Marquette University.
Clement J. Zablocki VA Medical Center, Milwaukee, WI.
Psychother Res. 2023 Mar;33(3):298-315. doi: 10.1080/10503307.2022.2110020. Epub 2022 Aug 29.
This study qualitatively examined client's definition and experiences of failed psychotherapy. Thirteen clients were interviewed by phone regarding their experience of failed psychotherapy. Data were analyzed using consensual qualitative research (CQR). Participants defined failed psychotherapy as negatively affecting clients, involving problems in the psychotherapy relationship, and not meeting clients' goals. When describing specific experiences of failed psychotherapy, participants gradually recognized the failure themselves, but the recognition was sometimes facilitated by others. Pre-termination, the failed psychotherapy yielded negative effects (worsened symptoms/functioning, deteriorating relationship, not addressing clients' concerns). Participants perceived therapists' contributions as involving action (insensitive/inappropriate responses to participants' concerns about psychotherapy) and inaction (not managing psychotherapy effectively). They perceived their own contributions as their difficulty voicing their concerns or asserting themselves. Post-termination effects were negative cognitively/affectively (heightened distress), behaviorally (disinterest in seeking mental health services), and interpersonally (relationship difficulties in later psychotherapy); the failed psychotherapy also helped participants pursue their needs in psychotherapy. Failed psychotherapy consisted of problems in the relationship and the treatment not meeting client's goals. Such psychotherapy worsened clients' functioning, further damaged an already tenuous psychotherapy relationship, and both therapists and clients contributed to the failure. After termination, failed psychotherapy yielded cognitive/affective, behavioral, and interpersonal effects.
本研究定性探讨了来访者对失败心理治疗的定义和体验。13 名来访者通过电话接受了关于其失败心理治疗体验的访谈。采用共识定性研究（Consensual Qualitative Research，CQR）对数据进行分析。参与者将失败心理治疗定义为对来访者产生负面影响、涉及心理治疗关系问题且未达到来访者目标的治疗。当描述具体的失败心理治疗体验时，参与者逐渐自我认识到失败，但这种认识有时也受到他人的影响。在治疗终止前，失败的心理治疗会产生负面效果（症状/功能恶化、关系恶化、未解决来访者的担忧）。参与者认为治疗师的贡献包括行动（对来访者对心理治疗的担忧做出不敏感/不恰当的反应）和不作为（未能有效地管理心理治疗）。他们认为自己的贡献是难以表达自己的担忧或主张自己的观点。治疗终止后，认知/情感方面的影响是负面的（加剧的困扰），行为方面的影响是（对寻求心理健康服务不感兴趣），人际关系方面的影响是（在随后的心理治疗中关系困难）；失败的心理治疗也帮助来访者在心理治疗中追求自己的需求。失败的心理治疗包括关系问题和治疗未达到来访者的目标。这种心理治疗会恶化来访者的功能，进一步破坏本已脆弱的心理治疗关系，治疗师和来访者都对失败负有责任。治疗终止后，失败的心理治疗会产生认知/情感、行为和人际关系方面的影响。
