One might assume that therapists and the average person want the same thing in therapy.
Copper et al. (2019) examined the question; What do laypeople prefer in psychotherapy, and do mental health professionals want the same in their own therapy?
Cooper’s team (2019) compared two samples of laypersons, a convenience sample (n = 228) and a sample representative of both the U.K. and the U.S. populations (n = 1,305) with one sample of mental health professionals (n = 615). This sample consisted of participants from:
- United Kingdom 80.2%
- United States 4.9%
- Europe (except United Kingdom) 8.1%
- Other/not stated 6.8%
They compared them on the four dimensions of the Cooper–Norcross Inventory of Preferences.
What is the Cooper–Norcross Inventory of Preferences?
The Cooper–Norcross Inventory of Preferences was developed by Cooper & Norcross (2015). They identified four dimensions of therapy preferences that clients may have.
The preferences include the following constructs:
- Therapist Directiveness Versus Client Directiveness
- Emotional Intensity Versus Emotional Reserve
- Past Orientation Versus Present Orientation
- Warm Support Versus Focused Challenge
These constructs were developed through principal components analysis of an online survey composed of 40 therapy preference items There were 860 respondents in the analysis. They were primarily female (n = 699), British (n = 650), White (n = 761). The sample also had a large proportion of mental health professionals (n = 615).
The experience of therapy ranged from:
- Those who had just begun therapy
- Those who had completed it
- Those who had never attended therapy or counselling
- Those who professionally conduct it.
Cooper & Norcross (2015) reported that the four scales accounted for 39% of the total variance and mapped well onto dimensions of therapist activity and the major preference dimensions identified in the research literature.
Internal consistency coefficients ranged between .60 and .85 (M = .71). The authors reported that their aim was to develop a multidimensional measure with clinical utility, which they achieved, however they noted that additional validity data were needed.
What do clients prefer in their psychotherapy?
Copper et al. (2019) found that:
On average, laypersons wanted more therapist directiveness and less emotional intensity compared with therapists: Mental health professionals wanted less therapist directiveness than did laypersons (Hedges’ gs = 0.92 and 1.43 between groups) and more emotional intensity (gs=0.49 and 1.33). Women also wanted more warm support than men (gs = 0.40 and 0.57).
They stated that “Laypersons typically enter therapy preferring that their therapists focus on specific goals, provide structure, teach skills, and take the lead far more than the therapists themselves prefer. At the same time, compared with professionals, laypersons typically favour less emotionally intense sessions, that is, being encouraged to express strong feelings less frequently and with less focus on the therapeutic relationship” (pg 210).
They also reported that Women in their sample wanted more warm support than men.
Copper et al (2019) Concluded that: “These findings suggest that psychotherapists should be mindful of their own treatment preferences and ensure that these are not inappropriately generalized to patients.” (pg 205)
Food for thought
The population in both studies is predominantly white, does this limit interpretation? What happens for populations from other cultures?
Cooper & Norcross’ (2015) development had a large sample size of therapist that responded. Does this mean the measure is skewed by this?
Despite these concerns, initiating a dialogue with clients about their preferences for therapy is likely to be good for therapeutic engagement. It is also the opportunity to understand cultural difference.
Reference
Cooper M, Norcross JC. A brief, multidimensional measure of clients’ therapy preferences: The Cooper-Norcross Inventory of Preferences (C-NIP). Int J Clin Health Psychol. 2016 Jan-Apr;16(1):87-98. doi: 10.1016/j.ijchp.2015.08.003. Epub 2015 Sep 18. PMID: 30487853; PMCID: PMC6225020.
Cooper, M., Norcross, J. C., Raymond-Barker, B., & Hogan, T. P. (2019). Psychotherapy preferences of laypersons and mental health professionals: Whose therapy is it? Psychotherapy, 56(2), 205–216. https://doi.org/10.1037/pst0000226
