Client experiences of agency in therapy

Abstract

This study sought an understanding of clients' experiences with psychotherapy from clients' own points of view. Eleven 18-23-year-old clients or former clients participated in in-depth, semi-structured interviews about their experiences and opinions of therapy. The interviews were transcribed, and themes were extracted, drawing on techniques from Grounded Theory. From the themes that emerged in this analysis, we focus in this paper on the major theme of client agency, by which we mean clients actively making and enacting choices regarding their therapy. Agency was consistently salient and highly valued by the participants; it encompassed participant accounts of (a) doing the work of therapy, (b) informing themselves about therapy, (c) different manifestations of agency in different therapeutic approaches, (d) their valuing of accomplishment and empowerment, (e) how experiences in therapy differed from expectations, and (f) experiences of compromised agency. Klienten erfahren sich als selbstwirksam Handelnde in der TherapieDiese Studie zielte darauf ab, die Erfahrungen von Klienten mit Psychotherapie aus deren eigener Perspektive erfassen. Elf 18-23 Jahre alte Klienten oder fru¨here Klienten nahmen an halbstrukturierten Tiefeninterviews u¨ber ihre Erfahrungen und Meinung zu Therapie teil. Die Interviews wurden mit Hilfe von Techniken der Grounded Theory transkribiert sowie dann Themen extrahiert. Von den Themen, die in dieser Analyse auftauchten, konzentrieren wir uns in diesem Artikel auf das Hauptthema des Klienten als selbstwirksam Handelndem. Damit meinen wir Situationen, in denen Klienten bezu¨glich ihrer Therapie aktiv eine Wahl treffen und dementsprechend handeln. Selbstwirksames Handeln beurteilten Teilnehmende als etwas Besonderes und es wurde sehr gescha¨tzt; es umfasste Berichte der Teilnehmenden zu (a) die Therapiearbeit tun, (b) sich u¨ber Therapie zu informieren, (c) verschiedene Manifestationen des selbstwirksamen Handelns in den verschiedenen therapeutischen Ansa¨tzen, (d) dass sie es scha¨tzten, etwas zu erreichen und bewirken zu ko¨nnen, (e) wie Erfahrungen mit Therapie sich von den Erwartungen zuvor unterschieden und (f) Erfahrungen, wo das selbstwirksame Handeln gesto¨rt wurde.Experiencias de los consultantes de ser su propio ''agente'' en terapia Este estudio busco´comprender las experiencias de psicoterapia de los consultantes desde sus propios puntos de vista. Once consultantes o ex consultantes de 18 a 23 an˜os de edad participaron en entrevistas en profundidad y semi estructuradas acerca de sus experiencias y opiniones de la terapia. Las entrevistas fueron transcritas y se *Corresponding author.

The development of therapeutic collaboration in a good outcome case of person-centered therapy

“…However, this type of therapist intervention was the most invalidated by the client, indicating her active agency in communicating and protecting herself from an intolerable risk experience. In accordance with Tallman (2010, as cited by Hoener, Stiles, Luka, &Gordon, 2012) we argue that the client was "capable of self-healing and of creatively using psychotherapy in [her] own therapeutic best interests" (p. 66), namely by feeling safe in her process of change. Indeed, despite the importance of empathic therapist interventions in an effective therapeutic collaboration, the findings also shed light on the client's healing power.…”

“…Having in mind the theoretical basis of PCT, this was an expected result since this type of therapy assumes that the client is an active agent of her therapy and process of change (e.g. Bozarth, 2012;Hoener et al, 2012;Moon & Rice, 2012) Nevertheless, our findings also shed light on the therapist's responsiveness to the moment-to-moment client experience and the growth in her readiness for change. When the client risked moving toward innovation, the therapist supported or challenged her perspective even more.…”

Therapeutic agency, in‐session behavior, and patient–therapist interaction

“…Moreover, the therapeutic interaction may include more complex dynamics. Patients have flexibility and capacity to find what they perceive as helpful from the therapists' repertoire (Hoener, Stiles, Luka, & Gordon, 2012), while therapists show responsiveness to their patients' needs and opportunities for agency (Stiles & Horvath, 2017;Williams & Levitt, 2007). Thus, patient and therapist behavior may influence one another in a more subtle and individual way.…”

Should I stay or should I go? The impact of a sense of control on young men's therapeutic engagement

“…In addition to decision‐making about initial therapeutic attendance, participants spoke of the influence of control on the therapeutic process itself. This may speak to the importance of young men having ‘agency’ in their therapeutic experience, whereby their actions produce an effect (Gibson & Cartwright, , ; Hoener, Stiles, Luka & Gordon, ). It may also be part of the young male exerting his sense of masculinity over the counselling process.…”