Date of Award


Document Type

Campus Access Dissertation


Educational Studies


Counselor Education

First Advisor

Kathy Evans


This study collected the perceptions of therapists on how they use continuous client feedback to alter, or adjust, psychotherapy. Recent quantitative research has demonstrated that continuous client feedback can improve client outcomes regardless of treatment modalities used (Anker, Duncan, and Sparks, 2009; Norsworthy, & Rowlands, 2009; Reese, Toland, Slone, & Norsworthy, 2010), but according to the literature, additional information was needed on how feedback works (Anker, Duncan, and Sparks, 2009). A qualitative, phenomenological study was chosen to further investigate how continuous client feedback works in the psychotherapy session. This study assessed the perceptions of five Scandinavian therapists who currently use continuous client feedback methods successfully (Jacobsen, 2007) at a treatment center in the Scandinavian country of Norway to discover how they use continuous feedback in psychotherapy. The study looked closely at what specific feedback these counselors were receiving from their clients, how the counselors were interpreting the feedback which they received, and how they translated this interpretation of the feedback into meaningful changes in the therapeutic approaches they used with the clients.

The results revealed seven themes including the two primary themes of client collaboration and counselor positional stance. The theme of counselor positional stance was comprised of five additional sub-themes, which were true acknowledgment of the client, prestige-free attitudes toward the client, trusting the client, flexibility in treatment, and willingness to negotiate therapy with the client. Overall, the results revealed how these seven themes served as a foundation for effective use of continuous client feedback in a clinical Scandinavian setting.