Step 1. Understanding Client Preferences

You treat a disease, you win, you lose. You treat a person, I guarantee you’ll win, no matter what the outcome. - Patch Adams

At 11:30 a.m., Gabriella arrives for her initial assessment appointment at the clinic. She has large dark eyes set in a rounded face and speaks in a soft Spanish accent. She describes the anxiety and low mood she has experienced for many years. “And would it be helpful to have goals for therapy?” I ask her. Gabriella responds, “I think it’s better to leave it open. . . Goals always put pressure on me; I feel I have to please.”

Gabriella explains that at least, for the first few contacts, she would like to have an “open space” to explore her childhood, focusing on the bereavements and abandonments she believes are at the root of her problems.

What works for one person may not work for another. Research and experience inform the probability of generic success - 80% of clients will experience improvement in psychotherapy, for instance - but not the promise of an individual’s success.

As a natural consequence, we seek “different strokes for different folks” or to personalize care. In fact, as we will see, evidence-based practice demands that mental health professionals attend to client characteristics, preferences, and values.

Client preferences in psychotherapy are the specific conditions and activities that clients want in their treatment experience. Strong preferences serve as the coin of this clinical realm. Our focus is on assessing and accommodating intensely held desires because they are most likely to impact treatment satisfaction and success. We prioritize strong preferences.

Psychotherapy preferences have commonly been grouped into three categories. First, treatment preferences concern any desires that clients might have for specific types of intervention. Second, preferences about the therapist concern the type of practitioner with whom clients would like to work. These inclinations are often based on the practitioners’ sociodemographic characteristics, such as gender, ethnicity, and age. Third, activity preferences refer to the specific actions that clients desire to engage in throughout the psychotherapy process. This is a more micro-level focus than treatment preferences that refers to the overall package of activities that the client desires.

Preferences for therapist demographics and competencies probably play the largest role in decisions about starting therapy; for instance, a client with limited English fluency may prefer a Spanish-speaking therapist, or someone seeking medication or trauma work might be the preference. However, once therapy begins, the practitioner’s in-session style and behaviors take the front stage.

A concept closely related to preference assessment and accommodation, with its roots in the medical field, is shared decision making (SDM). The emphasis of SDM is most commonly on specific, one-off treatment decisions, such as whether or not to have surgery for prostate cancer, rather than ongoing, within-treatment assessments and adjustments.

Individual differences at the core of psychological care. We improve the success efficacy of mental health care by personalizing care to the unique individual.

Reflect on the material you have read so far. What are your reactions?

Now, reflect on those instances when, as a client, you have been treated as a “number” or a “case”. How did that feel?