Abstract

Background: Even though research has shown that between 5% to 10% of patients worsen at the end of their psychotherapy (Lambert and Ogles, 2004), it seems there has been a publication bias, whereas successful therapies have been overrepresented and results regarding failures or non-improvement have not received enough attention. This may also be due to the difficulties in conceptualizing failure, since it may include aspects such as desertion, premature or unilateral termination and lack of response, as well as the difficulty associated with who determines what failure is (Strupp & Hadley 1977). Aim: To describe and analyze the relation between objective and subjective outcome measures in non-improved patients’ psychotherapies. Method: Initial and final OQs were collected and qualitative follow-up interviews were conducted with patients and their therapists. Six cases were selected for this presentation, taking into account different ways of considering a therapy as non-successful such as absence of clinically significant change and negative subjective assessment of patient or therapist. The cases were analyzed following the open and axial coding procedures of the Grounded Theory model of qualitative analysis. Results: A comprehensive model about the assessment of failure in psychotherapy is presented. These failure responds to a subjective experience organized around the evaluation of the outcome (the persistence of the presence of symptomatology) and aspects of the process and the therapeutic relationship. Discussion: The bridges between the objective and subjective measures of therapeutic outcomes and the way they relate in the construction of the perception of failure are discussed.