Dissatisfied psychotherapy patients: A tentative conceptual model grounded in the participants' view

Usually, between 5% and 20% of psychotherapy patients are dissatisfied with their treatments. This naturalistic study explores seven clearly dissatisfied patients' view of the therapeutic process and outcome. Interviews at termination of psychoanalytic psychotherapy and at a 1.5-year follow-up were analysed to create a tentative conceptual model of patient dissatisfaction using grounded theory approach. At the core of the model is an experience of abandonment by a therapist felt to be insufficiently flexible, a therapy lacking intensity, and links missing between therapy and everyday life. Dissatisfied patients lacked confidence in their relationship with the therapist, described their therapists in negative terms and concluded that their therapies lacked direction. They wanted more response from the therapist. Paying greater attention to the patient's emerging dissatisfaction may prevent lasting disappointment, unnecessary continuation of fruitless treatment, and probably increase efficiency.     

Ferenczi and Freud – From psychoanalysis as a “professional and personal home” to the creation of a “psychoanalytic home” for the patient1

Abstract

The author explores the relationship between Sándor Ferenczi and Sigmund Freud in the light of their correspondence. This allows us to see how Freud was able to offer and create for Ferenczi a “professional and personal home” that enabled the latter to find a much more meaningful and creative contact with himself. According to the author, this experience played an important role in Ferenczi’s later readiness to offer to and create with his patients a similar “psychoanalytic home.” As Freud was not able to share such clinical research work with Ferenczi, a conflict developed between them whose nature has occupied psychoanalysts ever since, and whose seeds can be found in the 1246 letters that they exchanged between January 1908 and May 1933. From this point of view, Ferenczi’s Clinical diary (written in 1932 and published only in 1985) can be seen as the continuation of the dialogue they had entertained for so many years, as well as Ferenczi’s attempt not to give up the “professional and personal home” that they had created together.