The Balancing Act of Fitting In: A Grounded Theory Study on How Patients With Posttraumatic Stress Disorder Following Childhood Maltreatment Experience Participating in a Randomized Controlled Psychotherapy Study

Randomized controlled trials are routinely used to assess the efficacy of psychotherapy. To date, our knowledge about how patients experience participation in such a trial is scant. Therefore, the present analysis aims at an in-depth exploration of patients' perspectives on how a trial environment affects them. This study was conducted within the framework of the ENHANCE study, a large randomized controlled trial comparing two trauma-focused treatments, that is, psychodynamic and cognitive behavioral therapy, for patients diagnosed with posttraumatic stress disorder resulting from childhood maltreatment. We analyzed 17 posttherapy interviews with trial participants, employing an extended version of the Client Change Interview and grounded theory methodology for analysis. Analysis yielded one core category, revolving around the extent to which participants needed to conform to the external research framework to obtain personal benefits. This ambivalence was intertwined with trauma-related characteristics specific to this patient group. Three clusters fed into the core category: (1) positive and negative fantasies aroused by the research framework, (2) basic needs of patients colliding with the study conditions, and (3) inner and outer confrontations prompted by participation in the study. Study participation affects patients at various intrapsychic levels, resulting in specific dilemmas. Participation primarily serves as a means to obtain a therapy spot. Patients willingly accept the challenges associated with the study setting, viewing them as the trade-off for treatment access. Due to a positive therapy experience, participants maintain a favorable attitude toward study participation at large. Implications for integrating our findings in future studies are discussed.