[Difficult situations in psychotherapy and how therapists deal with them]

Difficult situations in psychotherapy and how therapists deal with them Objectives: In theory and research, it is assumed that therapeutic competences are especially relevant in difficult situations. In the present study, we collected and categorized situations that psychotherapists subjectively evaluated as difficult. Additionally, we inspected therapists' reactions to these situations and considered correlations between situations and reactions. Methods: In an online-survey, 101 therapists described difficult situations and their corresponding reactions. The reports were analyzed by qualitative content analysis (Mayring 2015) and resulted in two category systems for the difficult situations and the reactions. Results: Difficult situations reached from everyday conflicts to extreme situations (e. g. threats). The most frequent difficult situations were in context of therapeutic frame, aspects of disorder, and critics, demands, accusations of patients. The most frequent reactions concerned therapeutic frame, external help and supportive interventions. We found significant correlations between difficult situations due to aspects of disorder and asking for external help. Conclusions: Although categories were sometimes difficult to isolate and few cognitive behavioral therapists participated, the collection of difficult situations can be of help for therapists and their training.