![]() It is estimated that 5 to 10% of patients deteriorates in therapy ( Cooper, 2008 Lambert, 2013), and a proportion of 35 to 40% of the participants in clinical trials do not improve ( Lambert, 2007). Negative outcome or nonresponse to treatment is undeniably part of clinical practice. Implications for both research and practice are discussed. It argues for more multi-method and multi-perspective research to gain a better understanding of (negative) outcome and treatment effects. “No change” in outcome scores therefore seems to involve a “partial change” when considering the patients' perspectives.Ĭonclusion: The study shows the value of integrating qualitative first-person analyses into standard quantitative outcome evaluation and particularly for understanding the phenomenon of non-improvement. Remaining issues (ambition to change but inability to do so) were attributed to the therapy hitting its limits, patients' resistance and impossibility and the context as a source of distress. Positive changes (mental stability, personal strength, and insight) were stimulated by therapy offering moments of self-reflection and guidance, the benevolent therapist approach and the context as important motivations. A grounded theory analysis was conducted on the transcripts of patients' interviews.įindings: From the patients' perspective, non-improvement can be understood as being stuck between knowing versus doing, resulting in a stalemate. Nineteen patients whose data showed no reliable change in depression symptoms were selected. A mixed methods study was conducted including patients' pre-post outcome scores on the BDI-II-NL and post treatment Client Change Interviews. Methods: The study took place in the context of a Randomised Controlled Trial evaluating time-limited psychodynamic and cognitive behavioral therapy for major depression. This study investigates the phenomenon of non-improvement in psychotherapy, by complementing quantitative pre-post outcome scores that indicate no reliable change in depression symptoms with a qualitative inquiry of patients' perspectives. To explore this meaning, it is imperative to combine treatment evaluation with quantitative and qualitative outcome measures. ![]() Yet, while outcome is predominantly evaluated by means of quantitative pre-post outcome questionnaires, it remains unclear what this actually means for patients in their daily lives. 2Fonds Wetenschappelijk Onderzoek, Brussels, BelgiumĪim: Understanding the effects of psychotherapy is a crucial concern for both research and clinical practice, especially when outcome tends to be negative.1Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium.Melissa Miléna De Smet 1,2 *, Reitske Meganck 1, Kimberly Van Nieuwenhove 1, Femke L. ![]()
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