Constructions of Nonagency in the Clients’ Initial Problem Formulations at the Outset of Psychotherapy

Abstract

This multiple case study investigated how clients construct nonagentic positions when formulating their problems in the beginning of their first psychotherapy session. The initial problem formulations of nine clients entering psychotherapy were analyzed with a detailed model drawing on discursive methodology, the 10 Discursive Tools model (10DT). We found ten problem formulation categories, each one distinguished by the tool from the 10DT model primarily used to construct nonagency. All clients gave several problem formulations from different categories and constructed nonagentic positions with a variety of discursive tools. When the resulting problem formulation categories were read in comparison with the descriptions of the client’s stance at the outset of psychotherapy as presented in two change process models, the Assimilation of Problematic Experiences Sequence and the Innovative Moments Coding System, some similarities were found. However, the 10DT model brought out much variation in the client’s nonagentic positioning in the formulations, forming a contrast with the more simplified presentations of the client’s initial nonagency given in the change process models. Therapists should pay close attention to how clients express their sense of lost agency at the outset of psychotherapy and how this positions both the client and the therapist as future collaborators in psychotherapy.