Clients’ Experiences of Psychotherapy for PTSD: A Qualitative Meta-analysis

Abstract
Posttraumatic stress disorder (PTSD) is prevalent and can be highly complex (e.g., highly heterogeneous presentations, the dissociative subtype of PTSD). Guidance based on meta-analyses for PTSD treatment has typically included only randomized controlled trials. This past guidance has been controversial because it has lacked ‘real world’ clinical applicability; for example, such guidance ignored considerations about dissociation. It was based on only a narrow range of evidence about PTSD treatments, ignoring studies like naturalistic and qualitative psychotherapy studies that may have been open to considering more complexity about the processes of trauma therapy. A first step of creating principles of practice for psychotherapy with clients with PTSD is understanding clients perspectives, experiences, preferences, and values related to PTSD therapy. Qualitative literature highlights these client perspectives. In this poster presentation, we review a qualitative meta-analysis completed with the aim of creating an understanding of processes and outcomes of individual psychotherapy for PTSD. This approach draws upon qualitative literature to understand psychotherapy processes and outcomes and create process-oriented recommendations for PTSD psychotherapy. 40 qualitative (or mixed-methods) articles focusing on clients experiences of PTSD therapy were included. Articles were analyzed using a critical-constructivist grounded theory meta-analytic approach (Levitt et al., 2021). In this presentation, we focus on main findings from the grounded theory analysis. We present preliminary findings related to clients’ processes of: (1) building a sense of relational safety through therapists ‘holding the space; (2) becoming grounded in the non-trauma present by attending to experiences in the “here and now” in the “held space”; (3) becoming empowered through transformational liberation from trauma via agentically ‘releasing’ it; and (4) becoming able to hold more complex and holistic understanding of themselves and their stories through therapeutic self-engagement. Of note, these findings had implications for dissociation as it occurred in PTSD therapy (e.g., holding space for dissociated emotions), and held for clients with complex trauma histories. Therapists can leverage these processes in order to helpfully move clients in PTSD therapy toward positive change. Based on these findings, we offer specific practical implications and recommendations for therapists working with clients with PTSD.