The Good and the Bad Events in Therapy:
Client & Therapist Perspectives on Significant Therapy Events
Clinical Update July 2014
By Zur Institute
Every therapist can name those significant moments in therapy when something important happens to shift a client’s awareness, elicit powerful emotion or when things fall perfectly into place. Yet studies in which clients and therapists are interviewed separately following therapy and asked to identify turning points often reveal a lack of agreement between therapists and clients over which moments were significant.
Obviously, it is essential to understand how therapy is proceeding from the client’s perspective. This is important for the following reasons:
- Growing research demonstrates that what the client perceives as important in therapy matters more in terms of successful outcome than what the therapist perceives is important.
- The clinician’s judgment may or may not be more accurate than the client’s about what is happening in therapy, but in terms of successful outcome and preventing those surprising, premature therapy terminations by clients, the client’s perspective is what matters more.
- Researchers such as Lambert, Duncan and Miller have alerted the field to the importance of therapists purposefully soliciting feedback from clients on how therapy is going.
- Many therapists erroneously believe that they know how their clients are viewing therapy, but they’re often wrong. Clients, especially dissatisfied clients, often don’t let on when they’re dissatisfied with therapy; instead they often simply quit therapy.
- Successful therapy alliances build on successes and on recognizing and repairing ruptures in the therapy alliance.
- Client-identified significant events in therapy aren’t merely dramatic feel-good moments. Research demonstrates that there is a positive relationship between significant events in therapy and successful therapy outcome.
Research has identified both personal characteristics of therapists and techniques which clients identify as more likely to be helpful or hindering. Today’s therapists can consciously incorporate characteristics and techniques which improve therapy outcomes and avoid common misperceptions about what’s effective. For example,
- It’s not necessary for clients to be honest about their emotions in therapy.
- Therapist-directed therapy isn’t always rated as important as the therapist asking questions, and the therapist appearing trustworthy.
- In terms of client-perceived helpfulness, a trustworthy therapist is more important than a therapist who seems competent.
- Clients state that helpful activities such as provision of information, monitoring, scheduling, restructuring, problem solving and distraction techniques lead to impacts such as learning new coping skills and behavioral changes, developing awareness and insight and achieving self-efficacy.