Werbart, A., von Below, C., Brun, J., & Gunnarstdottir, H. (2014). “Spinning one’s wheels”: Nonimproved patients view their psychotherapy. Psychotherapy Research, 25, 546-64.

Find the original article here.

Despite our best efforts as therapists or supervisors, some clients will fail to improve while in treatment. A significant amount of research has been conducting seeking to identify the client, therapist, treatment, and process variables associated with client change.

A number of methods have been developed to decrease the number of clients who stay the same or actually get worse while in psychotherapy. However, some clients still leave treatment no better than when they started. Thus, research exploring negative therapy outcomes is key to identifying methods to better help more clients improve while in treatment.

In a recently published study, Werbart, von Below, Brun, and Gunnarsdottir (2015) sought to identify reasons why some clients do not improve during psychotherapy by directly asking the non-improved clients. In this study, Werbart and colleagues interviewed 20 clients who either showed reliable deterioration or no reliable change at their termination from a psychoanalytically oriented treatment. Semi-structured interviews were conducted at two time points: shortly after termination and three years later. Using a grounded theory methodology, the interview responses were coded to identify themes explaining why change had not occurred.

Werbart and colleagues (2015) identified one core category: Spinning One’s Wheels. Falling under this, although some positives of treatment were identified, most of the participating clients talked about how they felt that therapy was either not going anywhere or going in the wrong direction.

The authors also identified three main domains:

  • Experiences of the therapy and the therapist,
  • Outcomes of therapy, and
  • Impacts of life circumstances.

Under the domain of Experiences of the Therapy and the Therapist, clients attributed the lack of treatment success to a non-confrontational therapist who was too passive, uncommitted, or distant and to whom they couldn’t completely connect or trust. These clients also reported difficulty understanding the goals or methods of treatment.

Under the domain of Impacts of Life Circumstances, clients recognized that events outside of therapy (i.e., death in the family, illness/disease, end of significant relationships) also had an impact on their lack of change.

While a more detailed description of the findings can be found in the article, these main findings illustrate the importance of techniques already identified in the literature, such as adequately preparing clients for treatment (i.e., role induction), fostering the therapeutic relationship, and helping clients translate gains made in therapy to the stressors that they face in their daily lives. In addition, this insightful article illustrates the depth of information that can be obtained by directly asking clients about their experiences, good and bad, in psychotherapy.

Joshua K. Swift, Ph.D. is an Assistant Professor in the Department of Psychology at Idaho State University. He conducts psychotherapy process and outcome research, with a special focus on client factors (preferences and expectations) and premature termination. He is also a licensed psychologist.

Cite This Article

Swift, J. K. (2015, October). Clients’ perspectives on treatment failure: An article review [Web article] [Review of the article “Spinning one’s wheels”: Nonimproved patients view their psychotherapy, by A. Werbart, C. von Below, J. Brun, & H. Gunnarsdottir]. Retrieved from


Werbart, A., von Below, C., Brun, J., & Gunnarsdottir, H. (2015). “Spinning one’s wheels”: Nonimproved patients view their psychotherapy. Psychotherapy Research, 25, 546-564. doi:10.1080/10503307.2014.989291


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