Swedish elite athletes’ experiences of psychotherapy for mental health concerns provided by licensed psychologists and psychotherapists: a qualitative study

This study explores elite athletes' experiences of psychotherapy administered by Swedish licensed psychologists or psychotherapists with and without specialisation in elite sports, addressing the research question: What do elite athletes experience as important for psychotherapy effectiveness when seeking treatment from a licensed clinical psychologist or psychotherapist? Five elite athletes (self-assigned women=4, self-assigned men=1; age range: 20-34 years) from three sports (fencing: n=2, handball: n=2, triathlon: n=1) volunteered to participate in interviews. All athletes had worked with more than one licensed psychologists/psychotherapist, either through a regional healthcare or an elite sports specialised clinic while being national or international elite sports level athletes. Data were inductively analysed by the use of reflexive thematic analysis. Trust and professionalism to the psychologist/psychotherapist were generated as an overarching theme. Themes created during data analysis included the psychologist/psychotherapist's (a) understanding of elite sports and of both the person and the athlete, (b) psychotherapeutic behaviours or skills (ie, holistic problem assessment, communication, empathy, validation, confidentiality, therapeutic alliance, goal-oriented content and ability to tailor psychotherapy to the athlete) and (c) conditions for psychotherapy (time, accessibility and appropriate support). Participants expressed difficulties in differentiating between qualified and unqualified mental health support providers. Mental health services originating within the sport context were perceived to improve accessibility and the possibility of regular sessions. Mental health services provided outside the immediate sporting context, with the psychologist/psychotherapist not being overly involved in sports, was however perceived to enable a more objective and holistic assessment of both non-sport and sport-related concerns impacting on athlete mental health. We conclude that sports organisations must facilitate athletes' access to psychological treatment, and additionally ensure that practitioners working with psychotherapy have professional expertise and are appropriately qualified. Sports organisations should also systematically evaluate mental health services to ensure quality and that they are up to date with best practices.