Client expertise: The active client in psychotherapy.

Abstract

R ecently, there has been increased interest in the client's experience of and contribution to the therapy process (e.g., Fuertes & Williams, 2017). In 1999, we proposed a modification to the way most of the field views psychotherapy. On the basis of the evidence we reviewed, we concluded that it is clients who ultimately make therapy work (Bohart & Tallman, 1999). This may not seem unusual; most therapists probably agree that clients make therapy work. If clients do not participate and invest in the therapeutic process and interventions offered, nothing will work.However, we were proposing something beyond client participation. In contrast to the dominant "interventionist" model of therapy, we proposed that it is clients' creativity, agency, initiative, and inventiveness that ultimately make therapy work. Therefore, looking at therapy by focusing on therapists' interventions is like listening to half of a conversation.The interventionist model of therapy is patterned after the medical model of practice (Wampold & Imel, 2015). Therapists choose appropriate interventions that "operate on" clients' dysfunctional ways of being (e.g., dysfunctional schemas, attachment styles, internal working models, emotion schemes, defense mechanisms) to create change. This can be diagrammed as follows:Therapist assesses client dysfunction Chooses appropriate interventions that operate on client dysfunctionTo produce client change