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This book examines therapeutic failures in psychotherapy. Despite the consistent positive outcome findings and psychotherapists' best intentions in their efforts to help their clients, psychotherapy simply does not work in all cases. In fact, 5-10% of adult clients deteriorate during psychotherapy. Although not exclusively due to treatment failures per se, almost a fifth of clients terminate their therapy prematurely and findings suggest that that between 20 and 30% of clients do not return after the first session with half terminating after just two sessions. Therapeutic failures could include a range of negative therapy outcomes, such as harm, deterioration, client non-response, premature termination, or dropout, as well as process factors, such as negative therapy experiences, impasses, or alliance ruptures. Investigating therapeutic failures holds the key to improving the effectiveness of psychotherapy as well as understanding some of the fundamental conditions that need to be in place for the change mechanisms of psychotherapy to take effect. Although psychotherapy has made many strides over the last few decades to improve research rigour and to promote evidence-based practices, it is a profession that is still growing. By embracing the opportunity to learn from therapeutic failures the profession will continue to refine its practices to better serve clients and to strive toward developing ethical and effective practices.
Both comprehensive and accessible, this book will be of great interest to psychotherapists in practice, therapists-in-training, as well as students and professionals in psychology and mental health in general. The chapters in this book were originally published in Counselling Psychology Quarterly.
List of contents
1. Improving our understanding of therapeutic failure: A review 2. The melody of ruptures: identifying ruptures through acoustic markers 3. Deadlock in psychotherapy: A phenomenological study of eight psychodynamic therapists' experiences 4. The beginning of the end: a comparison of treatment completers and early dropouts in trainee-provided time-limited cognitive behavioral therapy 5. Failure to respond to the patient's coaching: a case study of premature termination in psychodynamic psychotherapy 6. Alliance rupture and repair processes in psychoanalytic psychotherapy: multimodal in-session shifts from momentary failure to repair 7. Failure in psychotherapy: a qualitative comparative study from the perspective of patients diagnosed with depression 8. Therapist dishonesty across theoretical orientations 9. How Graduate-student or Recent Graduate Psychotherapists Experience and Manage Errors in Psychotherapy 10. The self-critical patient in clinical supervision: a qualitative study of therapists' alliance struggles and emotional reactions in short-term psychodynamic psychotherapy for depression 11. The final session of psychodynamic psychotherapy for satisfied and unsatisfied clients who initiate the end of treatment 12. Contrasting two improved and two unimproved cases of patients with medically unexplained physical symptoms after multicomponent treatment 13. What are the sources of feelings of incompetence in experienced therapists? 14. Psychotherapy failures: to err is human
About the author
Nicola Gazzola is Professor of Counselling Psychology in the Faculty of Education at the University of Ottawa, Canada. His main research interests are in the domains of clinical supervision, the experience of the therapist in the process of therapy, and counselling identity, including the collective identity of the profession of counselling as well as the individual professional identity of the counsellor.
Shigeru Iwakabe is Professor of Clinical Psychology at Ritsumeikan University in Osaka, Japan. He conducts psychotherapy research on client emotional processes from an integrative perspective. His research interests include training and professional development in psychotherapy, case study research methods, psychotherapy integration, and cultural and social issues related to the practice of psychotherapy.
Sarah Knox is Professor in the Department of Counselor Education and Counseling Psychology at Marquette University, Milwaukee, WI, USA. The vast majority of her research is qualitative, and specifically uses consensual qualitative research (CQR). She focuses primarily on the psychotherapy relationship and process, training and supervision, and advising relationships and processes.
Summary
This book examines therapeutic failures in psychotherapy. It will be a resource to psychotherapists in practice and therapists in-training, as well as students and professionals in psychology and mental health in general.
