Clients’ own perspectives on psychotherapy outcomes and their mechanisms.

Abstract

H aving read, lauded, and concurred with Fuertes and Williams's (2017) call for more client-focused psychotherapy research, we eagerly agreed to contribute this chapter on clients' own views of psychosocial treatment outcomes and their mechanisms. That said, we also appreciated the inherent challenge in identifying this chapter's unique and complementary scope within the overall volume. In its broadest sense, client-focused psychotherapy research could conceivably cover any outcome construct or variable that pertains to the client (whether defined by researchers, therapists, or clients), with data collected in any number of ways. After having recently contributed a comprehensive review of the research on the client, therapist, and relational factors to Bergin and Garfield's Handbook of Psychotherapy and Behavior Change (seventh ed.; Constantino, Boswell, & Coyne, 2021), we were acutely aware of how vast and unwieldy a review of "all things client related" could get! However, to us, truly client-focused outcome research requires more than an examination of any inherently client-related factors that change or predict change. Rather, such research needs to explicitly draw out and privilege the client's voice or narrative to understand these primary outcome-related elements. To draw on McLeod et al.'s (2009) rubric of stakeholder positions, such focus reflects user-constructed outcomes and their mechanisms, as opposed to researcher-or therapist-constructed outcomes and mechanisms. Accordingly, we discuss herein research that has, in both content and method, directly asked adult clients (this age criterion is consistent with the volume's overall

Can we harness therapist effects for therapeutic benefit?

“…Moving forward, with the existing methods as inspirations (but also hopefully creative floors, not ceilings), we see several promising research lines. For example, in recognition of the limitation that much of the previous literature on between and withintherapist effects, and predictors of them, focuses largely on patients' symptomatic and functional outcomes, it will be important for future research to examine therapist differences, and how best to leverage them, on other out comes that may be of interest to patients beyond symptoms/functioning (e.g., empowerment, agency/selfefficacy, improvements in selfesteem and selfconcept; for a review, see Constantino et al, 2022). Additionally, investigators can continue to use correlational designs to identify additional mutable therapistlevel predictors (e.g., humility) of more positive between therapist effects on global or specific outcomes (see .…”

Cultural humility, counseling alliance, and counseling outcome among LGBTQ+ clients

“…Positive constructs, such as psychological well‐being, are sometimes measured to represent desirable counseling outcomes (Alessi et al., 2019). The current study defines counseling outcomes as client‐rated perceived progress in counseling, in keeping with how it is commonly measured in counseling literature (Constantino et al., 2022).…”

“…Counseling outcome is a variable that has been long studied in counseling research to measure the success and effectiveness of counseling and psychotherapy in different forms (Constantino et al., 2022). Commonly measured outcome aspects include client‐reported progress or improvement of goals, problems, and issues that clients want to address in counseling, either during or after the course of counseling (Constantino et al., 2022; Hatcher & Barends, 1996; Hook et al., 2013). Outcomes can also be measured in behavioral terms, such as counseling continuance and premature termination (Hook et al., 2013; Owen et al., 2017).…”