Naming and working through differences with clients and colleagues

Key ideas

Goals

Agreement on goals matters. Meta-analyses found medium-sized links between outcome and both patient-therapist goal consensus (54 studies) and collaboration (53 studies), and the authors recommend seeking clients' input on goals and plans throughout therapy.

Values

When a psychologist's personal values differ from a client's, the client's self-determination governs the goals of the work. APA's Principle E and Standard 3.01 bar unfair discrimination, so a value conflict calls for self-examination and consultation, not for turning away a group of clients.

Scope of role and setting

Standard 2.01 keeps psychologists within their competence, and settings set limits too. Telling clients early what a role or program can offer is part of informed consent (Standard 10.01), and before services end, psychologists provide pretermination counseling and suggest other providers as appropriate (Standard 10.10).

Power differential

Clients, supervisees and junior colleagues may not voice disagreement with someone who holds power over them, and power narrows the holder's view: people primed with high power took others' perspectives less. So psychologists invite disagreement rather than reading silence as agreement.

Differences between professionals

With colleagues from other professions, differences in judgment are raised directly and with evidence, in service of a shared plan. Standard 3.09 asks psychologists to cooperate with other professionals, when indicated and appropriate, to serve clients effectively.

Worked example

Odile, 52, is in the third of twelve sessions offered by a community clinic's depression program. She says she hopes to keep coming weekly "for as long as it takes," since the psychologist is the only person she talks to openly, and adds that she did not like to say so sooner.

1. Name the difference: her need for ongoing connection, the program's twelve-session limit and the plan's focus on mood do not match, and the power gap helped keep this unsaid.
2. Thank her for raising it and be honest now about what the program can offer, so the limit does not surprise her near the last session.
3. Negotiate goals for the remaining sessions together, which could include building connections outside therapy so the work does not rest on one relationship.
4. Plan the ending early: discuss options for continued care, make referrals well before the last session, and keep checking whether the plan still fits her.

A difference raised early and openly protects both the alliance and the client's autonomy.