The Nature of Client Agency Prior to Therapy: A Qualitative Study on Clients’ Narratives

Abstract

Client agency is considered a crucial contributor to good treatment outcome. Recent studies, however, differ strongly in how they conceptualise and investigate agency. The current study explores the nature of client agency in ten clients’ pre-treatment interviews. Applying Consensual Qualitative Research, we constructed three overarching categories, subdivided into 14 sub-categories capturing both between- and within-person differences in agency before therapy. We found that all participants oscillated between the experience of a lack of grip on problems on the one hand and noticing their involvement in the problem and taking action on the other. These results present a dynamic conceptualisation of client agency. This allows us to ask pertinent questions for both future research and clinical practice.

Ecological Momentary Assessments of Trauma-Related Intrusive Memories: Potential Clinical Utility

“…Addressing the barrier of clinician involvement is particularly important, given reports of clinician hesitation to engage in exposure-based therapies [44]. It has the additional potential benefit of promoting selfagency within patients [45][46][47], which may be particularly relevant for individuals with traumarelated disorders, given the loss of agency that often stems from trauma exposure [46]. Ultimately, a protocol that emulates elements of exposure-based therapies and can be implemented without the guidance of a clinician may be of particular value when considering these barriers and the therapeutic efficacy of self-agency.…”

For one can always start something new: An Arendtian-psychoanalytic reflection on patient agency.

“…Likewise, Schafer (1993) stated that the telling and retelling of narrative claims of agency is quintessential in psychoanalytic therapy. Schafer’s conceptualization of the “unitary” agent, that is—far from a harmonious, integrated agent—a person who performs a variety of actions at the same time, mostly in self-contradiction and unaware of what is being done and why (Schafer, 1993), however, offers a conceptualization of agency that is always ambivalent and belongs to a unitary agent with a divided psyche (Acke et al, 2022).…”

The significance of connectedness: avoidant personality disorder patients’ subjective experiences of change after attending a specialized treatment program

“…Psychotherapy can be viewed as a co-constructive process that takes place within the matrix of interpersonal relations in a group setting or within a dyadic therapeutic relationship, which are influenced by the unique characteristics and meaning-making of the persons present and the dynamic between them ( Clarkin, 2012 ; Shean, 2013 ; Timulak and Keogh, 2017 ). In this co-constructive process, the clients’ active engagement is considered pivotal for therapeutic change ( Acke et al, 2022 ). People diagnosed with AvPD have been found to seek therapy to find greater self-confidence and inner strength to better stand their ground and cope with adversities as well as to get to know themselves better and feel connected and free to do what they want without fearing others’ evaluations and reactions ( Sorensen et al, 2019b ).…”