A mixed-methods study of psychotherapists' in-session experiences when working with bereaved patients

Psychotherapists' in-session experiences with bereaved patients remain an underexplored area, despite being widely recognized as a particularly challenging aspect of clinical practice. Using a mixed-method design, this study aimed to examine how patients' loss histories influence therapists' thoughts, feelings, and behaviors during the first therapy session. Therapists (clinical psychologists, expert counselors, psychiatrists, or clinical psychology master's students) were reached through convenience sampling. They were randomly assigned to one of two conditions: in the experimental group (N = 35), they conducted a session with a pseudopatient who had experienced a significant loss within the past two years; in the control group (N = 30), the patient had not experienced such a loss. Pseudopatients were trained with a standardized patient history. Each therapist conducted a 45-minute-long session with a pseudopatient. A multivariate analysis of covariance (MANCOVA) was conducted as part of an exploratory analysis to investigate potential group differences on the multiple affective states measured by the Positive and Negative Affect Schedule (PANAS). The study also explored therapists' ability to recognize symptoms of prolonged grief disorder (PGD) and their conceptualization of the patient's difficulties. Moreover, a thematic analysis was conducted to explore how psychotherapists describe their in-session experiences when in the session with a bereaved patient. Firstly, MANCOVA results revealed that therapists in the experimental group reported feeling significantly more interested and upset than those in the control group. Secondly, only 7 psychotherapists in the current study were able to identify the patient's symptoms as PGD. Lastly, thematic analysis of semi-structured interviews with therapists in the experimental group generated five themes: internal conflicts, emotions, relational dynamics, therapists' mental navigation and judgments, and personal reflections. By employing mixed-methods research, the study offers a comprehensive perspective on therapists' in-session experiences and highlights the need for improved grief assessment, enhanced death competence, and better support for clinicians working with bereaved patients.