What comes to mind: A multiple case study of patients' experiences of good -enough outcome in long -term psychodynamic psychotherapies.

In recent decades, psychotherapy outcome research has generated rigorous evidense that psychotherapy is successful in helping people, that different schools of therapy are similarly effective, and that talk therapies can compete with drug treatments in offering results. However, the dominance of the objectivist tradition in psychotherapy research and the pressures to prove efficacy in a competitive marketplace have left the details of what patients find helpful within a particular approach largely unexplored. However, the theory and practice of psychoanalysis and psychotherapy have undergone significant revisions in the last twenty years. These reflect a shift away from objectivism and toward the two-person, intersubjective nature of the psychotherapy relationship. At the center of contemporary theory and debate are the implications of this shift in conceptualizing the interpersonal context in therapy process and outcome. This multiple case study explores the details and diversity that characterize patients' perspectives on long-term, psychodynamic therapies they found helpful. To provide relevant context, the literature on psychotherapy outcome is selectively reviewed and memoirs written by psychotherapy patients are discussed. The study utilizes a discovery-oriented, narrative methodology designed to elaborate individual accounts and to enable an interpretive synthesis across accounts of important themes. These themes include the relevance of conflicts between dependency and autonomy in patients' experiences of their therapists' personal and professional qualities and in experiences of their therapists' authority; experiences of therapists' gendered identities as facilitating changes in self-experience; and experiences of therapists' techniques as they relate to patients' struggles to understand themselves as singular and complex. Patients' narratives are approached both as vital, experience-near accounts and as examples of patients' discourse on improvement in psychotherapy. The discourse is examined and interpreted in order to highlight contemporary emphases (e.g., authority, gender) and to illustrate how patients' sensibilities both express and construct current cultural trends and preoccupations. In particular, ideals of self-sufficiency, egalitarianism, and individuality are discussed. Further contemporary critiques of authority reflected in changes in therapists' theorizing, technique, and self-representations, are also addressed as they affect patients' experiences of therapeutic authority. Interesting areas of similarity and difference in patient and therapist discourse on therapeutic authority are highlighted.PhDClinical psychologyPsychologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/128566/2/3029425.pd