EXPERIENCING PSYCHOTHERAPY:

4
GROUNDED THEORY STUDIES
DAVID L. RENNIE

Inquiry in humanistic psychotherapy has involved the development

of research approaches consistent with its values. A major value is the
emphasis this type of inquiry places on the experience of therapy. Qualitative
research methods are in harmony with this emphasis. This chapter describes
how the application of the grounded theory approach to qualitative research
has helped to elucidate what it is like to be in therapy.
The term qualitative research has to do with a human science approach
to social science, in contrast to quantitative research, which is more in
keeping with the natural science approach (Fischer, 1977; Giorgi, 1970;
Rennie, 1995). Directed especially toward understanding the meaning of
human experience and conduct, qualitative research typically uses as its
“data” various verbal texts and expresses the understandings derived from
study of these texts in verbal language as well. It is perhaps more responsive
than is most quantitative research to the observation made by Giddens
(1976) that the social sciences involve a double hermeneutic. This means
that the social sciences involve the study of a preinterpreted world made
up of the same condition that is brought to the study of it-human social
conduct. Thus, the social sciences turn back on themselves, or are reflexive,
in ways not seen in the natural sciences. Still, assumptions having to do
with how knowledge is developed (i.e., epistemology) vary widely among
qualitative researchers. Some take a more realist stance and express positiv-
ism when developing research procedures (e.g., Hill, Thompson, 6r Williams,
1997). Others subscribe to a relativist epistemology and see the approach
as quite interpretive, or constructionistic (see Madill, Jordan, & Shirley,

Appreciation is extended to Kimberly Watson for her helpful comments.

117
2000; McLeod, 2001). Still others see it as a way of reconciling realism and
relativism (e.g., Kvale, 1996; Rennie, 2000b). Qualitative research is time
consuming and so, when it is directed toward the experience of aggregates
of individuals, the number of people studied is usually small by quantitative
research standards. Because of the unique features of qualitative research,
much energy has been put into the development of methodological principles
guiding the approach (e.g., Henwood & Pidgeon, 1992; Stiles, 1993). Re-
cently such principles have been incorporated into a set of guidelines for
the publication of qualitative research studies in psychology and related
fields (Elliott, Fischer, & Rennie, 1999).
A prominent form of qualitative research, the grounded theory method,
was developed by two sociologists, Barney Glaser and Anselm Strauss (1967),
who were critical of the conventional method in sociology. They worked
out a set of procedures designed to ground theory in facts as an antidote to
what they saw as the usual practice of testing rationally developed theory
with facts. In their initial methodology, Glaser and Strauss saw the method
mainly as a form of induction and that the method has more to do with
the context of discovery than the context of verification (see Reichenbach,
1949). More recently, Strauss and an associate, Juliette Corbin, modified
the method to include an interplay between induction and deduction, much
to the distress of Glaser (see Glaser, 1992; Rennie, 1998a, 2000b; Strauss
& Corbin, 1990). In any case, even under this modification, the method
retains many of the features of qualitative research given above. Meanwhile,
the grounded theory method has been adapted to psychological inquiry
(e.g., Rennie, Phillips, & Quartaro, 1988).
Most of the studies reviewed in this chapter entailed the basic proce-
dures constituting the method as originally conceived by Glaser and Strauss
(1967). In these procedures, texts of various sorts (such as transcripts of
interviews) are broken into units of meaning, and commonalitiesof meaning
among the units are conceptualized as categories in response to the cornrant
compurutive analysis of the units. That is, the units of meaning are compared
systematically with each other, and the categories generated from these
comparisons are compared as well. As such interpretation proceeds, the
growing list of categories eventually is judged sufficient to account for the
meaning apparent in additional texts. At this point, one can conclude that
the categories are saturated and can bring the gathering of texts to a close.
Meanwhile, the grounded theory analyst attempts to be aware of initial
conceptions (i.e., biases) about the phenomenon under study. Initially, in
particular, effort is made to put such conceptions aside as much as possible
(i.e., to bracket them) during the study in an attempt to address the meaning
of the text under analysis in an open-ended way. Similarly, new ideas,
hypotheses, and hunches coming to the analyst are bracketed and recorded
as theoretical memos. In the initial phase of the analysis, these memos are

118 DAVlD L. RENNlE

kept separate from the filing system used to record the categories and mean-
ings attached to them. As the analysis continues, however, the memos are
drawn on during constant comparative analysis of the categories as a way
of conceptualizing higher order categories and the relations among them.
Flowing out of this activity is the conceptualization of a core category that
gathers together the meaning of all other categories and their relations.
This core category is the main organizer of the theory of the social phenome-
non being studied.
Although the grounded theory method has been applied to the study
of couples counseling (Burr, 1994),family therapy (Tanji, 1996),and group
therapy (Bolger, 1999), with the exception of the study by Bolger, the
following review is restricted to its use in the study of the experience of
individual psychotherapy. In this review, I arranged these studies into four
sections: studies on the experience (a) of a course of therapy as whole, (b)
of an hour of therapy, (c) of spontaneous events occurring within a session,
and (d) of therapist-directed tasks in sessions. As will be seen, most of these
studies have focused exclusively on the client’s experience, although some
have addressed the therapist’s experience as well.

EXPERIENCE OF A WHOLE COURSE OF THERAPY

Three studies have called on clients to recall aspects of psychotherapy

in the light of having completed a whole course of therapy. Phillips (1984)
was interested in clients’ impressions of the contributors to change over the
course of therapy. Schneider ( 1985) inquired into clients’ recollections of
the positive and negative qualities of their therapists. More recently, Bolger
(1999) studied the experience and resolution of emotional pain.

Sources of Change in Psychotherapy

Phillips (1984) examined the extent to which events occurring both

inside and outside therapy were thought by former clients to have contributed
to change. He selected, from a number of volunteers to the study, 3 clients
who appeared similar in many ways and contrasted them with 4 other clients
who were different in many respects. The 5 women and 2 men who were
selected had been in therapy at a university counseling center, a behavior
modification clinic, or in private practice. Two clients had been engaged
in person-centered therapy, 2 were in cognitive therapy, 2 were in therapy
with inexperienced therapists with little specifiable orientation, and 1 client
who had undergone years of therapy had been engaged primarily with
psychoanalytic and behavioral approaches. In his inquiry, Phillips ( 1984)
was presented with reports such as the following:

EXPERIENCING PSYCHOTHERAPY 119

 And if you talk to somebody else, that forces you to go deeper. . . . If
I’m not going to be honest there’s no point in me going through with
this. . . . I mean I wasn’t doing it for fun. . . . I mean I took it very
seriously. I was doing it for myself. It was a sort of present to myself
. . . the excitement of becoming more aware of what’s going on . . . the
pleasure of discovering. (pp. 57-58)
Phillips (1984) found that, although he probed into extratherapy events
and conditions that contributed to change during the course of therapy,
the respondents had little to say in this regard. Instead, they talked mainly
about what they were able to get from their therapists that they were not
able to get from friends and acquaintances. The core category that he
conceptualized to represent the overall meaning of the interviewees’ reports
was self-focus. The respondents indicated that they saw their therapy as a
special occasion enabling them to pay attention to themselves. Phillips
interpreted the reports to mean that this self-focus entailed a process of
change involving (a) awareness of problems and issues, (b) motivation to
change, (c) pursuit of change, (d) acquisition of new understandings, (e)
acquisition of new behaviors, and (f) changes in the interpersonal environ-
ment. More concretely grounded in the reports and interpreted to support
the process model were categories having to do with (a) the interviewees
themselves (openness, hope, and respect for the therapist), (b) the therapist
(attending, caring support, separateness, techniques, and consistency), and
(c) the relationship with the therapist (humor and insight).
Thus, the interviewees mainly spoke more about in-therapy than out-
side-therapy influences on them when they were in therapy. They also
addressed their experience of themselves and of the relationship with the
therapist more than the experience of encountering therapeutic technique.

Clients’ Positive and Negative Appraisals of Therapists

Schneider ( 1985) conducted an investigation involving a combination

of empirical phenomenological psychology (Giorgi, 1975)and the grounded
theory method. He was interested in learning about clients’ positive and
negative appraisals of therapists in a way that was not constrained by the
views of the researcher. He interviewed 9 women and 6 men, 13 of whom
were counselors themselves, all of whom, on average, had completed a
course of long-term humanistic therapy 3.7 years prior to the study. Eight
of the interviewees evaluated their therapy as successful, 1 judged it as poor,
and the rest rated it as fair.
Among the positive appraisals Schneider (1985) was given was the
following comment: “One thing that I really felt positive about . . .was that
she gave me feedback. . . . And as she gave me feedback, she also let me
know that that’s the way she’s seeing it. . . . I didn’t have to take it as

120 DAVID L. RENNIE

ultimate truth” (p. 73). Alternatively, another interviewee who evaluated
his therapist negatively remarked, “It would‘ve been better if she hadn’t
disclosed the things she was unresolved with” (p. 119).
The analysis of such reports resulted in the conceptualization of four
main themes regarding the therapist: (a) personal involvement, (b) technical
restructuring, (c) authoritativeness, and (d) role modeling. Therapists who
were appraised positively were high on these themes, whereas those who
were judged negatively were low on them. Those who were personally involved
conveyed genuineness, support, acceptance, and deep understanding. Their
clients had felt less defensive, more genuine, responsible, and acceptant of
their feelings. These clients had also understood themselves better and took
themselves more seriously. Therapists who engaged in technical restructuring
conveyed cognitive and experiential skills. This intervention helped inter-
viewees to shift their perspectives on matters of concern, to feel clearer
about precipitating events and more capable of perceiving options, and to
become more aware of their responses and impact on others. Practitioners
who displayed authoritativeness conveyed firmness and self-assurance. In re-
sponse, the interviewees had felt secure, receptive to influence, and psycho-
logically edified. Finally, by virtue of how they were as people and how they
conducted themselves, positively appraised therapists were taken as role
models personally, socially, and professionally.
Therapists who were appraised negatively were interpreted to be unsat-
isfactory in terms of the four themes. These counselors expressed either too
much or too little personal or technical involvement. They did not know
when to withdraw and when to intervene. They failed to bring personal
and professional resources forward and burdened their clients with personali-
ties that lacked integration, maturity, and responsibility.
Significantly, whether positive or negative, the former clients reported
that the impact of their therapists on them was profound and lasted for a
long time after the therapy ended. Overall, Schneider (1985) found that
the interviewees evaluated their therapists mainly in terms of the relationship
that they had with them. Within this relationship, it was important for the
therapist to be a good listener, accepting, natural, and actively involved in
the therapy. Interventions such as intuitively timed interpretations, exer-
cises, and therapeutic games facilitated gains that may not have occurred
in a more permissive relationship. Schneider interpreted these accounts to
provide support for the claim made by existential-analytical and experiential
therapists that the person-centered attitudes of empathy, unconditional
positive regard, and genuineness are necessary but inefficient, and sometimes
insufficient. At the same time, he acknowledged that this interpretation
was contingent on his having spoken to sophisticated former clients and
recommended that his study be followed by one directed toward the experi-
ence of people less familiar with counseling theory and practice.

EXPERIENCING PSYCHOTHERAPY 121

Emotional Pain

The experience of emotional pain, and of its resolution, was examined

by Bolger (1999). She recruited 7 White women between 32 and 42 years
of age who were professionally employed and self-supporting. Most were
adult children of alcoholics. They were in group therapy for the resolution
of emotional pain, with Bolger sitting in as a participant observer. Partici-
pants were interviewed immediately following a group session and then 6
months later, as a follow-up. The participants’ reports were interpreted to
mean that they had developed a covered self that served to protect a hidden
self, through the use of “covers” and “containers.” The women used this
defensive strategy as a way of dealing with a broken self. The covered self
could be broken in any of a number of ways: retraumatization, remembering
past traumatic events, talking about them, or hearing others talk about
them. As Bolger (1999) described the experience,
Pain was initially experienced at a visceral level, as being opened sud-
denly and unnaturally against one’s will, like “being ripped apart”.
. . . There was also a feeling of “breaking apart”, “having a nervous
breakdown”, or “losing myself” completely, as if one might disintegrate.
(P. 3-52)

Some of the participants had undergone a resolution of broken self,

into a tranfomd self. The broken self was interpreted to be the core category
gathering together the meaning of experienced pain, and the covered self
and transformed self were conceptualized as higher order categories integrally
related to the core category. These categories were interpreted to subsume
11 main categories, 13 submain categories, and 99 descriptive categories.
From this hierarchy, Bolger (1999) developed a process model of working
through emotional pain. In this model, initial pain leads to the covered
self, which gets ruptured, resulting in surfacinglexposing,causing brokenness,
leading to loss of control, and then alarm. At this point, the individual either
(re)covers the pain or allows it, the latter then enabling expression of it,
which may eventuate in transformed self. Bolger observed that the moves
to transformed self were not taken by everyone in her sample. She remarked:
The process of working through pain outlined in this study bears similar-
ity to the model developed by Greenberg and Safran (1987). Allowing
pain appeared to facilitate change, and participants expressed relief at
surviving the experience. Both the identification of needs and a shift
in belief about the self seemed to be important in the change process.
However, although pain forced a positive change in some, for others
it had been wholly destructive. I was surprised to learn how powerful
and persisting the impact of previous painful experiences could be. Even
the constructive effects of feeling pain were not enough to overcome

122 DAVID L. RENNIE

 the negative impact of some former painful experience. . . . The results
confirmed that both the fear of annihilation and the fear of seeing the
self mediated the avoidance of pain. What was clarified for me was that
the fear of annihilation functioned to disallow pain, while the fear of
seeing the self interfered with staying with the pain, even when it
was allowed. In addition, overcoming the fear of annihilation was not
facilitative of change. Change happened when individuals were able to
overcome the fear and shame evoked when seeing themselves. Facing
Myself and Questioning emerged as critical processes that kept individu-
als focused on themselves, once the fear of not surviving was overcome.
(Bolger, 1999, pp. 358-359)
Thus, Bolger’s study illustrates how clients’ reports on the experience of
therapy add richness to understandings of what is involved in therapeutic
change and resistance to it.

THE EXPERIENCE OF AN HOUR OF PSYCHOTHERAPY

I conducted a study on clients’ moment-to-moment experiences of an

hour of therapy. In a research interview, either a videotape or audiotape of
a therapy session that the clients had just completed was played back to
the client in the presence of a researcher-interviewer. The interviewees
were asked to stop the tape at any point of recalled significance or interest
and to report what they recollected. Thus, the inquiry procedure was an
adaptation of Kagan’s ( 1975) technique of Interpersonal Process Recall
(IPR) and paralleled an adoption of the same technique for related purposes
by Elliott (1986). Both the therapy session and the IPR interview were
tape-recorded, and the latter was analyzed in terms of the grounded theory
method, with the therapy transcript serving as context (Rennie, 1990,1992,
1994a, 199413, 1994d, 1998b, 2000a).
The interviewees were mostly university students going to the counsel-
ing center at each of two major Canadian universities, although some of
the participants were with a private practitioner. The therapies were primar-
ily person centered and experiential, although cognitive therapy and behav-
ior therapy were represented as well. Fourteen people were interviewed in
all, with 2 participants interviewed about two separate therapy sessions each,
for a total of 16 interviews. Three of these interviews involved 2 of my
clients. I interviewed all participants other than my own clients. The core
category conceptualized in the grounded analysis was client’s reflexivity (see
below). It subsumed four main categories: (a) client’s relationship with
personal meaning, (b) client’s perception of the relationship with the thera-
pist, (c) client’s experience of the therapist’s operations, and (d) client’s
experience of outcomes. The relationship with personal meaning was further

EXPERIENCING PSYCHOTHERAPY 123

interpreted to involve both the pursuit and avoidance of meaning. The
relationship with the therapist was interpreted to entail deference to the
therapist and nonspecific relationship factors (see Frank, 1971). The rela-
tionship with the therapist’soperations was understood to involve the experi-
ence of operations bearing on (a) the client’s sense of identity, (b) the
client’s agency, and ( c ) the therapist’s relationship with the client. Finally,
the main category of the client’sexperience of outcomes involved the impact
of the therapy and impact of the inquiry. These main categories and their
properties in turn were interpreted to be supported by 5 1 fourth-level catego-
ries (for their specific nature, see Rennie, 1992).
The reflexivity attributed to clients has been defined as self-awareness
and agency within that self-awareness (Rennie, 1992, 1998b, 2000a).’ The
interviewees’ reports consistently indicated that the most salient, recalled
aspect of their experience was their active self-reflection as they dealt with
their own experience and with the presence and conduct of the therapist.
Moreover, in this self-reflection they listened to their feelings when proceed-
ing from moment to moment in the interaction with the therapist. Although
often rapid and subtle, this feeling-of-one’s-waywas interpreted to amount
to decision making. It is this decisional aspect of the client’s experience
that has led to the formulation that agency is integral to the client’s reflexiv-
ity. Once embarking on a given line of thought (whether expressed to the
therapist or followed covertly), related thoughts, memories, associations,
and feelings emerged in line with the topic. Thus, they followed a path or
track of thought and feeling (see also Gendlin, 1974, 1996; Pearson, 1974;
Wexler, 1974). When on the path, this pursuit was often nonreflexive,
which means that they were not aware that they were engaged in the pursuit
as such. Rather, they were “just doing it” (see Searle, 1983). In this state,
the presence and contributions of the therapist, if in line with the track,
were hardly noticed but nevertheless had a prompting effect. Thus, the
experience of therapy was characterized by an ongoing shifting back and
forth between a reflexive sense of where to go next, on the one hand, and
a nonreflexive pursuit of that line of meaning until it came to a close, on
the other hand.
The ending of the nonreflexive pursuit of a line of meaning appeared
to come about either because the intention originating the path of thought
came to fulfillment or because the path was disturbed in some way. An

‘Reflexivity has been defined as “a turning back on oneself, a form of self-awareness”(Lawson, 1985,
p. 9). When the clients participating in the study revealed how active they had been internally in
their interactions with their therapists, I initially conceptualized the core category representing the
clients’ experience as clients’ agency. Later, I decided that this category did not represent adequately
the self-referencing that was involved in the agency. It was for this reason that I opted for clients’
reflexivity, with the amendment to the usual definition of reflexivity to the effect that agency is
involved in it.

124 DAVID L. RENNIE

example of an intention in the process of fulfillment was a “point” that a
client wished to make, such as the conclusion of a statement or the climax
of a story.
Alternatively, disturbances were either internal or external. Internal
disturbances were unexpected distressingthoughts and feelings arising during
the tracking of experience. For example, the clients may have become upset
while telling a story, causing a shift from being immersed in the story to
being aware of being upset. In contrast, external upsets happened when the
therapist’s activity was not in line with the track. To illustrate, a client’s
smooth immersion in a story was interrupted when her therapist failed to
support her sufficiently during a brief moment when she needed it (Rennie,
1994d). In either case, the clients “snapped out of” the nonreflexive pursuit
to deal with the disturbance.
When the disturbance was internal, the clients had to decide on courses
of action such as continuing the pursuit despite the upset, easing the upset
by not disclosing the feeling or the memory/association that triggered the
upset, or by changing the subject. When external, the disturbance usually
placed clients in an awkward position. In general, they got out of it by
either ignoring the therapist’s response, giving token acknowledgment of it
until they could safely get back on track, or dropping what they were
thinking about and attending fully to the therapist. When the last response
happened, it was with a sense of loss, and they experienced considerable
relief if the therapist managed to return to the track. Thus, one client was
derailed when the therapist asked a question that the client did not under-
stand and was placed back on track when the therapist rephrased the question
(see the illustrative dialogue toward the end of the chapter).
I also came to understand that disjunctionscreated by the therapist inter-
acted powerfullywith the client’srelationship with the therapist. Clients who
felt good about their therapist generally could take therapist-induceddisjunc-
tions in stride. These clients rested on the realization that, if things did not
work out in this particular moment, they would come out all right in the end.
Alternatively, clients who had troubled relationships with their therapists
were prone to overreact to such a disjunction because they felt that it both
arose from the negative aspects of the relationship and was evidence of it.
Such an attributionwas made by a client being seen by a therapist who strenu-
ously urged her to be assertive in her interpersonal relationships. The client
resisted this advocation to a certain extent. Meanwhile, the therapist an-
swered the telephone a lot during their sessions, which irritated the client.
Although she realized that the idea was “wild,” as she put it, she suspected
that the therapist engaged in this behavior to demonstrate how to be assertive
when talking to someone over the telephone.
The reports revealed that the most significant experience often was
not expressed to the therapist. One the one hand, some interviewees reported

EXPERIENCING PSYCHOTHERAPY 125

that they were thinking faster than they could talk. As one remarked, her
engagement with herself was h e y process. She decided that her therapist did
not need to know about it and that, besides, she could work more quickly
when not conveying all of her thoughts to him. On the other hand, when
uncomfortable with aspects of their experience, the clients communicated
only what they felt they could express. This constraint was especially true
of moments when the clients had negative reactions to the therapist’s
manner or approach. It was evident that the clients had a strong tendency
to defer to the therapist (Rennie, 1990, 1994a, 1994c, 1998b; see also the
studies by Rhodes, Hill, Thompson, & Elliott, 1994; Watson & Rennie,
1994, addressed below). This deference was expressed in a number of ways.
They respected the therapist’s judgment even when not agreeing with it.
They made allowances. They followed the therapist’s lead. They attempted
to understand the therapist’s frame of reference to make the therapist’s work
easier. They resisted criticizing or challenging the therapist; and so on.
Interestingly, some clients revealed that, although what the therapist did
was unpleasant, it was not appraised as negative. They realized that what
a therapist did was good for them even though they did not like it, as when
a Gestalt therapist encouraged them to participate in exercises to facilitate
contact with painful emotions. In this circumstance, the relationship with
the therapist was crucial. In the presence of a relationship, the interviewees
willingly complied, albeit usually with initial resistance, whereas in an
unsettling relationship, they complied with an inwardly grudging diffidence.
The study is thus a reminder that clients are self-aware agents in
interaction with their therapists. Moreover, in this vein it illustrates that
(a) clients often do not disclose to the therapist all that they are experiencing,
and (b) some of what they do not disclose has to do with their sense of
the therapist. Accordingly, it points to the importance of nonverbal cues
indicating covert experience. The study also calls for therapists to discuss
openly with their clients the nature of the communication between them
and their clients. As addressed elsewhere (Rennie, 1998b), communication
may be thought to involve purposes and impacts (see Elliott, James, Reim-
schuessel, Cislo, & Sack, 1985). Accordingly, therapists may either inquire
into the purpose behind the client’s communication or reveal the purpose
of their own communication. Alternatively, they may either ask about
the impact of their communication or reveal the impact of the client’s
communication. Such communication about communication has been
termed metacommunication by Watzlawick, Beavin, and Jackson (1967; see
also Kiesler, 1996). In turn, the study helps to elucidate how metacommuni-
cation may facilitate the establishment, maintenance, and repair of the
working alliance (cf. Bordin, 1979; Rennie, 1998b; Rhodes et al., 1994;
Safran, Muran, & Wallner Samstag, 1994; Watson & Greenberg, 1994).

126 DAVlD L. RENNZE

 THE EXPERIENCE OF SPONTANEOUS EVENTS
WITHIN A THERAPY SESSION

Four studies have been conducted on the experience of particular kinds

of events occurring spontaneously in therapy. The events in question have
to do with misunderstanding, storytelling,metaphor, and therapists’ imagery.

Misunderstanding

Rhodes et al. (1994) conducted a study of the experience of being

misunderstood by the therapist. A total of 16 women and 3 men, who were
all therapists or therapists-in-training,described in writing an event that
had occurred in their therapy in which they felt that they had been misunder-
stood (3 of the study’s authors included themselves among the 19 partici-
pants). The therapists involved in the study were psychodynamic (n = 13),
psychodynamic/humanistic(TI = 3), humanistic (n = 2), and eclectic (n =
1). In a research approach that drew in part on the grounded theory method,
the written accounts were interpreted in terms of the pathway-to-change
model borrowed from comprehensive process analysis (Elliott, 1989). This
model characterizes change in therapy as occurring in significant therapeutic
events. The components of an event involving change are its long-term
background, immediate context, precipitant, experience of the event, client
action, ensuing therapist action, resolution, and ensuing process. The investi-
gators found that the accounts were quite different depending on whether
the participants appeared to have resolved the misunderstanding event,
which led to the conduct of separate analyses for the 11 resolvers and
8 nonresolvers.
The consensual understanding arrived at by Rhodes et al. (1994) was
as follows: The misunderstanding occurred when the therapist either gave
what the client had not wanted in that moment or did not give what the
client had wanted. Whether the misunderstanding was resolved depended
to a great extent on the client’s relationship with the therapist. On the
whole, the resolvers reported having a good relationship. Thus, although
some of the resolvers initially went underground (i.e., they quashed their
inner negative reaction to the therapist), roughly half of the resolvers spoke
up against the therapist immediately. Moreover, most of those who went
underground eventually expressed their negativity. In response, the thera-
pists of the resolvers accommodated the criticism by apologizing and negoti-
ating where to go from there. The result was that most of the resolvers
continued to work with the therapist after the immediate resolution and
to profit from it. In contrast, half of the nonresolvers specifically mentioned
a poor relationship, and only one indicated a good relationship. Most of

EXPERIENCING PSYCHOTHERAPY 127

these clients went underground and stayed there. Indeed, a majority of them
ended the therapy. Although the termination was not attributed entirely
to the event, it seemed clear that it had contributed to it. This account
supports the understanding given to Schneider (see page 121, this chapter)
on the profundity of the impact of therapy on sophisticated clients.

Storytelling

As an extension of my main study, I focused on the experience of

telling a story to the therapist (Rennie, 1994d). I came to understand that
storytelling was a way of dealing with inner disturbance. For clients who
intended to get into their disturbance, telling a story was a way of preparing
to address it directly. The structure of the story “housed,” as it were, a
number of internal experiencesrelated to the disturbance (such as memories,
associations, ideas, and appraisals). In this way, storytellers could engage
the experiences without necessarily having to express them. Through this
avenue, then, they could touch on and, to a certain extent, come to terms
with the disturbance privately. This preliminary work made it easier for
them to address the disturbance openly. Thus, it was as if they used the
story to “get their feet in the water.” In the bargain, they also found that
the act of telling the story was therapeutic in its own right. Not only did
they achieve emotional relief, they also managed to gain some insight in
the course of their private work with their inner disturbance.
Alternatively, there were some clients who could not avoid an inner
disturbance arising from a life event but who were disinclined to enter into
their disturbance. These clients altered the actual story of the life event that
had given rise to the disturbance. Thus, this strategy was a kind of “belief
management.” There was enough ambiguity about the painful event to
enable them to construe it in a way that made it less painful. Interestingly,
the intensity with which they told their stories seemed to indicate that they
were enveloped in creative tension until the story was complete. This tension
was reflected in a low tolerance for interference by the therapist until it
was completed. Ironically, these participants disclosed that, as much as they
wished to create more acceptable stories, they were aware of what they were
doing and of the alternative story (the “true” story), even though they did
not give that story to the therapist. Thus, the alteration of the true story
carried them to insight despite their intention to the contrary.

Metaphor

A study of both the client’s and the therapist’s experience of metaphor

in therapy was conducted by Angus (1992; Angus & Rennie, 1988, 1989).
Lakoff and Johnson’s (1980) definition of metaphor guided the selection of

I 28 DAVID L. RENNIE
metaphor in therapy discourse. Accordingly, metaphor was considered to
be a figure of speech that invokes a transaction between differing contexts
of meaning and construct systems. Thus, one may remark, “He’s a lion,’’
where the lion as the dominant species on the African plains is related to
a man who is considered more powerful than those around him. From each
of the single sessions of the four therapy dyads, Angus chose 5 client-
produced and 6 therapist-produced metaphors, or roughly three metaphors
per dyad. A n IPR inquiry was made into the client’s and the therapist’s
experience of the particular metaphors they produced. Examples of the 11
metaphors chosen for study were “giving a litany,” “on a broomstick,” “having
a tantrum,” “a witch,” and “an ogre.” The therapists participating in the
study entailed 1 psychoanalyst, 1 Gestalt therapist, and 2 eclectics working
within a person-centered and psychodynamic framework. All 4 therapists
were men. The 4 clients were 3 women studying at a university and 1
salesman. With a combination of grounded theory analysis (Glaser & Strauss,
1967) and empirical phenomenological psychology (Fessler, 1978),the coor-
dination of clients’ and the therapists’ perspectives led to the conceptualiza-
tion of two global themes: metaphoric communicative interaction and associated
meaning contexts.
The first global theme came from the realization that, for half of the
dyads, there was conjunction in the meaning of a metaphor as experienced
by both the client and the therapist, whereas for the other half, there was
disjunction in the meaning. Whether meaning conjunction or disjunction
occurred was contingent on the style of communication between the thera-
pist and the client. Meaning conjunction arose from a collaborative style
of communication, in which the therapist actively worked with both the
client’s and his own experience in trying to make sense of the metaphor
and in developing it further. In this case, the therapist shared his personally
held meanings in a tentative way, which stimulated similar exploratory
work by the client. During this give-and-take, the client and therapist
collaboratively teased out the ways in which the metaphor seemed to catch
the nuances of the client’s experience. Alternatively, in noncollaborative
communicative interaction, the therapist conducted a kind of Socratic in-
quiry evidently designed to stimulate the client to come to an understanding
of the meaning of the metaphor that the therapist had already decided was
“true” of a particular set of issues. Thus, the ultimate purpose of these
interactions boiled down to the therapist’s attempt to persuade the client
to come to the former’s point of view.
The second global theme, associated meaning context, referred to the
embeddedness of metaphors in a network of associated memories, incidents,
feelings, and images. The elements of this network were articulated either
in the therapy session itself or in the inquiry session about it. The partici-
pants’ reports were interpreted to indicate that metaphor symbolized inner

EXPERIENCING PSYCHOTHERAPY 129

experience in three ways: (a) It was an associative link in that it led to the
elaboration of specific memories or images related to an inner experience;
(b) it symbolized and made apparent a unique set of values and characteristics
on which clients implicitly drew when addressing themselves, thus providing
a framework for the client’s self-identity; and, last, (c), it figuratively charac-
terized the client’s role-relationship patterns. These patterns were repre-
sented as inner dialogues between particular speaker-listener pairs making
up the experiential social world of the client. As an example, the client
producing the ogre metaphor internally engaged in a dialogue between his
fantasized billy-goat self and his ogre or troll mother. Overall, as associated
meaning context, the use of metaphor provided the client and therapist
with a succinct way of referring to the complex fabric making up the meaning
of the client’s experience.

Therapist’s Imagery

Shaul (1994) conducted a study of the impact of therapists’ imagery

on the psychotherapeutic process. Four therapists were involved in the
study. Two were process-experiential, 1 was person-centered, and 1 was
psychodynamic in orientation; all had between 3 and 15 years of experience.
The clients were 2 men and 2 women, between the early 20s and early 30s
in age. Shaul audio-recorded a single session for each dyad. He arranged
for the therapists to indicate when they experienced an image by giving an
auditory sign of some sort, such as a clearing of the throat. Within no
more than a few hours after the session, the investigator conducted an IPR
interview with the therapist, focusing on two such images that were judged
by the therapist to be especially significant in some way. In this IPR interview,
once the moment when a given image had been experienced was located
on the tape, the tape was rolled back to approximately 4 minutes prior to
that moment. The therapist was asked to recall what he or she had experi-
enced during this period prior to the visual image. As the tape rolled forward,
the replay entered the moment of the visual image, and the therapist was
asked to recall what had been experienced at that moment. The inquiry
about the given image ended with the therapist being asked to recall what
he or she had experienced during the 4 minutes after the moment of imagery.
To illustrate, one of the therapists reported that, when listening to his client
talk about her desire to satisfy both herself and her parents over a matter
that was concern to the client, he had experienced an image of her walking
on a fence:
As I envision her walking on the fence, I sense that she wants me to
help her somehow balance on this fence instead of choosing a side. She
also appears quite scared in the image. I can see her face and she looks
quite scared, you know, like something terrible, really awful, will happen

130 DAVID L. RENNlE

 if she ends up on either side. It really struck me, I mean, I felt a strong
sense that the client in the image wanted to stay on that fence and
would rather balance precariously than try to get down, kind of like a
scared cat up a tree. (Shaul, 1994, pp. 60-61)
As it turned out, of the eight imagery events, only three were directly
shared with the clients. In the other incidents, the therapists had decided
to work with and to share their sense of the meaning of the image, without
actually imparting the image.
On completion of the IPR interview with the therapist, Shaul replayed
the same tape footage to the therapist’s client. Parallel to what had been
done with the therapist, the client was asked to recall what had been
experienced from moment to moment during that section of the therapy
session. This procedure was repeated for the four dyads. In addition, Shaul
administered the Working Alliance Inventory (Horvath& Greenberg, 1986)
to both the clients and the therapists. He also had raters use the Client
Experiencing Scale (Klein, Mathieu, Gendlin, & Kiesler, 1969) to appraise
the client’s processing of experience during the period of the therapy session
under study. Having in hand both the therapists’ and the clients’ reports
of their experience, Shaul proceeded to do separate grounded theory analyses
of the therapists’ and clients’experiences. He also integrated the two analyses
in a way that was informed by the returns from the Working Alliance
Inventory and the Experiencing Scale.
Shaul (1994) conceptualized Working With the Image as the core cate-
gory subsuming the many categories representing the therapist’s experience.
The main properties of this category were understood to be: (a) imagery
generation,(b) constructionof meaning, (c) decision regarding intervention,
(d) intervention, and (e) evaluation of intervention. It is noteworthy that
although the therapist’s reports were cast in such a way as to make a linear
process model appropriate the same was not true of the clients’ reports. A
“holographic” model, as Shaul put it, seemed more fitting for the latter in
the sense that what was true of the whole of the client’s experience was
true of each part of it as well. The core category of the clients’ experiences
was conceptualized as Client’s Processing: Responding to the Therapist’s C h L
knge. This category gathered together as its main properties (a) the client’s
analysis of therapist’s activity, (b) the internal check, (c) the client’sevalua-
tion of the therapeutic alliance, and (d) the client’s evaluation of the
therapeutic process.
The overall analysis led to the understanding that, whether the thera-
pist disclosed the actual image or made an intervention derived from his
or her interpreted meaning of the image, the clients experienced a positive
shift in their understanding of their experience. This pattern, derived from
the participants’ accounts, was corroborated by the pattern of Experiencing
Scale scores, judged by raters who were “blind” to the grounded theory

EXPERIENCING PSYCHOTHERAPY 131

analyses. Moreover, as would be expected, the clients who benefited the most
from the therapist’s imagery-based intervention were those who reported the
most satisfactory relationships with their therapist. This impression was
corroborated by the Working Alliance Scale scores. Shaul concluded that
therapist’s imagery appears to serve as an empathic lens, or exquisite articula-
tion of the client’s experience.

THE EXPERIENCE OF THERAPIST-DIRECTEDTASKS

A task prescribed by the process-experiential approach to therapy

(Greenberg, Rice, & Elliott, 1993) is the analysis of problematic reactions
(Rice & Saperia, 1984). The concept of problematic reaction refers to the
client’s overreaction to an interpersonal event that occurred outside therapy.
Thus, a client might remark, “It was such a small thing, but I was completely
devastated.” The task is to delve into the reaction to determine its meaning
and resolve it, under the therapist’s direction. Specifically, once a problem-
atic reaction is identified, the therapist uses the technique of systematic
evocative unfolding (Rice, 1974)-a form of empathic responding entailing
the use of imagery and vivid language-as a way of helping the client to
reexperience the problematic event and to understand its meaning.
A study was conducted on the client’ssubjectiveexperienceof undergo-
ing the task of attempting to resolve a problematic reaction (Watson &
Greenberg, 1994; Watson & Rennie, 1994). Watson recruited 8 clients
from both a university counseling center and undergraduate psychology
classes of a major Canadian university to undergo a 12- to 16-week course
of process-experiential therapy, offered by her and two colleagues. At the
end of the second and seventh session, the clients were asked to bring to
the next session a problematic reaction that they had experienced in the
previous week. Thus, the third and eighth sessions were devoted to the
task of resolving the problematic reaction in response to the therapeutic
technique of systematic unfolding. After each of these two therapy sessions,
the clients were asked to review the audiotape of their session and to locate
and rank three significant moments when something had shifted for them.
Within no more than 2 days following the session, an IPR interview was
used to inquire into the experience of these moments (if the moments
were not moments of addressing the problematic reaction, then the IPR
interviewer took the liberty of directing the client’s attention to such mo-
ments). Watson was the IPR interviewer of the clients of the other two
therapists, whereas I interviewed her two clients.
The grounded theory analysisof the clients’reports led to the conceptu-
alization of a core category titled Inquiry Into Self. This category was under-
stood to have two main properties: client operations and session momentum.

132 DAVlD L. RENNlE

Client operations was understood to subsume: (a) symbolic representation
of experience, (b) reflexive self-examination, (c) making new realizations,
and (d) revisioning self. Session momentum was interpreted to have two
properties, positive and negative (Watson & Rennie, 1994).
In terms of their operations when in the role of clients, the interviewees
reported that, once they began to comply with the therapist’s directive to
recall as vividly as possible the details of the problematic event, they found
themselves faced with the need to articulate adequately their experience.
It was important to use the right words. They attempted to match the
words they were using against the visual images and felt-senses they were
experiencing while recollecting the event. While trying to make sense of
their experience, they came to new realizations about themselves. Further-
more, when the exploratory process went well, they came to see themselves
and their relationship with others in a new light. This was an achievement
that connected in complex ways with the resolution of the problematic
reaction.
Regarding the second main category, session momentum, it was evident
from the interviewees’ reports that complying with the task was not always
easy. Compliance meant that they had to deal with their experience in the
therapist’s way, not their way, and it was necessary to get involved in the
task before it began to work for them. Watson and Greenberg (1994)
interpreted this aspect in terms of the concept of the working alliance as
advanced by Bordin ( 1979). Within this interpretation, they generalized
the experience of being confronted with the task of resolving problematic
reactions to the several tasks developed in process-experiential therapy
(e.g., two-chair work as a way of resolving conflicts involved in unfinished
business; see Greenberg et al., 1993).Watson found that most of the clients
deferred to the therapist’s judgment. In their deference, some experienced
an initial period of adjustment but found themselves, with growing excite-
ment and momentum, engaged in a path to clarification and resolution of
their disturbance. Alternatively, others had difficulty with the task, com-
plaining that the therapist’spressing for the details of the problematic event
got in the way of their preferred way of dealing with it. Watson and Greenberg
(1994) pointed out that in work of this sort it is important to distinguish
between the task and the bond components of the working alliance and to
give priority to the latter. Thus, it is best to make metacommunicative
probes into the state of the bond to ascertain willingness to engage in the
task, as a way of ascertaining when the client is ready to begin in the task
work. In this way, the working alliance is maintained.
On the whole, Watson’s study (Watson & Greenberg, 1994; Watson
& Rennie, 1994) led to the understanding that clients’ participation in the
activity of dealing with their problematic reactions is more complex than
has been outlined by the performance model advanced by Rice and Saperia

EXPERIENCING PSYCHOTHERAPY 133

(1984), based on analysis of the discourse between the client and the
therapist. As discussed by Watson and her colleagues, this finding is not
surprising in the sense that much of what clients experience in therapy is
covert. Thus, it is not to be expected that such activities are revealed
through the discourse with the therapist. Instead, to access them, one must
obtain clients’ reports on their inner experience.

IMPLICATIONS OF THE RESEARCH FOR

THE PRACTICE OF PSYCHOTHERAPY

As seen throughout, the above studies accessed the experience of

psychotherapy-usually the client’s experience but at times the therapist’s
as well. The studies were thus close to the actual practice of therapy and,
accordingly, shed new light on practice. Although what follows is not in
any way meant to be completely representative of the implications that
may be drawn from these studies, seven main points are presented:
1. Although the characterization is not total by any means, cli-
ents in therapy are self-aware agents. Their agency is engaged
when they match their experience against their sense of the
therapist’s understanding of it and act in terms of their sense
of their best interests in the light of this complex evaluation.
This understanding of the active role clients play in the con-
duct of therapy reinforces and elucidates Carl Rogers’s and
the existential-humanistic therapists’ prizing of clients’ self-
determination. It also imposes a constraint on the tenability
of attempts to develop “causal” therapist-driven performance
models of change. Clients will always respond in their own
ways to the tasks assigned by the therapist, and it is difficult
if not impossible for any model of change to take into account
the myriad options available to clients by virtue of their agency.
Thus, the most that could be expected from a model of change
is a gross estimation of change. Looking at this matter another
way, a plausible explanation for the well-known finding that
there are surprisingly few differences among the outcomes of
various approaches to therapy is that clients creatively use
whatever approach is applied to them (see Bohart & Tall-
man, 1996).
2. On the other side of the coin, the reports given by the clients
and former clients in these studies have indicated consistently
that they felt they benefited from their therapist’s agency

134 DAVID L. RENNlE

 so long as it was compatible with their own. Indeed, some
participants indicated that the therapist’s agency was in keep-
ing with their ideal agency and that they consequently forced
themselves to comply with the therapist’s agency. This under-
standing thus supports the existential-humanistic and feminist
emphases on real encounter. It also supports the process-
directivenessof the experiential therapies, provided this direc-
tiveness is consistently and sensitively negotiated. By the same
token, experiential therapists are especially called on to be
alert to the nuances of the working alliance; the same point
reasonably seems generalizableto any structuring/interventive/
interpretive approach to therapy.
3. The client’s relationship with the therapist is crucial. Clients
evidently pay much more attention to the relationship with
the therapist than to the therapist’s techniques. Indeed, it is
evident from these studies that technique is often inseparable
from the relationship with the therapist. This point is almost
a hallmark of Schneider’s (1985) study, but it is borne out in
a variety of ways in the other studies as well. This revelation
by clients supports the emphasis given by humanistic therapists
to the therapeutic relationship and, within it, the importance
of congruence and transparency. It also suggests’ however,
that humanistic therapists need not be concerned that tech-
nique gets in the way of contact with the client: The results
from these studies suggest that technique is taken in stride by
clients so long as it is in keeping with their experience and
is used in a good working relationship. Accordingly, it seems
appropriate for the therapist to probe metacommunicatively
into the status of the alliance from time to time.
4. Clients’ experience is often covert. Although it is often the
case that the client’s thoughts are at one with his or her
discourse, it is also true that the client has thoughts that are
not expressed. Moreover, this privacy may occur in the best
of working alliances. Even these alliances do not require the
client to be completely transparent. The right to privacy is
taken for granted by partners in other kinds of relationships,
and a psychotherapy relationship is no exception. The exercise
of this right to privacy has obvious implicationsfor psychother-
apy research involving the study of discourse in psychotherapy.
It also underscores the importance of signs of covert experi-
ence, such as the paralinguistic aspects of the discourse and
body language, as every skillful practitioner knows so well.

EXPERIENCING PSYCHOTHERAPY 135

 These studies thus give compelling evidence of the potential
gains to be made from sensitive initiatives that probe beneath
the unspoken.
5 . Clients have a strong tendency to defer to the therapist’s
authority. Clients may rail inwardly against any approach,
depending on their preferences, without letting the therapist
know about their discontent because of the power dynamics
entailed in the relationship with the therapist. Again, this
understanding underscores the importance of not taking for
granted that the therapy is going well and of checking on how
the client experiences the relationship, from time to time, in
a way designed to defuse the power differential between the
client and therapist.
6. Clients appear to experience storytelling as beneficial. More-
over, the benefits are in many ways experienced privately.
This understanding sheds a new light on the role of storytelling
in therapy. The activity can easily be viewed by therapists as
superficial, leading them to want to shift clients into a more
“direct” way of dealing with their experience. Instead, it ap-
pears that therapists might do better to be patient with story-
telling: In the best of circumstances, a story may be used rather
deliberately by the client as a way of entering into a more
direct focus on disturbing experience. Alternatively, at worst,
even if a story is used defensively, productive returns may flow
from the activity, despite the client’sintention to the contrary.
As seen, this may be the case because clients may “see through”
their own defensiveness while they are engaged in it, thereby
achieving insight despite their desire to avoid it.
7. Overall, then, clients’ reflexivity, covert experience,sensitivity
to the therapeutic relationship, and deference to the therapist
all point to the importance of accessing the client’s reactions
to the therapist’s manner and approach. As was concluded by
the authors of many of the above studies, the best way to
achieve this compatibility is by metacommunicating with the
client about the joint experience of the therapy. It needs to
be pointed out in this regard that metacommunication always
takes the client away from the direct experience of therapy
and so should be used sparingly. Still, as a way of getting on
track therapy that is off the rails, it seems indispensable once
it is realized that the derailing may be experienced only co-
vertly. This line of thinking is rather new for both person-
centered and process-experiential therapists. Carl Rogers

136 DAVlD L. RENNlE

 checked on whether or not he understood the client but
generally did not let the client in on what he, Rogers, was
up to, apart from conveying his general values and beliefs.
Alternatively, although the work of Watson and Greenberg
(1994) may mark a shift in direction, because of process-
experientialtherapists’ interest in getting at unreflected experi-
ence, they have tended to be skeptical of reflexivity in any
form, including metacommunication.
Some of these principles are exemplified by the following exchange
between one of my clients and myself. In reviewing the exchange after it
occurred, I judged that my responses involved four modes: (a) commentary
on the process in which the client seemed to be engaged in the moment
(process identification), (b) suggestions on how the client might proceed
in his inquiry into his experience (process direction), (c) metacommunica-
tion, and (d) empathic support. (For elaboration on these modes, see Rennie,
1998b.) The client was a male undergraduate, and the episode to follow
had to do with his concern about feeling tense in social situations (C
represents the client; T represents me, the therapist.)
T: I heard you say that you went to the group because of just one
person. (Empathy)
C: Just because I was friends.
T: I see. (Empathy)
C: I knew one person pretty casually.
T: Mm hm, I see. So then, it’s when you’re with people with whom
you’re not familiar that the pressure gets really intense. (Empathy)
C: Right.
T: Mm hm. (Empathy)
C: Where I feel real threatened.
T: Can you identify what it is about that, that’s so threatening? (Pro-
cess direction)
C: I want to look good in their eyes. I want me to look good.
T: Even though you don’t mean anything to them. (Empathy)
C: Yeah. I, uh, yeah.
T: You’re smiling at that. (Process identification)
C: Well, they do mean something to me. Not as a friend but (pause).
Huh! I don’t even know what they do. Maybe it’s just my own self-
esteem.
T: Would you like to examine that for a moment? (Process direc-
tion)
C: Uh. (pause)
T: Did the way I phrased that stop you? (Metacommunication)
C: Yeah.
T: Yeah. All right. Can I try again? (Metacommunication)

EXPERIENCING PSYCHOTHERAPY 137

 C: Sure.
T: How does self-esteem enter into it? (Empathy and tacit process
direction)
C: OK. That’s better (chuckles). Uh, well, there’s no reason why I
should want to look good in their eyes . . .
T: Mm hm. (Empathy)
C: . . .for any reason other than I should want them to see me as being
good. And the only reason why I should want them to see me as good
and intelligent, or whatever, is so I can feel better. Because if I really
felt I was good, then the threat wouldn’t be there. They wouldn’t see
it. If they wouldn’t see it, then that would be their mistake.
T: Mmmmf! (Empathy)
C So (unclear) reassurance.
T: Yeah. So we’re back again to, uh, defining yourself in terms of other
people’s expectations of you. (Process identification)
C Yeah. In this situation-it’s a threatening situation, and I think all
people would feel threatened. But I’m definitely kind of accentuating
it. (Pause)
T: So, does all consideration of that stop there, or does it lead to
anything? (Empathy and tacit process direction)
C: It leads to, again, the fact that I can recognize why I feel that way,
and what situations make me feel that way. If I could take the time to
think why I feel that way, it would again give me the choice of acting
in a role of acting as myself. In a situation where I feel threatened, the
important thing would be to think it through. That would give me the
choice. (Pause)
T: So (pause) I don’t know how to phrase this. What would be required
of you to be able to do that?Or how would you do that? (Metacommuni-
cation and process direction)
C: The first step would be to recognize when I feel that way.
T: When you feel threatened? (Empathy)
C: Right.
T: Yes. (Empathy)
C: And identify why.
T: Yes. Now let’s just stop there. (Process direction)
C: OK.
T: Could you go about identifying how you feel threatened? (Process di-
rection)
C: I know when I, uh-it’s a feeling in my stomach, I get a (pause)
T: Can you describe that feeling? (Process direction)
C: It’s like really intense butterflies. Really, uh (Pause).
T: Intense butterflies. Do you mean almost nauseous?
C: Mmm. Yeah (chuckles, then pauses) A little.
T: Not to the point where you want to throw up? (Empathy)
C: No. But (therapist interrupts)

I38 DAVID L. RENNIE

 T: It’s a churning. (Empathy)
C: Yeah, it’s a churning. It churns. I don’t feel nauseous but I do feel
sick to my stomach.
T: Mmm. It’s that strong. (Empathy)
C: Oh, yeah. Yeah. At times. Definitely.
T: That’s a pretty strong cue. (Empathy) (Rennie, 1998b)”
In an IPR interview of the client, conducted by a colleague, the client
positively appraised this exchange, remarking “It was really important and
it allowed me to focus and to be able to identify when I feel threatened
and how to deal with it” (Rennie, 1998b, p. 87). If one takes this remark
at face value, it would seem that the client had found the exchange useful.

CONCLUSION

The grounded theory studies reviewed in this chapter reveal that the
experience of therapy is rich and complex. On the one hand, clients appreci-
ate the guidance offered by their therapists so long as it is congruent with
expectations and aspirations. On the other hand, clients very actively use
the therapy interview as an occasion for their own work on themselves,
often carried out covertly. The studies also reveal that clients are finely
tuned to the nuances of the relationship with the therapist and often make
concessions to the therapist to keep the relationship intact.
These understandings have been derived from interpretations of re-
ported recollections of the conscious experience of therapy. Thus, the studies
are limited to what the participants were aware of and were willing to
disclose. For students of therapy who believe that the most important sources
of distress are beyond the reach of the client’s awareness, clients’ accounts
of their experiences would hold little interest. On this score, perhaps the
greatest significance of these grounded theory studies is that they serve as
a reminder that, apart from any unconscious mechanisms and processes
that may influence experience and conduct, the client’s consciousness is
also important.
Finally, the grounded theory method draws on intensive study of the
experience of individual participants in its attempt to derive an understand-
ing of what is common among them. It has been observed that this approach
to inquiry is similar to the one used by clinicians (Kvale, 1999; Maione &
Chenail, 1999; Rennie, 1994c) in that they, too, gather a general understand-
ing from a series of cases. It has also been observed that practitioners

*From Person-Centred Counselling: An E x i s t e n d Approach (pp. 84-86), by D.L. Rennie, 1998,

London: Sage. Copyright 1998 by Sage. Reprinted with permission.

EXPERIENCING PSYCHOTHERAPY 139

tend to disregard conventional research reports in favor of case studies and
theoretical works (see, e.g., Morrow-Bradley & Elliott, 1986). Reports of
grounded theory studies anchor general formulations in specific instances
of lived experience given in participants’ own words. Moreover, the results
of a grounded theory are conveyed in ordinary language rather than through
numerics, which makes the meaning of grounded theories studies more
immediate. Thus, clinicians may find that when compared with conventional
research reports grounded theory reports have more direct applicability, and
thus greater appeal. In this event, studies such as those reviewed in this
chapter may help to close the gap between research and practice-humanis-
tic or otherwise.

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