Client-therapist congruence in session-helpfulness ratings and its association with therapy outcomes

Abstract

Objective: The present study aimed to explore client-therapist congruence in helpfulness evaluations session-by-session and its association with therapy outcomes. As suggested by West and Kenny’s truth and bias model, we constructed congruence as both temporal congruence (i.e., the correlation between therapists’ and clients’ helpfulness judgments over time) and directional discrepancy (i.e., the average difference between therapists’ and clients’ helpfulness judgments). Method: Seventy-eight clients were treated by 22 experienced therapists within a 12-session course of integrative psychotherapy. At the end of each session, clients and therapists rated their perceptions of session helpfulness and, at the beginning of the next session, clients rated their own psychological functioning. Results: Therapists’ and clients’ helpfulness judgments were temporally congruent across treatment, and therapists’ judgments were lower than those of their clients. Moreover, we found that therapists’ negative directional discrepancy, but not temporal congruence, was associated with improvement in clients’ psychological functioning as well as with clients’ global treatment evaluations. Conclusion: Our results highlight the importance of therapists’ vigilant assessment of session helpfulness in a course of brief integrative psychotherapy. As such, they strengthen the importance of further research regarding client-therapist congruence (in different aspects of the therapeutic process) and its association with therapy outcomes. Clinical or methodological significance of this article In this study, we found that therapists’ tendency to provide lower session-helpfulness assessments than did their clients was associated with better therapeutic outcomes. These results may highlight the importance of therapists’ cautious and humble stance when assessing their perception of session helpfulness across treatment.