People Engaging Each Other: A Dual-Perspective Study of Interpersonal Processes in Useful Therapy

Abstract

To explore how clients and therapists experience and engage in a therapeutic relationship which the client can make use of. We explored 11 psychotherapy dyads using in-depth qualitative methods. Selected dyads were ones in which the client experienced the therapy as useful. The data collection method was serial interviews with both therapists and clients. Therapists and clients were interviewed separately, four and two times, respectively, about their personal development, their views on and experiences with therapy, and their collaboration in the concrete therapeutic dyad. Transcripts of interviews were analyzed using a hermeneutic phenomenological qualitative analysis. The analysis yielded an overarching theme identified as "engaging each other." This theme consisted of three constituent processes, developed from complementary descriptions from clients and therapists: (1) opening up to an encounter between humans, (2) trusting professionality, and (3) creating space for an unbearable story. We discuss how technical skill and personal warmth underlie the development of a helping relationship within which humans can open up to a personal encounter with suffering. We discuss how the personal aspect of the therapist position relates to psychotherapy as a moral practice, and suggest that this perspective is meaningful in understanding the therapist factor and the real relationship.

Barriers and Facilitators in Adolescent Psychotherapy Initiated by Adults—Experiences That Differentiate Adolescents’ Trajectories Through Mental Health Care

“…The real relationship is a construct that defines the need for genuineness and realism in treatment relationships ( Gelso, 2011 ), and it has been found to be independently associated with outcomes in adult populations ( Gelso, 2011 ). One hypothesis generated by our data and the relevant literature is that the construct of the real relationship ( Gelso, 2011 ; Råbu and Moltu, 2020 ) developed alongside the alliance construct in adult psychotherapy but less applied and developed for the adolescent population could be beneficial and, therefore, should be researched in this context.…”

“…Moreover, therapists often perceive adolescents as a difficult group to engage in therapy ( Everall and Paulson, 2002 ), and research on adult psychotherapy has found that therapists’ attitudes toward their clients form quickly and influence clinical judgment, including prognosis and diagnostic assessment ( Strupp, 1993 ). Therapy is, therefore, constituted by unique encounters between two persons, in which both parties bring with them experiences and expectations influencing the evolving interaction and relationship ( Bucci et al, 2016 ; Råbu and Moltu, 2020 ).…”

Negotiating System Requirements to Secure Client Engagement – Therapist Strategies in Adolescent Psychotherapy Initiated by Others

“…To succeed, both in establishing and maintaining alliance and collaboration, the therapist must be flexible and sensitive, accurately assessing what is going on in therapy, accessing the client’s perspective, and adjusting the content and timing of interventions to the individual client (i.e., therapist responsiveness; Stiles et al, 1998 ; Hatcher, 2015 ; Wu and Levitt, 2020 ). Psychotherapy, thus, consists of unique meetings between two persons, where both parties bring with them experiences and expectations that influence the evolving interaction ( Råbu and Moltu, 2020 ), but where the therapist bears particular responsibility – and especially so, in adolescent psychotherapy ( Bolton Oetzel and Scherer, 2003 ).…”

“…General psychotherapy research, both process-outcome research and research exploring the client perspective of therapy, has pointed to the significance of the therapist-as-person and the specific client-therapist relationship to understand therapeutic change processes (Elliott et al, 2011;Hatcher, 2015;Anderson et al, 2016;Swift et al, 2018;Heinonen and Nissen-Lie, 2020;Råbu and Moltu, 2020). Accumulating research documents therapist effects on outcomes (Wampold, 2014;Castonguay and Hill, 2017), with some therapists being more effective across a range of clients and different mental health problems.…”

Connecting with Clients: Assessing Clients Preference of Counsellor

“…There are still a dearth of local studies examining the characteristics of effective counsellors from the client's perspective. However, comparable studies conducted in other countries have advanced to a greater level by examining counselling process from both the client and counsellor perspectives (Sackett et al, 2012;Råbu & Moltu, 2021). Thus, it is pertinent for this study to look at the characteristics of counsellors that clients believe are necessary.…”