Friday, 10 June 2016

It can be a good thing for a therapist and client to disagree about the client's problems

Rapport between a client and therapist is important for therapy to be successful, and part of that is agreeing about the aims of the exercise. You’d think this would include the therapist and client agreeing about the specific nature of the client’s psychological problems. In fact, a new study in Psychotherapy Research finds disagreement isn't harmful to therapy and can even be beneficial.

Rolf Holmqvist and his colleagues recruited 846 therapy clients as they started a course of therapy at a Swedish primary care centre, most of them after having been referred by their family doctor. Seventy-three therapists, most of them psychologists and social workers, also took part.

Separately, the clients and therapists rated the nature of clients’ mental health problems at the start of therapy and again at the end. After each session, therapists and clients also completed measures of their “working alliance” – essentially their rapport and how well they felt that they collaborated.

Focusing on depression and anxiety, the researchers found that there was only moderate agreement between therapists and clients about whether these problems were present or not – for example, for just under half the clients, the therapists reported that the clients were depressed or anxious when the client themselves did not.

What’s more, amount of agreement on the presence or not of depression was not related to the success of therapy in reducing the clients’ self-rated symptoms, nor to ratings of working alliance. And regarding anxiety, some of the most successful outcomes were actually seen in those instances where the therapists rated the client as anxious, but the client did not seem themselves as having anxiety.

The study has some issues, such as that the therapists’ and clients’ views on the clients’ problems were measured in different ways, and that the research can’t say who had the more accurate insight because there was no third-party, objective measure of the clients’ problems, so far as this is possible. Notwithstanding these issues, the researchers said their findings were “remarkable” and that they suggest “patient and therapist may have different ways of understanding the patient’s problem without detriment for the treatment result – or event to its benefit.”


Holmqvist, R., Philips, B., & Mellor-Clark, J. (2015). Client and therapist agreement about the client's problems—Associations with treatment alliance and outcome Psychotherapy Research, 26 (4), 399-409 DOI: 10.1080/10503307.2015.1013160

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.

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