Few psychotherapy studies focus on the patient’s experience. Researchers often ask patients to fill out standardized questionnaires. Still, the questions and, thus, the responses tend to focus on what the researcher or therapist wants to know, not necessarily what the patient wants to convey, thus marginalizing the patient’s experience. In this study, Li and colleagues focused on patients’ experiences and perspectives of psychotherapy provided by the UK National Health Service (NHS). That service provides brief symptom-focused CBT across a wide range of clinics, often starting with an internet-based intervention and then followed by in-person therapy. Li and colleagues qualitatively analyzed open-ended questions posed to 148 patients who received psychotherapy. The patients represented a diverse group of adults, most of whom had anxiety or depressive disorders. The questions asked, “What made your therapy helpful or unhelpful?” and “What did the therapist do to make your therapy more helpful…”. Responses were thematically analyzed. The first theme highlighted the one-size-fits-all approach to therapy. Patients criticized the therapy as overly structured and impersonal. The second theme focused on the development of practical and coping skills as well as greater self-awareness. Patients wanted to develop skills while experiencing a deeper understanding of themselves. The third theme indicated that the therapeutic alliance was essential to patients. Patients found it most helpful when therapists saw and related to them as unique individuals, were nonjudgmental, empathic, and genuinely curious about the patient. The fourth theme highlighted that patients wanted more depth in the therapy experience. Therapy was sometimes experienced as superficial, did not address core issues, and provided only temporary relief. In the fifth theme, patients emphasized their reliance on self-management and individual resilience, particularly in unhelpful therapy. Patients who were not helped tried to become more self-reliant. Several themes also emerged regarding patients’ suggestions for improvements. One theme highlighted a strong desire for therapy to be personally relevant and not merely generic. That is, patients wanted a therapy tailored to their personal preferences and needs. Patients also wanted more consistency, clarity and predictability in therapy. They wanted clear expectations about treatment plans. Finally, patients reported a desire to work with a therapist who genuinely understood the patient and with whom they felt a bond. They expressed the importance of a fully engaged and nonjudgemental empathic therapist.
Practice Implications
Patients expressed a preference for personalized therapy, emphasizing the importance of life skills, the therapeutic alliance, and the depth of the therapy. To meet these preferences, therapists should be responsive and adjust their approach to align with the individual needs of each patient. Initiating a conversation with each patient about their preferences can help develop a tailored treatment plan, increasing the likelihood that patients will feel heard and view the therapist as empathic and competent.
Li, E., Kealy, D., Aafjes-van Doorn, K., McCollum, J., Curtis, J.T., Luo, X, & Silberschatz, G. (2024): “It felt like I was being tailored to the treatment rather than the treatment being tailored to me”: Patient experiences of helpful and unhelpful psychotherapy. Psychotherapy Research, Advance Online Publication. https://doi.org/10.1080/10503307.2024.2360448
To learn more about the Psychotherapy Practice Research Network, visit www.pprnet.ca.
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