A qualitative analysis of clients' experience of non-response to psychological therapy

Introduction: There has been an expansion of research into psychotherapy outcomes for both clients who improve and clients who deteriorate as a result of therapy. However, those who fail to respond to therapy have been overlooked. Estimates of non-response to therapy vary from 14% to 60%, yet research with this client group is lacking. Additionally, research suggests therapists are limited in their ability to predict negative outcomes in therapy. If this is equivalent for non-response to therapy, our ability to respond appropriately to these clients may be an issue that needs addressing further. This study aims to begin to understand what sense clients make of therapy which, they feel, has brought about no change. Method: Eight clients who had completed a course of therapy within psychological therapy services (6+ sessions) and subjectively felt that they had not benefitted from this were interviewed about their experience. An interpretative phenomenological analysis was employed to allow an in depth, inductive study of a new area, in order to develop a model of participants’ experiences. Results: Five themes emerged regarding the therapy experience; ‘what I expected’, ‘how I found my therapist’, ‘what was therapy like’, ‘external influences’ and ‘what I am left with’. These were brought together into a model which allowed further meaning to be drawn from the accounts and the experience understood as a process. Discussion: The analysis and model were explored in relation to the available literature. This included consideration of attachment theory in relation to managing therapy expectations, facilitating emotional expression and length of therapy required, in addition to seeking further clarity with regard to what is meant by the term ‘non-response’ in psychological therapy. Novel findings of this research were examined in the context of the strengths and limitations of this particular study. From this, areas of future research and potential clinical impactions were considered.