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.