How Clients Can Actively Shape Better Outcomes in Therapy
If you ask yourself what makes a good therapy session, what comes to mind? Qualitative research suggests that many people defined a good therapy session as something like this — My therapist offers a powerful, accurate, and novel interpretation of something I’m struggling with, insight arrives like a revelation, I not only understand something I've been struggling with for years, but I now know how to fix it, I am forever changed.
Sure, there are moments like that. And this answer is probably fairly close to the answer I would have given in graduate school if someone were to have asked me what makes a good therapist. But after nearly a decade of sitting on the therapist side of the room, it’s easy to see that definition is only half true. The glaring omission in this definition is the role of the client.
People often assume outcomes in therapy depend primarily on the therapist’s skill or the type of therapy used. While those factors matter, research consistently shows that how clients show up in therapy matters just as much, and sometimes more, than the specific techniques a therapist uses. The clients with the best outcomes viewed themselves as active participants in therapy rather than a passive recipient of support.
What does the research actually say about therapy success? Decades of psychotherapy research point to three major contributors:
The therapeutic relationship (trust, collaboration, feeling understood)
Client factors (motivation, openness, life context)
Engagement between sessions
Much of this research found that these client and relationship factors account for a larger portion of therapy outcomes than specific treatment models. In plain language: Therapy is something you co-create.
Therapy As Space To Practice, Experiment, and Participate, Not Just Talk
When potential clients inquire about my approach to therapy, I describe myself as engaged and action-oriented. Of course I intend for therapy to be a space for reflection, processing, and thoughtful discussion. But I also tell potential clients that I want them to leave the session with something actionable to try before next time. Clients will spend one, or at most two, hours with me in therapy over the course of the week. The work that happens inside of those 1-2 hours matters, but so does that work that happens in the other 166 hours.
Some models of therapy call this “client homework”. I’ve had many clients reach out to me specifically requesting “homework” after a previous experience of therapy that was too unstructured for them, or after a previous therapy experience where homework was assigned and they found it beneficial. Call it homework, an experiment, engagement, or something else — having something intentional to try outside of sessions is a key part of my therapeutic style.
My anecdotal observations agree with the research. Change happens faster when clients are actively engaged and view therapy as a collaborative experience.
What does active participation in therapy look like? I believe it means engaging with curiosity and willingness, even when things feel uncomfortable or unclear. Here are four actionable ways I hope my clients show up as a collaborative participant in therapy.
1. Be Honest. Be Real. As your therapist, my insight is limited by the material that enters the room. Many people filter themselves without realizing it. Afterall, there are relatively few spheres of life where you are encouraged to share all of yourself. I know my clients are having thoughts like “this sounds stupid”, “I don’t want to say this and derail the conversation”, “I shouldn't feel that way so I’m not going to share”. The thoughts you most want to edit are often the most useful ones to explore. Full Stop. Please don’t present an overly polished, organized version of yourself. In therapy, uncertainty, contradiction, and messiness are starting points, not problems.
2. Treat Therapy as Practice, Not Just Conversation. Insight feels good, but insight alone rarely creates lasting change. Your brain learns through experience, repetition, and new emotional outcomes. Think of therapy like physical training. Talking about running doesn’t build endurance, running does. Therapy sessions help design the training, but change happens when new behaviors are tried in real life. Leave the session with one small action to take or experiment to try before next time. Ask yourself “what will I do differently this week”, or “what am I excited to try”. Share your weekly intention with your therapist so they can follow up with you when they see you next.
3. Give Feedback to Your Therapist. Many clients don’t realize this is allowed. Spoiler alert, it’s incredibly helpful. A therapist is a guide, but without feedback it’s hard to know if you like the direction we’re heading in. If something isn’t working, feels confusing, or misses the mark, saying so strengthens therapy rather than harms it. When clients share feedback about the process, outcomes improve and dropout rates decrease. Every 2-3 months, ask yourself “Is therapy helping in the way I hoped”. I encourage you to talk about the answer to that question with your therapist.
Examples of helpful feedback might include sharing:
“I think we might be focusing on the wrong thing.”
“I leave sessions feeling overwhelmed.”
“Can we slow down or get more practical?”
4. Notice Change Outside the Therapy Room. Progress rarely looks dramatic. More often, it appears as subtle shifts like feeling slightly kinder toward yourself, having one conversation go differently, feeling slightly less stressed, pausing to consider trying something new. Since the change can feel subtle, it can go unnoticed. A therapist who knows you well can, and often will, be able to point out progress you may miss. In addition to this being the role of the therapist, this should be actively practiced by the client. Noticing when things go differently or well is actually a skill that can have a big impact on mood, anxiety, and stress levels. I often encourage clients to keep a note on their phone for things that felt different or slightly better this week. Not only will keeping such a note provide good material for clients to bring to the next session, it helps reinforce the progress they’re making.
Therapy Works Best When It’s Shared
Clients are not just the recipient of therapy, they are one of its primary drivers. As your therapist, my job is to bring training, perspective, and structure. As the client, your role is to bring your lived experience, openness and curiosity about change, and the courage to share and experiment in and outside of sessions with something new and at times uncomfortable.
Over the past decade I’ve had many clients, sometimes jokingly and sometimes not, share with me that they want me to help fix them. As your therapist, I’ll probably laugh, smile, and roll with this the first time. Maybe even the second. But at some point, as a good therapist, I would share with you that the reason you are here is to learn how to relate differently to yourself, your relationships, and your life, and in order to learn those things we have to work together. Giving yourself an hour away from the work grind to come to therapy is an amazing gift to give yourself, but it isn't enough. At some point in those 166 hours outside of my office over the week you’ll notice that you responded differently in a situation that once felt impossible, you’ll share that with me, we’ll celebrate. That’s therapy working.