Abstract
The patient’s perspective on improvement in psychotherapy is crucial for tailoring the therapy he or she is receiving. The present study aimed at exploring the factors aiding and the patients’ experiences of improvement in time-limited psychodynamic psychotherapy for depression. Semi-structured, in-depth interviews were conducted with ten adult patients who received up to 28 sessions of manualized psychodynamic psychotherapy in the Norwegian study “Mechanisms of change in psychotherapy” (the MOP study). The post-therapy interviews addressed the participants’ experiences from therapy. The data were analyzed with thematic content analysis and hermeneutic interpretation. The analysis identified four helpful dimensions: “Therapist activities” comprised supporting and acknowledging, advising and offering tips for everyday life, questioning and pressuring. “Patient activities” included opening up, caring for oneself and showing agency. “Facilitators” for improvement were learning from therapy, learning to receive therapy and agreed goals. “Achievements” comprised new perspectives and understandings, increased self-awareness and mastery and changed thinking and feeling. Improvements from psychodynamic therapy seemed reliant on the degree to which the therapy could activate and be relevant to the patients’ everyday life. Tailoring therapy for patients with depression should link the focus on symptoms and ways of thinking and feeling with their life circumstances.
Highlights
Depressive disorders are the third leading cause of disability worldwide [1]
The analysis identified many actions and processes within the therapy sessions that led to improvement
The present study focused on intra-therapeutic factors, we recognize that improvement is multifactorial and includes extra therapeutic factors, such as support from family and friends or getting a job [55,56]
Summary
Depressive disorders are the third leading cause of disability worldwide [1]. In spite of the increased use of antidepressant medications and easier access to modern psychotherapy, major depressive disorder (MDD) is expected to rank first in terms of Disability Adjusted Life Years (DALYs) in high-income countries by 2030 [2,3]. MDD is associated with significant mortality, economic burden, reduced quality of life (e.g., impeded relations in family or social life) and diminished capability to work or study [4]. Medication and psychotherapy are helpful for many patients, they do not help everyone, and many patients relapse and suffer from repeated depressive episodes [5]. Some patients even experience deterioration or worsening in therapy [6,7].
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