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The Informed Client: Exploring Choices, Styles, and Sensitivities in Psychotherapy

The Informed Client: Exploring Choices, Styles, and Sensitivities in Psychotherapy

This article unravels my exploration into the many criteria we employ consciously and subconsciously in selecting a therapist and the dynamics that can lead to a diminished focus in therapy. 


Embarking on a therapeutic journey, I have often pondered the intricate decisions that unfold in the therapy room. As potential clients, how do we navigate the complex process of choosing a therapist whose approach aligns with our unique needs? What internal or external factors might influence our commitment to the therapeutic process? Drawing upon a rich tapestry of psychological literature, I aim to delve into these pivotal considerations. This article unravels my exploration into the myriad criteria we employ consciously and subconsciously in selecting a therapist and the dynamics that can lead to a diminished focus in therapy. Venturing further, I will dissect the nuances between directional and non-directional therapeutic styles, referencing seminal works that highlight their practical implications (Beck, 2011; Rogers, 1957). In our diverse global community,

I must emphasize the significance of cultural sensitivity, mainly as we reflect on research underscoring its impact on therapeutic outcomes (Sue & Sue, 2016). Moreover, in a world that is increasingly embracing diverse identities, it is imperative to discuss LGBTQ+ awareness, given its historical and present importance in the realm of mental health (Drescher, 2015; Meyer, 2003). Join me on this introspective journey through the multi-dimensional world of psychotherapy.

The Ways Clients Pick a Psychotherapist to Work With

The decision about which therapist to work with is multifaceted and can be influenced by various factors. Research has identified several aspects that potential clients might consider when making this decision. Here are some key considerations based on research findings:

  • Therapist's Credentials and Experience: Many clients consider a therapist's qualifications, specialties, and years of experience when deciding whom to work with (Ogunfowora & Drapeau, 2008).
  • Recommendations and Referrals: Word of mouth, especially from trusted friends, family, or professionals, can influence a client's choice (Lambert & Ogles, 2004).
  • Cultural and Demographic Factors: Clients may prefer therapists of a specific gender, age, or cultural background or who speak a specific language, believing they would be more understood or comfortable (Cabral & Smith, 2011).
  • Therapeutic Approach and Orientation: Some clients prefer specific therapeutic modalities or philosophies, such as cognitive-behavioral therapy, psychoanalysis, or humanistic approaches (Cook & Biyanova, 2006).
  • Location and Accessibility: Convenience regarding the therapist's location and the availability of transportation or parking can be a determinant (Boisvert & Faust, 2006).
  • Fees and Insurance Coverage: The cost of therapy and whether the therapist accepts insurance or offers a sliding fee scale can be significant considerations for many clients (Meyer et al., 2011).
  • Initial Impressions and Comfort Level: The "gut feeling" or initial comfort level during a first interaction or consultation can profoundly influence a client's decision (Ackerman & Hilsenroth, 2003).
  • Therapist's Availability: Clients might consider how easy it is to get an appointment, the therapist's working hours, and the wait time for the initial session (Duncan et al., 2010).
  • Online Presence and Reviews: With the rise of technology, clients often turn to online platforms to read reviews or get a sense of the therapist's approach from their websites or social media profiles (Jones, 2015).
  • Personal Attributes: Clients may consider a therapist's warmth, empathy, genuineness, and other interpersonal qualities as critical factors in their decision-making (Ackerman & Hilsenroth, 2003).

Various emotional and cognitive responses can accompany clients' waning interest or focus in psychotherapy. At the heart of this process is often cognitive dissonance—a psychological discomfort that arises when there is an inconsistency between two or more cognitions (e.g., beliefs, attitudes, or behaviors). This discomfort can motivate individuals to reduce inconsistency and achieve cognitive consistency.

Here are some potential emotions and cognitive dissonance scenarios clients might experience, as well as ways they might resolve the inner conflict:

  • Guilt or Shame: Clients may feel guilty for not fully engaging in therapy, especially if they believe they are not living up to their own or their therapist's expectations. They might rationalize their lack of engagement as the result of external factors rather than their own choices (Festinger, 1957).
  • Doubt and Uncertainty: A client might doubt the effectiveness of therapy or their ability to change. This doubt can create dissonance, especially if they initially held strong beliefs in the benefits of therapy. They might resolve this by seeking additional information or reassurance, adjusting their expectations, or attributing their doubts to external factors (Harmon-Jones & Mills, 1999).
  • Defensiveness: If clients perceive being pushed too hard or confronted about issues they are not ready to address, they may become defensive. They might cope by minimizing the importance of these issues or shifting blame elsewhere (Cooper, 2007).
  • Avoidance: The emotional pain of confronting challenging issues can lead to avoidance. To reduce dissonance, clients might minimize the importance of these topics or convince themselves that they are still being prepared to tackle them (Festinger, 1957).
  • Rationalization: Clients might rationalize their decreased interest by attributing it to factors like the therapist's approach, lack of perceived progress, or external life circumstances. By doing so, they can maintain a positive self-view and reduce the discomfort associated with acknowledging their decreased commitment (Aronson, 1992).
  • Seeking Validation: Clients might talk to friends or family about their feelings towards therapy, seeking external validation. If others agree with their perspective, it can reduce the cognitive dissonance they feel (Harmon-Jones et al., 1996).

Ways of resolving these inner conflicts include:

  • Open Communication: Many therapists encourage clients to communicate doubts, feelings, or concerns about the therapeutic process. Through this open dialogue, the therapist and client can collaboratively address any dissonance and adjust the treatment plan as necessary (Rogers, 1951).
  • Self-compassion and Self-acceptance: Encouraging clients to practice self-compassion can help them acknowledge their feelings without judgment. This acceptance can reduce the cognitive dissonance of not meeting perceived expectations (Neff, 2003).
  • Re-evaluation of Goals: Sometimes, revisiting and adjusting therapeutic goals can help clients realign their expectations and rekindle their commitment to therapy (Locke & Latham, 2002).

The emotions and cognitive dissonance experienced during therapy are profoundly individual and can vary widely based on the person and their circumstances. A skilled therapist will be attuned to these shifts in engagement and work collaboratively with the client to navigate and address any arising conflicts.

The Ways Clients Lose Interest or Focus in Psychotherapy

Psychotherapy is a deeply personal process requiring commitment, time, and effort. Not all clients maintain the same interest or focus throughout their treatment. There are many reasons why clients might lose interest or focus in psychotherapy. Some of these reasons include:

  • Mismatches with the Therapist: The therapeutic alliance, or the relationship between therapist and client, is crucial to therapy success. Clients who do not "click" with a therapist may lose interest (Horvath & Symonds, 1991; Martin et al., 2000).
  • Unmet Expectations: Clients often come into therapy with certain expectations. They may lose motivation if these are not met, or they perceive the progress pace as slow (Lambert, 2013).
  • Life Distractions: External events or stressors (e.g., job change, illness, relationship difficulties) might divert a client's focus from therapy (Prochaska & Norcross, 2018).
  • Financial Constraints: The cost of therapy can be a deterrent for some clients, especially if they do not see immediate or perceived benefits.
  • Difficulty Confronting Painful Issues: The therapeutic process sometimes requires clients to face painful or traumatic memories. This can be overwhelming and might cause some to disengage to protect themselves from such distress (Castonguay et al., 2006).
  • Perceived Stigma: Even though strides have been made to reduce the stigma associated with mental health treatment, some clients still feel a stigma associated with attending therapy, which can impact their commitment (Corrigan, 2004).
  • Insufficient Skills or Coping Strategies: If clients feel ill-equipped to handle the emotional intensity of therapy or lack coping strategies, they may withdraw or lose focus (Neimeyer & Feixas, 1990).
  • Lack of Feedback: When therapists provide inadequate feedback, clients might feel less confident about their progress or the effectiveness of therapy, leading to decreased engagement (Lambert et al., 2018).
  • Premature Termination: Some clients believe they have achieved their goals earlier than the therapist might assess, leading to early dropout (Wierzbicki & Pekarik, 1993).
  • Culture and Worldview Mismatch: Clients from diverse cultural backgrounds may feel misunderstood or not wholly represented in therapy, leading to disengagement (Sue & Zane, 1987).

How Clients Give Themselves to Best Change of Making the Right Decision

Selecting a therapist is a significant decision that can profoundly impact a client's therapeutic experience and outcomes. To give themselves the best chance of making an informed decision, clients can consider several strategies, as research suggests.

  • Self-Reflection: Before starting the search, clients can reflect on their specific needs, preferences, and goals for therapy. This might include determining the issues they want to address, the kind of therapeutic approach they believe would be beneficial, and their preferences regarding the therapist's demographics or background (Norcross & Wampold, 2011).
  • Research Different Therapeutic Approaches: Understanding the various therapeutic modalities can help clients align their needs with a therapist's approach (Norcross, 2011).
  • Seek Recommendations: Referrals from trusted individuals, such as primary care physicians, friends, or family, can be invaluable. These individuals might provide insights based on personal experiences or professional knowledge (Lambert & Ogles, 2004).
  • Verify Credentials and Licensure: Ensuring that the therapist has appropriate qualifications and licenses to practice in their jurisdiction is essential. This can often be verified through state licensing boards or professional associations (American Psychological Association, 2010).
  • Consult Therapist Directories: Various professional organizations, like the American Psychological Association, offer directories to help clients find therapists based on specialties, location, and other factors.
  • Conduct an Initial Consultation: Many therapists offer initial consultations, either free or for a fee. This meeting can help clients gauge their comfort level with the therapist, understand the therapist's approach, and clarify any logistical or treatment-related queries (Swift & Callahan, 2011).
  • Assess Logistical Factors: Practicalities such as location, availability, fees, and whether the therapist accepts insurance can significantly impact the feasibility and longevity of therapy (Boisvert & Faust, 2006).
  • Trust Gut Feelings: While empirical factors are crucial, clients should also trust their instincts. Personal comfort and the ability to develop a rapport with the therapist can significantly impact the therapeutic alliance, which has been identified as a critical factor in positive therapeutic outcomes (Ackerman & Hilsenroth, 2003).
  • Seek Feedback: Once therapy begins, clients can continually assess whether they feel progress is being made and if they are comfortable with the direction therapy is taking. If not, it is essential to communicate these feelings with the therapist or seek a different professional (Lambert, 2013).

Selecting a therapist is crucial in an individual's mental health journey. This decision is not taken lightly, as the therapist-client relationship holds significant implications for the effectiveness of therapy and the client's overall well-being. The therapeutic alliance – the bond between therapist and client and the shared understanding of therapeutic goals – consistently predicts successful therapy outcomes (Horvath et al., 2011). Hence, ensuring compatibility, trust, and rapport between the therapist and client from the outset can significantly influence the treatment trajectory.

Furthermore, an appropriate match between the therapist's approach and the client's needs and preferences can increase client engagement and adherence to therapeutic interventions. Misalignments, however, might lead to premature therapy termination, linked to poorer outcomes (Swift & Greenberg, 2012). Additionally, therapy is an emotional and financial investment. Making a hasty decision without due reflection might lead to increased costs, both monetary and emotional, particularly if the client feels the need to switch therapists or restart their therapeutic journey elsewhere.

Lastly, therapy involves delving into deep-seated vulnerabilities, traumas, and personal histories. Sharing these intimate details requires immense trust. A carefully chosen therapist, who resonates with the client's needs and values, can provide a safe and supportive environment conducive to healing and growth. In contrast, a mismatch could lead to feeling misunderstood or not validated, hampering the therapeutic process (Norcross & Wampold, 2011).

Taking the time and effort to carefully and reflectively choose a therapist is pivotal. It sets the foundation for a solid therapeutic alliance, ensures effective engagement and adherence, optimizes the use of resources, and fosters a nurturing environment for the client's journey toward mental and emotional well-being.

Consider Directional versus Non-Directional Styles

Directional and non-directional styles represent two distinct approaches to psychotherapy, each emphasizing the therapist's role and methodology in the therapeutic process.

Directional Psychotherapy: This style of therapy is more structured and active. Therapists employing a directional approach are more guided, offering explicit advice, feedback, and techniques tailored to the client's specific issues. They might set goals for the client, assign homework, or use targeted interventions to address particular symptoms or behaviors. This approach is often associated with cognitive-behavioral therapy (CBT), where the therapist provides clear direction regarding cognitive restructuring, behavior modification, and skill-building (Beck, 2011).

Non-Directional Psychotherapy: In contrast, non-directional psychotherapy is characterized by a more passive and listening-focused role of the therapist. Instead of directly steering the therapeutic process or offering explicit guidance, these therapists create a supportive environment that facilitates self-exploration and self-directed growth in clients. The therapist might reflect on what the client says, clarify feelings, or ask open-ended questions to help the client understand their insights. Person-centered therapy, rooted in the work of Carl Rogers, exemplifies this approach, emphasizing the therapist's role in providing unconditional positive regard, empathy, and congruence to facilitate the client's self-healing (Rogers, 1957).

While both styles have their merits, the appropriateness of each depends on various factors, including the client's preferences, presenting problems, desired outcomes, and the therapist's training and orientation. Some therapists might also integrate elements from both styles, tailoring their approach based on the individual needs of the client.

Consider Cultural Awareness and Cultural Sensitivity

Psychotherapist cultural sensitivity, often called cultural competence or responsiveness, refers to a therapist's awareness, understanding, and ability to interact with individuals from diverse cultural backgrounds effectively. This entails recognizing and respecting differences in race, ethnicity, religion, gender, sexual orientation, socioeconomic status, and other facets of identity. Cultural sensitivity also involves acknowledging one's biases, prejudices, and potential blind spots and understanding how power, privilege, and oppression might influence the therapeutic relationship (Sue & Sue, 2016).

The significance of cultural sensitivity in psychotherapy is underscored by its direct impact on therapeutic outcomes. A culturally sensitive therapist can foster a stronger therapeutic alliance, which is crucial for adequate therapy (Horvath, Del Re, Flückiger, & Symonds, 2011). Clients who perceive their therapists as understanding and respecting their cultural backgrounds and experiences are more likely to feel safe, understood, and validated, promoting engagement and openness (Cardemil & Battle, 2003). Conversely, cultural misunderstandings or oversights can hinder rapport, alienate clients, and lead to premature termination or poorer treatment outcomes.

Moreover, understanding the client's cultural context can guide therapists in making more accurate diagnoses, avoiding potential misinterpretations rooted in cultural differences. It can also help tailor interventions that align with the client's beliefs, values, and cultural practices, ensuring the treatment is practical but also relevant and respectful (Bernal & Sáez-Santiago, 2006).

In a globalizing world, where diverse cultural intersections are increasingly commonplace, cultural sensitivity in psychotherapy is not just an asset but a necessity. It ensures that therapy remains inclusive, effective, and respectful, honoring the diverse tapestries of clients' experiences and identities in the therapeutic space.

LGBTQ+ Awareness and Sensitivity

LGBTQ+ awareness and sensitivity in psychotherapy are paramount in recognizing, understanding, and respecting the unique experiences, challenges, and strengths of individuals who identify as lesbian, gay, bisexual, transgender, queer, and other non-heteronormative or non-cisnormative identities. Historically, many members of the LGBTQ+ community have faced stigmatization, discrimination, and pathologization in both broader society and, regrettably, within the realm of mental health care. For instance, it was not until 1973 that the American Psychiatric Association removed homosexuality from its list of mental disorders (Drescher, 2015).

Given this history and the ongoing challenges LGBTQ+ individuals face, psychotherapists must be equipped not just with a theoretical understanding of LGBTQ+ experiences but also with profound empathy and respect for their clients' lived experiences. LGBTQ+ awareness in psychotherapy encompasses recognizing the intersecting identities that clients might hold and understanding how societal attitudes, discrimination, and internalized negative beliefs might influence their mental well-being (Shelton & Delgado-Romero, 2011).

Sensitivity towards LGBTQ+ clients also means challenging heteronormative and cisnormative assumptions, recognizing the fluidity of gender and sexuality, and providing a safe space where clients can express and explore their identities without fear of judgment. Therapists should be particularly attuned to the elevated risks of mental health issues, substance abuse, and suicidality within the LGBTQ+ community, often due to minority stress and discrimination (Meyer, 2003).

Furthermore, therapists must remain vigilant about their biases and, when necessary, seek supervision or further education to ensure they provide the best care possible. Affirmative psychotherapy, which recognizes and celebrates LGBTQ+ identities, has been posited as an efficient approach to working with this community, emphasizing the strength and resilience inherent in these identities (Crisp & McCave, 2012).

Even for individuals who do not personally identify as members of the LGBTQ+ community, LGBTQ+ awareness, and sensitivity remain vitally crucial for various reasons.

Firstly, from a professional perspective, therapists, educators, healthcare professionals, and other service providers are likely to encounter individuals from the LGBTQ+ community in their work. Therefore, cultural competence ensures they can provide respectful, effective, and ethical care or services to everyone, regardless of their sexual orientation, gender identity, or expression. Failing to understand or acknowledge the unique challenges faced by LGBTQ+ individuals can lead to misdiagnoses, ineffective treatments, or further stigmatization and harm (Institute of Medicine, 2011).

Moreover, on a broader societal level, LGBTQ+ awareness promotes inclusivity and reduces prejudice and discrimination. By fostering understanding and empathy towards diverse identities, we cultivate communities where all members feel valued, respected, and safe. It is worth noting that societies characterized by acceptance and inclusivity typically experience fewer mental and physical health disparities among marginalized groups (Hatzenbuehler et al., 2013).

Additionally, even those who do not identify as LGBTQ+ may have friends, family members, or colleagues who do. By gaining insight into the experiences and challenges of the LGBTQ+ community, individuals are better equipped to offer support, understanding, and allyship. Such interpersonal connections and relationships can be deepened and strengthened by mutual respect and understanding (Herek et al., 2009).

LGBTQ+ awareness and sensitivity, even for those outside the community, enrich professional practice and the broader tapestry of human relationships, creating a more inclusive, empathetic, and informed society. LGBTQ+ awareness and sensitivity in psychotherapy are essential in providing ethical, effective, and empathetic care to historically marginalized and misunderstood communities.


In this introspective exploration of psychotherapy, the article delves deep into the many considerations clients confront when seeking therapy. Clients often grapple with selecting a therapist, a decision shaped by various conscious and subconscious criteria. Research indicates that the therapeutic alliance, which involves mutual trust, understanding, and collaboration, is pivotal for treatment efficacy (Horvath et al., 2011). However, sustained interest and engagement in therapy can wane due to factors ranging from personal circumstances to therapeutic techniques employed.

The piece further dissects the distinctions between directional and non-directional therapeutic styles, highlighting their unique merits. Directional therapies, such as Cognitive Behavioral Therapy, offer structured approaches, while non-directional styles, championed by Carl Rogers, emphasize client autonomy and self-exploration.

Diving deeper, the article emphasizes the importance of cultural sensitivity in psychotherapy, drawing from seminal works by Sue and Sue (2016). In an era of increased global interaction, clients' cultural backgrounds cannot be overlooked, as they significantly influence their worldviews, coping mechanisms, and therapeutic needs.

Lastly, the spotlight turns to LGBTQ+ awareness. Grounded in historical and recent literature, the article champions the necessity for therapists to recognize and affirm the experiences of LGBTQ+ individuals, fostering an inclusive and understanding therapeutic environment.



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