Patient Perspectives on Working with Preferences in Psychotherapy: A Consensual Qualitative Research Study

Cooper, Mick; Di Malta, Gina; Knox, Sarah; Oddli, Hanne and Swift, Joshua (2023). Patient Perspectives on Working with Preferences in Psychotherapy: A Consensual Qualitative Research Study. Psychotherapy Research, 33(8) pp. 1117–1131.



Assessing and accommodating patient preferences is integral to evidence-based practice. This qualitative study sought to explore patient perspectives and experiences of working with preferences in psychotherapy.

Participants were 13 UK-based patients who had 24 or fewer sessions of a collaborative–integrative psychotherapy. Ten participants identified as female and three as male. Interviews were conducted at endpoint and analyzed using a team-based, consensual qualitative research approach.

Three superordinate domains were developed: Preferences Themselves, Process of Working with Preferences in Psychotherapy, and Effect of Preference Work (or its Absence). Patients typically wanted leadership, challenge, and input from their psychotherapist, and an affirming style. Patients attributed the origin of their preferences to Preferences originated from patients’ personal history, characteristics, or circumstances; the present psychotherapy; or past episodes of psychotherapy. Some preferences changed over time. Preference work had positive effects on the therapeutic relationship and patients’ intrapersonal worlds; however, not accommodating patient preferences could also be beneficial.

Our findings provide in-depth answers to a range of novel questions on preference work—the mechanisms by which preference work yields positive outcomes, factors that facilitate preference work, and origins of patients’ preferences—as well as helping to nuance previously established quantitative findings. Implications of these results for clinical training and practice are discussed.

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