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

Emma Acke,Kimberly Van Nieuwenhove,Melissa Miléna De Smet,Reitske Meganck

doi:10.5334/pb.1104

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.

Highlights

Decades of efficacy research provided evidence for the effectiveness of psychotherapy in treating various mental health issues such as Major Depressive Disorder (MDD) (Cuijpers, 2015)
Psychotherapeutic treatment generates longer lasting effects than medical treatment alone (Cuijpers et al, 2013; Hollon and Ponniah, 2010). While it is well-established that psychotherapy is effective, to date limited knowledge exists on how psychotherapy works (Cuijpers et al, 2013; Kazdin, 2009)
As Bohart and Wade (2013, p. 246) state: ‘If clients really do play a central role in therapy outcome, more research needs to focus on how clients do this’

Summary

Introduction

Decades of efficacy research provided evidence for the effectiveness of psychotherapy in treating various mental health issues such as Major Depressive Disorder (MDD) (Cuijpers, 2015). In order to advance the field, further examination of the processes of change is needed (Kazdin, 2007) In this regard, especially the role of the client is considered quintessential for understanding how therapy works. We approach client agency as constructed in the client’s life course, which aligns with an idiographic, narrative take on agency (Mackrill, 2009). Bamberg (2011) considers agency, alongside constancy/change and sameness/difference, as a central ‘dilemma’ in identity-constructing narratives In his theorization, he opposes a binary interpretation of agency that either ascribes control to an ‘agentic I’, or to the outside world that determinates an ‘undergoing me’. Via an in-depth, qualitative investigation of clients’ pre-treatment interviews, we constructed a bottom-up, tentative understanding of client agency prior to therapy

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Conclusion