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How to manage endings in unsuccessful therapy: A qualitative comparison of youth and clinician perspectives.

Bear, HA; Dalzell, K; Edbrooke-Childs, J; Garland, L; Wolpert, M; (2021) How to manage endings in unsuccessful therapy: A qualitative comparison of youth and clinician perspectives. Psychotherapy Research pp. 1-14. 10.1080/10503307.2021.1921304. (In press). Green open access

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Abstract

Background: Approximately half of those who access child and adolescent mental health services do not show measurable improvement in symptoms. This study aimed to provide practice recommendations for managing treatment endings, particularly when outcomes have not improved. Method: Semi-structured interviews were carried out with 26 young people with a history of anxiety and/or depression along with 7 roundtable sessions with 52 mental health clinicians. Data were analyzed using Framework Analysis. Results: A common experience for young people when outcomes did not improve was a poor experience of the treatment ending, which often resulted in setbacks in their mental health and feelings of loss and abandonment. Clinicians agreed that ending was hard for young people and reported that they found managing ending hard on a personal and professional level. This was compounded by unrealistically high public expectations about the impact of therapy on outcomes and trying to strike a balance between fostering hope and managing expectations, within a context of inflexible service structures and resource constraint. Implications: Recommendations include establishing expectations from the outset and a shared understanding of what outcomes matter most to the young person. This can be achieved through communicating honestly about likely outcomes, while also providing hope.

Type: Article
Title: How to manage endings in unsuccessful therapy: A qualitative comparison of youth and clinician perspectives.
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1080/10503307.2021.1921304
Publisher version: https://doi.org/10.1080/10503307.2021.1921304
Language: English
Additional information: © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: child psychotherapy, mental health services research, outcome research, qualitative research methods
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences > Clinical, Edu and Hlth Psychology
URI: https://discovery.ucl.ac.uk/id/eprint/10127628
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