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

Bowie, Christine; McLeod, Julia; McLeod, John

doi:10.1002/capr.12066

Cited by 20 publications

(11 citation statements)

References 32 publications

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“…Some experienced the therapist positively, for example, as validating. This contrasts with findings from the literature on harmful therapy, where therapists are experienced as uncaring (Bowie, McLeod & McLeod, ). Some participants described experiences of fearing judgement from a critical therapist.…”

Section: Discussioncontrasting

confidence: 85%

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

Radcliffe

Masterson

Martin

2018

Couns and Psychother Res

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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.

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Section: Discussioncontrasting

confidence: 85%

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

Radcliffe

Masterson

Martin

2018

Couns and Psychother Res

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“…On the other hand, there have been numerous explorations of patients’ experiences of individual psychotherapy for problems other than insomnia [ 18 ]. Some have focused on experiences of treatment-related change [ 19 , 20 ] and others on helpful [ 21 , 22 ] or unhelpful aspects of treatment [ 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Patients’ experiences of motivation, change, and challenges in group treatment for insomnia in primary care: a focus group study

Sandlund¹,

Kane²,

Ekstedt³

et al. 2018

BMC Fam Pract

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BackgroundThe majority of patients who seek help for insomnia do so in primary health care. Nurse-led group treatment in primary care based on cognitive behavioral therapy for insomnia (CBT-I) can lead to improvements in both day- and nighttime symptoms. This study aimed to explore patients’ experiences of nurse-led group treatment for insomnia in primary health care.MethodsSeventeen patients who had participated in the group treatment program were interviewed in five focus groups. Interview transcriptions were analyzed with qualitative content analysis.ResultsFour themes emerged that described patients’ experiences of the group treatment program. Involvement and trust open the door for change: Motivation to engage in treatment arose from patients’ own desire for change, from being together with others who shared or understood their struggles, and from feeling emotionally affirmed and trustful. Competence arising from deeper understanding: Patients obtained knowledge and made it their own, which enabled them to develop functional sleep habits and let go of sleep performance and worry. The ability to impact their insomnia increased patients’ trust in their own efficacy and helped them persist in behavioral change. Struggling with vulnerability and failure: Treatment was tough, and patients could feel challenged by external circumstances. Moreover, they could distrust their own efficacy. Tailoring treatment to individual needs: Patients experienced different life circumstances and adapted the techniques to their needs and abilities by focusing on what felt right for them.ConclusionsPatients went through a process of motivation, change, and challenges. They experienced certain aspects of treatment as essential to changing behavior and achieving improvements. Examples included being in a group with others who shared similar experiences, gaining knowledge about sleep, keeping a sleep diary, and practicing the sleep restriction technique. The study provides insights into patients’ struggles during treatment, both those related to external circumstances and those related to feelings of vulnerability and failure. It also highlights the importance of adapting treatment to patients’ differing needs, underscoring the value of person-centered care.

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“…The integration of multiple methods and specifically the comparison of quantitative and qualitative methods is an indispensable development for the field of psychotherapy research (McLeod, 2013; Bowie et al, 2016). The current study therefore provides a mixed-method analysis of patients suffering from major depression.…”

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confidence: 99%

No Change? A Grounded Theory Analysis of Depressed Patients' Perspectives on Non-improvement in Psychotherapy

et al. 2019

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Aim: Understanding the effects of psychotherapy is a crucial concern for both research and clinical practice, especially when outcome tends to be negative. Yet, while outcome is predominantly evaluated by means of quantitative pre-post outcome questionnaires, it remains unclear what this actually means for patients in their daily lives. To explore this meaning, it is imperative to combine treatment evaluation with quantitative and qualitative outcome measures. This study investigates the phenomenon of non-improvement in psychotherapy, by complementing quantitative pre-post outcome scores that indicate no reliable change in depression symptoms with a qualitative inquiry of patients' perspectives. Methods: The study took place in the context of a Randomised Controlled Trial evaluating time-limited psychodynamic and cognitive behavioral therapy for major depression. A mixed methods study was conducted including patients' pre-post outcome scores on the BDI-II-NL and post treatment Client Change Interviews. Nineteen patients whose data showed no reliable change in depression symptoms were selected. A grounded theory analysis was conducted on the transcripts of patients' interviews. Findings: From the patients' perspective, non-improvement can be understood as being stuck between knowing versus doing, resulting in a stalemate. Positive changes (mental stability, personal strength, and insight) were stimulated by therapy offering moments of self-reflection and guidance, the benevolent therapist approach and the context as important motivations. Remaining issues (ambition to change but inability to do so) were attributed to the therapy hitting its limits, patients' resistance and impossibility and the context as a source of distress. “No change” in outcome scores therefore seems to involve a “partial change” when considering the patients' perspectives. Conclusion: The study shows the value of integrating qualitative first-person analyses into standard quantitative outcome evaluation and particularly for understanding the phenomenon of non-improvement. It argues for more multi-method and multi-perspective research to gain a better understanding of (negative) outcome and treatment effects. Implications for both research and practice are discussed.

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

Cited by 20 publications

References 32 publications

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

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

Patients’ experiences of motivation, change, and challenges in group treatment for insomnia in primary care: a focus group study

No Change? A Grounded Theory Analysis of Depressed Patients' Perspectives on Non-improvement in Psychotherapy

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