Table 3.

Quotes

First theme, difficulty coping with intense emotions:
1	“He just got overwhelmed. We were doing Prolonged Exposure and it was too much. He just couldn’t tolerate the anxiety”;
	“She was starting to get very emotionally aroused during the imaginal exposures and while doing the homework… she couldn’t handle the emotions anymore, it was too much for her”;
	“I believe that when we got to the hot spot [most arousing aspect of the trauma], that’s when things got a little too intense for her.”
2	“It was really anxiety-provoking for her, and I think she used it [knee surgery] as an excuse not to come… from my understanding, she gave up. She succumbed to her fears and avoidance.”
3	“He was starting to feel more anger, which means that the treatment was working, and he didn’t like that.”
Second theme, readiness for change:
4	“I think the patient wasn’t ready to engage in therapy… [the patient preferred] to get more medications rather than do the work of psychotherapy”;
	“I think that he had trouble committing to even starting the treatment… he was never really, on some level, on board with it”;
	“Asking him to change a lot… was something that was going to be too disruptive… he was used to what his routine was already”;
	“I think there was just some part of him that just didn’t want to deal with it, wasn’t fully committed.”
Third theme, suitability for outpatient treatment:
5	“We were eager to provide treatment and he was a veteran… he wasn’t the kind of guy who was appropriate for our setting. I think he needed more formal structure, like a partial hospitalization or outpatient day program”; “I don’t think he was a good fit for our center… he needed something that our clinic was not designed to do.”
Role of treatment and communication
6	“I would still choose IPT for him. Like I said, he made a lot of progress. I think this is what he needed”;
	“I don’t think I would have chosen a different treatment for her [PE]. If I were back in that position, I think my train of thought made sense”;
	“I didn’t want to reinforce the thought that she couldn’t handle this, to discontinue treatment, that she couldn’t handle the negative emotions”;
	“IPT was the appropriate choice for him… I don’t think that other treatment modality would have addressed that, and that was something that was salient for him.”
7	“I could have maybe pointed out more directly to him earlier on in the treatment that guardedness and kind of fear of intimacy with me and others”;
	“I should have taken more into consideration that her being able to complete the therapy was going to be an issue and this should have been spoken about in each and every session”;
	“I wish that, in the last moment, in the last session, I had sensed she was uneasy, and I wish that I would have stopped the session to say, ‘What is going on today? You seemed unsettled,’ and to encourage her to tell me… I wish I had found the way to tell her what was bothering her… and I think if I could have done that, she would have continued treatment.”
8	“We didn’t discuss it at all, I took it for granted that she would come back after the knee surgery and I think this is where I might have missed”;
	“I should have been more aware and made her more aware of this potential stress that she can, you know, get up and leave.”
9	“She felt very comfortable here, she would voice that”;
	“He felt comfortable talking about things that he didn’t talk about with anyone else;”
	“We had a great relationship I would say, our alliance was very strong.”