In this study, we explore the etymology and history of "agency," link it with relational psychoanalytic literature, and examine how it can be understood within Lacanian psychoanalytic theory and practice. Building on its history, we find that "agency" embodies a binary distinction between the person as an actor, on the one hand, and as a being who is subject to determining structures, on the other. This binary approach, however, limits the debate concerning agency. Arendt's concept of "action," which builds on the same etymological stem as "agency" (i.e., "agere"), allows for nuance in the concept and moves it beyond its otherwise binary understanding. Through this conceptual work, we draw three conclusions regarding patient agency: (a) agency can only come about in relation to others; (b) initiating a new beginning in speech acts and actions already implies agency; and (c) one must be willing to take responsibility for the consequences of one's actions to be able to feel agentic. Lastly, we relate these three conclusions to Lacanian psychoanalysis, in particular to the notions of alienation and separation, full speech, and guilt.

Client agency is considered a crucial contributor to good treatment outcome. Recent studies, however, differ strongly in how they conceptualise and investigate agency. The current study explores the nature of client agency in ten clients’ pre-treatment interviews. Applying Consensual Qualitative Research, we constructed three overarching categories, subdivided into 14 sub-categories capturing both between- and within-person differences in agency before therapy. We found that all participants oscillated between the experience of a lack of grip on problems on the one hand and noticing their involvement in the problem and taking action on the other. These results present a dynamic conceptualisation of client agency. This allows us to ask pertinent questions for both future research and clinical practice.

In the present paper we examine four cases in which the assumption that "good outcome" necessarily means "good therapy" did not hold. Cases were selected that reported good pre-post outcome (i.e., clinically reliable decrease in symptom severity) but a negative (disappointing) therapy experience, drawn from a randomized controlled trial (the Ghent Psychotherapy Study) and a naturalistic outcome study (the Stockholm Young Adults Psychotherapy Project). Analysis of these seemingly contrasting findings made it possible to identify three distinct patterns of client experience of outcome. Implications for research and practice are discussed.Wenn "gutes Ergebnis" nicht mit "guter Therapie" übereinstimmt: Überlegungen zu Diskrepanzen zwischen den Ergebniswerten und der Therapiezufriedenheit der Patienten ZUSAMMENFASSUNG In der vorliegenden Arbeit untersuchen wir vier Fälle, in denen die Annahme, dass "gutes Ergebnis" notwendigerweise "gute Therapie" bedeutet, nicht zutraf. Es wurden Fälle ausgewählt, die ein gutes Prä-Post-Ergebnis (das heißt eine klinisch zuverlässige Abnahme der Symptomschwere), aber eine negative (enttäuschende) Therapieerfahrung aus einer randomisierten kontrollierten Studie (Gent-Psychotherapie-Studie) und einer naturalistischen Outcome-Studie (Stockholm Young) berichteten Psychotherapieprojekt für Erwachsene). Die Analyse dieser scheinbar gegensätzlichen Ergebnisse ermöglichte es, drei unterschiedliche Muster der Kundenerfahrung des Ergebnisses zu identifizieren. Implikationen für Forschung und Praxis werden diskutiert.

People with a history of complex trauma (i.e., being exposed to prolonged and repeated interpersonal traumatic events) suffer from a wide variety of symptoms, including interpersonal difficulties (e.g., Herman, 1992; van der Kolk et al., 2005; Van Nieuwenhove & Meganck, 2017). These interpersonal problems are often related to a lack of trust in others and the world as a result of childhood experiences in which primary caregivers were unreliable and unpredictable. Drawing from attachment theory, this insecure basis gives rise to certain deeply engrained interpersonal patterns that mark interpersonal relations later in life (Pearlman & Courtois, 2005). These interpersonal patterns can be broadly defined as a seemingly coherent representational frame via which a person perceives him/herself, in relation to others and the world. This frame corresponds with the internal working model in attachment theory (Bretherton & Munholland, 2008), cognitive schemas in Piaget's developmental theory