A Case of Premature Termination in a Treatment for Generalized Anxiety Disorder

Client perspectives on psychotherapy failure

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.

The Difficult Task of Assessing and Interpreting Treatment Deterioration: An Evidence-Based Case Study

Objectives: Literature on outcome assessment suggests that 35–40% of patients in randomized control trials terminate treatment with unchanged or higher levels of symptomatology. The goal of the present study was to shed light on this phenomenon and the factors accounting for it using a single case study design that investigates the process and outcome of a treatment conducted within a non-randomized clinical trial comparing a cognitive behavioral and a brief relational treatment.

Method: The condition of L., a Caucasian man undergoing cognitive-behavioral therapy in a large metropolitan research program, was classified as deteriorating using the Reliable Change Index for the Inventory of Interpersonal Problems (IIP) and the Symptom Checklist-90 (SCL-90). Therapeutic process and outcome were examined using quantitative and qualitative methods rated by several sources.

Results: Analysis showed that the treatment was delivered skillfully, and that despite initial difficulties, a strong alliance eventually developed between the patient and the therapist whose perspectives on the outcome of therapy nevertheless diverged. The patient's satisfaction with treatment was high, and he believed his deterioration was caused by its termination.

Discussion: Results suggest that the deterioration was not caused by a negative process or a faulty delivery of the therapy. Several explanations were discussed in the context of the literature.