"Spinning one's wheels": Nonimproved patients view their psychotherapy

Area of Science:

• Psychology
• Psychotherapy Research
• Clinical Psychology

Background:

• Psychoanalytic psychotherapy is a common treatment for young adults.
• Understanding patient experiences is crucial for treatment improvement.
• Many young adults do not achieve desired outcomes in psychotherapy.

Purpose of the Study:

• To explore the psychotherapy experiences of young adults who did not improve in psychoanalytic psychotherapy.
• To identify factors contributing to lack of improvement in long-term psychoanalytic treatment.

Main Methods:

• A mixed-method design was employed with 20 patients.
• Patients were categorized as having reliable deterioration or no reliable change.
• Grounded theory analysis was used for termination and 3-year follow-up interviews.

Main Results:

• A core category of "Spinning One's Wheels" emerged.
• Patients perceived the therapeutic relationship as distanced and artificial.
• Therapy was seen as overly focused on insight and the past, despite patients finding active therapy components and life activities beneficial.

Conclusions:

• Patient benefit from therapy is limited when therapists do not actively contribute to treatment goals.
• Lack of perceived therapist contribution to goals impedes full patient profit from psychotherapy.
• Patient-centered goal achievement is vital for successful psychoanalytic psychotherapy outcomes.