Treatment failure in psychotherapy: the pull of hostility.
Client-therapist interactions were studied in 14 positive-change (PC) and 14 negative-change or nonchange (NC) therapies with the same therapists and similar clients. Aggregated structural analysis of social behavior (SASB) scores showed increasingly dissimilar interaction styles between client and therapist in NC therapies. First-lag transition analyses of SASB codings of Sessions 3, 12, and 20 showed the following differences: Stable hostile complementarity characterized NC within and across sessions. Hostile complementarity was nevertheless relatively rare. Therapists met clients' invitations to hostile responses most frequently in nonhostile ways, yet they initiated more belittling and ignoring interactions with NC clients, pointing to the subtly hostile therapeutic climate created. Rejection of therapists' interventions predicted negative outcome most strongly and escalated with time. Clients' skepticism may make therapists vulnerable to feelings of inadequacy and, if not dealt with therapeutically, may easily release the therapists' own hostility.
von der Lippe
Anna Louise
AL
Department of Psychology, University of Oslo, Blindern, Oslo, Norway. a.v.d.lippe@psykologi.uio.no
Monsen
Jon Trygve
JT
Rønnestad
Michael Helge
MH
Eilertsen
Dag Erik
DE
D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006791:Hostility; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D011369:Professional-Patient Relations; D012919:Social Behavior; D011795:Surveys and Questionnaires