What Clients Hear in Therapy

The Deseret News recently published an article about signs that your therapist may be trying to undermine your faith.

The article has ignited a strong response on social media. Some have called the article anti-therapy. Many have claimed that therapists are neutral and do not impose their ideas on their clients.

Therapy has taken on an outsized role in our culture very quickly. But in many ways, it remains a very under-explored arena. And, naturally, most of those who do research in this space are themselves therapists. It was an area I wanted to know more about. So, in 2022, I spent over 100 hours interviewing more than 50 Latter-day Saint and former Latter-day Saint therapy clients about their experiences to better understand the client side of therapy. I sought out perspectives from individuals who worked with religious and non-religious therapists throughout the United States. The interviews were intimate and insightful, yielding many observations about how clients feel about the therapeutic process. 

A strong majority of the people I spoke to had a good experience in therapy. And I personally have an excellent therapist I trust and believe has been helpful. My conclusions should not be understood as anti-therapy. 

That being said, I have noticed a stark difference between how my interviewees described the therapy experience and how therapists themselves describe it. There seems to be a gap between what therapists think they are doing and how their clients experience what is happening. And this does not seem to be limited to poorly trained or unethical therapists. 

I believe these conversations have given me some insights into the client experience and how bias operates that may be missing in the critiques of those pushing back on the Deseret News piece.

Most People Experience Their Therapist Giving Them Advice

Many therapists insist that they do not give advice in therapy sessions. But most of the clients I spoke to experienced the opposite. 

I would characterize most people’s experience in therapy as their therapist telling them that what they were doing in their lives was good, that they were on the right side of any conflicts they were in, and that they would be happier if they made minor adjustments. 

Those adjustments were usually in the direction the clients were already inclined to pursue. So therapists might simply see themselves as merely helping clients talk themselves into a position. But the clients saw these therapists as trained, neutral third parties agreeing with their position.

Of the people I interviewed who believed their therapists gave them advice, many said their therapists had told them during intake not to interpret their takeaways as endorsed by the therapist. Others said their therapists frequently stated during sessions that they did not necessarily agree with or endorse the course of action the client had chosen. 

A handful of those who believed their therapists gave them advice also said their therapists made disclaimers that they were not giving advice. I remember one man I interviewed who held this view. When he mentioned the disclaimer, I pushed him to explain why he believed his therapist was giving him advice, even though his therapist had explicitly told him the opposite. The man shrugged and said, “Come on,” as if the answer were very obvious. He explained that the therapist’s disclaimer sounded legalistic and was intended only to protect the therapist, not to reflect the therapist’s actual feelings. 

One effect I saw repeated in many of my conversations was that clients intensified their conflicts. They left therapy further convinced they were in the right because their therapist advised them to either continue what they were doing or intensify a course of action they were already inclined to take. 

Who Believes Their Therapist Is Neutral?

Among those I spoke with, there was much broader disagreement about whether their therapists were neutral, with quite a few saying they did not know.

Among those I spoke to who said their therapist was neutral, there was a common pattern in their experience of therapy. They had a major conflict in their life (such as divorce, faith transition, parent-child conflict) and made substantial changes in their life near or during therapy. They were also much more likely to believe that their therapist was giving them advice that aligned with the path they were pursuing.

I found it interesting that many people said they were unsure whether their therapists were neutral. And those who said they did not know didn’t fall into the same pattern as those who said their therapist was neutral.

Among the people I interviewed, there was a pretty strong gender divide, with men more likely to believe their therapists were biased than women. 

Those who did not believe their therapists were neutral split into two camps. People in one camp said their therapist disclosed their biases clearly in therapy; those in the other believed their therapists were either pretending to be or attempting to be neutral, but that the therapists’ biases were clear. 

The most common pattern involved individuals with conservative social, religious, or political values who believed their therapist did not share their values. Surprisingly, this was common even among those who sought out Latter-day Saint counselors, although I spoke to quite a few people outside Utah who sought out generically “Christian” counselors, and none of them reported this experience.

Even though these individuals believed their therapist was biased against their worldview, most still felt they benefited from therapy but simply had to account for their therapists’ biases. Interestingly, these individuals often said that the discussion itself was ultimately valuable, even though the advice their therapists gave them was less valuable.

How Bias Functions in the Therapy Room

In my conversations with therapists, they often use the phrase “client-guided therapy.” Therapists seem to view their clients as having the power in the interaction and their own role as simply guiding clients in the direction those clients choose.

Among the clients I spoke to, almost no one viewed therapy this way. They saw their therapists as having almost all of the power in the space. They believed or hoped that their therapists had either the answers or the tools to help them address what was troubling them. 

Many of the people I spoke to said they felt directed by the therapist, through nonverbal signals, into which areas of their lives the therapist wanted to discuss. One client mentioned that whenever she complained about her parents, the therapist would sit up and lean in. This individual was a teenager forced into therapy by her parents. She was trying to manipulate the therapist so she could quickly get out of therapy, and she found that responding to those nonverbal cues made it much more likely to get a good report from the therapist to her parents. 

Most participants, of course, were not trying to manipulate their therapists. But they also described similar responses when they discussed parents, childhood trauma, and religion. Several told me they consciously recognized these signals and believed it was their therapists’ way of communicating which issues they should discuss to get to the root of their problems. Almost none of them resented their therapists for doing this or saw it as a harmful practice. 

One of the people who described her therapist as neutral also told me that the first time she mentioned her religion, the therapist’s follow-up question was “When did your religion first make you feel guilty?”

As you might expect, people overwhelmingly reported that their therapists asked questions aimed at finding problems. But my conversations suggest that the combination of therapy’s problem-focused framework, paired with therapists’ specific areas of interest, leads many clients to find problems in those areas at elevated rates. Most of those who reported their therapist being interested in those areas of their life believed the actual problem that needed fixing was in those areas. 

The clients I interviewed were generally quite hesitant to shape the discussion themselves. After all, their lives weren’t working. When I would ask my interviewees about setting boundaries around what they would address with a therapist, no one said they had done so, and most people looked at me like I was crazy. 

When I used a word other than boundary, I did get a handful of people who described limits around what they would discuss with their therapists: Two women explained to their therapists early on that they had no problems with their spouses, and had no interest in exploring those relationships; one client said something similar about her mother; and one said the same thing about her faith. Still, only a small minority specifically directed their therapist away from parts of their lives they believed were working. 

If the clients do not make their value systems explicit, therapists have no framework for their questions. When interviewees described their early therapy sessions, they reported being asked questions which often presupposed a value system grounded in Rogerian humanism and expressive individualism—most commonly, questions aimed at identifying what was preventing the client from expressing their most authentic selves.

So it’s not that therapists retreated to a truly neutral position (if such a thing exists); there appears to be a default value setting that therapists revert to when they are not directed otherwise by their clients. Questions from this worldview appeared among the questions asked to every person I interviewed, regardless of whether they believed their therapist was neutral or not. While I don’t personally believe those worldviews are inherently antagonistic to parental relationships or religion, there is also no legitimate therapeutic reason to replace a client’s value system with those worldviews. 

I have not had nearly the same breadth of conversation with therapists as I have had with clients. But I suspect it’s these mechanisms that allow therapists to honestly say they are neutral and don’t direct their clients, even as their clients report a very different experience. 

Although many people see therapy as “settled science,” there is relatively little research that supports the kinds of therapy most people engage in. Therapy has significant potential, and it has done much good for many people that I spoke to. These conversations I have had with therapy clients should not be taken as anti-therapy, but instead as useful insights that therapists can integrate into their work. The field is still largely exploratory. Asking these kinds of questions and looking for how therapy impacts other arenas of life is exactly what good researchers and journalists should be doing. You can believe that therapy is a net good for society, and still believe that, given its incredible influence in our lives and its rapid ascent in our culture, therapy deserves more attention and critique, not less.