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Mark Dombeck, Ph.D.Mark Dombeck, Ph.D.
Essays and Blogs Concerning Mental and Emotional Health

What Clients Find Helpful in Psychotherapy

Mark Dombeck, Ph.D. Updated: Sep 25th 2006

I had the good fortune today to come across an article authored by Heidi Levitt, Mike Butler and Travis Hill (all of the Department of Psychology at the University of Memphis) titled, "What Clients Find Helpful in Psychotherapy: Developing Principles for Facilitating Moment-to-Moment Change", and appearing in the Journal of Counseling Psychology (July 2006 Vol. 53, No. 3, 314-324). I wish I could link you directly to this article, but this isn't possible at present, so if you are really interested, you can find a copy at your local university library or through interlibrary loan.

The authors of this article went out and interviewed 26 adult community members who had recently (and independently of the study) participated in psychotherapy for a variety of problems. Data from these interviews were analyzed in a qualitative fashion and reformulated as a series of principles that summarized what the subjects (considered as a group) thought were the most important aspects of their recently concluded therapy.

Six clusters of themes were identified, each containing one or more sub-themes. The first cluster had to do with subjects discussion of how they figured out whether or not they could trust their therapists. Generally, the clue that subjects described that let them know it was safe to trust their therapist had to do with the therapist's behavior. As the study authors summarized: "A sense of professional caring is needed, or the therapist is experienced as too distant, defensive, or unattuned to clients' emotions. However, caring is too intense if the therapist is experienced as jealous, controlling, or pitying."

Other clusters spoke to the manner in which therapists conducted themselves with clients, and how clients interpreted this therapist behavior:


  • "Therapists' emotional expression was humanizing so long as it conveyed concern about the client rather than about the therapist's self-interest, bias, or need."

  • "Therapist professional status [and displays of knowledge] added to credibility unless it was thought to preclude the therapists' sincerity of caring."

  • "Confrontation was thought [by clients] to disrupt trust and compromise the therapy in most cases, with the exception of when the client was being manipulative or avoidant of difficult material, and then it was desirable."


All of this makes complete sense to me, based on my past experiences both as a therapist and as a client, but seldom have I seen these principles laid out so clearly.

Implicit in these principles is the idea that what effective therapists are doing is constantly adjusting their behavior to adapt to the needs of their clients. In order to help clients, therapists are needing to display that they are knowledgable, but not too knowledgable such that they'll be a know-it-all. They need to convey that the therapy environment (and their person, too) is safe, but the therapist should never be so safe that he or she is unwilling to confront clients who are stalling or manipulating so as to avoid dealing with issues. They need to express caring and genuine concern, but not to the point where the client becomes afraid of hurting the therapist's feelings. Therapy is a balancing act, and these pithy principles capture that dynamic nicely.

Most people reading this weblog entry will have been in therapy, either as a client or as a therapist. If you have been a client in therapy (past or present), please leave a comment below describing what it was about your therapist (what he or she did or didn't do) which made him or her an effective (or ineffective) helper and facilitator of healthy change in your life.

Mark Dombeck, Ph.D.

Mark Dombeck, Ph.D. was Director of Mental Help Net from 1999 to 2011. Presently, he is an Oakland Psychologist (Lic#PSY25695) in private practice offering evidence-based acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT) and addressing a range of life problems. Contact Dr. Dombeck by calling 510-900-5123, send Dr. Dombeck email or visit Dr. Dombeck's practice website for more information.

Reader Comments
Discuss this issue below or in our forums.

What made me trust my therapist. - - Mar 25th 2009

My therapist put her concerns upon me as a client above herself.  She gave me ample time to express myself without interrupting.  This allowed me to bring out thoughts and feeling that I held deep inside enabling me to release pent-up emotions.

How I Benefited From My Therapist. - Robert - Nov 15th 2008

My therapist always shows concern and is not afraid to confront me when I begin to resist the hard emotional territory.  She always put her concern over her knowledge, yet shared her knowledge with me when I asked for it.  I'm very fortunate to have her as my therapist.

Journaling/Preparing for Disclosing - amanda - Nov 5th 2008

Taken from my journal before eventually breaking a 30 yr silence

"You cannot collaborate with another person toward some common end unless you know him.  How can you know him, and he know you unless you have engaged in enough mutual disclosure of self to be able to anticipate how he will react and what part he will play?"

~Sidney Jourard

The Transparent Self

Response to Sidney Jourard written in my journal after disclosure:

Yes you can.  It's called trust.  Trust really in your own self to do what you have to do to move, to grow, to build, to tear down, to open, to speak, to risk, to be "transparent," to unearth 30 yrs of something much deeper than the word shame can ever touch.

My therapist earned my trust by letting me learn I can trust myself and be confident in standing on my own to do so.  I so appreciate, and means much to me.

not just the therapist - Bears star - Sep 19th 2008

I think what made my therapy work was because because of my own willingness to make changes.  At that point, everything was a better option than my state of mind at the time. 

Back to the therapist issue.  What made me comfortable about my therapist was that she told me what SHE FELT if she were in the same situation (showing sympathy).  BUT, she also told me other possible feelings that might arise in the same situation (pointing out other options).  I think what I'm trying to say is that she was equal to me in our sessions.  She did not have the "know-it-all" feeling. 

Another thing I felt happy with was the way she gave me the feeling that SHE TRUELY WANTED to help and was concerned for my well-being.  I think that the therapist's state of mind in sessions is really important.

Mixed - - Sep 27th 2006
Not-so-good: Recommended a religiously oriented self-help book even though I'd said I wasn't religious. Good: Actuially listened respectfully when I brought up something uncomfortable, like sex. With some therapists, it feels like a taboo subjest.

Good when a T doesn't let you get away with stuff - - Sep 25th 2006
My old T had a good BS detector. He could quickly tell when I was not wanting to talk about an issue, and he let me know it. It was intimidating at first to experience this sort of demand to get to the point. I didn't like it! But then, after a while I came to value it, becuase it meant he wasn't wasting my time, but rather was interested in helping me get the best value for my time.

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