In China, a significant proportion of individuals with psychological disorders rarely seek psychological counseling, indicating the limited reach of mental health interventions. Despite common beliefs in the positive impact of psychological counseling, negative experiences, often unrecognized by counselors, can occur. The negative experiences in counseling may be attributed to a lack of counselor competence, poor therapeutic alliance, and high client expectations. However, considering the cultural discrepancies between Chinese traditions and Western-imported counseling practices, coupled with the unique development trajectory of the mental health industry in China, these findings may not fully encapsulate the negative experiences encountered by Chinese clients. Additionally, the lack of evidence-based practice in China could further contribute to adverse treatment outcomes. Therefore, this research aims to delve into the subjective negative experiences of Chinese clients in counseling.
Adopting the sample size calculation method for qualitative research proposed by Fugard and Potts (2015), this study included 42 participants. Participant selection was designed to mirror the market demographics of clients, utilizing a combination of purposeful and quota sampling methods. Data were collected via semi-structured one-on-one telephone interviews, with an average length of 25 minutes. The interview question list was refined based on insights from the preliminary interviews. Following Braun and Clarke's (2006) six-step phenomenological thematic analysis, the study analyzed the transcripts to ensure a systematic and credible derivation of themes, with multiple validation processes throughout the coding and theme development phases.
The analysis revealed four main themes concerning clients' negative experiences in counseling: (1) constraints inherent to the industry, (2) poor matching between the counselor and the client, (3) negative experiences associated with poor competence, and (4) dissatisfaction with treatment outcomes. The four main themes are further delineated into twelve subthemes for a detailed examination of the challenges faced. The first theme highlights two subthemes: the intrinsic characteristics of counseling, such as theoretical orientations, fixed counseling settings, and unequal power dynamics, as well as the development stage of the counseling industry in China, marked by the difficulty in finding qualified counselors and issues of cultural fit. The theme of mismatch between counselors and clients encompasses three subthemes: a mismatch in personal styles, hardship in trusting the therapist, and disliking the therapist. The theme of counselor incompetence, which contains the most significant number of nodes, is characterized by counselors' lack of professionalism and experience, proper attitudes, the ability to arrange sessions, and ethical violations. The final theme encapsulates clients' dissatisfaction with treatment outcomes, encompassing three subthemes: unmet expectations, negative effects of counseling, and becoming disappointed or stopping counseling.
This study underscores the profound impact of industrial factors on clients' subjective experiences, particularly highlighting how issues such as cultural adaptability and the imbalance of power relations significantly influence these experiences. It also reveals deficiencies in the fundamental competencies of Chinese counselors. Furthermore, it acknowledges the potential for negative effects in psychological counseling and the significance of client expectations. These findings not only deepen and enrich our understanding of clients' negative experiences in the psychological counseling process but also highlight the complexity of the counseling process itself. The study emphasizes the interplay between clients, counselors, and the industrial environment. By identifying and understanding these negative experiences, the research offers insights for improving counselor training and contributes to the localization of counseling in China.