title: "Spinning one's wheels": Nonimproved patients view their psychotherapy.
abstract: OBJECTIVE
  To explore psychotherapy experiences among nonimproved young adults in psychoanalytic psychotherapy.
  
  
  METHODS
  A two-stage, mixed-method design was used. Twenty patients in the clinical range at pretreatment were identified as either with reliable deterioration or with no reliable change at termination. Interviews at termination and 3-year follow-up were analyzed with grounded theory methodology.
  
  
  RESULTS
  "Spinning One's Wheels" emerged as a core category. The patients described the therapeutic relationship as distanced and artificial. While they saw active components in therapy and their own activities in life as beneficial, therapy itself was experienced as overly focused on problem insight and past history.
  
  
  CONCLUSIONS
  When the therapist does not contribute to the achievement of the patient's treatment goals--even when the patient gains some benefit--the patient does not fully profit from the therapy.
authors.affiliation: a Department of Psychology , Stockholm University , Stockholm , Sweden.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Werbart
authors.forename: Camilla
authors.initials: C
authors.lastname: von Below
authors.forename: Jonas
authors.initials: J
authors.lastname: Brun
authors.forename: Hulda
authors.initials: H
authors.lastname: Gunnarsdottir
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D063868:Patient Outcome Assessment; D011575:Psychoanalytic Therapy / Q000592:standards*; D013811:Psychotherapeutic Processes; D036301:Qualitative Research; D017211:Treatment Failure; D055815:Young Adult
keywords: nonimprovement; outcome research; patient perspective; process research; psychoanalytic/psychodynamic therapy; qualitative research methods