Therapist-Client Agreement on Helpful and Wished-For Experiences in Psychotherapy: Associations With Outcome

• Published in: Journal of counseling psychology Vol. 67; no. 3; pp. 349 - 360
• Main Authors: Chui, Harold, Palma, Beatriz, Jackson, John L., Hill, Clara E.
• Format: Journal Article
• Language: English
• Published: United States American Psychological Association 01-04-2020
• Subjects: Agreements; Client Attitudes; Clients; Female; Human; Interpersonal Interaction; Interpersonal problems; Interpersonal Relationships; Male; Mixed methods research; Modeling (Psychology); Professional associations; Psychological problems; Psychotherapists; Psychotherapy; Qualitative research; Resistance (Psychology); Simulation; Termination; Test Construction; Therapeutic alliances; Therapists; Therapy; Validity; psychoanalysis/psychodynamic therapy; therapist-client agreement; helpful experiences; process and outcome
• ISSN: 0022-0167; 1939-2168
• DOI: 10.1037/cou0000393

Therapists and clients often have different perspectives about what is helpful and what they wish for in therapy, but it is unclear how their perspectives differ and whether their agreement have implications for therapy outcome. In a mixed-method study, 18 therapists and clients were interviewed separately after termination about their experiences and what they wished had been different about their psychotherapy. Transcripts were analyzed using consensual qualitative research. Therapists and clients agreed moderately that exploration of the therapeutic relationship, therapists' use of challenges, and therapist validation and support were helpful. In contrast, there was low agreement on wishes. Whereas clients wished that therapists had provided more structure and direction, therapists did not mention any typical wishes. Using multilevel modeling, a high level of agreement on what was helpful was associated with reductions in psychological symptoms and interpersonal problems, although no relationship was found between agreement on wishes and outcome. The findings underscore the importance of therapist-client agreement about helpful aspects of therapy for successful therapy.
Public Significance Statement
Therapist and client agreement and its association with psychotherapy outcome were studied using quantitative and qualitative methods. Therapists and clients agreed that exploration of the therapeutic relationship, therapists' challenges, and therapist validation and support were helpful. Agreement on the tasks of psychotherapy appears to be an important consideration for improving psychotherapy effectiveness.