A Phenomenological Exploration of the Dialectic of Success and Failure in Psychotherapy: Explaining Interactional Patterns and the Therapeutic Alliance from Clients’ Perspectives

Nastaran Sadat  Ghasemi; Shahram Vaziri; Farah  Lotfi Kashani; Saeed  Imani

Authors

Nastaran Sadat Ghasemi Department of Psychology, UAE.C, Islamic Azad University, Dubai, United Arab Emirates Author https://orcid.org/0009-0004-2945-9146
Shahram Vaziri Associate Professor, Department of Clinical Psychology, Roudehen Branch, Islamic Azad University, Tehran, Iran https://orcid.org/0000-0001-5035-6054
Farah Lotfi Kashani Associate Professor, Department of Clinical Psychology, Roudehen Branch, Islamic Azad University, Roudehen, Iran Author https://orcid.org/0000-0003-3383-6931
Saeed Imani Associate Professor, Department of Counseling, Faculty of Educational Sciences and Psychology, Shahid Beheshti University, Tehran, Iran Author https://orcid.org/0000-0001-5290-2995

Keywords:

Psychotherapy, Therapeutic Alliance, Clinical Success and Failure, Phenomenology, Interactional Patterns, Client Experience

Abstract

Purpose: This study aimed to phenomenologically explore clients’ lived experiences of the dialectic between success and failure in psychotherapy, with particular emphasis on interactional patterns, therapeutic alliance, and the relational processes underlying perceived therapeutic effectiveness or rupture.

Methods and Materials: This qualitative study employed a descriptive–interpretive phenomenological design. The study population comprised individuals with prior experience of individual psychotherapy. Using purposive sampling with maximum variation in successful, unsuccessful, and ambivalent therapeutic experiences, 18 participants were recruited until experiential and thematic saturation was achieved. Data were collected through in-depth semi-structured interviews focused on clients’ perceptions of therapeutic interactions, relational safety, clinical responsiveness, treatment ruptures, and factors contributing to continuation or discontinuation of therapy. Interviews were transcribed verbatim and analyzed according to Colaizzi’s seven-step phenomenological method. MAXQDA software was used to organize, code, compare, and integrate the qualitative data and facilitate the development of overarching thematic structures.

Findings: The analysis indicated that perceived therapeutic success emerged from an interconnected relational configuration characterized by a “liberating secure bond,” flexible clinical competence, unconditional acceptance, and empathic regulation of emotions. These processes strengthened clients’ sense of psychological safety, participation, trust, and agency and facilitated sustained therapeutic engagement. Conversely, perceived therapeutic failure was associated with technical rigidity, excessive dependence on inflexible protocols, authoritarian interactional patterns, and violations of client agency. The convergence of these relational disruptions progressively weakened the therapeutic alliance, intensified emotional exhaustion and alienation, and, in some cases, culminated in disengagement or premature termination.

Conclusion: Psychotherapy appears to function fundamentally as an intersubjective encounter in which technical interventions become effective when embedded within clinical humility, relational flexibility, democratic collaboration, empathic responsiveness, and respect for clients’ dignity and autonomy.

Downloads

Download data is not yet available.

References

Barlow, D. H. (2010). Negative Effects from Psychological Treatments: A Perspective. American psychologist, 65(1), 13-20. https://doi.org/10.1037/a0015643

Bohart, A. C., & Wade, A. G. (2013). The Client in Psychotherapy. In (6th ed., pp. 219-257). John Wiley & Sons.

Dandachi-FitzGerald, B., Otgaar, H., & Merckelbach, H. (2023). When Psychotherapy Fails. In (pp. 301-319). Springer International Publishing. https://doi.org/10.1007/978-3-031-14332-8_16

Farahani, H., Azadfallah, P., Roshan Chesli, R., Pourmohammadreza-Tajrishi, M., Esrafilian, F., Fathali Lavasani, F., & Chiniforushan, F. (2021). Methodology for Analyzing 'Treatment Failure' in Psychotherapy Research: A Guide for Clinicians and Researchers. Clinical Psychology and Personality, 19(2), 173-182.

Ghaderi, F., & Mehrabi, A. (2023). A Review of Process-Based Therapy: A New Paradigm in Psychotherapeutic Interventions. Journal of Clinical Excellence, 13(1), 45-56.

Ghamari Zamehrir, V., Pournaghash Tehrani, S. S., & Ghorbani, N. (2023). Clients' Lived Experiences of the Therapeutic Relationship: A Phenomenological Study. Journal of Psychological Science, 22(124), 667-684.

Hardy, G. E., Bishop-Edwards, L., Chambers, E., Connell, J., Dent-Brown, K., Kothari, G., & Parry, G. D. (2019). Risk Factors for Negative Experiences during Psychotherapy. Psychotherapy Research, 29(3), 403-414. https://doi.org/10.1080/10503307.2017.1393575

Heydari Kia, J., & Esmaeili, F. (2024). Identifying Affective Structures in the Experience of Repeated Failures in Psychotherapy Treatments. Health Psychology and Behavioral Disorders, 2(2).

Hill, C. E., Chui, H., & Baumann, E. (2013). Revisiting and Envisioning the Outcome Problem in Psychotherapy: An Argument to Include Individualized and Qualitative Measurement. Psychotherapy, 50(1), 68-76. https://doi.org/10.1037/a0030571

Hosseini Beyouki, N., Salimi Bajestani, H., Esmaeili, M., & Farahbakhsh, K. (2024). Strategies for Coping with Ethical Challenges in Counseling and Psychotherapy. Ethics Research(24), 109-141.

Knox, S., Miller, C., Twidwell, R. E., & Knowlton, G. (2023). Client Perspectives on Psychotherapy Failure. Psychotherapy Research, 33(3), 298-315. https://doi.org/10.1080/10503307.2022.2110020

Lambert, M. J. (2011). What Have We Learned about Treatment Failure in Empirically Supported Treatments? Some Suggestions for Practice. Cognitive and Behavioral Practice, 18(3), 413-420. https://doi.org/10.1016/j.cbpra.2011.02.002

Mays, D. T., & Franks, C. M. (2025). Negative Outcome in Psychotherapy and What to Do About It. Springer.

McElvaney, J., & Timulak, L. (2013). Clients' Experience of Therapy and Its Outcomes in 'Good' and 'Poor' Outcome Psychological Therapy in a Primary Care Setting: An Exploratory Study. Counselling and Psychotherapy Research, 13(4), 246-253. https://doi.org/10.1080/14733145.2012.761258

McLeod, J. (2013). Qualitative Research: Methods and Contributions. In (6th ed., pp. 49-84). John Wiley & Sons.

Mylona, A., Avdi, E., & Paraskevopoulos, E. (2023). Alliance Rupture and Repair Processes in Shifts from Momentary Failure to Repair. In (pp. 98-125). Routledge. https://doi.org/10.4324/9781003439219-6

Shabib Asl, N., & Alinaghi Lou, S. (2020). Client and Therapist Personality in Psychotherapy. Tehran.

Tschuschke, V., Koemeda-Lutz, M., von Wyl, A., Crameri, A., & Schulthess, P. (2020). The Impact of Patients' and Therapists' Views of the Therapeutic Alliance on Treatment Outcome in Psychotherapy. The Journal of Nervous and Mental Disease, 208(1), 56-64. https://doi.org/10.1097/NMD.0000000000001111

Werbart, A., Annevall, A., & Hillblom, J. (2019). Successful and Less Successful Psychotherapies Compared: Three Therapists and Their Six Contrasting Cases. Frontiers in psychology, 10, 816. https://doi.org/10.3389/fpsyg.2019.00816

Werbart, A., Gråke, E., & Klingborg, F. (2023). Deadlock in Psychotherapy: A Phenomenological Study of Eight Psychodynamic Therapists' Experiences. In (pp. 28-46). Routledge. https://doi.org/10.4324/9781003439219-3

Ziaei, L., & Zarani, F. (2026). Culturally Adapted Psychotherapy: A Systematic Review and Introduction of the Integrated Model of Cultural Adaptation of Psychotherapy (IMCAP). Applied Psychology(77), 10-33.

Zilcha-Mano, S., & Fisher, H. (2022). Distinct Roles of State-Like and Trait-Like Patient-Therapist Alliance in Psychotherapy. Nature Reviews Psychology, 1(4), 194-210. https://doi.org/10.1038/s44159-022-00029-z