Category Archives: counseling science

In a qualitative outcome analysis studying what clients find helpful in psychotherapy, researchers at U of Memphis describe some interesting phenomena. They asked 26 former clients about significant experiences and moments recalled from prior therapy (therapy had ended between 2 and 12 months prior). The article isn’t the best piece of writing nor the best qualitative work I’ve seen, but here are some interesting tidbits:
1. “On average clients were able to describe only 1.6 discrete significant moments that occurred across their therapy experiences…” [This may mean clients remember feelings and sensations from therapy more than the actual things we say. That should keep us humble.]
2. “Clients are needing just enough structure [of sessions] to facilitate reflexivity while needing to feel special enough to risk revealing and to be known.” [Clients seem to know they need to do the exploration of the self and yet it feels quite risky to do so. Therefore they often choose to seek safety and hide. If therapists aren’t careful, they easily collude with this avoidance tendency. Either a counselor can be too structured (which may stop clients from pursuing important issues) or too loose (which may allow client to stay on the surface).
3. “It was noticeable that clients rarely discussed symptomatic change per se as an important outcome of their psychotherapy….Although symptom reduction may be a positive effect of therapy, it may not be the primary benefit for many clients.” [Sample size is a bit small to make much hay with this. And yet, global changes such as feeling better about oneself, being understood, relating better to others, etc. may be more important to clients. Symptom checklists, which might make managed care companies happy, probably don’t really measure the best aspects of therapy success. I suspect that clients dome into therapy looking for symptom reduction but leave realizing that something greater than symptom reduction was gained. For example:  normalization of a problem can be just as powerful as its removal.]

I see a parallel in the christian life. We come to God, to the Scriptures, looking for relief from some sort of problem. Often we leave with the comfort of having met God and knowing that he is with us–and less focused on whether the particular suffering is actually reduced (notice I said less focused, not uncaring).

Levitt, H. et al (2006). What clients find helpful in psychotherapy: Developing principles for facilitating moment-to-moment change. Journal of Counseling Psychology, 53:3, 314-324.

Each Monday I am going to try to discuss interesting research that relates to counseling process and interventions. In the latest Journal of Counseling Psychology (53:4), a group of U of Maryland researchers looked at how novice counselors felt about their capacities to counsel. The assumption is that counselors who possess adequate sense of capacity to help will provide more helpful counseling responses, will work harder when problems arise, and convey a greater sense of professionalism. Makes sense. If you think you are going to be able to do something, you’re more likely to succeed. If all you can think is that you are a failure, you’re likely to be one. This study looked at both general confidence  and client-specific confidence (some may have general confidence but when put in a specific situation find that they lack the confidence they need). General counselor confidence is predictive of a counselor’s comfort with the role of counselor and their likelihood of pursuing a career. But what of the client-specific confidence?

While they made numerous findings, the one that interested me is that higher counselor confidence correlates with higher client satisfaction over the course of the therapy. Why is that? Well, for one, if the counselor portrays herself as competent, then the client will likely perceive that the work is going well. Obviously there is a limit to this correlation. At some point we all realize that the Wizard of Oz is only the little man behind the curtain. However, if a counselor is lacking in confidence, it probably makes him less able to hear and focus on the client since he is focusing on his lack of capacity. The client will sense this and not want to engage. I’m sure this is similar to sales. If you believe you can make the sale, your focus is on the person you want to sell to. If you think you can’t sell your product, it’ll sound like, “you probably don’t want to buy this and I’m not any good at selling, so I’ll be going now…”

Lent, R.W. et al (2006). Client-specific counselor self-efficacy in novice counselors: Relation to perceptions of session quality. Journal of Counseling Psychology, 53:4, 453-463.