Skilled therapists' experiences of how they contributed to constructive change in difficult therapies: A qualitative study

Abstract

Background: Psychotherapy is effective, but knowledge about how it produces change is insufficient. Researching how skilled therapists obtain change in naturalistic settings is recommended as a fruitful research strategy to advance this knowledge. Aims: We studied how skilled therapists from various affiliations experience their own contribution in specific therapies, and how they integrate therapeutic techniques. Method: We performed semi-structured in-depth interviews with 12 experienced therapists from various affiliations, and analysed transcripts with an explorative and reflexive systematic qualitative approach. Results: We report the overarching theme of maintaining double awareness to provide a relational space for growth, achieved through three concrete themes: (1) tailoring the therapeutic frame to relational struggles, (2) using embodied empathy, and (3) creating meaning from the perspective of a theoretical model. Themes are common across therapeutic modalities. Conclusions: We discuss how the themes offer a relational contextualisation that allows for a constructive understanding of the place of theory and technique in therapy.

Keywords:

• therapy integration
• therapist effect
• psychotherapy relationship
• psychotherapy technique

Acknowledgement

We thank the participant therapists for their open and sharing participation in this study.

Additional information

Notes on contributors

Christian Moltu

Biographies

Christian Moltu is a Clinical Psychologist specialising in adult clinical psychology, working in the public healthcare system. He also holds a researcher/teacher position at the University of Bergen. His professional interests are relational, emotion-focused and integrative approaches to psychotherapy.

Per-Einar Binder

Per-Einar Binder is a Professor of Clinical Psychology at the University of Bergen, and is trained in psychodynamic psychotherapy with children and adults, as well as mindfulness approaches. His professional interests are relational, emotion-focused humanistic, and mindfulness-based approaches to psychotherapy.