Failure in psychotherapy: a qualitative comparative study from the perspective of patients diagnosed with depression

ABSTRACT

This qualitative study’s objective was to understand how failure in psychotherapy develops from depressed patients’ perspective. Forty-seven patients were interviewed after brief psychotherapy. Data analysis was conducted according to Grounded Theory. Patients evaluated their own psychotherapies’ outcome according to their subjective criteria. Then, negative, positive and mixed-results evaluations were compared in the main categories. Results showed that patients reporting negative evaluations considered null or adverse outcomes as failure. Distrust in their psychotherapists (both as persons and professionals) developed in early stages of the process and was apparently hard to revert. This early onset of distrust led patients to a lack of collaboration and an unreceptive attitude. They perceived their psychotherapist as not understanding, distant, and uninterested, losing focus on relevant problems and not providing new information. The relationship was experienced as uncomfortable and distant, and sometimes became harmful. Therefore, distrust led patients to regard their psychotherapies as an unhelpful experience, in contrast to what occurred in patients with positive or mixed results evaluations. Conclusions contribute to a clarification of how patients conceptualize failure and suggest reevaluating the relevance of their perspective, which seems not to be fully reflected in current outcome measures. Clinicians should consider building trust as a baseline and encourage patients to disclose even the earliest negative feelings about treatment and psychotherapist

KEYWORDS:

• Failure
• patient perspective
• trust
• patient subjective evaluation
• client subjective assessment
• negative outcome
• psychotherapy experience

Acknowledgments

Laura Moncada, Alejandro Ávila, Candice Fischer, Paula Armas, Susan Villena, Paulina Araya, Catalina Barriga, Alejandra Varas, Adriana Gómez, Javiera Cerda, Paulina Brown, Rosario O´Ryan.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by the Consejo Nacional para Investigaciones Científicas y Tecnológicas [Doctorado Nacional 21110733]; Iniciativa Cientifica Milenio [IS130005,NS100018]; Fondo Nacional de Desarrollo Científico y Tecnológico (Fondecyt), N°1141179.

Notes on contributors

Nicolás Suárez-Delucchi

Nicolas Suarez is a Clinical Psychologist and Psychotherapist. He obtained his doctoral degree in Psychotherapy Research from the Pontificia Universidad Católica de Chile and Universidad de Chile. He was trained as Psychoanalyst in the Chilean Society of Psychoanalysis (ICHPA) He has a master’s degree in Clinical Psychology from the Pontificia Universidad Católica de Chile and is an Accredited Psychotherapist by the National Accreditation Commission for Clinical Psychologists, College of Psychologists and the Chilean Society of Clinical Psychology. He has teaching experience in Psychoanalysis and Clinical Supervision. In addition to this, Nicolás has published articles in scientific journals such as Psykhe, Terapia Psicológica, Psychotherapy Research and International Journal of Psychoanalysis, on subjects such as Internal Speech and Psychoanalysis, Depression, Therapeutic Alliance, Father-Mother-Child bond and videofeedback. He has worked in his private practice for more than 17 years treating patients with depressive, anxiety, post-traumatic, obsessive, and personality disorders.

Alex Keith-Paz

Alex Keith-Paz is a Clinical Psychologist from Pontificia Universidad Católica de Chile, Psychotherapist and a psychoanalyst candidate at Instituto de Psicoanálisis APSAN (Asociación Psicoanalítica de Santiago, ascribed to IPA). He obtained an Academic Minor in Sociology at Pontificia Universidad Católica de Chile. He holds Postgraduate Diplomas in Personality Disorders and in Relational Psychoanalysis, both from Pontificia Universidad Católica de Chile, and in Winnicott’s Theory and Clinics from Universidad Diego Portales. He was trained in Rorschach Comprehensive System at FERSIC - Rorschach Training Program Latino America, in Buenos Aires, Argentina. He works at his private practice, and at CEPE (Centro Especializado en Personalidad) since 2019. He was Professor at Universidad de Santiago de Chile’s School of Psychology from 2015 to 2019. From 2004 to 2014, he worked in Millward Brown, a WPP company, conducting qualitative and mixed-methods research about brand strategy and advertising with adults and children, using neuroscience, online and audio-visual tools too; he was its Qualitative Client Service Director in Chile from 2012 to 2014.

Mahaira Reinel

Mahaira Reinel is Psychologist from Fundación Universitaria Konrad Lorenz, Colombia. She obtained a master’s degree in Clinical Psychology and is currently candidate to doctorate in Psychotherapy, both at Pontificia Universidad Católica de Chile. Her research lines are psychotherapy process, therapist’s facilitative skills, mindfulness and depression.

Sofía Fernandez

Sofía Fernandez is a psychologist and holds a master’s degree in clinical psychology from Pontificia Universidad Católica de Chile. She is a psychotherapist specialized in working with children, adolescents, and survivors of abuse. She has experience in psychotherapy research, conducting qualitative research about different aspects of the psychotherapeutic process, such as expectation, therapeutic alliance, change, and outcomes. She is currently a Ph.D. student at the School of Psychology at the Pontificia Universidad Católica de Chile.

Mariane Krause

Mariane Krause is Professor at Pontificia Universidad Católica de Chile’s School of Psychology. She obtained her doctoral degree at Freie Universität Berlin (Germany). Her areas of research are change processes in psychotherapy, depression, and the interaction between sociocultural and mental health conditions. She has led several research projects in these areas, with funding from the Chilean Millennium Scientific Initiative (ICM), the Chilean National Committee of Scientific and Technological Research, and the United Nations Development Program. Between 2013 and 2016 she was President of the Latin American Chapter of the Society for Psychotherapy Research (SPR). In 2016 she received the National Award of the Chilean Society for Clinical Psychology. Between 2018 and 2019 she was President of SPR. During 2019 she was President of the Chilean Council for Research and Technology. From 2014 to 2019 she was the Principal Investigator of the Millennium Institute for Research in Depression and Personality (MIDAP). From 2017 to 2019 she was principal investigator of the Latin American Network in Psychotherapy Process Research. She is currently involved in international research initiatives in depression, and psychotherapeutic change processes, and integrates the Council of the Chilean Ministry for Science, Technology, Knowledge, and Innovation.