Therapist-client agreement on helpful and wished-for experiences in psychotherapy: Associations with outcome

Therapists and clients often have different perspectives about what is helpful and what they wish for in therapy, but it is unclear how their perspectives differ and whether their agreement have implications for therapy outcome. In a mixed-method study, 18 therapists and clients were interviewed separately after termination about their experiences and what they wished had been different about their psychotherapy. Transcripts were analyzed using consensual qualitative research. Therapists and clients agreed moderately that exploration of the therapeutic relationship, therapists' use of challenges, and therapist validation and support were helpful. In contrast, there was low agreement on wishes. Whereas clients wished that therapists had provided more structure and direction, therapists did not mention any typical wishes. Using multilevel modeling, a high level of agreement on what was helpful was associated with reductions in psychological symptoms and interpersonal problems, although no relationship was found between agreement on wishes and outcome. The findings underscore the importance of therapist-client agreement about helpful aspects of therapy for successful therapy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).