A Grounded Theory Analysis of the Experience of Therapy in the Context of Negative Change

Negative change occurring during psychotherapy is relatively underresearched and current theories take little account of social context. Eight clients and four therapists were interviewed about their therapy experience when reliable score deterioration on an outcome measure was observed, with the aim of generating a Grounded Theory model of negative change. The emerging model identified three major themes: a context of adversity, the therapeutic experience, and help withdrawn (within the context of positive outcomes). Difficulties included wanting therapy to provide more advice, talking about distressing issues, relationship difficulties, ambivalence, and a wish for support instead of change. Client context merits increased attention. Changes in outcome measures used, more diverse supervision models, training to use outcome measures constructively, and sensitive, routine analysis of negative change are indicated. Increased availability of therapies able to address clients’ interpersonal and social context and a wider choice of therapy type would allow interventions to better fit the individual in context.