Growth in challenging situations: A qualitative investigation of therapists' experience of delivering emotion-focused therapy.

Psychotherapy does not work equally well for all clients. For research to support clinicians in helping more clients, we need to better understand the process of when therapy become particularly challenging. In this study, we investigated challenging change processes from the therapists' perspective when applying Emotion-Focused Therapy (EFT). We interviewed 14 therapists trained in EFT about their experiences of difficulties with applying EFT to clients with varying severity of mental health difficulties. Interviews were analyzed using reflexive thematic analysis. Five themes were constructed. Three describing what EFT therapist find challenging; (1) Challenges in the therapeutic relationship, (2) When feelings are too big, too small or difficult to experience, (3) Matching EFT with the client's challenges, and two describing therapist responses to the challenges: (4) Do I know EFT, and what would I have needed to know more? (5) What do I do when it becomes difficult? A total of 20 subthemes were identified. Reported experiences of applying EFT to a diverse population suggests a need for either model refinement or strengthening of the dissemination process to better enable EFT-therapists to help clients with more severe mental health difficulties.