No Change? A Grounded Theory Analysis of Depressed Patients Perspectives on Non-improvement in Psychotherapy

Course overview

This course is based upon material published in the Frontiers in Psychology and is available as an open access article. Understanding the effects of psychotherapy is a crucial concern for both research and clinical practice, especially when outcome tends to be negative. Yet, while outcome is predominantly evaluated by means of quantitative prepost outcome questionnaires, it remains unclear what this actually means for patients in their daily lives. To explore this meaning, it is imperative to combine treatment evaluation with quantitative and qualitative outcome measures. This study investigates the phenomenon of nonimprovement in psychotherapy, by complementing quantitative prepost outcome scores that indicate no reliable change in depression symptoms with a qualitative inquiry of patient perspectives. The study took place in the context of a Randomized Controlled Trial evaluating timelimited psychodynamic and cognitive behavioral therapy for major depression. A mixed methods study was conducted including patients prepost outcome scores on the BDIIINL and post treatment Client Change Interviews. Nineteen patients whose data showed no reliable change in depression symptoms were selected. A grounded theory analysis was conducted on the transcripts of patients interviews. From the patients perspective, nonimprovement can be understood as being stuck between knowing versus doing, resulting in a stalemate. Positive changes (mental stability, personal strength, and insight) were stimulated by therapy offering moments of selfreflection and guidance, the benevolent therapist approach and the context as important motivations. Remaining issues (ambition to change but inability to do so) were attributed to the therapy hitting its limits, patients resistance and impossibility and the context as a source of distress. No change in outcome scores therefore seems to involve a partial change when considering the patients perspectives. The study shows the value of integrating qualitative firstperson analyses into standard quantitative outcome evaluation and particularly for understanding the phenomenon of nonimprovement. It argues for more multimethod and multiperspective research to gain a better understanding of (negative) outcome and treatment effects. Implications for both research and practice are discussed. This course on the grounded theory analysis of nonimproving depressed patients is designed for social workers, professional counselors, psychologists, nurses, and substance abuse counselors, who do clinical work. This course is appropriate for intermediate and advanced level practitioners who wish to develop enhance their knowledge of grounded theory and patients with serious depression. The course material is based upon a research study, limitations of the study are included. It may also be useful for licensed clinicians who require clinical continuing education courses for license renewal. The course is based on a journal article which includes research. It contains statistical analysis and data that some clinicians enjoy reading and others do not. A major benefit of reading research based articles for continuing education is they provide practitioners with the latest findings in their field. Authors: De Smet, Meganck, Van Nieuwenhove, Truijens, Desmet Learning Objectives: This course will provide the practitioner with detailed information regarding [analysis of nonimproving depressed patients]. Specifically, a professional will: Identify why analyzing patients failure to improve is necessary Describe from a patients perspective why there is often failure to improve their depressed state Recognize the unique contributions of both qualitative and quantitative data are required for this analysis Citation: De Smet, M. M., Meganck, R., Van Nieuwenhove, K., Desmet, M., & Truijens, F. L. (2019). No Change? A Grounded Theory Analysis of Depressed Patients Perspectives on No