Neuroscience
Rapport between a client and therapist is important for therapy to be successful, and part of that is agreeing about the aims of the exercise. You’d think this would include the therapist and client agreeing about the specific nature of the client’s psychological problems. In fact, a new study in Psychotherapy Research finds disagreement isn't harmful to therapy and can even be beneficial.
Rolf Holmqvist and his colleagues recruited 846 therapy clients as they started a course of therapy at a Swedish primary care centre, most of them after having been referred by their family doctor. Seventy-three therapists, most of them psychologists and social workers, also took part.
Separately, the clients and therapists rated the nature of clients’ mental health problems at the start of therapy and again at the end. After each session, therapists and clients also completed measures of their “working alliance” – essentially their rapport and how well they felt that they collaborated.
Focusing on depression and anxiety, the researchers found that there was only moderate agreement between therapists and clients about whether these problems were present or not – for example, for just under half the clients, the therapists reported that the clients were depressed or anxious when the client themselves did not.
What’s more, amount of agreement on the presence or not of depression was not related to the success of therapy in reducing the clients’ self-rated symptoms, nor to ratings of working alliance. And regarding anxiety, some of the most successful outcomes were actually seen in those instances where the therapists rated the client as anxious, but the client did not seem themselves as having anxiety.
The study has some issues, such as that the therapists’ and clients’ views on the clients’ problems were measured in different ways, and that the research can’t say who had the more accurate insight because there was no third-party, objective measure of the clients’ problems, so far as this is possible. Notwithstanding these issues, the researchers said their findings were “remarkable” and that they suggest “patient and therapist may have different ways of understanding the patient’s problem without detriment for the treatment result – or event to its benefit.”
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Holmqvist, R., Philips, B., & Mellor-Clark, J. (2015). Client and therapist agreement about the client's problems—Associations with treatment alliance and outcome Psychotherapy Research, 26 (4), 399-409 DOI: 10.1080/10503307.2015.1013160
Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.
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Neuroscience
It can be a good thing for a therapist and client to disagree about the client's problems
Rapport between a client and therapist is important for therapy to be successful, and part of that is agreeing about the aims of the exercise. You’d think this would include the therapist and client agreeing about the specific nature of the client’s psychological problems. In fact, a new study in Psychotherapy Research finds disagreement isn't harmful to therapy and can even be beneficial.Rolf Holmqvist and his colleagues recruited 846 therapy clients as they started a course of therapy at a Swedish primary care centre, most of them after having been referred by their family doctor. Seventy-three therapists, most of them psychologists and social workers, also took part.
Separately, the clients and therapists rated the nature of clients’ mental health problems at the start of therapy and again at the end. After each session, therapists and clients also completed measures of their “working alliance” – essentially their rapport and how well they felt that they collaborated.
Focusing on depression and anxiety, the researchers found that there was only moderate agreement between therapists and clients about whether these problems were present or not – for example, for just under half the clients, the therapists reported that the clients were depressed or anxious when the client themselves did not.
What’s more, amount of agreement on the presence or not of depression was not related to the success of therapy in reducing the clients’ self-rated symptoms, nor to ratings of working alliance. And regarding anxiety, some of the most successful outcomes were actually seen in those instances where the therapists rated the client as anxious, but the client did not seem themselves as having anxiety.
The study has some issues, such as that the therapists’ and clients’ views on the clients’ problems were measured in different ways, and that the research can’t say who had the more accurate insight because there was no third-party, objective measure of the clients’ problems, so far as this is possible. Notwithstanding these issues, the researchers said their findings were “remarkable” and that they suggest “patient and therapist may have different ways of understanding the patient’s problem without detriment for the treatment result – or event to its benefit.”
_________________________________
Holmqvist, R., Philips, B., & Mellor-Clark, J. (2015). Client and therapist agreement about the client's problems—Associations with treatment alliance and outcome Psychotherapy Research, 26 (4), 399-409 DOI: 10.1080/10503307.2015.1013160
Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.
Our free weekly email will keep you up-to-date with all the psychology research we digest: Sign up!
- Therapy More Effective When Psychologists Focus On Their Clients' Strengths
There's a growing body of evidence showing that, rather than just focusing on problems, it can be beneficial for psychologists to remind clients of their strengths - an approach sometimes known as "resource activation". Now Christoph Fluckiger and...
- Introducing The Super Shrink
From 'the archives', first published in the Digest 19/1/2004 When it comes to client recovery, it's not the type of therapy that matters so much as the individual therapist who's giving it - that's the message from a study by researchers...
- Successful Therapists Focus On Their Clients' Strengths
Research is increasingly showing that the success of therapy depends not on the theoretical orientation of the therapist, but on key therapeutic processes that cross theoretical boundaries. Two such processes are ‘problem activation’ – helping...
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Cognitive therapy for depression could be improved by the therapist focusing more on the therapeutic process itself. That’s according to Jonathan Kanter (University of Wisconsin-Milwaukee) and colleagues who compared the effectiveness of therapy given...
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It’s not easy for people living on Scotland’s remote islands to find specialist psychological help. Susan Simpson and colleagues at Aberdeen’s Eating Disorders Service investigated the plausibility of using videoconferencing to deliver specialist...