Mick Cooper, Professor of Counselling Psychology, University of Roehampton

Asking clients, directly, what they want from therapy isn’t always helpful. Sometimes, it’s just too direct, too blunt, and can be difficult for clients to answer. So having gentler ways of asking this question can be important in identifying clients’ preferences. Every therapist will have their own ways of finding these out (do add suggestions to this blog as comments), but here are some examples, adapted from my forthcoming book with John Norcross, Personalizing psychotherapy: Assessing and accommodating client preferences.

• ‘What would you like in our work together?’
• Do you have any sense of what might be helpful or unhelpful for you here?’
• ‘Is there anything you would rather we did, or didn’t do, in the therapy?’
• ‘Based on your previous experiences of therapy, what do you think might be useful here?’ ‘What wouldn’t be useful?’
• ‘We’ve learnt over the years from research and practice that it’s really important to tailor therapy to the needs and wants of each individual client. So, if it’s OK, can I ask you what kind of things you might want or not want here?’
• ‘From what you’ve described in the first few sessions, it sounds like what you want from therapy is ….’ Do you have any thoughts on how we can work together to help you get there?’
• ‘Try this brief exercise. Close your eyes, breathe deeply a few times, and imagine in your mind’s eye what you would strongly like to happen in here. What would I ideally do? What would I not do?’
• ‘Let’s think together about how to reach your therapy goal. Which treatment method? What type of therapy relationship? What type of out-of-office activities: self-help, exercise, apps, and so on?’

These are just openers, of course, and it’s generally the dialogue that follows this where more nuanced and detailed answers can start to emerge.

Remember to ask about dislikes as well as likes–those may actually be more important in terms of making the therapy most suited to the individual client.

If clients don’t find it easy to answer such questions, or dislike being asked, it’s generally best to move on. In some–perhaps, many–cases, clients may not know what they want (particularly if they haven’t had therapy before) or find it uncomfortable to answer. Be sensitive to this and ensure clients don’t don’t feel ‘put on the spot’. Their preferences is always something you can come back to later on in the work.

Strong likes and dislikes, as my colleague John Norcross always says, are the key currency in preference work. So focus your inquiry into things that they particularly want or don’t want, rather than more minor preferences.

As well as asking about preferences in relation to therapy methods, you can ask about preferred goals, format (e.g., frequency of sessions), or style of therapy.

You can ask about preferences before therapy starts, at assessment, or in ongoing therapy sessions: for instance, if therapy doesn’t seem to be progressing well, when you’re not sure what to do, or when you’ve come to the end of one piece of work and looking at what to do next. I’m most likely to have this dialogue with clients in assessment meetings, or in the first few sessions, after I’ve got a sense of what’s brought them to therapy and what they’d like to change in their lives. So that’s when I’d then ask them how we might most helpfully achieve that.

A really useful way of assessing client preferences can be using the Inventory of Preferences. This is a brief form which asks clients about a range of preferences, and allows you to identify–and stimulate a dialogue around–any strong preferences they might have.

Just at a purely personal level, if I was going to ask just one thing about preferences, it would be this: ‘Have you had therapy before and, if so, what was really helpful or unhelpful for you in it?’ My sense is that most strong preferences come from previous experiences of therapy, and that can be a really good guide to what the client wants to avoid this time, or else have more of.

Final word, of course we can’t always adapt to client preferences. Sometimes, what clients want is not what we can provide. John and I write about a range of options in relation to clients’ preferences, the 4As: Adopt, Adapt, Alternative, or Another (i.e., referral onwards). But even when onward referral is indicated, talking to clients about their preferences is generally a good way towards greater transparency and collaboration in the relationship, and supporting the client towards more of what can help them most.