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ORIGINAL RESEARCH article

Front. Psychol.
Sec. Psychology for Clinical Settings
Volume 15 - 2024 | doi: 10.3389/fpsyg.2024.1403736
This article is part of the Research Topic Rethinking Unsuccessful Psychotherapies: When and How do Treatments Fail? View all 4 articles

Rethinking treatment failures. Research on a group of Italian psychotherapists

Provisionally accepted
Osmano Oasi Osmano Oasi Francesca De Salve Francesca De Salve *Chiara Rossi Chiara Rossi Simone Maggio Simone Maggio Ilaria Casabona Ilaria Casabona Sara Molgora Sara Molgora
  • Department of Psychology, Catholic University of the Sacred Heart, Milan, Lombardy, Italy

The final, formatted version of the article will be published soon.

    Introduction. Psychotherapeutic failures involve situational, relational, and personal factors. Dropout refers to a patient's unilateral termination of treatment without the therapist's knowledge or approval.Premature termination occurs when therapy is discontinued before achieving a sufficient reduction in initial problems. Objective. This study explores the role of therapist's emotional response (countertransference), gender, psychotherapeutic orientation, and patient diagnosis in the context of psychotherapeutic failures. Method. A mixed-method approach was used. 59 Italian psychotherapists, practicing mostly privately with at least 5 years of experience, were recruited through Italian professional internet websites. The Therapist Response Questionnaire and the Impasse Interview were administered to each psychotherapist. Each therapist was asked to reflect on their last dropout patient.Quantitative (MANOVA) and qualitative analyses (textual content analysis) were conducted with SPSS and T-LAB, respectively. Results. The quantitative analysis revealed that the most frequent countertransference response was Helpless/Inadequate, with female therapists experiencing this more frequently than male therapists. The qualitative analysis identified two main factors explaining most of the variance in countertransference responses: Parental/Protective versus Hostile/Angry, and Positive/Satisfying versus Helpless/Inadequate, with Helpless/Inadequate central. Additionally, the qualitative analysis of treatment interruption methods revealed two factors explaining over 50% of the variance. Lack of communication was linked to negative themes, while mediated and direct communication were associated with positive terms. Direct communication was characterized as useful, while mediated communication was linked to dropout and attachment figures. Conclusion. Under pressure, psychotherapists' anxiety levels increase, often managed ambivalently or avoidantly. These results suggest that awareness of psychotherapist emotional responses is important to limit psychotherapeutic failures. These findings offer valuable insights for clinical practice.

    Keywords: psychotherapeutic failures, Countertransference, emotional response, dropout, gender, Treatment interruptions

    Received: 19 Mar 2024; Accepted: 25 Jul 2024.

    Copyright: © 2024 Oasi, De Salve, Rossi, Maggio, Casabona and Molgora. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Francesca De Salve, Department of Psychology, Catholic University of the Sacred Heart, Milan, 20123, Lombardy, Italy

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