Client preferences and the specific versus common factors debate

Abstract

Scope and Method of Study: Client preferences for psychological treatments have been found to play an important role in therapy outcomes. The present study was designed to examine client preferences for treatment using a delay-discounting model. In this study adult clients presenting for therapy services were asked to indicate their preferences on four delay-discounting choices concerning treatments with altering levels of effectiveness and another therapy-related variable.

Findings and Conclusions: Data from 66 adult participants indicated that clients would desire a treatment that was 48% less effective in order to ensure that they received a therapist who was warm, empathetic, and accepting; a 38% less effective treatment in order to ensure that they received a therapist with whom they could develop a relationship with; a 34% less effective treatment in order to ensure that they would do more of the talking in session; and a 25% less effective treatment in order to ensure that their therapist was high in expertise. Further, clients were found to cluster into four groups depending on their expressed preferences: those who preferred the common factors over treatment effectiveness, those who preferred treatment effectiveness above any common factor, those who desired most an empathetic therapist, and those who desire most to develop a therapeutic relationship with an empathetic therapist. Given that comparative trials often find small differences in effectiveness levels between treatments and the findings from this study indicating that clients desire less effective treatments if some other therapy-related factor is involved, client preferences should be included in the treatment decision-making process.