Motivation. Psychotherapy is sometimes a
lengthy and arduous process. It demands much
from a patient. It can be fraught with anxiety, set-
backs, and periods of a seeming absence of progress.
Most of the work occurs outside of the therapy
room through homework and challenging exercise
that occur between therapy sessions. These exer-
cises may demand that the patient engage in new
behaviors that will provoke anxiety. For these and
other reasons, successful psychotherapy seems to
require motivation.
At some level, the patient must want psycho-
therapy (though there are times during psychother-
apy when even highly motivated patients want
out). It follows, then, that psychotherapy is a vol-
untary process. One cannot be forced into it. When
people are forced, either openly or subtly, to
become patients, they rarely profit from the expe-
rience. Therapy is not likely to be of much benefit
to the prisoner who seeks therapy to impress a
parole board; to the college student who, following
a marijuana charge, is given the option of reporting
to a counseling center or facing the prospect of jail;
or to the person who undergoes therapy to protect
an insurance claim.
Despite the conventional wisdom that cites cli-
ent motivation as a necessary condition for positive
change, research support is mixed (Garfield, 1994).
One methodological problem concerns how best to
assess client motivation. Studies vary widely in how
they attempt to measure motivation. For example,
Yoken and Berman (1987) used client payment for
services as an index of client motivation. Finding
relatively little difference in outcome between cli-
ents who paid the standard fees for services and
those whose fees were waived, Yoken and Berman
(1987) concluded that motivation appears unrelated
to outcome. The lack of definitive findings, how-
ever, may simply reflect the difficulty researchers
have experienced in defining and measuring client
motivation.
Openness. Most therapists intuitively attach a bet-
ter prognosis to patients who seem to show some
respect for and optimism about the utility of psycho-
therapy. They are relieved when patients are willing
to see their problems in psychological rather than
medicalterms.Suchpersonscanbemoreeasily
“taught to be good psychotherapy patients,”in con-
trasttopatientswhoviewtheirdifficultiesassymp-
toms that can be cured by an omniscient,
authoritative therapist while they passively await the
outcome. Thus, a kind of“openness”to the thera-
peutic process appears to make the patient a better
bet for therapy (Zinbarg, Uliaszek, & Adler, 2009).Gender. What is the relationship between the
outcome of therapy and the gender of the patient?
Many would hold that women do better in therapy
than do men. However, research does not support
the view that biological sex of the client is sig-
nificantly related to outcome in psychotherapy
(Clarkin & Levy, 2004; Garfield, 1994). Although
sex of the client has not been reliably linked to out-
come, it is probably true that sex or gender of the
therapist may be especially important to consider in
certain cases. For example, women rape victims may
feel much more comfortable talking to women psy-
chotherapists than to men psychotherapists.Race, Ethnicity, and Social Class. For years,
debate has raged over the effectiveness of therapy
for ethnic minority patients—especially when they
are treated by White therapists. It does appear that
many therapeutic techniques have been designed
and developed for White middle- and upper-class
patients. Too few procedures seem to take into
account the particular cultural background and
expectations of patients. Banks (1972) has suggested
that greater rapport and self-exploration may occur
when both therapist and patient are of the same
race. Others have reached the same conclusion
regarding social class, background, values, and
experience and have proposed that conventional
therapies be abandoned in favor of more supportive
techniques. Still, two decades of research have
seemingly failed to show conclusively that ethnic
minorities achieve differential treatment outcomes
(Sue, 1988; Sue, Zane, & Young, 1994; Zane, Hall,
Sue, Young, & Nunez, 2004).
Schofield (1964) described the psychothera-
pist’s belief in the ideal patient as the YAVISPSYCHOLOGICAL INTERVENTIONS 323