Assessment of Subjective Client Agency in Psychotherapy: A Review

Abstract

Theoretical accounts of psychotherapy, especially of a constructivist or humanistic sort, often assert the importance of the client's active efforts in “making therapy work.” Psychotherapy research also supports the importance of the client's contribution to therapy outcomes. Research on subjective client agency, defined as a client's expectations for taking an active role in psychotherapy, is limited, however. This review describes and evaluates the psychometric qualities of six measures of this construct and provides recommendations for future research. Three of these measures are particularly suitable for further work by constructivist investigators of therapy process and outcome, a topic too rarely studied in the literature to date. Those studies that exist suggest that agency is positively related to the therapeutic alliance but does not directly affect therapy outcome. Additional process-outcomes studies in this area are warranted and could benefit from placing client agency in a broader framework that views therapy, and even therapy supervision, as an active process of mutual inquiry.