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While a nuanced understanding of nonresponse is crucial for improving treatment, quantitative measures may not fully capture clinically meaningful processes of change from the patients' perspectives. We therefore explored how individuals with PTSD\u2010CM who showed no or limited numerical improvement after trauma\u2010focused psychodynamic psychotherapy (TF\u2010PDT) experienced change.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This qualitative study was embedded in a large randomized controlled trial on PTSD\u2010CM (DRKS00021142).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>From 75 qualitative post\u2010treatment interviews, we purposively sampled eight TF\u2010PDT recipients meeting criteria for numerical nonresponse, defined as current PTSD diagnosis and less than 50% reduction in the Clinician\u2010Administered PTSD Scale for DSM\u20105 (CAPS\u20105). Client Change Interviews were analysed using Critical\u2010Constructivist Grounded Theory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We derived two clusters (\u2018Progress\u2014A Double\u2010Edged Sword\u2019, \u2018When Building Trust Collides with the Therapeutic Framework\u2019) and one overarching core category (\u2018Unfinished Business\u2019), which captured a dialectic process. Within a responsive therapeutic relationship, patients began confronting their relational trauma, experiencing relief, increased emotional regulation and hope. However, this very engagement surfaced emotional challenges that exceeded what could be addressed within the limited therapeutic framework, leaving the process meaningful but unfinished.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>What is often labelled as numerical nonresponse in PTSD\u2010CM may reflect a dynamic interplay of emerging improvement and emotional distress that needs more time to unfold. Moreover, the results underscore the value of integrating qualitative, patient\u2010reported outcomes into treatment evaluation and relationship\u2010focused treatment tailored to patients' individual needs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/papt.70040","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T05:16:22Z","timestamp":1771478182000},"page":"621-644","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Unfinished business: A grounded theory analysis of change among individuals classified as numerical non\u2010responders to psychodynamic psychotherapy for post\u2010traumatic stress disorder related to childhood maltreatment"],"prefix":"10.1111","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7231-3457","authenticated-orcid":false,"given":"Fatima","family":"N\u00f6ske","sequence":"first","affiliation":[{"name":"International 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