Therapeutic factors from clinician’s perspectives. A comparative qualitative study

Quantitative research has extensively investigated therapeutic factors. However, there is still little research using a qualitative approach. This is especially true for qualitative studies taking into account the perspective of psychotherapists. The present study attempts to contribute to fill this gap. Participants were 20 psychotherapists of four therapeutic approaches (psychodynamic [PT], cognitive-behavioral [CBT], systemic [ST], and Gestalt [GT]; 5 for each approach). Data collection took place through a semi-structured interview adapted from the Change Interview. Data were analyzed through a combination of top-down and bottom-up thematic analysis. Results showed the following therapeutic factors in the overall sample: therapeutic operations and technical interventions (34%), new patient learning (24%), governance of the therapeutic relationship (21%), patient motivation and engagement (16%), active interventions on patient's environment (3%), and patient extra-therapeutic resources (2%). These factors were differently distributed across the therapeutic approaches, with therapeutic operations and technical interventions mostly prominent in CBT and ST and least in PT, new patient learning and patient motivation and engagement mostly present in CBT and rather equally in the others, governance of the therapeutic relationship similarly present in all the approaches, active interventions on patient’s environment mostly present in ST, and patient extra-therapeutic resources characteristic of GT and ST. Our findings support the idea that therapeutic factors are both common and specific and can be ascribed to the therapist, client, and their relationship. Moreover, each different therapeutic approach seems to be characterized by a different configuration of common and specific factors. Future qualitative studies should further explore these issues in the context of a theory-building approach, while quantitative designs should attempt to test the emerging hypotheses.