CONCORDANCE AND DISCORDANCE IN HOW PATIENTS AND THERAPISTS EXPERIENCE THE PSYCHOTHERAPY PROCESS IN THE TREATMENT OF DEPRESSION

Abstract

Despite the extensive literature on the outcome and process of psychotherapy in the treatment of depression, little is known about how the underlying factors of depression and the therapy process are experienced by the patients and therapists. In particular, the recognition of themes that are discordantly experienced by patients and therapists may have practical significance for how the therapy process should be conducted. We have previously developed a process description questionnaire to explore the views of patients with major depression and their therapists during the psychodynamic therapy process. In this study, we used factor analysis on the data collected with the process description questionnaire to explore the perceptions of the patients and therapists at different stages of the therapy process. We derived 15 clusters of variables from the questionnaire, on which we conducted primary and secondary factor analysis. The formation of the factors was found to be largely consistent between the patients and therapists regarding the alliance and affectively neutral aspects of the treatment process, whereas the variables of the patients vs. therapists concerning symptoms of depression and their underlying factors dispersed to a greater extent into separate factors. Dispersion was found especially in the experience of processing affectively laden themes and the developmental background factors underlying depression. Our findings refer to a defective insight of the patients into the developmental, interactional and affective factors underlying their symptoms. These factors should be especially targeted in psychotherapy of depression.

Keywords

• psychotherapy process
• psychodynamic psychotherapy
• depression
• insight