Varieties of client experience in psychotherapy: An analysis of the literature

Elliott, Robert; James, Elisabeth

doi:10.1016/0272-7358(89)90003-2

Cited by 233Psychotherapy Techniques and ApplicationsPsychoanalysis and Psychopathology ResearchCounseling, Therapy, and Family Dynamics

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Varieties of client experience in psychotherapy: An analysis of the literature

Elliott, Robert, James, Elisabeth·1989·Clinical Psychology Review

DOI 10.1016/0272-7358(89)90003-2

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The common helpful factors in psychotherapy found in this study are consistent with previous research on patients' experiences.
“The common helpful factors in psychotherapy are consistent with previous research on patients' experiences [11].”
From Helpful and hindering factors for remission in dysthymia and panic disorder at 9-year follow-up: A mixed methods study (2008) · cites this paper as [11]

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Safran, 1986, Empirically linking psychotherapy process to psychotherapy outcome: Conceptual and methodological issues
Stiles, 1985, Impact of exploratory and prescriptive psychotherapy sessions
Tarragona, 1987, Patients'experiences of therapy between sessions and their role in the therapeutic process
Wagner, 1982, Vol. 2

Sorted by citations

How clients make therapy work: The process of active self-healing.
Bohart, A. C., & Tallman, K. (1999) · American Psychological Association eBooks · doi:10.1037/10323-000 · Cited by 404
Hermeneutic Single-Case Efficacy Design
Elliott, R. (2002) · Psychotherapy Research · doi:10.1080/713869614 · Cited by 303
“(See Elliott & James, 1989, for a review.)”
Self-citation
Clients' deference in psychotherapy.
Rennie, D. L. (1994) · Journal of Counseling Psychology · doi:10.1037/0022-0167.41.4.427 · Cited by 294
“…have applied both the natural science approach and the human science approach (see Hoshmand, 1989; Polkinghorne, 1988; Rennie & Toukmanian, 1992) to gaining and analyzing clients' accounts of their experience of therapy (for reviews see Elliott & James, 1989; McLeod, 1990; Sexton & Whiston, 1994).”
Background
The therapeutic relationship.
Norcross, J. C. (2010) · American Psychological Association eBooks · doi:10.1037/12075-004 · Cited by 278
A qualitative meta-analysis examining clients’ experiences of psychotherapy: A new agenda.
Levitt, H. M., Pomerville, A., & Surace, F. I. (2016) · Psychological Bulletin · doi:10.1037/bul0000057 · Cited by 241
“…of qualitative studies have identified the processes of increasing clients’ autonomy, available resources, empowerment, and engagement in therapeutic tasks as a central client experiences in psychotherapy (e.g., Elliott & James, 1989; McElvany & Timulak, 2013; Paulson, Truscott, & Stuart, 1999).”
Clients' perception of the therapeutic alliance: A qualitative analysis.
Bachelor, A. (1995) · Journal of Counseling Psychology · doi:10.1037/0022-0167.42.3.323 · Cited by 194
The narrative reconstruction of psychotherapy and psychological health
Adler, J. M., Skalina, L. M., & McAdams, D. (2008) · Psychotherapy Research · doi:10.1080/10503300802326020 · Cited by 169
“…forces in human life (i.e., Bakan, 1966; Deci & Ryan, 2000), comprises a key component of folk psychological accounts of human action (i.e., White, 2004), and has long been of interest to psychotherapy researchers (e.g., Elliott & James, 1989; Nilsson et al., 2007; Williams & Levitt, 2007).”
What clients find helpful in psychotherapy: Developing principles for facilitating moment-to-moment change.
Levitt, H. M., Butler, M., & Hill, T. (2006) · Journal of Counseling Psychology · doi:10.1037/0022-0167.53.3.314 · Cited by 176
“For instance, a review of prior literature by Elliott and James (1989) organized the research on clients’ psychotherapy experiences in the following nine categories: clients’ intentions, feelings, style of relatedness, style of relating, central concerns, therapists’ intentions, therapists’…”
Background
Clients' perceptions of helpful experiences in counseling.
Paulson, B. L., Truscott, D., & Stuart, J. (1999) · Journal of Counseling Psychology · doi:10.1037/0022-0167.46.3.317 · Cited by 167
Critical Incidents in the Formation of the Therapeutic Alliance from the Client's Perspective.
Bedi, R. P., Davis, M. D., & Williams, M. (2005) · Psychotherapy · doi:10.1037/0033-3204.42.3.311 · Cited by 188
The client as a common factor: Clients as self-healers.
Tallman, K., & Bohart, A. C. (1999) · American Psychological Association eBooks · doi:10.1037/11132-003 · Cited by 158
Patients’ experiences of change in cognitive–behavioral therapy and psychodynamic therapy: a qualitative comparative study
Nilsson, T., Svensson, M., Sandell, R., & Clinton, D. N. (2007) · Psychotherapy Research · doi:10.1080/10503300601139988 · Cited by 170
“Quasi-qualitative1 studies of clients’ experiences of psychotherapy seem often to identify common, relational factors as the most helpful (Elliott & James, 1989; Gershefski, Arnkoff, Glass, & Elkin, 1996; Murphy, Cramer, & Lillie, 1984; Norcross, Dryden, & DeMichele, 1992; Sloane, Staples, Cristol,…”
Concept mapping the client's perspective on counseling alliance formation.
Bedi, R. P. (2006) · Journal of Counseling Psychology · doi:10.1037/0022-0167.53.1.26 · Cited by 139
Exploratory in-session process research in individual psychotherapy: A review.
Hill, C. E. (1990) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.58.3.288 · Cited by 134
The therapeutic alliance–A conceptual analysis.
HOUGAARD, E. (1994) · Scandinavian Journal of Psychology · doi:10.1111/j.1467-9450.1994.tb00934.x · Cited by 128
Personality and the coherence of psychotherapy narratives
Adler, J. M., Wagner, J., & McAdams, D. (2007) · Journal of Research in Personality · doi:10.1016/j.jrp.2007.02.006 · Cited by 106
Comprehensive process analysis of insight events in cognitive-behavioral and psychodynamic-interpersonal psychotherapies.
Elliott, R., Shapiro, D. A., Firth‐Cozens, J., Stiles, W. B., Hardy, G. E., Llewelyn, S. P., & Margison, F. R. (1994) · Journal of Counseling Psychology · doi:10.1037/0022-0167.41.4.449 · Cited by 118
Self-citation
Relationships among client and counselor agreement about the working alliance, session evaluations, and change in client symptoms using response surface analysis.
Marmarosh, C. L., & Kivlighan, D. M. (2012) · Journal of Counseling Psychology · doi:10.1037/a0028907 · Cited by 131
Perspective divergence in the working alliance
Fitzpatrick, M. R., Iwakabe, S., & Stalikas, A. (2005) · Psychotherapy Research · doi:10.1080/10503300512331327056 · Cited by 115
“Keywords: Alliance, participant viewpoints, session evaluation, phase of therapy, convergence, trainee therapists Counselor and client perspectives often offer quite divergent views of what happens in the counseling situation (Elliott & James, 1989; Heppner, Kivlighan, & Wampold, 1999).”
Background
Humanistic psychotherapy research 1990–2015: From methodological innovation to evidence-supported treatment outcomes and beyond
Angus, L. E., Watson, J. C., Elliott, R., Schneider, K. J., & Timulák, L. (2014) · Psychotherapy Research · doi:10.1080/10503307.2014.989290 · Cited by 104
“…to enrich our clinical understanding of how change happens in effective HP treatments, including helpful aspects of therapy post-session inquiry (Elliott & James, 1989), comprehensive process analysis (Elliott, 1989), conversational analysis (Muntigl et al., 2013; Sutherland, Peräkylä, &…”
BackgroundSelf-citation
Negative experiences in psychotherapy from clients’ perspective: A qualitative meta-analysis
Vybíral, Z., Ogles, B. M., Řiháček, T., Urbancová, B., & Gocieková, V. (2023) · Psychotherapy Research · doi:10.1080/10503307.2023.2226813 · Cited by 107
“Until recently, however, despite calls for exploratory studies on this topic (e.g., Elliott & James, 1989; Rennie, 1994), research on clients ’ firsthand experiences, especially negative experiences, has remained sporadic.”
Background
Researching clients' experiences: A review of qualitative studies
Hodgetts, A., & Wright, J. (2007) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.527 · Cited by 100
Research on client experiences of therapy: Introduction to the special section
Elliott, R. (2008) · Psychotherapy Research · doi:10.1080/10503300802074513 · Cited by 99
“Elliott and James ( 1989 ) carried out a meta-synthesis of the first 40 years of this literature; among the wide range of domains of client experience reviewed, two are most relevant to the present special section: helpful aspects and posttherapy changes.”
ResultSelf-citation
Trends in psychotherapy process research: Samples, measures, researchers, and classic publications.
Hill, C. E., Nutt, E. A., & Jackson, S. (1994) · Journal of Counseling Psychology · doi:10.1037/0022-0167.41.3.364 · Cited by 99
Mindfulness-based cognitive therapy for severe health anxiety (hypochondriasis): An interpretative phenomenological analysis of patients' experiences
Williams, M. J., McManus, F., Muse, K., & Williams, J. M. G. (2011) · British Journal of Clinical Psychology · doi:10.1111/j.2044-8260.2010.02000.x · Cited by 96
“…literature search of studies exploring factors that influence treatment success, such as motivation, homework compliance, acceptance of the treatment rationale, and an external support network (e.g., Elliott & James, 1989; Helbig & Fehm, 2004; Schulte, 2008; Westra , Dozois, & Marcus, 2007).”
Background
Counseling for Suicide: Client Perspectives
Paulson, B. L., & Worth, M. J. (2002) · Journal of Counseling & Development · doi:10.1002/j.1556-6678.2002.tb00170.x · Cited by 89
What Young People Want: A Qualitative Study of Adolescents’ Priorities for Engagement Across Psychological Services
Gibson, K. L., Cartwright, C., Kerrisk, K., Campbell, J., & Seymour, F. W. (2015) · Journal of Child and Family Studies · doi:10.1007/s10826-015-0292-6 · Cited by 86
“This seems to parallel a broader trend which has eschewed client perspectives due to concerns that they give unreliable feedback about what is effective about counseling and therapy (Elliott and James 1989).”
Background
Helpful impacts in group counseling: Development of a multidimensional rating system.
Kivlighan, D. M., Multon, K. D., & Brossart, D. F. (1996) · Journal of Counseling Psychology · doi:10.1037/0022-0167.43.3.347 · Cited by 86
Important Goals, Meanings, and Relationships in Flourishing and Languishing States: Towards Patterns of Well-being
Wissing, M. P., Schutte, L., Liversage, C., Entwisle, B. M., Gericke, M., & Keyes, C. L. M. (2019) · Applied Research in Quality of Life · doi:10.1007/s11482-019-09771-8 · Cited by 96
The importance of considering clients' perspectives in psychotherapy research
Macran, H. R. S. (1999) · Journal of Mental Health · doi:10.1080/09638239917256 · Cited by 76
Culture, Interpersonal Perceptions, and Happiness in Social Interactions
Oishi, S., Koo, M., & Akimoto, S. A. (2008) · Personality and Social Psychology Bulletin · doi:10.1177/0146167207311198 · Cited by 80
“The importance of feeling understood is also widely recognized in the literature on psychotherapy, as a client who feels misunderstood at the first session is unlikely to continue the client–therapist relationship (Elliott & James, 1989).”
Background
Restructuring insight: An integrative review of insight in problem-solving, meditation, psychotherapy, delusions and psychedelics
Tulver, K., Kaup, K., Laukkonen, R., & Aru, J. (2023) · Consciousness and Cognition · doi:10.1016/j.concog.2023.103494 · Cited by 83
Process and outcome research in the treatment of adult victims of childhood sexual abuse: Methodological issues.
Beutler, L. E., & Hill, C. E. (1992) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.60.2.204 · Cited by 71
Patient-Centered Assessment in Psychotherapy: A Review of Individualized Tools
Sales, C. M. D., & Alves, P. (2016) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12162 · Cited by 75
“The patient experience of treatment includes “sensations, perceptions, thoughts and feelings during and with reference to therapy sessions” (Elliott & James, 1989, p. 444).”
Background
"Common factors" and "nonspecific variables": Clarification of the two concepts and recommendations for research.
Castonguay, L. (1993) · Journal of Psychotherapy Integration · doi:10.1037/h0101171 · Cited by 79
The Active Client: Therapy as Self-Help
Bohart, A. C., & Tallman, K. (1996) · Journal of Humanistic Psychology · doi:10.1177/00221678960363002 · Cited by 67
A Model of Therapeutic Action Grounded in the Patients' View of Curative and Hindering Factors in Psychoanalytic Psychotherapy.
Lilliengren, P., & Werbart, A. (2005) · Psychotherapy · doi:10.1037/0033-3204.42.3.324 · Cited by 70
Felt Understanding as a Bridge between Close Relationships and Subjective Well‐Being: Antecedents and Consequences Across Individuals and Cultures
Oishi, S., Krochik, M., & Akimoto, S. A. (2010) · Social and Personality Psychology Compass · doi:10.1111/j.1751-9004.2010.00264.x · Cited by 67
“Elliott and James (1989) found that the effectiveness of psychotherapy was predicted by the therapist’s perceived acceptance and warmth.”
Background
Client accounts of personal change in process–experiential psychotherapy: A methodologically pluralistic approach
Klein, M. J., & Elliott, R. (2005) · Psychotherapy Research · doi:10.1080/10503300500090993 · Cited by 63
“Elliott and James (1989) reviewed five studies using this approach, reporting that increased client self-esteem was most frequent across studies, followed by symptom relief, improved relationships, and enhanced sense of mastery.”
BackgroundSelf-citation
Insight in Psychotherapy: A Review of Empirical Literature.
Gibbons, M. B. C., Crits-Christoph, P. F., Barber, J. P., & Schamberger, M. (2007) · American Psychological Association eBooks · doi:10.1037/11532-007 · Cited by 61
The client as expert: Researching hindering experiences in counselling
Henkelman, J., & Paulson, B. L. (2006) · Counselling Psychology Quarterly · doi:10.1080/09515070600788303 · Cited by 72
“Increasingly, value is being placed on including the client perspective in research (Clarke, Rees, & Hardy, 2004; Duncan & Miller, 2000; Elliott & James, 1989; Heppner, Rosenberg, & Hedgespeth, 1992).”
Background
Assessment considerations in the identification of failing psychotherapy: Bringing the negatives out of the darkroom.
Mash, E. J., & Hunsley, J. D. (1993) · Psychological Assessment · doi:10.1037/1040-3590.5.3.292 · Cited by 54
Meeting an adult ally on the way out into the world: Adolescent patients' experiences of useful psychotherapeutic ways of working at an age when independence really matters
Binder, P., Moltu, C., Hummelsund, D., Sagen, S. H., & Holgersen, H. (2011) · Psychotherapy Research · doi:10.1080/10503307.2011.587471 · Cited by 53
“Elliot and James ( 1989 ) point out the value of utilizing client perspectives as a direct source of information about client experiences, due to the fact that “clients have ‘privileged access’ to certain areas of therapy process, including the felt quality of their therapeutic relationship” (p.”
Background
Five Dimensions of Therapy Process
Elliott, R. (1991) · Psychotherapy Research · doi:10.1080/10503309112331335521 · Cited by 52
Self-citation
Clients’ Relational Conceptions of Conjoint Couple and Family Therapy Quality: A Grounded Formal Theory
Chenail, R. J., George, S. S., Wulff, D., Duffy, M., Scott, K. W., & Tomm, K. (2011) · Journal of Marital and Family Therapy · doi:10.1111/j.1752-0606.2011.00246.x · Cited by 50
Indicadores genéricos de cambio en el proceso psicoterapéutico
Krause, M., de la Parra, G., Arístegui, R., Dagnino, P., Tomicic, A., Valdés, N., Vilches, O., Echávarri, O., Ben-Dov, P., Reyes, L., et al. (2006) · Dialnet (Universidad de la Rioja) · Cited by 47
Personal accounts of consumer/survivors: Insights and implications
Marsh, D. T. (2000) · Journal of Clinical Psychology · doi:10.1002/1097-4679(200011)56:11 · Cited by 19
A Qualitative Study of Patients' Perceptions of a ‘Minimal’ Psychological Therapy
Macdonald, W., Mead, N., Bower, P., Richards, D., & Lovell, K. (2007) · International Journal of Social Psychiatry · doi:10.1177/0020764006066841 · Cited by 49
“There are multiple ways to examine client experience in psychological therapy (Elliott & James, 1989).”
Background
Client perceptions of hindering experiences in counselling
Paulson, B. L., Everall, R. D., & Stuart, J. (2001) · Counselling and Psychotherapy Research · doi:10.1080/14733140112331385258 · Cited by 45
The narrative reconstruction of psychotherapy
Adler, J. M., & McAdams, D. P. (2007) · Narrative Inquiry · doi:10.1075/ni.17.2.03adl · Cited by 45
“successful psychotherapeutic outcome across theoretical orientations (e.g., Elliott & James, 1989; Williams & Levitt, 2007).”
Background
Techniques for framing questions in conducting family meetings in palliative care
Dumont, I., & Kissane, D. W. (2009) · Palliative & Supportive Care · doi:10.1017/s1478951509000212 · Cited by 43
“Study could be made of the family members’ reactions to the therapist’s interventions and also the family within the context of the therapy (Elliott & James, 1989).”
Background
Cluster Analysis of Patient Reported Psychotherapy Outcomes
Connolly, M., & Strupp, H. H. (1996) · Psychotherapy Research · doi:10.1080/10503309612331331558 · Cited by 43
Clients with borderline personality disorder: Exploring their experiences of dialectical behaviour therapy
Hodgetts, A., Wright, J. C., & Gough, A. (2007) · Counselling and Psychotherapy Research · doi:10.1080/14733140701575036 · Cited by 35
“However, these key factors continue to fail to incorporate the important contribution of experiences clients have of their therapy (Elliott & James, 1989 ).”
Background
Therapists' and clients' significant experiences underlying psychotherapy discourse
Levitt, H. M., & Piazza-Bonin, E. (2010) · Psychotherapy Research · doi:10.1080/10503307.2010.518634 · Cited by 47
“Although some researchers might be suspicious of clients' or therapists' conscious accountings of their experience, these accountings are used routinely in completing outcome and alliance measures in psychotherapy studies (eg, Elliott & James, 1989 ; Levitt, Stanley, Frankel, & Raina, 2005 ).”
Method
“Spinning one's wheels”: Nonimproved patients view their psychotherapy
Werbart, A., von Below, C., Brun, J., & Gunnarsdottir, H. (2014) · Psychotherapy Research · doi:10.1080/10503307.2014.989291 · Cited by 46
“Negative factors include a therapist who is experienced as distanced, cold, uninvolved, harsh, rigid, passive and lacking “human qualities” (Elliott, 1985; Elliott & James, 1989; Orlinsky & Norcross, 2005), and one who is a poor fit.”
Background
A Qualitative Study on the Stress of University Students for Preparing Employment
Park, M., 정민선, & Hee, K. J. (2009) · Korea Journal of Counseling · doi:10.15703/kjc.10.1.200903.417 · Cited by 38
Client Perceptions of Couples Therapy: Helpful and Unhelpful Aspects
Bowman, L., & Fine, M. (2000) · American Journal of Family Therapy · doi:10.1080/019261800437874 · Cited by 38
The Role of Forgiveness in Divorce Adjustment and the Impact of Affect
Rohde-Brown, J. D., & Rudestam, K. E. (2011) · Journal of Divorce & Remarriage · doi:10.1080/10502556.2011.546233 · Cited by 37
“Lack of self-forgiveness has been shown to be among the most important issues for individuals seeking psychotherapy ( Elliott & James, 1989 ; Mahoney, 1991 ).”
Background
Dissatisfied psychotherapy patients: A tentative conceptual model grounded in the participants' view
von Below, C., & Werbart, A. (2012) · Psychoanalytic Psychotherapy · doi:10.1080/02668734.2012.709536 · Cited by 37
“However, patients have privileged access to certain areas of the therapy process (Elliott & James, 1989).”
Background
Behavior therapy: Redefining strengths and limitations
Goldfried, M. R., & Castonguay, L. G. (1993) · Behavior Therapy · doi:10.1016/s0005-7894(05)80315-6 · Cited by 37
“They have developed innovative, yet rigorous, research strategies (e.g., task analysis, interpersonal process recall, comprehensive process analysis; see Elliott, 1983; Elliott & James, 1989; Goldfried & Safran, 1986), with the goal of discovering important mechanisms of change in psychotherapy.”
Background
How to Conduct Clinical Qualitative Research on the Patient's Experience
Chenail, R. J. (2011) · The Qualitative Report · Cited by 36
Clients' experience of the process of change in cognitive analytic therapy
Rayner, K., Thompson, A. R., & Walsh, S. (2010) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1348/147608310x531164 · Cited by 35
Reformulation in cognitive analytic therapy: Effects on the working alliance and the client's perspective on change
Shine, L., & Westacott, M. C. (2009) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1348/147608309x471334 · Cited by 34
Characteristics of client-identified helpful events in emotion-focused therapy for child abuse trauma
Holowaty, K. A. M., & Paivio, S. C. (2011) · Psychotherapy Research · doi:10.1080/10503307.2011.622727 · Cited by 34
“This is consistent with expert opinion that psychotherapy processes should be studied from multiple vantage points because each is associated with particular strengths and limitations (Castonguay et al., 2010; Elliott & James, 1989; Greenberg & Pinsoff, 1986).”
Result
Client-identified important events in psychotherapy: Interactional structures and practices
Viklund, E., Holmqvist, R., & Nelson, K. Z. (2009) · Psychotherapy Research · doi:10.1080/10503300903170939 · Cited by 33
“…tell the researcher may be deliberately or unconsciously limited or otherwise distorted depending on a number of circumstances, and there are subtle ways that clients (as well as interviewers and therapists) can influence the course of conversation (e.g., Elliott & James, 1989; Rennie, 1994).”
Client experiences of agency in therapy
Hoener, C., Stiles, W. B., Luka, B. J., & Gordon, R. A. (2012) · Person-Centered & Experiential Psychotherapies · doi:10.1080/14779757.2011.639460 · Cited by 33
“The emphasis that these participants gave to their own agency suggests a reason for the often-reported lack of correlation between clients' and therapists' evaluations of therapy relationships, processes, and outcomes (Elliott & James, 1989 ; Gurman, 1977 ; Hannan et al, 2005 ; Hunsley, Aubry, Verstervelt, & Vito, 199…”
Background
On learning from being the in-patient
Woods, A., & Springham, N. (2011) · International Journal of Art Therapy · doi:10.1080/17454832.2011.603697 · Cited by 30
The Process Leading to Help Seeking Following Childhood Trauma
Stige, S. H., Træen, B., & Rosenvinge, J. H. (2013) · Qualitative Health Research · doi:10.1177/1049732313503907 · Cited by 29
Experiencing gay affirmative therapy: An exploration of clients' views of what is helpful
Pixton, S. (2003) · Counselling and Psychotherapy Research · doi:10.1080/14733140312331384372 · Cited by 28
Client experiences of motivational interviewing: An interpersonal process recall study
Jones, S., Latchford, G. J., & Tober, G. (2015) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12061 · Cited by 27
Do You Want to Convince Me or to Be Understood?
Faber, N. S., Mojzisch, A., Kerschreiter, R., & Schulz‐Hardt, S. (2012) · Personality and Social Psychology Bulletin · doi:10.1177/0146167212458707 · Cited by 27
“This perspective also seems plausible, given the central role felt understanding plays for the assessment of different types of relationships (e.g., Elliott & James, 1989) and for the willingness to engage in future interaction (e.g., Reis et al., 2004), and given the positive emotions (e.g., Oishi…”
Background
Proceso de Cambio Psicoterapéutico: Análisis de Episodios Relevantes en una Terapia Grupal con Pacientes Adictos
Valdés, N., Krause, M., Vilches, O., Dagnino, P., Echávarri, O., Ben-Dov, P., Arístegui, R., & de la Parra, G. (2005) · Psykhe (Santiago) · doi:10.4067/s0718-22282005000200001 · Cited by 26
Successful psychotherapies with young adults: an explorative study of the participants' view
Palmstierna, V., & Werbart, A. (2013) · Psychoanalytic Psychotherapy · doi:10.1080/02668734.2012.760477 · Cited by 26
“Thus, the patients seem to focus on common factors (Elliott & James, 1989), while the therapists focus on specific factors.”
Background
Exploring corrective experiences in a successful case of short-term dynamic psychotherapy
Friedlander, M. L., Sutherland, O., Sandler, S., Kortz, L., Bernardi, S., Lee, H.-H., & Drozd, A. (2012) · Psychotherapy · doi:10.1037/a0023447 · Cited by 23
What aspects of treatment matter to the patient in the treatment of cocaine dependence?
Siqueland, L., Crits-Christoph, P. F., Barber, J. P., Gibbons, M. B. C., Gallop, R., Griffin, M. L., Frank, A. F., Thase, M. E., Luborsky, L. B., & Liese, B. S. (2004) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2004.06.007 · Cited by 25
Ex‐clients' evaluation of bereavement counselling in a voluntary sector agency
Gallagher, M. S., Tracey, A., & Millar, R. (2005) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1348/147608304x21392 · Cited by 25
“You Feel They Have a Heart and Are Not Afraid to Show It”: Exploring How Clients Experience the Therapeutic Relationship in Emotion-Focused Therapy
Nødtvedt, Ø. O., Binder, P., Stige, S. H., Schanche, E., Stiegler, J. R., & Hjeltnes, A. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.01996 · Cited by 28
“Qualitative studies may be important to form new empirical knowledge that can only be acquired by exploring clients’ idiosyncratic experiential worlds (Elliott and James, 1989; Binder et al., 2012).”
Background
A meaningful struggle: Trauma clients' experiences with an inclusive stabilization group approach
Stige, S. H., Rosenvinge, J. H., & Træen, B. (2013) · Psychotherapy Research · doi:10.1080/10503307.2013.778437 · Cited by 24
“Over the past decades the client perspective has become increasingly recognized as providing unique and valuable knowledge to the field of psychotherapy research (Connolly & Strupp, 1996; Elliott & James, 1989; Rennie, 2000).”
Background
Using Personal Growth Groups in Multicultural Counseling Courses to Foster Students' Ethnic Identity Development
Rowell, P. C., & Benshoff, J. M. (2008) · Counselor Education and Supervision · doi:10.1002/j.1556-6978.2008.tb00058.x · Cited by 24
Student experiences in a personal development group: the question of safety
Payne, H. (2001) · European Journal of Psychotherapy & Counselling · doi:10.1080/13642530110086983 · Cited by 24
“…offer valuable insight into processes which help or hinder outcome particularly since they differ from therapists’ perceptions (such as Orlinsky and Howard 1986; Elliott and James 1989; Hill 1989; Bachelor 1991; Heppner et al. 1992; Grafanaki and McLeod 1995; Howe 1996; Gershefski et al. 1996).”
Background
Both sides of the story: exploring how improved and less-improved participants experience mindfulness-based stress reduction for social anxiety disorder
Hjeltnes, A., Moltu, C., Schanche, E., Jansen, Y., & Binder, P.-E. (2018) · Psychotherapy Research · doi:10.1080/10503307.2016.1169330 · Cited by 23
“Qualitative studies may be important to describe what clients experience as helpful and unhelpful in psychotherapy (Elliott, 2010; Elliott & James, 1989), and there is a need for ecologically valid and contextually sensitive studies of how young adults with SAD experience and relate to their…”
Background
A qualitative study of client experiences of working with novice counsellors
Stefano, J. D., Mann-Feder, V. R., & Gazzola, N. (2010) · Counselling and Psychotherapy Research · doi:10.1080/14733141003770713 · Cited by 23
“Based on comprehensive analyses of the available studies on this topic, Elliott and James ( 1989 ) generated a number of categories of client experiences of therapy.”
Method
Therapeutic change and the experience of joy: Toward a theory of curative processes.
Dick‐Niederhauser, A. (2009) · Journal of Psychotherapy Integration · doi:10.1037/a0016020 · Cited by 24
“In their seminal review, Elliott and James (1989) identified nine types of client experiences in psychotherapy: intentions, feelings, selfrelatedness, relating to the therapist, central concerns, perceptions of therapist intentions, perceptions of therapist characteristics, therapeutic impact, and…”
Background
What 75 Psychoanalysts Found Helpful and Hurtful in Their Own Analyses.
Curtis, R. C., Field, C., Knaan-Kostman, I., & Mannix, K. (2004) · Psychoanalytic Psychology · doi:10.1037/0736-9735.21.2.183 · Cited by 22
What Young People Want from Clinicians: Youth-Informed Clinical Practice in Mental Health Care
Stubbing, J., & Gibson, K. L. (2022) · Youth · doi:10.3390/youth2040039 · Cited by 20
Meaningful Experiences in the Counseling Process
Sackett, C. R., Lawson, G. F., & Burge, P. L. (2012) · The Professional Counselor · doi:10.15241/css.2.3.208 · Cited by 21
“In addition, significance sampling is used, which is the examination of units that have significant meaning to the client and counselor, or therapeutic impact (Elliott & James, 1989).”
BackgroundMethodInfluential
“Directive Approach” for Chinese Clients Receiving Psychotherapy: Is That Really a Priority?
Ng, C. T. C., & James, S. (2013) · Frontiers in Psychology · doi:10.3389/fpsyg.2013.00049 · Cited by 19
“Specifically, by analyzing research literature concerning clients’ notions on the helpful aspects of therapy, Elliott and James (1989) found five themes: (a) therapists were facilitative, (b) client self-expression was permitted, (c) therapist-client relationships were supportive, (d)…”
BackgroundMethod
The weirdness of having a bunch of other minds like yours in the room: The lived experiences of mentalization-based therapy for borderline personality disorder.
Gardner, K., Wright, K., Elliott, A., Graham, S., & Fonagy, P. (2020) · Psychology and psychotherapy · doi:10.1111/papt.12243 · Cited by 19
“Future research could address this by supplementing client experience with therapists’ perspectives of the client experience and the impact of the therapy on their client, as these perceptions can differ considerably from clients’ experiences (Elliot & James, 1989).”
BackgroundMethod
Can in-depth research interviews have a ‘therapeutic’ effect for participants?
Morecroft, C. W., Cantrill, J., & Tully, M. P. (2004) · International Journal of Pharmacy Practice · doi:10.1211/0022357045002 · Cited by 19
Comment donnons-nous sens a notre vécu d’événements significatifs de vie ?
Gelin, Z., Simon, Y., & Hendrick, S. (2015) · Thérapie Familiale · doi:10.3917/tf.151.0133 · Cited by 19
‘Hard work’ in a new context: Clients’ experiences of psychotherapy
Göstas, M. W., Wiberg, B., Neander, K., & Kjellin, L. (2012) · Qualitative Social Work · doi:10.1177/1473325011431649 · Cited by 19
“There is thus a great need to study clients’ experiences of the therapy process in order to gain a better understanding of this process (Bohart and Tallman, 2010; Elliott, 2008; Elliott and James, 1989).”
Background
A systematic review of service user’s experience of cognitive analytic therapy (CAT)
Balmain, N., Melia, Y., Dent, H., & Smith, K. (2020) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12305 · Cited by 18
The development of the inventory of countertransference behavior
Friedman, S. M., & Gelso, C. J. (2000) · Journal of Clinical Psychology · doi:10.1002/1097-4679(200009)56:9 · Cited by 109
Client as expert: A Delphi poll of clients’ subjective experience of therapeutic alliance formation variables
Bedi, R. P., & Duff, C. T. (2013) · Counselling Psychology Quarterly · doi:10.1080/09515070.2013.857295 · Cited by 18
“For example, the 23 most consensual, highest rated variables from the current study fit well into the five categories of client-identified alliance formation variables identified by Fitzpatrick et al. (2006), the six categories identified by Fitzpatrick et al.”
Background
Helpful aspects of metacognitive therapy and cognitive behaviour therapy for depression: a qualitative study
Straarup, N. S., & Poulsen, S. (2015) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x15000574 · Cited by 18
“…finding from existing qualitative studies that do not focus specifically on cognitive behavioural therapies is that common, non-therapy specific factors are typically mentioned as most important by the client (Elliott & James, 1989; Levitt et al. 2006; Hodgetts & Wright, 2007; Elliott, 2008).”
BackgroundResult
Clients' and therapists' stories about psychotherapy.
Adler, J. M. (2013) · Journal of Personality · doi:10.1111/j.1467-6494.2012.00803.x · Cited by 18
A Phenomenological Inquiry of Clients’ Meaningful Experiences in Counseling With Counselors‐in‐Training
Sackett, C. R., & Lawson, G. F. (2016) · Journal of Counseling & Development · doi:10.1002/jcad.12062 · Cited by 25
Empirical Research on Factors in Psychotherapeutic Change
Arnkoff, D. B., Victor, B. J., & Glass, C. R. (1993) · Springer eBooks · doi:10.1007/978-1-4757-9782-4_3 · Cited by 17
Using Multivariate Concept-Mapping for Examining Client Understandings of Counselling
Bedi, R. P., & Alexander, D. A. (2009) · Canadian Journal of Counselling and Psychotherapy · Cited by 16
Examining Supervisor and Supervisee Agreement on Alliance: Is Shame a Factor?
Bilodeau, C., Savard, R., & Lecomte, C. (2010) · Canadian Journal of Counselling and Psychotherapy · Cited by 16

Authors: Elliott, R., & James, E.
Affiliations: University of Toledo (US)
Corresponding author: Elliott, Robert
ORCID: Elliott, Robert
Venue: Clinical Psychology Review
Publisher: Elsevier BV
Published: 1989-01
Volume: 9
Issue: 4
Pages: 443-467
ISSN: 0272-7358 (ISSN-L)
DOI: 10.1016/0272-7358(89)90003-2
OpenAlex: W2067579068
Cited by: 233
References: 132
Citations by year: 2026: 4 · 2025: 4 · 2024: 5 · 2023: 8 · 2022: 4 · 2021: 5 · 2020: 5 · 2019: 5 · 2018: 4 · 2017: 8 · 2016: 9 · 2015: 11 · 2014: 11 · 2013: 12 · 2012: 13
FWCI: 3.15
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Clinical Psychology Review (publishedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
Keywords: self-relatedness, therapeutic relationship, therapist characteristics, therapeutic change, interpersonal control

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