Table 2.
Qualitative Data Analysis: Themes and Codes
| Category | Participants who endorsed (%) | Exemplar response |
|---|---|---|
| 1. Facilitators to sustained practice outside of study | 100% | |
| 1.1. Adaptation to the intervention | 100% | I’m using it in that [less structured] way versus using it in a very structured module, manualized approach. |
| 1.2. Alignment with or complementary to existing practice | 92% | I’m definitely psychodynamic, but I’m also, I incorporate a lot of CBT into my work because I feel like it is really the most effective form of treatment. |
| 1.3. Belief in relative advantage for clients | 77% | I think that for the clients it was definitely a benefit. One, my girl now who has OCD and had been really, really treatment resistant, had tried another treatment in the past that hadn’t gone anywhere. Her mom had recently said to her…something about “aren’t you glad we found this study?” And the girl said, “I know, it’s like a miracle.” |
| 2. Knowledge transfer | 100% | |
| 2.1. Value of study supervision and training | 100% | …Just the way, how knowledgeable [the study supervisor] was about this stuff…Whenever there was a problem, she had exactly the thing to do. |
| 2.2. Increased confidence/ competence |
92% | I think that for me [in] those sessions or [with] those clients [i.e., FIRST] I felt more effective and capable. And I think it’s helped my practice in general. |
| 2.3. Enhanced understanding of principles and theory | 62% | It wasn’t the, you know, the Winnicott and holding environment … it was, you know, I’m going to make you do things that are really uncomfortable for you. So that was a shift, but when I saw that, hey this actually really works and it’s giving her relief, not just in the moment but giving her long-term relief, I started to grow a bit of a backbone and say you know, yes, I know it ‘s going to be hard but I was able to kind of see that, okay, this is helpful. |
| 3. Barriers to sustained practice outside of study | 92% | |
| 3.1. Lack of goodness of fit with client | 77% | For some cases my intuition and clinical experience tells me that I need to really sit with the patient and hear what they’re saying and something needs to happen with the relationship. |
| 3.2. Practical and logistical challenges | 69% | Not getting paid for the time [to prepare] outside of session and not setting aside time outside of the session. |
| 3.3. Organizational culture | 38% | Not at the [name of clinic] because they’re pretty resistant to it…I think they’re afraid of change, to be honest. I mean they’re set in their ways. |
| 3.4. Incomplete knowledge transfer | 30% | They were teaching us a lot of information so I don’t want to say that it requires more training but I definitely didn’t feel like an expert on it. |
| 3.5. Lack of goodness of fit with clinician | 23% | I’m a long-term provider. You know, my clients tend to stay in therapy with me for a while so maybe it’s because I’m not used to the quick fix sort of treatment. |
| 4. Clinic-wide upscaling of the intervention | 92% | |
| 4.1. Training a critical mass | 85% | It’s not that everybody has to use it but I feel that the whole clinic should be exposed to it and what’s involved in the different skills. |
| 4.2. Ongoing expert support | 77% | I don’t think that anyone would say that they were expert enough to be the leader or the one that’s giving all these suggestions. |
| 4.3. Ability to train and supervise others in the EBP | 54% | Maybe you could create…a CBT team and then those people on the team who are interested and able could be trained in it and then they could supervise [others]. |
| 4.4. Fidelity monitoring for quality assurance | 38% | I just felt like I needed to be my sharpest and at my best, which unfortunately with so many clients you can’t always do… |
Note. Text included in brackets has been included by the author for clarification or to replace identifying information.