Hindering events in psychotherapy: A retrospective account from the client's perspective

Abstract

Background Hindering events in the therapeutic process have been associated with client dissatisfaction, disagreements in therapy, and premature withdrawal from the therapeutic process. However, hindering events in therapy have not been extensively researched from the client's perspective and lack subjective details on how these events are experienced in therapy. Aims This study explored how hindering events are experienced by clients and their influence on the therapeutic process and outcome from the client's perspective. Method Nine individuals who previously attended therapy and experienced hindering events were interviewed using an in‐depth semi‐structured interview protocol created by the authors. Data were analysed using structured thematic analysis. Results Four major themes emerged, each containing themes and sub‐themes to further expand on client experiences: (a) identified hindering events (felt mistreated by therapist, distracted/inattentive therapist, perceived clinical mistakes, tensions from the management of the therapeutic frame); (b) subjective experience of the event (negative emotional experience, making sense of the event, parallel personal dynamics); (c) response to the event (client response/decision to continue or end therapy, reaction to discontinuing therapy); and (d) handling/addressing the event (not handled/addressed, handled/addressed, interest in handling/addressing event, reasons given for not addressing/handling event). Results from this study contribute to the further understanding of client experiences of hindering events that occur in therapy as well as how these events influence therapeutic processes and outcomes. Conclusion The study adds nuance to the scholarly work that informs client experiences of negative events in therapy. Implications for therapeutic organisations, therapists/counsellors, and educators are discussed.

Clients’ own perspectives on psychotherapy outcomes and their mechanisms.

“…Nonetheless, the existing research points to a handful of key themes that center on client disappointment. For example, one study provided preliminary evidence that clients find some of the logistics of therapy (e.g., fee reminders, an inflexible cancellation policy, pressure to schedule additional sessions) to disrupt its benefits (Burton & Thériault, 2020). Moreover, supporting the earlier discussion of therapist responsivity, clients have also expressed general disappointment with (and a negative impact of) the perceived absence of a personally good treatment fit (e.g., Chui et al, 2020;.…”

“…Also, future client-focused research should focus more on conceptions of poor outcomes and improvement-hindering events or actions in therapy. Not only has more research to date understandably focused on positive outcomes and improvement-facilitating mechanisms, but we also know that clients are more likely to underreport negative events and outcomes (Burton & Thériault, 2020). Finally, client-focused research, just like any form, will have to contend with discrepancies that may emerge across studies versus only building a type of "thick description" from which we can derive relatively few representative themes or directions.…”

“…For example, some clients receiving psychodynamic therapies have commented on a lack of structure and strategies, while some clients receiving cognitive behavior therapy have said that treatment was too structured and focused too heavily on the present day. In addition, whereas clients acknowledged the role of their own agency, motivation, and internal obstacles in impeding (or facilitating) their improvement (e.g., Nilsson et al, 2007), they also highlighted a number of hindering therapist actions, such as when therapists seem inattentive or distracted; make clients feel disrespected, misunderstood, unheard, judged, or stigmatized; and/or fail to address such transgressions (Burton & Thériault, 2020;Levitt et al, 2016;Timulak, 2010;Timulak & Keogh, 2017). Clients also believe their progress is hindered when they perceive clinical mistakes or therapist misdirection; this can happen when therapists engage core therapy elements unskillfully (e.g., ineffective reflective listening or inauthentic empathy), when therapists are more directive than the client would like (e.g., structuring the session without client input, inserting too much of their own perspective, disguising advice as a question), or even when clients perceive therapist mistreatment, negligence, or incompetence (e.g., asking inappropriate questions, assessing clients inaccurately, pushing clients into action before they are ready; Burton & Thériault, 2020;Swift et al, 2017;Timulak, 2010).…”

“…Given that clients can experience helpful and hindering events on a moment-by-moment basis (Swift et al, 2017), therapists need to attune to subtle (often nonverbal) reactions, especially those that suggest disappointment or misunderstanding (Timulak, 2010). While the aspiration is to avoid making mistakes, the inevitability of missteps underscores the importance of how therapists respond after they occur, especially given that leaving them unresolved can contribute to client perceptions of poorer outcomes (Burton & Thériault, 2020;Swift et al, 2017;Wucherpfennig et al, 2020). Therefore, because clients may be hesitant to raise these issues themselves, therapists should explicitly address possible ruptures, openly solicit feedback, and metacommunicate about possible negative therapy process (and their own contributions to it).…”

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“…Clients frequently find it difficult to address negative experiences (e.g., Burton and Thériault, 2020;Calabro et al, 2024), contributing to the challenge of identifying them. Meanwhile, therapists may struggle to recognize negative events during therapy sessions and their own role in them (Hannan et al, 2005;Hatfield et al, 2010;Werbart et al, 2019;Dandachi-Fitz Gerald et al, 2022).…”