What Clients Actually Want: New Research Challenges Assumptions About Therapy Style

If you've been questioning whether your CBT approach is "too structured" or "not warm enough," new research offers surprising insights into what clients really prefer from their therapists.

Feb 13, 2025

The Evidence Gap

While we have robust research on CBT techniques and training in Socratic questioning, we've had less clarity on how clients actually want us to show up in the therapy room.

We know that adapting to clients' preferences leads to positive outcomes, including decreased dropout rates and overall improved treatment outcomes1.

But what do clients want?

A new study published in January 2025 explores this question with a qualitative analysis2.

Key Findings

Perhaps surprisingly, particularly for critics of CBT, clients preferred active, structured engagement - exactly what CBT offers. One participant specifically chose CBT for its guidance and structure, challenging the notion that a structured approach feels less therapeutic and ‘robotic’.

The study interviewed participants who had recently completed pluralistic therapy, revealing three key preferences:

1. Active Engagement

Clients did not want passive listeners. They wanted therapists who:

Actively participate rather than passively listen
Share expertise and perspectives
Challenge and guide

2. The Human Element

Despite preferring structure, clients still needed:

Approachability and warmth
Non-judgmental validation
Security from rejection fears

3. Flexibility Alongside The Above

However, clients also want:

Adaptation to individual needs
Responsiveness to changing situations
Space for organic development

The Protocol Paradox

As CBT therapists, we are navigating multiple needs.

On one side, we have robust protocols and evidence-based techniques that research shows are effective. On the other, we have individual clients with unique preferences and needs. This new research suggests we need to be pragmatic about this balance.

How do we reconcile these seemingly opposing needs?

Finding Middle Ground

Being pragmatic (and perhaps, pluralistic) doesn't mean abandoning CBT principles.

Instead, it means:

Using structure flexibly
Adapting protocols thoughtfully
Meeting clients where they are
Maintaining therapeutic goals while respecting preferences

The Art Within the Science

Perhaps this is where CBT becomes relies on clinician judgment and therapeutic skill - knowing when to hold firm to protocol and when to adapt.

The 2025 study offers clear guidance for clinical practice, but its implications go deeper than simple recommendations.

The research actually validates more directive aspects of CBT that therapists sometimes feel uncertain or anxiety about. The findings suggest we can:

Challenge with confidence, knowing many clients actively seek this
Set boundaries around unfocused discussion
Guide conversations back to therapeutic goals
Structure sessions without guilt, but remaining flexible

The participant group of the study was small, and therefore further research is needed, however, it gives an interesting insight into the minds of clients.