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What do clients find helpful and harmful?

Over the years, a lot of research has been done into what is effective and what isn't in various kinds of counselling and psychotherapy. Early on in my training, I was writing a paper about mutuality in therapy, and quickly discovered that the vast majority of research had been done by asking therapists about what happens in therapy. Until quite recently, it was unusual for researchers to ask clients about their experience.

I'm delighted that this bias has started to be redressed - not least because there is some evidence that what therapists think are their finest moments may mean little to their clients; and what clients value most may be overlooked by their therapists. For a fascinating example of this happening repeatedly over the course of one person's therapy, I highly recommend Irvin Yalom's "Every Day Gets A Little Closer: A Twice-Told Therapy."

Researchers in a recent report asked a small sample of clients to consider specific aspects of their therapist's behaviour, and report whether they find them helpful or harmful. The findings are interesting, in that clients seemed to find the same events helpful or harmful, depending on whether or not they were timely or effective. For example, clients valued when their therapist made a helpful connection for them, but found the same behaviour unhelpful when they felt it was premature, or missing the point.

I think it's terribly important that we have ways to hear what clients want from their therapists and counsellors, because although a good therapist gets regular feedback and challenge of their work through supervision, the client is the only other person who directly experiences the sessions. If you're a client, I'd encourage you to give your therapist feedback on how they are with you and what they do. When you've got to know each other a bit, consider letting them know what works for you, and what doesn't. I know it's not always easy, especially if you're not happy with what you're getting, or if you're afraid that they might reject you. But I don't believe therapy will be helpful if you're dissatisfied, yet - for whatever reason - feel unable to say so. We need to hear from you!

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