Varieties of client experience in psychotherapy: An analysis of the literature

Abstract

We propose that psychotherapy researchers, theoreticians, and practitioners can better understand the process and action of psychotherapy if they are acquainted with the types of experience clients have in therapy. To this end, we analyze the main themes in the research literature. We begin by describing the methodological options for measuring client therapy experiences. We then present nine domains of client experience that appear in the existing empirical literature. Five of these pertain to clients' experiences of their own psychological processes during therapy: intentions, feelings, style of self-relatedness, style of relating to therapist, and central concerns. Two domains refer to clients' experiences of the action and person of their therapists: therapists' intentions and characteristics. The final two domains concern clients' experiences of change in therapy — therapeutic impacts and helpful aspects of therapy. We analyze each domain for its content themes and summarize available measures. Three dimensions seem to underlie the domains and themes within each: evaluation/affiliation, interpersonal control/independence, and interpersonal/task factors. We conclude with some recommendations for future research and implications and suggestions for the practice of psychotherapy.