Agency via Awareness: A Unifying Meta-Process in Psychotherapy

Abstract

To address the need for conceptual and clinical consensus within the field, psychotherapy research has increasingly focused on identifying common principles of change. While the field contends that this approach is atheoretical, we argue that principles of change cannot be fully understood or applied without the context of some theoretical framework. This article develops such a framework by identifying and explicating two theoretical assumptions that are implicitly shared by multiple therapeutic approaches: (1) that increasing agency is a fundamental aim of psychotherapy, and (2) that therapists enhance clients' agency by increasing their awareness. Building on the largely disparate empirical literatures demonstrating the importance of client agency and awareness to successful therapeutic outcomes, we provide a theoretical account of the highly iterative and synergistic meta-process by which these two factors jointly produce change. Explicit identification and empirical investigation of this Agency via Awareness psychotherapy meta-process, we argue, could facilitate scientific and clinical progress within the field. The hypothesized meta-process is discussed in relation to existing integrative models of therapeutic change, and its manifestations in the theory and practice of major therapeutic orientations are reviewed and illustrated. We discuss how this framework can facilitate psychotherapy research by providing a common language and conceptual foundation for wide-ranging therapeutic approaches, constructs, and findings. Finally, by raising clinicians' awareness of the implicit assumptions underlying their therapeutic work, we suggest that the Agency via Awareness framework can increase their agency over when and how they apply these assumptions in therapy to maximize client improvement.

Life stories of patients with personality disorders before and after treatment: Change and stability in agency and communion

“…These results match with a review and previous study on recovery for persons with PDs in which safety, social relationships and autonomy are decisive factors to recovery ( 19 , 43 , 49 ). And the results are in line with the ‘Agency via Awareness’ framework by ( 20 ) in which increasing awareness is assumed to lead to increasing agency. Also, psychotherapy outcome research utilizing the Core Conflictual Relationship Theme (CCRT), shows that mastering negative relationship patterns is supporting in developing better relationship patterns with oneself and others ( 7 ).…”

“…Also, there is moderate to strong evidence that emotional change (regulation, awareness, and transformation), socio-cognitive change (mentalizing, meta-cognition, and interpersonal patterns), and increase in insight and change in defense mechanisms contribute to healthy change in treatment for PDs ( 19 ). Based on meta-theoretical models of therapeutic change, ( 20 ) proposed a theoretical framework named ‘Agency via Awareness’ in which they identify two theoretical assumptions: (1) that increasing agency is a fundamental aim of psychotherapy, and (2) that therapists enhance patients’ agency by increasing their awareness. Life stories of patients with PDs form a reflection of their awareness of their internal and external reality.…”

COVID-19 Related Traumatic Distress in Psychotherapy Patients during the Pandemic: The Role of Attachment, Working Alliance, and Therapeutic Agency

“…Therapeutic agency, which was the other significant predictor of patients' resilience over time, has been proposed to be a common factor of change in psychotherapy [70,71] and our results support its importance in the specific context of the pandemic and online psychotherapy. It is noteworthy that the working alliance was not a direct predictor of COVID-related traumatic distress over time across the sample.…”

Agency via speech: A Lacanian perspective on the process toward agency in psychoanalytic therapy.

“…Applied to psychoanalysis, Gorlin and Békés (2021) argued that even though unconscious forces determine a person's choices, this person can become aware of these unconscious forces and as such increase one's agency over previously unconscious processes. They, therefore, draw on Freud's (1915Freud's ( -1917Freud's ( /1961) argument that the aim of psychoanalysis is to make unconscious material conscious.…”