Qualitative exploration of negative experiences in counseling clients

doi:10.3724/SP.J.1041.2025.1216

Abstract

Abstract:

To explore the negative experiences of clients in psychological counseling in China, this study conducted semi-structured one-on-one interviews with 42 participants and performed phenomenological thematic analysis. The results indicate that the negative experiences of clients in psychological counseling include four themes:

The first is negative experiences related to the characteristics of the psychological counseling industry, including issues related to the nature of counseling itself and the developmental stage of the industry. The second is low therapist-client match, including mismatched styles, difficulty for clients to open up, and clients' aversion to the therapist. The third is negative experiences related to the therapist's competence, including dissatisfaction with the therapist's abilities, experience, attitude, approach to organizing counseling, and ethical concerns. The last is dissatisfaction with counseling outcomes, including unmet expectations, negative impacts caused by counseling, and clients' disappointment or decision to stop counseling.

In summary, issues such as cultural adaptability and the unequal power dynamics in counseling have a significant impact on clients' experiences. Clients ' dissatisfaction with the therapist's competence primarily centers on fundamental aspects of competence. Therapists should remain vigilant to clients' negative experiences. The study provides valuable insights for improving local psychological counseling practices and enhancing the quality of counseling.

Key words: psychological counseling, therapeutic alliance, therapist competence, cultural adaptability, thematic analysis

LI Muyang, LEI Ting, XIE Xie, GUO Zeyu, LIU Kexin, CHEN Wenqing, SUN Qinyi, DONG Yuntao, ZANG Yinyin. (2025). Qualitative exploration of negative experiences in counseling clients. Acta Psychologica Sinica, 57(7), 1216-1230.

Figures/Tables 2

References 55

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Characteristics	N (%)
Gender (Female proportion)	35 (83%)
Age
18~25	23 (55%)
26~35	16 (38%)
36~45	2 (5%)
≥46	1 (2%)
Counseling Location¹
Commercial Institution	38 (90%)
Hospital	11 (26%)
School	19 (45%)
Counseling Fee (Yuan)¹
Free	18 (43%)
1~199	11 (26%)
200~399	12 (29%)
400~599	12 (29%)
600~799	5 (12%)
800~999	2 (5%)
1000 or above	2 (5%)
unknown²	4 (10%)
Psychological Counseling Approach¹
Humanistic	16 (38%)
Cognitive Behavioral	14 (33%)
Psychoanalysis or Psychodynamic	30 (71%)
Sandplay Therapy	2 (5%)
Family Therapy	4 (10%)
Rational Emotive Therapy	1 (2%)
Hypnotherapy	1 (2%)
Other Approaches³	9 (21%)
Unclear Approach²	13 (31%)
Number of Counseling Sessions
1 Session	14 (33%)
2 Sessions	13 (31%)
3 Sessions	9 (21%)
4 Sessions	2 (5%)
5 Sessions or above	4 (10%)
Counseling Status	35 (83%)
Ongoing counseling, no completed sessions	6 (14%)
Ongoing counseling, with completed sessions	16 (38%)
All counseling completed	20 (48%)

Characteristics	N (%)
Gender (Female proportion)	35 (83%)
Age
18~25	23 (55%)
26~35	16 (38%)
36~45	2 (5%)
≥46	1 (2%)
Counseling Location¹
Commercial Institution	38 (90%)
Hospital	11 (26%)
School	19 (45%)
Counseling Fee (Yuan)¹
Free	18 (43%)
1~199	11 (26%)
200~399	12 (29%)
400~599	12 (29%)
600~799	5 (12%)
800~999	2 (5%)
1000 or above	2 (5%)
unknown²	4 (10%)
Psychological Counseling Approach¹
Humanistic	16 (38%)
Cognitive Behavioral	14 (33%)
Psychoanalysis or Psychodynamic	30 (71%)
Sandplay Therapy	2 (5%)
Family Therapy	4 (10%)
Rational Emotive Therapy	1 (2%)
Hypnotherapy	1 (2%)
Other Approaches³	9 (21%)
Unclear Approach²	13 (31%)
Number of Counseling Sessions
1 Session	14 (33%)
2 Sessions	13 (31%)
3 Sessions	9 (21%)
4 Sessions	2 (5%)
5 Sessions or above	4 (10%)
Counseling Status	35 (83%)
Ongoing counseling, no completed sessions	6 (14%)
Ongoing counseling, with completed sessions	16 (38%)
All counseling completed	20 (48%)

The theme structure of this study		Number of Reference Points	Number of Participants	Negative Experience of Western Participants¹
Theme	Sub-theme	Number of Reference Points	Number of Participants	Theme	Sub-theme
Negative Experiences Related to the Characteristics of the Psychological Counseling Industry				Poor Treatment Fit	Negative evaluation of practical aspects of therapy
	Negative experiences caused by the characteristics of psychological counseling	188	39		Lack of fit with the intervention
	Difficulties due to the insufficient development of the industry in China	174	37		Dissatisfaction with therapy ending
					Unmet expectations
Low Therapist- Client Match	Mismatch between the therapist's characteristics and the client's preferences	70	23	Hindering Aspects of the Relationship	Experiencing poor interpersonal match with the therapist
	Clients struggling to open up to the therapist	16	8		Experiencing distance and/or lack of empathy
	Clients feeling dislike or aversion toward the therapist	26	14		Experiencing insecurity or distrust
					Experiencing confusion or uncertainty
Negative Experiences Related to the Therapist’s Competence				Therapists’ Misbehavior	Therapist perceived as incompetent.
	Clients feeling the therapist is incompetent or lacking experience	91	35		Therapist not listening/ understanding
	Clients feeling the therapist's attitude was problematic	267	39		Therapist devaluing the client
	Clients feeling uncomfortable with the organizational management of the consultation	7	5		Therapist judging
	Violations of ethical standards by the therapist	113	35		Therapist using client for own benefit
					Other Inappropriate verbal reactions
Dissatisfaction with the Consultation Effect				Negative Impacts of Treatment	No change or insufficient change
	Unmet expectations	123	35		Increased problems after therapy
	Harmful effects of consultation	76	30		Feeling fear of the therapy process
	Disappointment with consultation or discontinuing therapy	22	14		Loss of motivation or hope
					Unpleasant feelings during therapy
					Negative cognitions aroused in therapy

The theme structure of this study		Number of Reference Points	Number of Participants	Negative Experience of Western Participants¹
Theme	Sub-theme	Number of Reference Points	Number of Participants	Theme	Sub-theme
Negative Experiences Related to the Characteristics of the Psychological Counseling Industry				Poor Treatment Fit	Negative evaluation of practical aspects of therapy
	Negative experiences caused by the characteristics of psychological counseling	188	39		Lack of fit with the intervention
	Difficulties due to the insufficient development of the industry in China	174	37		Dissatisfaction with therapy ending
					Unmet expectations
Low Therapist- Client Match	Mismatch between the therapist's characteristics and the client's preferences	70	23	Hindering Aspects of the Relationship	Experiencing poor interpersonal match with the therapist
	Clients struggling to open up to the therapist	16	8		Experiencing distance and/or lack of empathy
	Clients feeling dislike or aversion toward the therapist	26	14		Experiencing insecurity or distrust
					Experiencing confusion or uncertainty
Negative Experiences Related to the Therapist’s Competence				Therapists’ Misbehavior	Therapist perceived as incompetent.
	Clients feeling the therapist is incompetent or lacking experience	91	35		Therapist not listening/ understanding
	Clients feeling the therapist's attitude was problematic	267	39		Therapist devaluing the client
	Clients feeling uncomfortable with the organizational management of the consultation	7	5		Therapist judging
	Violations of ethical standards by the therapist	113	35		Therapist using client for own benefit
					Other Inappropriate verbal reactions
Dissatisfaction with the Consultation Effect				Negative Impacts of Treatment	No change or insufficient change
	Unmet expectations	123	35		Increased problems after therapy
	Harmful effects of consultation	76	30		Feeling fear of the therapy process
	Disappointment with consultation or discontinuing therapy	22	14		Loss of motivation or hope
					Unpleasant feelings during therapy
					Negative cognitions aroused in therapy