“The therapist responded to my coaching”: patients’ perspectives on coaching communications in psychotherapy

Patients in psychotherapy may inform, orient, and redirect their therapist according to their particular problems, goals, and needs––conceptualized by Control-Mastery Theory as the patient coaching the therapist. Yet there has been limited research on patients’ subjective experiences of engaging in coaching communication. This study used an online survey to obtain patients’ perspectives on the degree to which they coached their therapist and the effects and implications of having done so. Of 248 participants who had received psychotherapy, 123 provided text responses for qualitative analysis regarding their experience of coaching communication. Thematic analysis was employed to extract themes from these narratives. Major themes included the use of coaching to orient the therapist to desired goals and preferred intervention approaches, and to redirect the therapist when necessary. Themes regarding the impact of coaching included positive experiences when coaching was well received and negative experiences when therapists ignored the patient’s coaching. Findings from this preliminary investigation suggest that coaching communication may be an important feature of the therapeutic process for many patients, with implications for therapist responsiveness and therapy outcomes. Moreover, the findings indicate that patients’ coaching communication is a worthy subject for future psychotherapy research.