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Abstract

Objective: To explore psychotherapy experiences among nonimproved young adults in psychoanalytic psychotherapy. Method: A two-stage, mixed-method design was used. Twenty patients in the clinical range at pretreatment were identified as either with reliable deterioration or with no reliable change at termination. Interviews at termination and 3-year follow-up were analyzed with grounded theory methodology. Results: "Spinning One's Wheels" emerged as a core category. The patients described the therapeutic relationship as distanced and artificial. While they saw active components in therapy and their own activities in life as beneficial, therapy itself was experienced as overly focused on problem insight and past history. Conclusions: When the therapist does not contribute to the achievement of the patient's treatment goals--even when the patient gains some benefit--the patient does not fully profit from the therapy.
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... O nepříjemných zkušenostech nás informují často velmi výstižně. Terapie, která nevede ke zlepšení, nebo dokonce zhoršuje stav klientů, byla přirovnána k "protáčení se kol" (terapie se nehnula z místa; Werbart et al., 2015;von Below, 2020). Klienti někdy nabývají dojem, že terapeut na ně mluví nějakým cizím jazykem (Cragun et al., 2012). ...
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... At the beginning of my practice, when I was less used to expressing my irritation for the sake of maintaining the alliance and make it grow through conflict managing, some clients left when they felt angry or disappointed, or have disappeared without explanation. But for many years I have experienced no more drops, and I am never fired by a client who expresses her dissatisfaction through a fair long phase of painful clarification about failures and shortcomings of the treatment (clients tend to leave or drop in "flat" phases, Werbart et al. (2015Werbart et al. ( , 2018. The point is, with some emphasis indeed, that I "must be there, must always be there, and must be indestructible-as are water and earth" (Balint, quoted by Shaw, 2003, p. 263). ...
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All the empirical literature on what is effective in psychotherapy, not just psychoanalytic therapy, ends up emphasising relationship and personality. And when you talk about relationship or about the working alliance, you're talking about the two parties making an attachment to each other, which is just a fancy word for love. I will try to show how this applies to a very difficult case.
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Problematic interactional patterns between client and therapist involve several phenomena, such as different forms of ruptures, enactments, impasses, and stalemates. This study explores psychodynamic therapists’ experiences and understanding of deadlock in the psychotherapy process. Interviews with eight experienced therapists were analyzed applying the Interpretative Phenomenological Analysis (IPA). Generally, the therapists described the deadlock as a negative process, blocking the progress of therapy. The deadlock confronted them with unfulfilled expectations of closeness and connection, as well as unwelcome feelings and wishes, and evoked self-doubt and questioning of their own professional role. The therapists experienced a loss of agency and reflective capacity in the encounter with the client. We found an elusive quality of something absent and incomprehensible in the therapists’ experiences. Resolution of deadlock interacted with therapists finding a constructive role in the therapeutic relationship and being able to give meaning to their experiences. We conclude that the therapists need to be observant of their experiences of deadlock and talk to others about them. The knowledge of deadlocks as natural phenomena in the therapy process that can be recognized, addressed, and worked with must be more widely diffused and should be an integral part of psychotherapy education and training.
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Problematic interactional patterns between client and therapist involve several phenomena, such as different forms of ruptures, enactments, impasses, and stalemates. This study explores psychodynamic therapists’ experiences and understanding of deadlock in the psychotherapy process. Interviews with eight experienced therapists were analyzed applying the Interpretative Phenomenological Analysis (IPA). Generally, the therapists described the deadlock as a negative process, blocking the progress of therapy. The deadlock confronted them with unfulfilled expectations of closeness and connection, as well as unwelcome feelings and wishes, and evoked self-doubt and questioning of their own professional role. The therapists experienced a loss of agency and reflective capacity in the encounter with the client. We found an elusive quality of something absent and incomprehensible in the therapists’ experiences. Resolution of deadlock interacted with therapists finding a constructive role in the therapeutic relationship and being able to give meaning to their experiences. We conclude that the therapists need to be observant of their experiences of deadlock and talk to others about them. The knowledge of deadlocks as natural phenomena in the therapy process that can be recognized, addressed, and worked with must be more widely diffused and should be an integral part of psychotherapy education and training.
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Chapter
Problematic interactional patterns between client and therapist involve several phenomena, such as different forms of ruptures, enactments, impasses, and stalemates. This study explores psychodynamic therapists’ experiences and understanding of deadlock in the psychotherapy process. Interviews with eight experienced therapists were analyzed applying the Interpretative Phenomenological Analysis (IPA). Generally, the therapists described the deadlock as a negative process, blocking the progress of therapy. The deadlock confronted them with unfulfilled expectations of closeness and connection, as well as unwelcome feelings and wishes, and evoked self-doubt and questioning of their own professional role. The therapists experienced a loss of agency and reflective capacity in the encounter with the client. We found an elusive quality of something absent and incomprehensible in the therapists’ experiences. Resolution of deadlock interacted with therapists finding a constructive role in the therapeutic relationship and being able to give meaning to their experiences. We conclude that the therapists need to be observant of their experiences of deadlock and talk to others about them. The knowledge of deadlocks as natural phenomena in the therapy process that can be recognized, addressed, and worked with must be more
... Other qualitative studies about negative results transmit patients' sentiment of being captive inside a vicious cycle, an imbalance between patient's expectations, relational and thinking patterns, and the therapeutic proposal. This imbalance is perpetuated and intensified, causing a feeling of making no progress or worsening (Conrad, 2009;De Smet, Meganck, Van Nieuwenhove, Truijens, & Desmet, 2019;Erb, 1993;Hardy et al., 2019;Shaw, 2004;Werbart, von Below, Brun, & Gunnarsdottir, 2015). ...
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