A qualitative analysis of client expressions of meaning in psychotherapy

Finding meaning has long been considered a critical component in human development and flourishing (Carlsen, 1991; Erikson, 1968; Frankl, 1959), but there has been relatively little qualitative research on how the meaning-making process occurs within psychotherapy. The purpose of this study was to explore therapy clients\u27 processes of making-meaning as well as the factors which hinder its resolution. Archival videotapes of 5 adult clients of diverse age, gender, ethnicity, religious/spiritual orientation and presenting issues were observed during their 3rd or 5th psychotherapy session at a university\u27s community counseling clinic. Employing a content analytic approach, the researchers used a modified version of the Change and Growth Experiences Scale (CHANGE; Hayes & Feldman, 2005) to code and examine client statements related to the meaning-making process. CHANGE codes included cognitive-emotional processing, unproductive processing, and historical antecedents. Results indicated that the process of making-meaning is complex and appears to occur on a continuum with insight and/or realization at one end of the spectrum and uncertainty and rumination at the other. One\u27s position on this continuum appeared to be affected, in part, by clients\u27 levels of rumination and uncertainty (the primary unproductive processing themes); for example, some clients\u27 expressions contained both unproductive processing and cognitive-emotional processing. The primary cognitive-emotional processing themes discovered across participants included: questioning, explaining, justifying, realization, reflecting, and mindreading. Further, our findings indicate a large social/interpersonal component to the meaning-making process, which is in accord with previous literature (Cacioppo, Hawkley, Rickett, & Masi, 2005; Debats, 1999; Mascaro & Rosen, 2005). Finally, examination of therapist questions preceding client coded statements found that a more open and non-direct therapy approach (i.e., asking open-ended questions; making empathic reflections/statements) was more likely to be followed by cognitive-emotional processing, than a more direct therapist approach (i.e., asking direct or closed-ended questions; giving advice; making interpretations). In order to further clarify the meaning-making process of clients in psychotherapy, more attention should be paid to microanalyses of verbal and non-verbal interactions between therapists and clients, including a consideration of variables found to be associated with meaning-making in this study (i.e., hope, avoidance, rumination, uncertainty, and past social interactions)