Therapeutic change in young people—A qualitative investigation of client and therapist perspectives

Abstract

Background: Young people's vulnerability to developing mental illness makes it important to understand therapeutic change, integrating the views of both young people and their therapists, to improve treatment effectiveness. To date, qualitative research aiming to triangulate experiences of therapeutic change in young people has not clearly differentiated the unique perspectives of clients and therapists. Instead both groups’ perspectives have been analysed together, which may be phenomenologically problematic considering clients are the site of change, while therapists observe it. Aims: This study explored experiences of therapeutic change from the perspectives of young people and their therapists. Three clients aged 17–19 years, and their two therapists, participated in semi-structured interviews post-therapy. Methods: Six themes were identified for clients: facing problems alone; how the therapeutic space was used; change characteristics; partial changes; the role of context in change; and growing into the new self. Four themes were identified for therapists: problematic experiences; change processes; therapist-related change process; and change qualities. Results: Six themes were identified for clients: facing problems alone; how the therapeutic space was used; change characteristics; partial changes; the role of context in change; and growing into the new self. Four themes were identified for therapists: problematic experiences; change processes; therapist-related change process; and change qualities. Conclusions: Congruent with adult research, common and specific factors was important to change. Contextual and relational factors were particularly important for young people, who described that isolation caused by their problems caused distress beyond the impact of symptoms. Therapeutic change was facilitated through responsive therapy practices that led to developmentally normal levels of activity and changes in selfhood. Participants accepted a good-enough level of recovery which was anticipated to continue post-therapy.