Journal of Psychotherapy Integration, Vol 36(2), Jun 2026, 169-179; doi:10.1037/int0000398
Although psychotherapy research increasingly recognizes patients as active contributors to change, less attention has been given to patients’ subjective experience of influencing the therapeutic process. Informed by control mastery theory, this cross-sectional survey examined patients’ perceived capacity to influence psychotherapy and its associations with relational, process, and outcome variables. Participants were 364 adults (65.9% female; Mage = 34.7, SD = 11.2) who had received more than one session of psychotherapy through the U.K. National Health Service. Participants completed an online questionnaire assessing perceived patient influence (using the Client Influence Scale), therapeutic alliance, therapist responsiveness, therapeutic agency, psychological distress, and subjective evaluations of treatment. Greater perceived patient influence was moderately associated with stronger therapeutic alliance (r = .45), higher perceived therapist responsiveness (r = .44), greater therapeutic agency (r = .47), higher satisfaction (r = .38), greater perceived productivity (r = .39), and greater estimated change (r = .33), all p