“Spinning one's wheels”: Nonimproved patients view their psychotherapy

Abstract

Objective: To explore psychotherapy experiences among nonimproved young adults in psychoanalytic psychotherapy. Method: A two-stage, mixed-method design was used. Twenty patients in the clinical range at pretreatment were identified as either with reliable deterioration or with no reliable change at termination. Interviews at termination and 3-year follow-up were analyzed with grounded theory methodology. Results: “Spinning One's Wheels” emerged as a core category. The patients described the therapeutic relationship as distanced and artificial. While they saw active components in therapy and their own activities in life as beneficial, therapy itself was experienced as overly focused on problem insight and past history. Conclusions: When the therapist does not contribute to the achievement of the patient's treatment goals—even when the patient gains some benefit—the patient does not fully profit from the therapy.

Abstract

Objective: To explore psychotherapy experiences among nonimproved young adults in psychoanalytic psychotherapy. Method: A two-stage, mixed-method design was used. Twenty patients in the clinical range at pretreatment were identified as either with reliable deterioration or with no reliable change at termination. Interviews at termination and 3-year follow-up were analyzed with grounded theory methodology. Results: “Spinning One’s Wheels” emerged as a core category. The patients described the therapeutic relationship as distanced and artificial. While they saw active components in therapy and their own activities in life as beneficial, therapy itself was experienced as overly focused on problem insight and past history. Conclusions: When the therapist does not contribute to the achievement of the patient’s treatment goals—even when the patient gains some benefit—the patient does not fully profit from the therapy.

Zusammenfassung:

Ziel: Psychotherapeutische Erfahrungen von sich nicht-verbesserten jungen Erwachsenen in psychoanalytischer Psychotherapie zu explorieren. Methode: Verwendet wurde ein zweifach gestuftes, Mixed-Method Design. Es wurden 20 Patienten identifiziert, welche sich zum Zeitpunkt der Vorbehandlung innerhalb des klinischen Bereichs befanden, aber sich zum Abschluss der Therapie entweder reliabel verschlechtert hatten oder keine reliable Veränderung zeigten. Interviews zum Ende der Therapie und eine drei Jahre spätere Follow-up Erhebung wurden mittels der Methode der Grounded Theory analysiert. Ergebnisse: Zeitverschwendung stellte sich als eine Kernkategorie heraus. Die Patienten beschrieben die therapeutische Beziehung als distanziert und künstlich. Während sie aktive Komponenten der Therapie und ihre eigenen Aktivitäten im Leben als förderlich sahen, wurde die Therapie selbst als zu fokussiert auf Problemerkenntnis und die Vergangenheit erlebt. Zusammenfassung: Wenn der Therapeut nicht zur Erreichung der Ziele des Patienten beiträgt – selbst, wenn der Patient sich etwas verbessert – profitiert der Patient nicht voll und ganz von der Therapie.

Objetivo: Explorar a experiência psicoterapêutica de jovens adultos que não exibiram melhorias em psicoterapia psicanalítica. Método: Foi utilizado um design misto de duas fases. Vinte pacientes na faixa clínica no pré-tratamento foram identificados como apresentando uma deterioração significativa ou como não apresentando alterações significativas aquando da finalização do tratamento. As entrevistas realizadas aquando da finalização do tratamento e no follow-up após 3 anos foram analisadas através da metodologia de grounded theory. Resultados: Emergiu uma categoria central: “Andar em Círculos”. Os pacientes descreveram a relação terapêutica como distante e artificial. Apesar de terem percebido as componentes ativas na terapia e as suas próprias atividades de vida como sendo benéficas, a terapia em si foi experienciada como excessivamente centrada no insight sobre o problema e na história passada. Conclusões: Quando o terapeuta não contribuiu para a concretização dos objetivos terapêuticos – mesmo que o paciente tenha obtido algum ganho – o paciente não beneficiou totalmente da terapia

目的:本研究旨在探索接受心理分析心理治療無效的年輕病患之治療歷程經驗。方法：本研究採用二階段的混合研究設計。根據治療的前後測結果，這20位病患的情況在臨床可信賴範圍內不是惡化就是沒有改變，蒐集他們在結案當時、以及三年後的追踨訪談，相關質性資料採用紮根理論加以分析。研究結果:形成一個核心的類別“治療無效”，病患們描述治療關係是有距離和”表面化“的，認為治療過度強調對問題的洞察和過往的歷史；不過，他們也看見治療中的主動成份，也認為自己生活中的一些活動對他們有益。 結論：當治療師無法協助病患達成治療目標時，雖然病患仍從治療中獲得一些好處，但是整體而言治療歷程對他們而言並無助益。

Keywords:

• process research
• psychoanalytic/psychodynamic therapy
• outcome research
• qualitative research methods
• nonimprovement
• patient perspective