[Problems and goals of psychotherapy patients. A qualitative-content analytic study of patient statements at initial assessment]

Abstract

The present paper has the objective of demonstrating the content-analytical assessment of problems reported by the patient and of his expectations in respect of psychotherapeutic treatment. In this approach of qualitative research, the interpretation process is split up into several steps which can be tested with regard to their adequacy to the material. This reduces the range of subjective interpretations. The development of the analysis of content is described in detail. First of all, a system of categories was outlined on the basis of patients' Nos. 1-40. This system was then used to rate the texts Nos. 41-80 and modified. After that, the revised version was applied to rate the texts Nos. 81-120, and so on. As can be shown, high interrater reliabilities were achieved by this procedure. The coding of the entire sample of n = 198 patient reports yielded the following results. Of all problems, depressive complaints, bodily complaints, anxiety and interpersonal problems were most frequent. The most important goals concerned coping with anxiety, gaining joy of living/happiness/satisfaction, greater self-assertion, better family relations/partnership, coping with problems and peace of mind/calmness. The categories of goals (18 items) seemed to be more complex and manifold than the categories of problems (10 items) and went beyond mere reduction of complaints or problems. As was to be expected, differences between diagnostic groups with regard to frequency of problems and expectations could be demonstrated. However, these differences were found only in the frequencies of deficits (complaints and problems) and reduction of complaints or coping with problems, respectively, whereas positive, health-related goals did not seem to be specific to the disorder. This suggests that it would be worth while to utilise patients' subjective definitions of problems and goals for assessment schedules to evaluate treatment outcomes.