‘Does that mean I have to offer every therapeutic methods to every client I meet?’ It’s often more tentative and recursive: opening up the discussion, trying things, and being willing to change the way of working if clients are not finding it helpful or want something else. That means that assessing client preferences is not a ‘set-and-forget’ process. Yes, some do and some don’t (though our research shows that most client preferences are pretty stable over time). ‘Clients preferences can change over the course of therapy’ It’s not about handing over responsibility to clients, but working collaboratively with them-‘shared decision making’, as they call it in the medical field-to work out, together, the best way forward. Moreover, when therapists think that what a client requests will not prove helpful, then can then raise that concern with them. But, as we have seen, research shows that, overall, clients succeed better in therapy when they get the approach they want. A client, for instance, might want warmth and reassurance from their therapist when, actually, what would help them is to learn to tolerate anxieties and tensions in interpersonal relationships. ‘What clients want isn’t necessarily what they need’ But preference work is not an all-or-nothing thing: it’s about gently and sensitively offering clients an opportunity to share their preferences, if and when they have them and would like to do so. It’s certainly true that some clients don’t have strong preferences, particularly if they have not been in counselling or psychotherapy before. ‘Most of my clients don’t know what they want’ Therapists, quite rightly, have a number of concerns about working with client preferences, and these are worth addressing up front. When we ask, therefore, we share power we move away from a comparatively authoritarian, expert-led stance towards a more egalitarian and democratic one. A White male counsellor, for instance, who does not ask his female Pakistani client about her particular preferences may end up imposing European, ‘male’ assumptions on her.
Such honouring of difference is also important across cultures. It also means respecting our clients’ rights to be autonomous, self-governing agents and recognising that they are not uniform, ‘machine-made’ products, but individualized beings with distinctive wants. Ethically, preference assessment and accommodation can convey a deep respect for our clients and their ways of seeing their worlds: a core requirement of any ethical framework. So, for instance, a client who wants a warm, supportive, client-led therapy style may be particularly likely to drop out-or show relatively poor outcomes-if they are given a highly directive and therapist-led CBT. Research shows that clients are as much as 50% less likely to drop out of therapy when the treatment matches their preferences, and also show somewhat better outcomes. There are both ethical and empirical reasons why therapists should concern themselves with client preferences. In preference work, we can also distinguish between preference assessment-the identification of clients’ strong likes and dislikes-and preference accommodation-the therapist adjustment of their way of working to the client’s expressed desires. This can include the frequency and format of therapy (for instance, online therapy), the methods and techniques to be used (for instance, two-chair work), the preferred topics to focus on (for instance, early childhood), and the therapist’s particular style (for instance, focusing on emotions). Third are activity preferences: the specific actions that clients desire to engage in throughout the therapy process. This is the kind of counsellor or psychotherapist that the client would like to work with for instance, lesbian, Asian, or an older adult. Second are preferences about the therapist. First are treatment preferences: the desires that clients have for specific types of intervention, like person-centred or psychodynamic.
The literature suggests three main types of client preferences. Norcross, University of Scranton, PA, USAĬlient preferences can be defined as the specific conditions and activities that clients want in their therapy. Mick Cooper, University of Roehampton, London John C.