Increasing subjective client agency for psychotherapy at a Veterans Administration hospital: A process-outcome study

• Main Author: Coleman, Rachel A
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-2012
• Subjects: Clinical psychology
• ISBN: 1303182858; 9781303182853

Subjective client agency, defined as client expectations for actively influencing therapy process and outcome, is hypothesized to contribute to psychotherapy process and outcome. Previous work has linked higher degrees of subjective client agency to more positive client ratings of the therapeutic working alliance, while results for outcome studies are mostly non-significant. The current project extended the limited body of research in this area by (a) examining associations for subjective client agency at the outset of group therapy with ratings of group process, therapeutic alliance and treatment outcome for 84 clients at a Veterans Administration outpatient clinic, and (b) attempting to manipulate subjective client agency via a pre-therapy orientation. Internal locus of control for therapy was associated with positive group process ratings. Expectations for taking verbal initiative were associated with greater client-rated agreement on therapeutic goals. However, neither of these operational definitions of SCA was significantly related to therapist-rated alliance or to symptom change in the first eight weeks of group therapy. Moreover, two distinct versions of the pre-therapy orientation failed to alter veterans’ expectations for taking an active role in treatment. Implications for further research are discussed.