How clients feel when psychotherapy doesn't work

Edited by Jill Wright, 02 March 2015

I imagine a lot of psychologists would feel quite ambivalent about some recent research picked up by the British Psychological Society's Research Digest on the way clients feel when their treatment doesn't work.

At Psychology Melbourne, however, it very much justifies a good deal of the extra effort that we have made over several years to improve the outcome of therapy.

The research was carried out by Andrzej Werbart and his colleagues at the University of Stockholm's Psychological Institute.

They conducted in-depth interviews with 17 clients who failed to improve after an average of 22 months of therapy, and another three whose symptoms deteriorated. 

One important point is that these clients were undergoing psychoanalytic therapy, which is a long-term and these days relatively uncommon form of treatment.

Another point is that therapists who take the psychoanalytic approach very often come across as quite passive, remaining silent or perhaps taking notes while the client "free associates" about his childhood, dreams, reflections etc.

That's not generally the way most modern psychotherapy proceeds. These days, client and practitioner tend to be involved in a more active partnership towards more rapid progress.

Nevertheless, the clients' comments reveal a common thread: feeling that they were "spinning their wheels", feeling uncertain about the goals of therapy and the methods used to achieve them.

So much of the additional research that Psychology Melbourne has carried out, and the special training and methods that we have developed with the help of academics, is directly aimed at establishing a more solid therapeutic alliance between client and psychologist with the precise intention of identifying and responding to issues like that.

The results are very clear: at Psychology Melbourne, we continue to achieve a much higher success rate than the industry average.

One of the reasons for that may well be that we take the approach that the researchers recommended for therapists: that they take care to address their clients' treatment preferences and expectations.

We regard the consequent alignment of the therapist's theory of change with the too-often-overlooked client's theory of change - as an essential.

As the researchers put it, clients need to be involved in setting the goals of therapy and educated about what the process will entail, but also, "the therapist needs to learn to be the unique patient's therapist."

We have also put a lot of effort into gathering client feedback, to address a point raised by a good number of researchers: that therapists are poor at identifying when therapy is not working.

One positive emerging from the Swedish research is that between the end of therapy and later follow-up, more than half the non-improved clients showed beneficial decreases in their symptoms. 

Significantly, that ongoing change was not observed for clients who showed more immediate improvements after therapy, suggesting these changes were not a mere consequence of maturing. "Rather, the conclusion is that non improvement at [therapy] termination does not imply lasting symptoms," the researchers said.