Title: A Qualitative Investigation of Psychotherapy Clients' Perceptions of Positive Regard
Description: This qualitative study aimed to investigate psychotherapy clients’ phenomenological experience of positive regard. Though positive regard is broadly accepted as a useful and effective clinical tool across orientations, it has been under-researched and overlooked in favor of more clearly conceptualized variables, such as empathy and working alliance. Designed as a follow-up to a quantitative study that yielded a tentative factor structure and inventory for measuring positive regard (Psychotherapist Expressions of Positive Regard, PEPR), the study also aimed to elucidate the extent to which those findings could be replicated in a qualitative format. Following Consensual Qualitative Research (CQR) methodology, 15 psychotherapy clients, primarily white women, participated in semi-structured interviews eliciting the factors that contribute to their experience of positive regard in therapy, the absence of positive regard in therapy, and the impact of positive regard on the course of psychotherapy.

Nine domains and several key findings emerged from the analysis. While clients named a wide range of therapist behaviors and actions that served as markers of positive regard in the relationship, three constituent attitudes appeared repeatedly throughout the CQR categories, suggesting an underlying tripartite structure of positive regard – warm authenticity, flexible responsiveness, and empathic understanding. Clients viewed positive regard as a crucial ingredient of therapy, suggesting that it facilitates self-disclosure, risk-taking, personal growth, and rupture resolution. In relationships where positive regard was lacking, clients became disengaged from treatment, and terminating without explanation was not uncommon. Clinical implications and recommendations for optimizing the experience of positive regard are offered. The substantial overlap and interdependence of positive regard with the other Rogerian facilitative conditions of congruence and empathy is discussed. Convergence and divergence between the PEPR factor structure and the results of the current study are also highlighted, with future directions proposed.