The experience of patients and therapists in psychological therapy.

Patients and therapists are rarely asked to describe their subjective experiences as participants in psychological therapy. In this study 40 therapist/patient pairs were asked to record, after each session of psychological therapy, their subjective views concerning the helpful and unhelpful events which took place, and also to evaluate the helpfulness of those events and the session itself. On completion of therapy. they described their views of the helpful events in retrospect, and provided outcome data. A total of 1076 events were collected from 399 therapy sessions. These were content-analysed using Elliott's Therapeutic Impact Content Analysis System. Results showed that during therapy. patients found the most helpful aspects of therapy to include reassurance/relief and problem solution events; whereas therapists chose the gaining of cognitive and affective insight. After the conclusion of therapy, both patients and therapists also reported the importance of personal contact. Although decreasing with time, the differences between the two perspectives were highly significant. More differences between the views were found when outcome was poor, although the perspectives could be clearly distinguished even when outcome was good. It was suggested that different aspects of the therapeutic process have a different degree of salience for therapists and patients, in that patients are most interested in gaining a solution to their problems. whereas therapists are more concerned with the aetiology of the problem and its transformation through patient insight. Despite these differences, however, most therapies seemed to be reasonably helpful. It was therefore speculated that one mechanism of therapeutic intervention may be the alternative way of making sense of the world with which both patients and therapists are confronted in therapy, suggested by the differing types of events which the two groups of participants see as helpful.