Can psychotherapists’ guidance affect patients’ personal autonomy? A consensual qualitative research study

Introduction: This multidisciplinary research project aims to explore the beliefs, attitudes, and experiences of psychotherapists from diverse theoretical orientations regarding therapeutic guidance (i.e., advice, suggestions, recommendations) and the impact on patients’ personal autonomy. It incorporates perspectives from clinical practice as well as deontological and moral philosophy. Methods: We interviewed a sample of 40 Italian psychotherapists (21 F: 19 M; mean age: 52.93; mean years of experience: 19.55) using a semi-structured interview format with 10 questions. The consensual qualitative research (CQR) method was employed to analyze the interview transcripts. Results: Analysis yielded five superordinate domains: i) “type of patient requests,” illuminating the kinds of requests patients make to therapists; ii) “emotions disclosed by the therapist,” revealing therapists’ responses to their own emotional activation; iii) “neutrality of the therapists” and iv) “directiveness of interventions,” which span a spectrum from neutral to directive approaches for safety or therapeutic strategy reasons; and v) “therapists’ view of personal autonomy,” examining therapists’ perspectives on the nature of patient autonomy within psychotherapy. Discussion: Striking a balance between therapeutic neutrality and directiveness proves more complex in practice than theory. While autonomy is upheld as a critical aim in psychotherapy, opinions diverge on the balance between independence and interdependence within concepts of autonomy. Clinicians often customize their level of directiveness to meet patient needs—particularly when therapeutic guidance's benefits overshadow risks to autonomy, especially in urgent situations or with specific patient characteristics. The study underlines the significance of interdisciplinary dialogue in understanding and navigating the ethical terrain of therapeutic guidance.