The Responsiveness Problem in Psychotherapy: A Review of Proposed Solutions

Therapist responsiveness is defined as therapist behavior being influenced by emerging context. Responsiveness is ubiquitous and creates serious problems for a ballistic, cause-effect understanding of how psychotherapy works. This conceptual literature review examines ways psychotherapy researchers have constructively engaged the responsiveness problem. We note classical approaches to the responsiveness problem and review all available citations of the formulation of the problem by Stiles, Honos-Webb, and Surko (1998, p. 439), focusing on proposed solutions. We identified N = 58 studies that cited the 1998 article and engaged with the responsiveness problem. These along with additional engagements with the responsiveness problem identified by us and by colleagues were reviewed. We distinguished six categories of ways researchers have addressed the responsiveness problem: (a) demonstrating effects of responsiveness, (b) measuring responsiveness quantitatively, (c) describing responsiveness qualitatively, (d) using evaluative measures, (e) developing responsive clinical interventions, and (f) extending responsiveness concepts to related domains. There are ways to engage the responsiveness problem that are scientifically productive. However, appropriately engaging the problem may require some psychotherapy researchers to ask different questions than they have previously asked.