Facts don't cease to exist because they are ignored.-Robert Louis StevensonProfessional discoutse and practice have long ptivileged the position and point of view ofthe therapist. In the "dtama" of therapy, clinicians restructure clients' cognitions, extinguish fears, bring forth insight, unlock repressed affects, help restore brain functioning, and loosen the bonds of familial terror. Clients, in contrast, have nearly always played Nell Fenwick to the field's Dudley Do-Rights, bound to the tracks of destruction by weak ego stmctutes, regressive potential, borderline defenses, lack of skills, and other presumed deficits. Thus, therapists "intervene," whereas clients "respond," or worse, "resist" the heroic efforts ofthe helper (cf. Angus, 1992). Told in this way, it is hard if not impossible to imagine a countemarrative, one in which the consumer of thetapeutic services is more protagonist than prop, managing at least some wotkable accommodations no matter how debilitating his ot het problems (Rosenbaum, 1996).Yet the fact is that clients' active involvement in the therapeutic process is critical to success. Indeed, in a comprehensive review of 50 years of literature on the subject for the fifth edition ofthe Handbook of Psychotherapy and Behavior Change, Orlinsky, R0nnestad, and Willutzki (2004) stated, "the quality of the patient's participation . . . [emerges] as the most [italics added] important 83
