Five episodes of clients’ contributions to the therapeutic relationship: a qualitative study in adult mental health care

Abstract

Research on the effectiveness of psychotherapy has contributed to a contextual model that links therapeutic outcomes to a broad set of interacting factors, including the client’s involvement, the therapist’s techniques and the therapeutic relationship. The focus in this article is on the bidirectional nature of the therapeutic relationship, and more specifically on the clients’ contributions to the relationship with the music therapist. This focus is linked to current perspectives in music therapy that promote collaboration and equal relationship. The article reports on a multiple case study using video observation and research interviews with clients and their therapists, with an adapted Interpersonal Process Recall (IPR) procedure being used during the interviews. Five purposively selected episodes of clients’ contributions for the relationship were analyzed using a combination of narrative and interpretative methods. These episodes document clients’ active and reflexive commitment to the therapeutic relationship, and three interlinked commonalities are discussed: (1) the clients’ reflexivity regarding the asymmetric structure of the relationship; (2) the clients’ engagement for reciprocity in the relationship; and (3) the clients’ reflexivity related to their own needs in the relationship.