What Influences Women with Sexual Assault PTSD to Disengage from Therapy?

Background

Approximately 20% of clients disengage from mental health psychological therapies for PTSD in the UK, irrespective of mental health providers in primary care, secondary care or third sector mental health services. Regardless of treatment approach, therapeutic model and developments in specialist psychological therapy approaches, high rates of client disengagement remain across all mental health services for PTSD therapy. It will be seen that no one modality is optimal for the treatment of PTSD. Research and development of trauma-focused models of psychotherapy indicates that client disengagement remains problematic even in these recommended therapeutic approaches. Furthermore, research to reduce rates of disengagement from PTSD psychotherapy predominantly focuses on the client, that maintains a negative view by placing the burden of disengagement on the client.

Aim

The practical aim of the research is to inform and discover those influences for women who received psychotherapy for PTSD from sexual assault, and who disengaged. This research attempted to address this by asking clients directly why they disengaged from psychotherapy before completing the recommended number of sessions assessed.

Methods

The methods for this thesis question was addressed by qualitative exploration of the experiences of four participants who had received psychotherapy at a UK based counselling charity for women, for sexual assault PTSD. The charity offers psychotherapy sessions for PTSD that is focused on the specialism of sexual violence. Participants were aware from the outset the number of psychotherapy sessions offered, established at assessment. Participants were interviewed using a semi structured audio-recorded interview covering ten questions about the participants experience of therapy and the reasons they disengaged. Interview data were qualitatively analysed using interpretative phenomenological analysis (IPA) to learn about the participants experience, from their perspective.

Results

The findings revealed potential influences that persuade participants to disengage from therapy for sexual assault PTSD, before any noticeable improvement in their mental health and wellbeing. The findings of this research calls attention to: 1) the paucity of research for client disengagement that uses actual client accounts 2) the paucity of research for psychotherapy models that are effective for the treatment of sexual assault PTSD beyond that of symptom reduction, that emphasises quality of life and wellbeing 3) the ubiquitous and prolific presence of medical model approaches that dominates research for psychotherapy treatment modalities for PTSD 4) the paucity of delineation of differential trauma types and psychotherapy research for PTSD 5) the impact of the therapeutic relationship on disengagement from psychotherapy for sexual assault PTSD, and finally, 6) therapist effect and impact on disengagement.

Conclusion

Each of the four women in this study shared their experience of a therapy that failed them. Future research for effective therapy models for PTSD without attending to therapist effects and the centrality of the therapeutic relationship will likely bring the same results for disengagement, from across all therapeutic modalities. Research for non-trauma focus treatment approaches for PTSD, though scant, continues a long-held focus on client deficits for disengagement. Therapeutic outcomes from qualitative research that measure for example, therapist effect, therapeutic relationship, and successful rupture resolution, is the next imperative in research, to redress the balance of research available for disengagement from sexual assault PTSD in non-trauma focus treatment approaches.

Further research into those therapeutic process influences that induce clients to disengage from therapy is crucial for advancing our understanding of client-therapist patterns of relating, the interpersonal and attachment patterns of the therapist, and the skills and experience the therapists bring to therapy that sustains a client to completion of therapy treatment. The therapeutic relationship is a collaborative dyad: two individuals working towards the same goals for the client's wellbeing.