The Melbourne Study of Psychoanalytic Psychotherapy III: Patients' and psychotherapists’ perspectives on progress and challenges

Abstract

Qualitative exploration of the experience of psychoanalytic psychotherapy complemented the quantitative evaluation of mental health and life functioning improvements in the Melbourne Study of Psychoanalytic Psychotherapy. Twice-weekly treatment was offered to adults for 2 years by the private sector Glen Nevis Clinic for Psychoanalytic Psychotherapy, established by the Victorian Association of Psychoanalytic Psychotherapists as a subsidized, low-cost community service over 8 years. This paper is the second of two presenting the qualitative arm of the study, involving in-depth narrative interviews with patients and psychotherapists. Analysis of 143 transcripts further contributes to evidence of the Reach, Effectiveness, Adoption, Implementation and Maintenance of psychoanalytic psychotherapy in a community setting. The first qualitative paper reports themes concerning patient expectations of psychotherapy and perspectives of both patients and psychotherapists on the experience and benefits of the treatment. This paper reports what was perceived by participants as facilitative or challenging for therapeutic progress, illuminating how experiences of the nature of psychoanalytic psychotherapy may have affected the Implementation, Effectiveness and Maintenance of the program. The most notable facilitative factors emerging were the exploratory, insight-oriented nature of the work, elements of the patient-psychotherapist relationship, and the frame of the treatment. Challenges were also often seen as inherent to Effectiveness; however, proposing the frame of 2-year treatment, as both an expectation and a limit, probably inhibited program Reach, Adoption and overall Implementation. The limitations and strengths of the qualitative arm of the research, together with implications for further investigation, are discussed.