events collected from their third sessions. The analysis identified that 12 of the events contained clients' expressions of disagreement. Three different ways that the therapists handled the disagreement were discerned: The first, and most common, way was to orient to the client's cues of disagreement by inviting the client to elaborate on his or her point of view and to establish a shared understanding acceptable to both participants. The second way was to orient to the client's disagreement cues but define the therapist's own point view as more relevant than the client's, and the third way was a single case in which the therapist did not in any way orient to the client's disagreement cues.In Study II, two qualitative methods based on different epistemologies were used to analyse the same set of eight clients' accounts of 18 important events. The aim was to first identify what types of events clients describe as important, and then explore how their accounts of these events were contextually shaped and organized, and the consequences of this. The first analysis, a content analysis, yielded descriptions of five different types of events, which were similar to the ones found in previous research on important events. The second analysis, a discourse analysis, demonstrated how clients' accounts were not only influenced by the participants' ability to accurately remember and report their experience, but also by what was sayable within the context of the research interview. In conclusion, the two studies demonstrate how qualitative methods based on a socialconstructive perspective can contribute to our understanding of clientidentified important events by highlighting and ...

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An Introduction to Qualitative Research in Counselling Psychology

MCLEOD

2015

Counselling Psychology ‐ a Textbook for Study and Practice

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Dissatisfied psychotherapy patients: A tentative conceptual model grounded in the participants' view

Cited by 28 publications

References 46 publications

‘It was almost like the opposite of what I needed’: A qualitative exploration of client experiences of unhelpful therapy

‘It was almost like the opposite of what I needed’: A qualitative exploration of client experiences of unhelpful therapy

Therapy talk and talk about therapy : Client-identified important events in psychotherapy

An Introduction to Qualitative Research in Counselling Psychology

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