Agency-Enhancing Psychotherapy

a cross-therapy Approach

Agency-enhancing therapy is a set of values and approaches to intervention that can be brought to any psychotherapy orientation (see Levitt, 2026).  Using it, therapists support clients to develop confidence in their own ability to process their experiences and develop a sense of agency in solving problems in their lives.  Research has shown that agency has an positive effect on symptom change that is additive to the therapist-client bond (e.g., Huber et al., 2021; Jennissen et al., 2022).  Learning to effectively enhance patients' agency can strengthen these effects.

There are five central values and associated skills in which agency-enhancing therapists engage.  Agency-enhancing therapists value: 

1. Client-shaped interventions and so actively encourage clients to interpret therapists’ interventions and adapt them to their own contexts and needs as well as to propose their own therapy tasks (e.g., Bohart & Wade, 2013; Bohart & Tallman, 1999; Greaves et al., 2025; Levitt et al., 2016; Oddli & Rønnestad, 2012; Rennie, 2001; von der Lippe et al., 2017); 

2. Transformative moments of silent introspection, and so invite clients to reflect inwardly to contact their emotions, symbolize confusing experiences, and explore connections and insights, as well as inquire about silences in which clients are disengaged or concerned about the therapist’s perspective (e.g., Levitt et al., in press; Levitt, 2001, 2001, 2002; Levitt & Morrill, 2021, 2023; Pascual-Leone & Yeryomenko, 2017); 

3. Holistic pattern exploration because although agency-enhancing therapists often teach clients to recognize patterns in one modality, clients make change across them, and so therapists encourage clients to gradually consider problematic patterns as they influence emotion, cognition, interpersonal relationship, behavior, and power structures (e.g., Levitt et al., 2016; Rennie, 2004; Rosenbaum & Bohart, 2021);

4. The reduction of constraining power dynamics and so address both the cultural and professional expectations that clients and therapists bring to therapy as well as the ways they interact (e.g., Levitt et al., 2022; Levitt & Morrill, 2026; Levitt & Whelton, 2024; McCrory, 2022; Rennie, 1994); 

5. The promotion of client agency and self-healing in goal setting and so therapists encourage clients to consider and direct their self-development goals and check in with clients often to support a responsive therapy practice (e.g., Bohart, 2000, 2001; Broz & Klitmøller, 2025; Levitt et al., 2016; Rennie, 1994; Williams & Levitt, 2007).  

For descriptions of how to adopt an agency-enhancing framework in multiple approaches to therapy, see Levitt, in press; Levitt et al., 2019 and for examples see references below).  The references below include descriptions of agency-enhancing therapy specifically with clients with psychosis (Avdi et al., 2015; Hasson-Ohayon et al., 2017; Morey, 2008) borderline personality (Lind et al., 2019) or trauma histories (Beaudoin et al., 2022; Pierorazio & Levitt, in press) as well as other issues. To learn about a measure that can be used in assessing nonsymptom outcomes that clients' value in psychotherapy, including the agency-enhancing process, see Levitt et al., 2024). 

Bibliography Of Writings and research on Agency-Enhancing therapy

Anderson, T., & Perlman, M. R. (2022). Therapist and client facilitative interpersonal skills in psychotherapy. In The other side of psychotherapy: Understanding clients’ experiences and contributions in treatment. (pp. 99–124). American Psychological Association. https://doi.org/10.1037/0000303-005

Avdi, E., Lerou, V., & Seikkula, J. (2015). Dialogical features, therapist responsiveness, and agency in a therapy for psychosis. Journal of Constructivist Psychology, 28(4), 329–341. https://doi.org/10.1080/10720537.2014.994692

Beaudoin, M.-N. (2022). Agency and choice in the face of trauma: A narrative therapy map. Journal of Systemic Therapies, 41(4), 67–85. https://doi.org/10.1521/jsyt.2022.41.4.67

Bohart, A. C. (2000). The client is the most important common factor: Clients’ self-healing capacities and psychotherapy. Journal of Psychotherapy Integration, 10(2), 127–149. https://doi.org/10.1023/A:1009444132104

Bohart, A. C. (2001). A meditation on the nature of self-healing and personality change in psychotherapy based on Gendlin’s theory of experiencing. The Humanistic Psychologist, 29(1–3), 249–279. https://doi.org/10.1080/08873267.2001.9977016

Bohart, A. C., & Tallman, K. (2022). Client expertise: The active client in psychotherapy. In The other side of psychotherapy: Understanding clients’ experiences and contributions in treatment. (pp. 13–43). American Psychological Association. https://doi.org/10.1037/0000303-002

Bohart, A. C., & Tallman, K. (1999). How clients make therapy work:The process of active self-healing. American Psychological Association. https://doi.org/10.1037/10323-000

Bohart, A. C., & Tallman, K. (2010). Clients: The neglected common factor in psychotherapy. In The heart and soul of change: Delivering what works in therapy., 2nd ed. (pp. 83–111). American Psychological Association. https://doi.org/10.1037/12075-003 

Bohart. A. C., & Wade, A. G. (2013). The Client in Psychotherapy. In M. J. Lambert (Ed.), Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change (6th ed., pp. 219-257). John Wiley & Sons, Inc.

Boswell, J. F., & Scharff, A. (2022). Client-focused assessment and intervention: Tailoring the work to the client. In The other side of psychotherapy: Understanding clients’ experiences and contributions in treatment. (pp. 235–263). American Psychological Association. https://doi.org/10.1037/0000303-009

Broz, A. S., & Klitmøller, J. (2025). Beyond the medical-contextual binary: Recentring client agency through epistemic shifts in perspective and context. Journal of Contemporary Psychotherapy: On the Cutting Edge of Modern Developments in Psychotherapy. https://doi.org/10.1007/s10879-025-09706-5

Coleman, R. A., & Neimeyer, R. A. (2015). Assessment of subjective client agency in psychotherapy: A review. Journal of Constructivist Psychology, 28(1), 1–23. https://doi.org/10.1080/10720537.2014.939791

Constantino, M. J., Gaines, A. N., & Coyne, A. E. (2022). Clients’ own perspectives on psychotherapy outcomes and their mechanisms. In The other side of psychotherapy: Understanding clients’ experiences and contributions in treatment. (pp. 317–349). American Psychological Association. https://doi.org/10.1037/0000303-012

Fuertes, J. N. (2022). The other side of psychotherapy: Understanding clients’ experiences and contributions in treatment. American Psychological Association. https://doi.org/10.1037/0000303-000

Frankel, Z. F., & Levitt, H. M. (2006). Postmodern strategies for working with resistance: Problem resolution or self-revolution? Journal of Constructivist Psychology, 19, 219-250. https://doi.org/10.1080/13854040600689141     

Frankel, Z.  F., & Levitt, H. M. (2009). Clients’ experiences of disengaged moments in psychotherapy: A grounded theory analysis.  Journal of Contemporary Psychotherapy, 39, 171-186. https://doi.org/10.1007/s10879-008-9087-z  

Gelso, C. J., & Kline, K. V. (2022). The client’s function in the psychotherapy relationship: What clients experience and contribute. In The other side of psychotherapy: Understanding clients’ experiences and contributions in treatment. (pp. 205–233). American Psychological Association. https://doi.org/10.1037/0000303-008

Geraghty, A. W. A., Wood, A. M., & Hyland, M. E. (2010). Dissociating the facets of hope: Agency and pathways predict dropout from unguided self-help therapy in opposite directions. Journal of Research in Personality, 44(1), 155–158. https://doi.org/10.1016/j.jrp.2009.12.003

Gibson, K., & Cartwright, C. (2013). Agency in young clients’ narratives of counseling: “It’s whatever you want to make of it”. Journal of Counseling Psychology, 60(3), 340–352. https://doi.org/10.1037/a0033110

Goodyear, R. K., & Sera, H. (2022). Clients’ influence on psychotherapists and the treatment they provide. In The other side of psychotherapy: Understanding clients’ experiences and contributions in treatment. (pp. 295–316). American Psychological Association. https://doi.org/10.1037/0000303-011

Greaves, A. (2022). Clients’ agentic and self-healing activities in psychotherapy. In The other side of psychotherapy: Understanding clients’ experiences and contributions in treatment. (pp. 159–201). American Psychological Association. https://doi.org/10.1037/0000303-007

Greaves, A., Levitt, H. M., Fuertes, J. Goodyear, R., Cruz Oliveira, J. T. T, Hand, A. B., & Sera, H. (2025). Prioritizing the central role of clients: Identifying and working with clients’ capacities and contributions in psychotherapy.  Counselling Psychology Quarterly. Advance online publication. https://doi.org/10.1080/09515070.2025.2572567 

Hasson-Ohayon, I., Arnon-Ribenfeld, N., Hamm, J. A., & Lysaker, P. H. (2017). Agency before action: The application of behavioral activation in psychotherapy with persons with psychosis. Psychotherapy, 54(3), 245–251. https://doi.org/10.1037/pst0000114

Hoener, C., Stiles, W. B., Luka, B. J., & Gordon, R. A. (2012). Client experiences of agency in therapy. Person-Centered and Experiential Psychotherapies, 11(1), 64–82. https://doi.org/10.1080/14779757.2011.639460

Huber, J., Jennissen, S., Nikendei, C., Schauenburg, H., & Dinger, U. (2021). Agency and alliance as change factors in psychotherapy. Journal of Consulting and Clinical Psychology, 89(3), 214–226. https://doi.org/10.1037/ccp0000628 

Jenkins, A. H. (1997). Free will and psychotherapy: The enhancement of agency. Journal of Theoretical and Philosophical Psychology, 17(1), 1–12. https://doi.org/10.1037/h0091158

Jennissen, S., Huber, J., Nikendei, C., Schauenburg, H., & Dinger, U. (2022). The interplay between agency and therapeutic bond in predicting symptom severity in long-term psychotherapy. Journal of Counseling Psychology, 69(4), 506–517. https://doi.org/10.1037/cou0000602

Kannan, D., & Levitt, H. M. (2009).  Challenges facing the developing feminist psychotherapist.  Women and Therapy, 32, 406-422. http://doi.org/10.1080/02703140903153377  

Levitt, H. M. (In press).  The shift to agency-enhancing therapy from theoretical orientation-focused therapy: A transtheoretical integration of key findings on clients’ experiences and contributions. In the Autobiographical Reflections Series in the Journal of Contemporary Psychotherapy. https://doi.org/10.1007/s10879-026-09717-w 

Levitt, H.  (2002). Voicing the unvoiced:  Narrative formulation and silences. Journal of Counseling Psychology Quarterly, 15, 333-350. http://doi.org/10.1080/0951507021000029667 

Levitt, H. M.  (2001).  Clients’ experiences of obstructive silence: Integrating conscious reports and analytic theories.  Journal of Contemporary Psychotherapy, 31(4), 221-244. http://doi.org/10.1023/A:1015307311143 

Levitt, H. M. (2001).  The sounds of silence in psychotherapy: The categorization of clients’ pauses.  Psychotherapy Research, 11(3), 295-309. http://doi.org/10.1080/713663985 

Levitt, H. M., Butler, M., & Hill, T. (2006).  What clients find helpful in psychotherapy:  Principles for facilitating change.  Journal of Counseling Psychology, 53(3), 314-324. http://doi.org/10.1037/0022-0167.53.3.314  

Levitt, H. M., Collins, K. M., Morrill, Z., Gorman, K. R., Ipekci, B., Grabowski, L., Karch, J., Kurtz, K., Orduña Picón, R., Reyes, A., Vaswani-Bye, A., & Wadler, B. (2022). Learning clinical and cultural empathy: A call for a multidimensional approach to empathy-focused psychotherapy training. Journal of Contemporary Psychotherapy: On the Cutting Edge of Modern Developments in Psychotherapy, 52(4), 267–279. https://doi.org/10.1007/s10879-022-09541-y 

Levitt, H. M., Collins, K. M., Rizo, J. L., & Hand, A. (2022).  Why clients’ experiences of psychotherapy should direct the training of therapists’ skills and a re-thinking of responsiveness.  In J. N. Fuertes (Ed.), The Other Side of Psychotherapy: Understanding Clients’ Experiences and Contributions in Treatment  (pp. 266- 294). American Psychological Association. 

Levitt, H., Frankel, Z., Hiestand, K., Ware, K., Bretz,, K., Kelly, R., McGee, S., Nordtvedt, R., & Raina, K. (2004). The transformative experience of insight: A life-changing event. Journal of Constructivist Psychology, 17, 1-26. http://doi.org/10.1080/10720530490250660 

Levitt, H. M., Grabowski, L. M., Minami, T., & Morrill, Z. (2024). An initial validation of the Clients’ Experience of Therapy Scale (CETS): Assessing the quality of psychotherapy process and outcome from clients’ perspectives. Counselling Psychology Quarterly, 37(1) 112-136. http://dx.doi.org/10.1080/09515070.2023.2191171   

Levitt, H. M., & Morrill, Z. (2023). Silences in psychotherapy: An integrative meta-analytic research review. Psychotherapy, 60(3), 320-341. https://dx.doi.org/10.1037/pst0000480  

Levitt, H. M., & Morrill, Z. (2023).  Silence.  In C. E. Hill & J. C. Norcross (Eds.), Psychotherapy Skills and Methods That Work (pp. 281-326).  American Psychological Association. 

Levitt, H. M. & Morrill, Z. (2026).  Elements of power in humanistic and existential therapy.  In L. Hoffman (Ed.), APA Handbook of humanistic and existential psychology (Vol. 2: Clinical and social applications), pp. 335-350. APA Books. 

Levitt, H. M. & Morrill, Z. (2021). Measuring silence: The pausing inventory categorization system and a review of findings (pp. 233-250). In Michael Buchholz & Aleksandar Dimitrijevic (Eds.), Silence and silencing in psychoanalysis: Cultural, clinical and research perspectives. New York: Routledge.

Levitt, H. M., Piazza-Bonin, E. (2011). Therapists’ and clients’ significant experiences underlying psychotherapy discourse.  Psychotherapy Research, 21, 70-85. http://doi.org/10.1080/10503307.2010.518634 

Levitt, H. M. & Piazza-Bonin, E. (2016). Wisdom and psychotherapy: Studying expert therapists’ clinical wisdom to explicate common processes. Psychotherapy Research, 26(1), 31-47.  http://doi.org/10.1080/10503307.2014.937470.  

Levitt, H. M. & Piazza-Bonin, E. (2017). The professionalization and training of psychologists: The place of clinical wisdom.  Psychotherapy Research, 27(2), 127-142. http://dx.doi.org/10.1080/10503307.2015.1090034 

Levitt, H. M., Pomerville, A. & Surace, F. I. (2016). A qualitative meta-analysis examining clients’ experiences of psychotherapy: A new agenda.  Psychological Bulletin, 142(8), 801-830.  http://dx.doi.org/10.1037/bul0000057  

Levitt H. M. & Rennie, D. L. (2004). The act of narrating: Narrating activities and the intentions that guide them.  In L. Angus & J. McLeod (Eds.), The Handbook of Narrative and Psychotherapy: Practice, Theory and Research (pp. 299-314).  Thousand Oaks, CA: Sage. ISBN: 9780761926849

Levitt, H. M., Rizo, J. L., Pierorazio, N. A. (In press). The Pausing Inventory Categorization System.  In H. Westra, C. Eubanks, & T. Boritz (Eds.), Developing Process Sensitivity: A Transtheoretical Path to Improving Psychotherapy Training.  APA Books.

Levitt, H. M., & Whelton, W. J. (2024). On the need to reconcile cultural and professional power in psychotherapy: Humanistic principles that are foundational for feminist multicultural practice. The Humanistic Psychologist, 52(2), 137–162. https://doi.org/10.1037/hum0000327  

Levitt, H. M., Whelton, W. J., & Iwakabe, S. (2019).  Integrating Feminist-Multicultural Perspectives into Emotion-Focused Therapy.  In L. Greenberg & R. Goldman (Eds.), Clinical Handbook of Emotion-Focused Therapy (pp. 425-444).  Washington, DC: American Psychological Association. ISBN: 978-1-4338-2977-2

Levitt, H. M. & Williams, D. C. (2010). Facilitating client change:  Principles based upon the experiences of eminent psychologists. Psychotherapy Research, 20, 337-352. http://doi.org/10.1080/10503300903476708 

Lind, M., Jørgensen, C. R., Heinskou, T., Simonsen, S., Bøye, R., & Thomsen, D. K. (2019). Patients with borderline personality disorder show increased agency in life stories after 12 months of psychotherapy. Psychotherapy, 56(2), 274–284. https://doi.org/10.1037/pst0000184 

Mackrill, T. (2009). Constructing client agency in psychotherapy research. Journal of Humanistic Psychology, 49(2), 193–206. https://doi.org/10.1177/0022167808319726

Madill, A., & Doherty, K. (1994). “So you did what you wanted then”: Discourse analysis, personal agency, and psychotherapy. Journal of Community & Applied Social Psychology, 4(4), 261–273. https://doi.org/10.1002/casp.2450040406 

Mallinckrodt, B. (2022). Clients’ experiences of attachment in the psychotherapy relationship. In The other side of psychotherapy: Understanding clients’ experiences and contributions in treatment. (pp. 125–158). American Psychological Association. https://doi.org/10.1037/0000303-006

Marecek, J., & Kravetz, D. (1998). Power and agency in feminist therapy. In Feminism and psychotherapy: Reflections on contemporary theories and practices. (pp. 13–29). Sage Publications, Inc.

Marmarosh, C. (2022). Clients’ experiences of therapy ending. In The other side of psychotherapy: Understanding clients’ experiences and contributions in treatment. (pp. 351–378). American Psychological Association. https://doi.org/10.1037/0000303-013

McCrory, M. (2022). Theorising agency for socially just career guidance and counselling scholarship and practice. British Journal of Guidance & Counselling, 50(4), 503–514. https://doi.org/10.1080/03069885.2022.2026881

Moltu, C., Binder, P.-E., & Stige, B. (2012). Collaborating with the client: Skilled psychotherapists’ experiences of the client’s agency as a premise for their own contribution in difficult therapies ending well. Journal of Psychotherapy Integration, 22(2), 85–108. https://doi.org/10.1037/a0028010

Morey, C. M. (2008). Impaired agency in schizophrenia: Family therapy with a young adult patient. Journal of Family Psychotherapy, 19(4), 345–357. https://doi.org/10.1080/08975350802475080

Nikzad, A. H., Lysaker, P. H., Minor, K. S., Leonhardt, B., Liberman, M. Y., Vohs, J., Wiesepape, C. N., & Tang, S. X. (2025). Evolution of linguistic markers of agency, centrality and content during metacognitive therapy for psychosis: A pilot exploratory study. Early Intervention in Psychiatry, 19(1). https://doi.org/10.1111/eip.13628 

Norcross, J. C., Cook, D. M., & Fuertes, J. N. (2022). Patient readiness to change: What we know about their stages and processes of change. In The other side of psychotherapy: Understanding clients’ experiences and contributions in treatment. (pp. 73–97). American Psychological Association. https://doi.org/10.1037/0000303-004

Oddli, H. W., & Rønnestad, M. H. (2012). How experienced therapists introduce the technical aspects in the initial alliance formation: Powerful decision makers supporting clients’ agency. Psychotherapy Research, 22(2), 176–193. https://doi.org/10.1080/10503307.2011.633280

Oliveira, J. T., Gómez-Penedo, J. M., & Holtforth, M. grosse. (2022). Understanding and enhancing client motivation. In The other side of psychotherapy: Understanding clients’ experiences and contributions in treatment. (pp. 45–71). American Psychological Association. https://doi.org/10.1037/0000303-003

Pascual-Leone, A., & Yeryomenko, N. (2017). The client “experiencing” scale as a predictor of treatment outcomes: A meta-analysis on psychotherapy process. Psychotherapy Research, 27(6), 653–665. https://doi.org/10.1080/10503307.2016.1152409 

Rennie, D. L. (1994). Clients’ deference in psychotherapy. Journal of Counseling Psychology, 41(4), 427–437. https://doi.org/10.1037/0022-0167.41.4.427

Rennie, D. L. (2001). The client as a self-aware agent in counselling and psychotherapy. Counselling & Psychotherapy Research, 1(2), 82–89. https://doi.org/10.1080/14733140112331385118

Rennie, D. L. (2004). Reflexivity and person-centered counseling. Journal of Humanistic Psychology, 44(2), 182–203. https://doi.org/10.1177/0022167804263066 

Rosenbaum, R., & Bohart, A. (2021). Mindfulness is full engagement. The Humanistic Psychologist, 49(1), 122–132. https://doi.org/10.1037/hum0000166

Rubenfeld, S. (2003). Encouraging Personal Agency in Analytic Group Therapy. Group Analysis, 36(3), 391–406. https://doi.org/10.1177/05333164030363012

Shulman, J. L., Horne, S. G. & Levitt, H. M. (2003).  To pass or not to pass: Exploration of conflict splits for Bisexual-Identified clients (pp. 32-36).  In J.S. Whitman and C. J. Boyd (Eds.), The therapist's notebook for Lesbian, Gay and Bisexual clients.  Bingham, NY: Haworth Press. ISBN: 0789012529

Stringer, J. V., Levitt, H. M., Berman, J. S., & Mathews, S. S. (2010). A study of silent disengagement and distressing emotion in psychotherapy. Psychotherapy Research, 20, 495-510. http://doi.org/10.1080/10503301003754515 

von der Lippe, A. L., Oddli, H. W., & Halvorsen, M. seeger. (2019). Therapist strategies early in therapy associated with good or poor outcomes among clients with low proactive agency. Psychotherapy Research, 29(3), 383–402. https://doi.org/10.1080/10503307.2017.1373205

Wahlström, J., & Seilonen, M.-L. (2016). Displaying agency problems at the outset of psychotherapy. European Journal of Psychotherapy & Counselling, 18(4), 333–348. https://doi.org/10.1080/13642537.2016.1260616

Wahlström, J. (2023). Person references, change in footing, and agency positioning in psychotherapeutic conversations. Frontiers in Psychology, 14. https://doi.org/10.3389/fpsyg.2023.1206327

Whelton, W. J. & Levitt H. M. (In press). Humanistic psychotherapy, agency and flourishing.  In J. Owen & S. Sandage (Eds.), Addressing suffering and flourishing in psychotherapy. APA Books.

Williams, D. C., & Levitt, H. M. (2008). Clients’ experiences of difference with therapists: Sustaining faith in psychotherapy.  Psychotherapy Research, 18, 256-270. http://doi.org/10.1080/10503300701561545 

Williams, D. C. & Levitt, H. M.  (2008). When constructs collide: Constructivist research on when and how to challenge clients.  In J. D. Raskin & S. K. Bridges (Eds.) Studies in Meaning III.  Pace University Press. ISBN: 0944473865

Williams, D. C. & Levitt, H. M. (2007). Principles for facilitating agency in psychotherapy. Psychotherapy Research, 17(1), 66-82.  http://doi.org/10.1080/10503300500469098  

Yao, X., Dong, B., & Ji, W. (2022). Formulation and clients’ agency in cognitive behavioral therapy. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.810437