Client factors associated with psychotherapeutic process and outcome: A concept analysis

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Abstract

Background and objective: Common factors theory proposes that clients make significant contributions to psychosocial change processes and outcomes in psychological therapy. However, the client factors concept contains such a wide range of client activities, characteristics and extratherapeutic circumstances that without some form of structural logic, it is difficult to understand how clients contribute to change processes, or how counselling psychology theory might be shaped to work with the most potent client factors. Using first-hand participant experience and published peer-reviewed psychotherapy outcomes research, this study sets out to identify client factors associated with psychosocial change and non-change, and to organise them into a conceptual framework. Method: A deductive qualitative 'hierarchy of abstraction' concept analysis method is used to interpret and organise data from nine participant interviews and 68 research studies. Graphic frameworks derived from each data source are compared, then combined into a single reconstructed concept framework. Findings: The resulting conceptual hierarchy model presents client factors associated with change and non-change over four levels of abstraction. The detail of experience is located at the least abstract elemental and categorical levels of change-related activity and inactivity; then abstracted to stages of change and non-change; then further abstracted to two broad client factors. In this provisional model, the first of these factors is client use of available social support resources, which inspires and reinforces the second factor, which is reflective and experiential learning. Inadequate social support is implicated in the learning and experiential stagnation associated with non-change. The adequacy of the reconstructed concept is assessed against seven criteria; and by comparing its fit with two social learning theories. Conclusion and implications: In view of the importance of reflective and experiential learning in this conceptual model, social learning theory is proposed as relevant for informing future developments in counselling psychology theory and research. In this model, the term 'social learning factors' more accurately points to the potentially major constellation of wider client and extratherapeutic social contributions to therapy outcomes currently indicated by 'client factors' in common factors theory.

Keyword(s)

client factors ; common factors theory; concept adequacy; concept analysis; psychotherapy outcome; psychotherapy process

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