You’ve been in this situation hundreds of times:
A session ends and you wonder how your client feels about it. Was it beneficial to them? What did they struggle with? Was something important not addressed? And how are they finding therapy overall?
Therapists are often curious about how clients are experiencing therapy, but hesitant to ask. While that’s understandable (feedback can be intimidating!), it’s also unfortunate, because research shows that asking for client feedback improves the therapeutic alliance and outcome.
This guide offers a roadmap for requesting and responding to client feedback in a way that builds trust and rapport.
When feedback is flowing well, both therapist and client regularly share their thoughts and feelings about their interactions. They talk openly about what’s going well and what’s not going well. They communicate their impressions and revise them as they receive new insights or information. The advantages are numerous:
|Benefits of Client Feedback|
|improves therapy outcomes||reduces early termination or dropout||offers chance to improve therapy skills|
|identifies barriers to client progress||models skills clients can use in other relationships||increases trust between client and therapist|
|corrects or revises false assumptions||empowers clients to shape their therapy experience||deepens understanding of clients|
Therapists sometimes believe they can discern what clients think and feel without asking directly. After all, they’re masters in reading the room, right?
Unfortunately, research shows that therapists struggle to identify clients who are not benefiting from therapy. In fact, the perceptions of clients—not therapists—are the best predictors of the outcome of therapy. This highlights the importance of regularly asking clients to share how they’re finding the therapy experience.
So how do therapists get a clearer view of how clients are experiencing therapy?
It’s helpful to establish an atmosphere of feedback at the outset of therapy. This means talking about why feedback is important and gauging clients’ willingness to be open. Here’s an example of what that conversation might look like in the intake session:
Therapist: I believe therapy works best when we’re open about how we’re finding our work together. This means occasionally sharing our take on how our sessions are going. Does that sound okay to you?
Therapist: If you’re wondering what that looks like, I usually ask two or three questions toward the end of each session. Questions like what you found most helpful about the session, or whether something important was missed. This gives us a chance to address any concerns. Does this feel doable?
Client: I think so. I feel a little nervous, though.
Therapist: That’s understandable! It can feel a little intimidating at first, but I believe it’ll get a lot easier once we get to know each other better.
Client: Okay – sounds good.
A conversation of this sort explains the rationale for requesting feedback and addresses any concerns clients may have.
What questions should you ask when seeking client feedback?
Any of the following questions are good options for requesting feedback in a direct, but non-intimidating way:
|Questions to Ask Clients|
|Focused on one session||Focused on all sessions|
|How do you feel about how today’s session went?||How are you finding therapy overall?|
|Did you struggle with anything in our session today?||Where do we need to focus more attention in our work together?|
|Is there something important we missed today?||Has therapy met your expectations so far?|
|Did anything come up in our session that you didn’t expect?||What can we do to help you get the most out of therapy?|
How you ask these questions is as important as the questions themselves.
While there’s no one right way to do this, some general principles apply:
- Limit the number of questions you ask. No one likes to be bombarded with question after question. In any one session, ask no more than three or four feedback questions. When you’re still building trust with a client, consider asking just one question per session.
- Ask about both positive and negative experiences. While it may be tempting to ask only about what went well, encourage clients to share what they’re finding challenging or difficult. This is your best opportunity to address obstacles and signal that you genuinely care about how clients feel.
- Include questions about individual sessions and therapy overall. It’s important to explore how clients are experiencing a given session as well as therapy in general. This helps you understand both the big picture and occurrences specific to individual sessions.
- Reserve feedback requests for the end of session. This rule isn’t written in stone, but it helps avoid interrupting the flow of the session. Be sure to leave some time to address clients’ responses before the session ends.
To use these questions effectively, remind clients why you’re asking, reassure them it’s okay to respond honestly, and show that you take their concerns seriously. Below are two examples of what this might look like in practice:
Did you struggle with anything in our session today?
Therapist: I’d really like to hear about anything you found difficult in today’s session. Talking about this ensures you’ll get the most out of therapy. Don’t worry – you won’t hurt my feelings!
Client: Okay. Overall, I thought it was a good session, but I struggled with the long silences.
Therapist: I really appreciate your honesty. Those silences can be awkward, can’t they?
Therapist: I’m glad you brought this up. I find that silences can allow emotions to surface. This happened last session when you brought up your wife. Remember that?
Client: I do. That was a rough session, but it was helpful to get in touch with what I was feeling.
Therapist: I’m glad you appreciate the value of silences. But I definitely understand about them being awkward. I’m happy to incorporate a bit more structure to help with that. Sound good?
Therapist: Great – let’s check in on this issue further down the road to see if we’re getting the balance right.
Where do we need to focus more attention in our work together?
Therapist: In therapy, it’s important to make sure we’re addressing the most important issues. It’s easy to get off track, so I like to ask this question from time to time. Are you aware of anything that deserves closer attention?
Client: Hmm. I’m not really sure. We’ve talked a lot about coping skills for anxiety. That’s been useful, but I think it’d be helpful to talk more about my relationship.
Therapist: I’m glad you mentioned this. I remember you saying that you’re concerned about your relationship. Is this an area where your anxiety impacts you?
Client: Definitely. It comes up in other areas too, but my relationship is where I’m struggling most.
Therapist: I agree we should talk more about this. I’m realizing it may not be clear how to apply the coping skills we discussed to your relationship.
Client: Exactly. My relationship anxiety is about worrying how my partner will respond.
Therapist: That makes sense. Let’s agree to devote our next session to exploring how anxiety comes up in your relationship and how you can work with it. Agreed?
Client: Absolutely – I agree.
Therapist: Excellent. I’ll make a point to ask about this when we start our next session.
Therapists may want to request client feedback, but struggle to do so out of a fear of criticism. A negative comment about the therapeutic relationship can bring up feelings of incompetence, guilt, anxiety, and anger.
It’s understandable that therapists want to shield themselves from these feelings. But in doing so, they miss an ideal opportunity to reflect on their practice and understand their clients on a deeper level.
What’s the best way forward for therapists in this position?
The following suggestions are a good starting point:
- View therapy skills as a work in progress. The best therapists continually reflect on and improve their skills throughout their careers. Research even shows that therapists who doubt their abilities have better client outcomes.
- Challenge problematic thinking. Therapists who fear negative feedback often fall prey to catastrophic or all-or-nothing thinking. The occasional client criticism doesn’t negate all your good work. Remember that no therapist is perfect!
- Imagine yourself as your own client. If one of your clients were avoiding something of value due to uncomfortable emotions it might bring up, what would you advise them? You’d probably encourage them to confront their fear. Consider applying that to your own situation.
- Don’t feel obligated to make major changes. Negative client feedback doesn’t always require changing your approach. Arguably more important is showing clients you take their concerns seriously. In many cases, a discussion or explanation can fully resolve the issue.
- Start with easy questions. If the prospect of negative feedback terrifies you (or your client), ask the easier questions first. For example, instead of asking what your client didn’t like, ask what they found most beneficial. Then, with time, try asking one of the more challenging questions.
With practice, you can make therapy more rewarding and effective by exploring clients’ thoughts and feelings about the therapeutic process. By encouraging honesty and open communication, you also equip clients with powerful skills they can apply to their other relationships.