Therapists' private theories on the helpful and hindering factors of long-term psychoanalytic psychotherapy for treatment-resistant depression (TADS study)

Rost, Felicitas; Maissis, Guy and Fonagy, Peter (2019). Therapists' private theories on the helpful and hindering factors of long-term psychoanalytic psychotherapy for treatment-resistant depression (TADS study). In: Society for Psychotherapy Research 5th Joint European & UK Chapters Conference, 19-21 Sep 2019, Krakow, Poland.

URL: https://www.sprconference.com/EU-UK-2019/#:~:text=...

Abstract

Background: The Tavistock Adult Depression Study demonstrated that once-weekly, long-term psychoanalytic therapy is more effective than treatment as usual for individuals suffering from treatment-resistant depression (TRD), reporting that 40% of the patients reached partial remission (Fonagy et al., 2015). Aim: The aim of this study was to elucidate the findings by focusing on the therapists' private theories of curative and hindering factors that influenced the therapeutic process and therefore treatment outcome.

Methods: Thematic analysis based on Brown and Clark (2001) was used to analyse 23 PTI's from therapists whose patients completed the treatment. Of particular interest was thereby to compare and contrast the emerging themes among therapists whose patients benefitted from the treatment (N=12) and those who did not (N=11). Partial remission was defined as a Hamilton Depression Rating Scale score (lt) 12. Results: Two main themes were identified as helpful: 'a containing and meaningful therapeutic relationship' and 'an effective psychoanalytic intervention'. Therapists regarded the establishing of a positive therapeutic relationship through effective containment of the various attempts of the patients to hinder the progress as pivotal. This enabled therapists to address the severe pathology more directly. Challenges were attributed to the patients' highly negative view regarding the usefulness and helpfulness of the therapy and of the therapists themselves. The use of supervision and the support of others involved in the patients' care was needed to mitigate the challenges. Discussion: Results are discussed with respect to the need to adapt psychoanalytic psychotherapy for this particularly complex and severe patient group.

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