Narratives of clients' experiences of cognitive-behaviour therapy : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Albany, New Zealand

Abstract

Clients’ perspectives on the process and outcomes of CBT have been given little attention in CBT research. This research sought to obtain and explore clients’ perspectives of the process and outcomes of CBT with the aims of informing clinical practice and suggesting new avenues for future research, while at the same time giving clients an opportunity to voice their experiences. The narratives of twelve adult male and female CBT clients were elicited during unstructured interviews. Participants were encouraged to speak freely about the aspects of therapy most significant to them. A critical approach based on a social constructionist epistemology was taken toward the interview data, and this revealed the influences of cultural discourse - including popular ideas about psychology - on the clients’ narratives. A narrative analysis of the data showed a wide diversity among CBT clients, with respect to the problems they hoped to address, the therapy process they depicted, and the outcomes they valued. Some of the clients’ narratives aligned with the way CBT has been conceptualised by theorists and practitioners while others did not. The findings showed clients to be active participants and agential in extracting from CBT what they perceived they needed. Clients who conceptualised their problems as mental health issues and stress tended to seek, obtain, and value the acquisition of practical CBT techniques that assisted them to cope with ongoing emotional distress and associated behaviours. Clients who sought to understand the effects of their personal history on their sense of self and identity emphasised the importance of gaining insight and self-understanding, and used their experience of CBT to re-author previously held unhelpful self-narratives with positive alternatives. Although the therapy relationship is typically depicted as only facilitative of change in CBT literature, participants in this study represented the therapy relationship as a crucial component of therapy that was both facilitative and, in some cases, curative in itself. The findings suggest that CBT clients place greater emphasis on the significance of the therapy relationship than do CBT theorists and researchers. The findings also show that cultural discourse influences how clients experience CBT, and that clients may adapt CBT for purposes other than symptom reduction. Implications for practice and research are discussed and possible avenues for future research are suggested.