How do clients’ previous therapy experiences affect how subsequent therapy is experienced and navigated by CBT therapists in NHS Talking Therapies services?

Introduction: Around a third of clients return to NHS Talking Therapies (NTT). Findings from practice-based studies suggest; (a) clients with previous NTT referrals have poorer outcomes; (b) therapists can find working with returning NTT clients stressful. This study aimed to explore NTT high-intensity cognitive behavioural therapists’ experiences of working with therapy-experienced clients. Specifically, the study aimed to understand the impact clients’ previous therapy experiences have on how therapists navigate and experience therapy, and the ways in which these experiences may facilitate or hinder subsequent therapy.

Method: Semi-structured interviews were carried out with twelve therapists. Therapists were invited to talk about examples of work with clients whose previous therapy experiences had appeared impactful. The resulting interview transcripts were analysed using reflexive thematic analysis.

Results: Four themes were created which represented therapists’ diverse experiences with therapy-experienced clients. A single contextual theme: Preventability of return – therapist lenses described therapists’ views on how therapy works, and the pressures therapists are subject to working in the NTT service context. Three further themes followed a temporal flow: (1) Conducting a post-mortem of previous therapy, captures therapists' approach to and interest in building a picture of clients’ previous therapy experience; (2) Previous therapy as a wellspring – setting the course of therapy, explores how the picture of clients’ previous therapy experiences generates emotional responses within therapists and influences how they approach therapy; and (3) The big finale, describes how therapists are left feeling in relation to the outcome of therapy and the extent to which their own therapy expectations were met.

Discussion: The findings are discussed in relation to the available literature. Clinical implications and directions for future research are outlined. Strengths and limitations of the study are also explored.