Psychological therapy as viewed by clients and therapists

Results are presented from a study in which 40 therapist-client pairs were asked to record, after each session of psychological therapy, their views concerning the helpful and unhelpful events which took place. On termination they were asked to describe their views of the helpful and unhelpful events in retrospect, and to report on outcome. A total of 1076 events was collected from 399 therapy sessions, and was content analysed using Elliott's Therapeutic Impact Content Analysis System. Results showed that during therapy the types of event most frequently reported by clients were reassurance/relief and problem solution events, whereas therapists reported the clients' gaining of cognitive and affective insight. After termination, both participants reported the importance to the client of personal contact. Many of the differences between the two perspectives were highly significant, although more differences were found when outcome was poor. It is suggested that different aspects of the therapeutic process have a different degree of salience for therapists and clients, in that clients are most interested in gaining a solution to their problems and feeling better, whereas therapists are more concerned with the aetiology of the problem and its transformation through insight. The implications of these differences are discussed.