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

Abstract

Usually, between 5% and 20% of psychotherapy patients are dissatisfied with their treatments. This naturalistic study explores seven clearly dissatisfied patients' view of the therapeutic process and outcome. Interviews at termination of psychoanalytic psychotherapy and at a 1.5-year follow-up were analysed to create a tentative conceptual model of patient dissatisfaction using grounded theory approach. At the core of the model is an experience of abandonment by a therapist felt to be insufficiently flexible, a therapy lacking intensity, and links missing between therapy and everyday life. Dissatisfied patients lacked confidence in their relationship with the therapist, described their therapists in negative terms and concluded that their therapies lacked direction. They wanted more response from the therapist. Paying greater attention to the patient's emerging dissatisfaction may prevent lasting disappointment, unnecessary continuation of fruitless treatment, and probably increase efficiency.

Keywords:

• psychoanalytic psychotherapy
• process research
• grounded theory
• dissatisfied patients
• young adults

Acknowledgements

This study is a part of the prospective, longitudinal Young Adult Psychotherapy Project conducted at the former Institute of Psychotherapy, Stockholm County Council, and the Psychotherapy Section, Department of Clinical Neuroscience, Karolinska Institutet. The project was supported by grants from the Bank of Sweden, Tercentenary Foundation, and from the R&D Secretariat, Stockholm County Council. The project has been approved by the Regional Research Ethics Committee at the Karolinska Institutet and all participants have given their informed consent.