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What Clients Find Helpful in Psychotherapy

Mark Dombeck, Ph.D. was Director of Mental Help Net from 1999 to 2011. Dr. Dombeck received his Ph.D. in Clinical Psychology in 1995 ...Read More

I had the good fortune today to come across an article authored by Heidi Levitt, Mike Butler and Travis Hill (all of the Department of Psychology at the University of Memphis) titled, "What Clients Find Helpful in Psychotherapy: Developing Principles for Facilitating Moment-to-Moment Change", and appearing in the Journal of Counseling Psychology (July 2006 Vol. 53, No. 3, 314-324). I wish I could link you directly to this article, but this isn’t possible at present, so if you are really interested, you can find a copy at your local university library or through interlibrary loan.

The authors of this article went out and interviewed 26 adult community members who had recently (and independently of the study) participated in psychotherapy for a variety of problems. Data from these interviews were analyzed in a qualitative fashion and reformulated as a series of principles that summarized what the subjects (considered as a group) thought were the most important aspects of their recently concluded therapy.

Six clusters of themes were identified, each containing one or more sub-themes. The first cluster had to do with subjects discussion of how they figured out whether or not they could trust their therapists. Generally, the clue that subjects described that let them know it was safe to trust their therapist had to do with the therapist’s behavior. As the study authors summarized: "A sense of professional caring is needed, or the therapist is experienced as too distant, defensive, or unattuned to clients’ emotions. However, caring is too intense if the therapist is experienced as jealous, controlling, or pitying."

Other clusters spoke to the manner in which therapists conducted themselves with clients, and how clients interpreted this therapist behavior:

  • "Therapists’ emotional expression was humanizing so long as it conveyed concern about the client rather than about the therapist’s self-interest, bias, or need."
  • "Therapist professional status [and displays of knowledge] added to credibility unless it was thought to preclude the therapists’ sincerity of caring."
  • "Confrontation was thought [by clients] to disrupt trust and compromise the therapy in most cases, with the exception of when the client was being manipulative or avoidant of difficult material, and then it was desirable."

All of this makes complete sense to me, based on my past experiences both as a therapist and as a client, but seldom have I seen these principles laid out so clearly.

Implicit in these principles is the idea that what effective therapists are doing is constantly adjusting their behavior to adapt to the needs of their clients. In order to help clients, therapists are needing to display that they are knowledgable, but not too knowledgable such that they’ll be a know-it-all. They need to convey that the therapy environment (and their person, too) is safe, but the therapist should never be so safe that he or she is unwilling to confront clients who are stalling or manipulating so as to avoid dealing with issues. They need to express caring and genuine concern, but not to the point where the client becomes afraid of hurting the therapist’s feelings. Therapy is a balancing act, and these pithy principles capture that dynamic nicely.

Most people reading this weblog entry will have been in therapy, either as a client or as a therapist. If you have been a client in therapy (past or present), please leave a comment below describing what it was about your therapist (what he or she did or didn’t do) which made him or her an effective (or ineffective) helper and facilitator of healthy change in your life.

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