J Contemp Psychother (2009) 39:171–186

DOI 10.1007/s10879-008-9087-z

ORIGINAL PAPER

Clients’ Experiences of Disengaged Moments in Psychotherapy:

A Grounded Theory Analysis
Ze’ev Frankel Æ Heidi M. Levitt

Published online: 16 September 2008

Springer Science+Business Media, LLC 2008

Abstract The study offers an empirically derived model the frequent, manifold and unavoidable sensations of
of clients’ experiences of disengaged moments, defined as pain and unpleasure the removal and avoidance of
moments when clients withdraw, distance, or lessen their which is enjoined by the pleasure principle, in the
intensity of involvement with therapy-relevant material or exercise of its unrestricted domination. (Freud 1930/
relationships. Interpersonal Process Recall (IPR) interviews 1959)
were conducted with nine psychotherapy clients of thera-
Emotional processing is stressed as an important component
pists with varied orientations and experience. The
of the therapeutic change process by all of the three major
interviews were transcribed verbatim and subjected to
psychotherapy schools—psychodynamic (Freud 1959/
qualitative analysis using grounded theory analysis (Glaser
1914; Fromm-Reichmann 1950; Gabbard 2004; Messer
and Strauss, The discovery of grounded theory: Strategies
and Wolitzky 1997; Vakoch and Strupp 2000), humanistic
for qualitative research, 1967) methodology. The results
(Greenberg and Pascual-Leone 1995; Greenberg et al. 1998;
suggested that clients use disengagement for protection
Rogers 1951), and cognitive-behavioral (Foa and Kozak
from pain, strategic retreat, relationship management, self-
1986; Rachman 1980)—and has been supported by empir-
through-other discovery, and self-betterment. The core
ical findings as well (Elliott et al. 2004; Hoehn-Saric 1974;
category across all of the experiences of disengagement
Kamphuis and Telch 2000; Pos et al. 2003; Rauch and Foa
relates to communicating difficulties and experimenting
2006). Nonetheless, the opposite phenomenon of emotional
within the therapy relationship toward self-change. Rec-
disengagement, although not an infrequent event in psy-
ommendations are offered for research and practice.
chotherapy, has received little attention. The present study
aims to contribute to this area of psychotherapy process
Keywords Disengagement
Resistance
Psychotherapy

research, by investigating clients’ experiences of disen-
Qualitative research
Grounded theory
gaged moments, defined as moments when clients
withdraw, distance, or lessen their intensity of involvement
with therapy-relevant material or relationships.
Introduction

Client Disengagement in Psychotherapy

A further incentive to a disengagement of the ego
from the general mass of sensations…is provided by
Z. Frankel (&)
The University of Memphis, Memphis, TN 38152, USA
e-mail: zfrankel@memphis.edu
H. M. Levitt
Department of Psychology, The University of Memphis,
202 Psychology Building, Memphis, TN 38152, USA
Four research areas in psychotherapy specifically have
emphasized the importance of disengagement. Research on
client resistance, storytelling, secrecy, and silences have
each described points in therapy during which processes of
disengagement occur. These occurrences are by no means
mutually exclusive; in fact they can overlap a great deal.
However, each area of research has been explored indi-
vidually in the psychotherapy literature.

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172
Resistance
Reviews of psychotherapy outcome research consistently
have found clients’ resistance in therapy, as opposed to
collaboration or compliance, to be negatively associated
with psychotherapy outcome (Beutler et al. 2004; Beutler
et al. 2002; Clarkin and Levy 2004; Orlinsky et al. 2004).
In psychotherapy process research the findings have been
less clear cut, however. For instance, Patterson and Forg-
atch (1985) found that resistance measured in family
behavior therapy sessions was significantly and positively
related to counselors’ ‘‘teaching’’ and ‘‘confronting’’
behaviors, while it was significantly negatively related to
counselors’ ‘‘supportive’’ and ‘‘facilitative’’ behaviors.
Chamberlain et al. (1984) found that resistance occurred
significantly more during the middle phase (‘‘teaching’’) of
family behavior therapy, among premature terminators,
and among those clients referred by external agencies.
Bischoff (1997) assessed the relationship between client
resistance and therapist directiveness and found a signifi-
cant but small positive relationship between therapist
directiveness and client resistance, replicating to some
degree the earlier findings of Patterson and colleagues
(1985; Chamberlain et al. 1984), but also found that this
relationship was moderated by clients’ levels of reactance
and satisfaction. Clients with low reported satisfaction
consistently exhibited resistance in the face of therapist
directiveness, regardless of their level of reactance. Among
clients with higher levels of reported satisfaction, those
clients with higher levels of reactance were more likely
than lower reactance clients to exhibit resistance when
therapists were directive.
In addition, Rice (1999) assessed the relationship of
client distress, client–therapist alliance, and client aware-
ness of self and other, differentiating five objects of
resistance. She found that lower other-awareness was
related significantly to resistance to therapist; lower self-
awareness was related significantly to resistance to recol-
lect material; client–therapist alliance was negatively
related to resistance to expressing painful affect, while the
alliance subscale of task alliance was negatively related to
resistance to change; and distress was unrelated to any
form of resistance. Weller (2003) explored the relationship
between resistance and early client psychotherapy dropout
and found that clients who dropped out early had both
higher proportions of resistance behaviors (48.2% vs.
34.4%) and more intense manifestations of resistance.
Although these findings are not readily consolidated,
they seem to broadly suggest that increasing the overall
therapeutic alliance will help to reduce client resistances of
all sorts, both toward the therapist and toward themselves.
This general finding is consistent with one of the most
robust findings in psychotherapy outcome research to date:
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J Contemp Psychother (2009) 39:171–186
a significant and moderate relationship between alliance
and outcome (Orlinsky et al. 2004). More specifically,
however, the findings raise significant questions about what
therapists are to do when clients emotionally disengage
from the exploration, experiencing, and experimenting that
so often comprise the work of therapy.
Storytelling and Reporting
A narrative view of human experience in psychology has
become more popular over the past 20 years, in which
people are thought to generate stories of their lives and
their surroundings in their search for coherence and
meaning (Angus et al. 1999; McAdams 1997; Monk et al.
1997; Neimeyer 2000; Polkinghorne 1988). In addition to
these potentially productive functions of narrative, psy-
chotherapy researchers and clinicians also have identified
styles of storying that can obstruct the processes of psy-
chotherapy. For example, Hailparn and Hailparn (1999)
described ‘‘reporting’’ as a powerful defense against dis-
closing or addressing information that would be
experienced as fear inducing or shameful. This avoidance
is accomplished by talking at length about those issues the
client feels safer to verbalize during the therapy session.
They accordingly warn that such incidents can get in the
way of therapeutic gains and recommend keen observation
and subsequent intervention to return the clients to the
substantive issues of therapy.
Similarly, Rennie (1994) conducted a qualitative anal-
ysis of storytelling and found that clients can utilize
storytelling to avoid personal discomfort or uneasiness. He
found that some clients told stories as a way to delay
talking about a disturbing subject. Other clients used sto-
rytelling as a way to evade the feelings associated with an
upsetting topic. Storytelling and reporting, then, has been
studied as narrative means of self construction and defini-
tion as well as strategic ways of disengaging from
emotionally charged issues.
Secrecy
Secrecy had been theorized to correlate negatively with
therapeutic gains as well. For instance, the Preoccupation
Model of Secrecy (Lane and Wegner 1995) predicts that
engaging in thought suppression in order to keep a secret
will lead paradoxically to greater intrusion of the very
thought one is trying to suppress. Although Finkenaeur and
Rime (1998) found no direct effect of emotional secrecy on
subjective well being; they found an indirect effect via the
negative impact of secrecy on physical health.
In contrast, Kelly (1998) found that keeping secrets was
actually a predictor of positive outcomes among outpa-
tients at a community hospital. She explains that clients
J Contemp Psychother (2009) 39:171–186
come to see themselves in a more favorable light by
withholding negative personal information and helping
their therapists to view them favorably. Such positive
outcome findings have not gone without debate. Hill et al.
(2000), upon reviewing findings on non-disclosure in
psychotherapy, concluded that clients do not withhold a
great deal of information and that the relationship between
such withholding and outcome is not clear. In addition,
Farber et al. (2006) found that while clients may struggle
somewhat with disclosure, they consider it to be a valuable
component of psychotherapy.
Indeed, Kelly et al. (2001) found that revealing secrets
can in fact be beneficial, under certain conditions. Their
study was designed to ascertain what differentiates revela-
tions of secrets that lead to positive and to negative feelings
in a non-clinical sample. They found that after subjects
anonymously revealed their secrets in writing while trying
to gain new insight they reported feeling better than those
simply attempting catharsis by letting the secret out. Fur-
ther, they found that not coming to terms with the secret was
associated with bad feelings about the secret. Together,
these findings suggest that secrecy may be a heterogeneous
variable that impacts change depending on both its mode of
expression and context, and direct our attention to both the
helpful and harmful potential of disengagement.
Silence
Within the last decade researchers have begun to investi-
gate the effects of silence within psychotherapy (e.g., Hill
et al. 2003; Ladany et al. 2004; Levitt 2001a, b; 2002).
These empirical findings together with the theoretical lit-
erature (e.g. Greenson 1961; Trad 1993; Zeligs 1961)
suggest that while some silences may alert therapists and
researchers to processes potentially hindering progress in
psychotherapy, other silences may signal engagement in
change and growth.
This heterogeneous understanding of silences was fur-
thered by Levitt (1998, 2001a, b, 2002; H.M. Levitt and Z.
Frankel, Unpublished manuscript), who conducted a
grounded theory analysis (Glaser and Strauss 1967) of
clients’ experiences of silent processes in session, and
systematically identified seven different types of silences.
The silent moments were conceptualized heuristically as
falling within three categories: Productive Silences, Neu-
tral Silences, and Obstructive Silences. The Obstructive
Silences category was comprised of two types of silences:
disengaged and interactional. Disengaged silence was
associated with avoiding emotion or withdrawing. Inter-
actional silence entailed considering communication with
the therapist or safeguarding the alliance. Frankel and
colleagues (Frankel 2004; Frankel et al. 2006), upon testing
the hypotheses laid out in Levitt’s silence typology, found
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that poor outcome client-centered therapy dyads did indeed
exhibit significantly more disengaged silences than good
outcome dyads while the good outcome dyads exhibited
more productive silences than the poor outcome dyads.
These findings demonstrated the utility of differentiating
types of silence, and underscored the salience of emotional
disengagement in psychotherapy.
Common to the research of resistance, secrecy, story-
telling, and silence in psychotherapy are the recent findings
that differentiate multiple forms of each. No longer can we
conceive of these events in psychotherapy as homogeneous
occurrences, but rather as complex multifaceted phenom-
ena that may be beneficial when prompted by some
motivations but detrimental when motivated by others. For
this reason it is important that the exploration of disen-
gaged moments be undertaken to deepen our understanding
of the multiple processes and constructions involved, to
identify therapy events associated with disengagement, and
to develop better strategies for handling their occurrences
in therapy. While past research suggests a negative corre-
lation between disengaged moments and psychotherapy
outcome, this study aims to develop a theory of their inner
workings to guide the development of testable hypotheses
and intervention strategies. The qualitative approach uti-
lized allows for rigorous inquiry into subjective experience
and facilitates the development of empirically-grounded
theory.
Method
Participants
Clients and therapists were recruited within three different
settings—community psychologists and psychiatrists, a
university psychological services center, and a university
counseling center. Participant diversity is a strength in this
qualitative design as it can allow for the study of variation
of experiences and the development of a more encom-
passing theory. As a result, diversity was sought in
therapists’ gender, experience, training background, set-
ting, and therapeutic orientation and in clients’ gender, age,
and length of therapy. Descriptions of therapist and client
participants are presented in Table 1.
Therapists
Eight therapists were recruited by word of mouth for this
study, one of whom worked with two clients in the study.
They included two licensed clinical psychologists, one
licensed counseling psychologist, one board certified psy-
chiatrist, and four advanced doctoral students in clinical
psychology meeting clinical practicum requirements.
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Table 1 Description of participants and their Therapists

# Gender Age Range Ethnicity Length Therapist Primary orientation

1 Female 50–60 Caucasian 2 Years 4th-Year student, male* Constructivist

2 Female 40–50 Caucasian 1.5 Years 4th-Year student, male* Constructivist
3 Female 50–60 Caucasian 6 Months 5th-Year student, female Cognitive behavioral
4 Male 30–40 Caucasian 2 Years 4th-Year student, male Cognitive behavioral
5 Female 30–40 Caucasian 2 Years 3rd-Year student, male Process-experiential
6 Female 20–30 Caucasian 3 Months Licensed Ph.D., female Feminist
7 Female 20–30 Caucasian 6 Months Licensed Ph.D., female Process-experiential
8 Male 50–60 Caucasian 2 Years Licensed Ph.D., female Cognitive behavioral
9 Female 30–40 Caucasian 4 Years Licensed M.D., male Unified therapy
* The same therapist worked with two clients

Five theoretical orientations of psychotherapy were rep-
resented by the therapists: Cognitive Behavioral Therapy;
Constructivist Therapy; Feminist Therapy; Process-Expe-
riential Therapy; and Unified Therapy. Cognitive behavioral
therapy (Beck 1975) works to dispel cognitions and
behavioral contingencies that are understood to lead to and
maintain distress by the use of Socratic questioning and
homework assignments. Constructivist psychotherapy
(Mahoney 2003) integrates techniques from various psy-
chotherapy schools within a constructivist philosophy
with the goal of enhancing meaning making and reducing
suffering. Feminist therapy (Brown 1994) is a feminist-
theory-based integrative therapy that focuses on the ineq-
uitable societal influences on personal meaning making.
Process-experiential therapy (Greenberg et al. 1993) is a
contemporary emotion-focused therapy with humanist
underpinnings, which combines client-centered relationship
conditions and experiential exercises in a process-directive
manner toward understanding and changing emotional
schemas. Unified therapy was developed specifically for
patients with personality disorders by David Allen (1993),
and integrates elements of psychodynamic, family systems,
and cognitive behavioral therapies.
Interviewees
Interviewees were recruited through therapists. Intervie-
wees admissible for this study were 18 year-old and older
clients in ongoing outpatient psychotherapies who did not
exhibit any psychotic symptoms and were not judged to be
at high risk for suicide or violence by their therapists, nor
in the first two or last two scheduled sessions of therapy.
The sample reflected some diversity, including clients with
a range of ages from 20s to 60s, professionals and non-
professionals, in short-term and long-term psychotherapies,
who described themselves variously as being depressed,
anxious, having interpersonal difficulties, suffering with
fibromyalgia, and suffering with Borderline Personality
Disorder. Interviewees were paid $20 to compensate them
for their time and participation.
Researchers
The interviews were conducted, transcribed, and analyzed
by the first author, who received training in qualitative
interviewing and analysis as well as ethics training about
interviewing by the second author. The interviews and
analyses were reviewed and discussed with the second
author until consensus regarding the findings was reached.
Procedures
Interpersonal Process Recall Interviews
IPR interviews entailed the interviewees reviewing a
recording of a psychotherapy session to cue their cognitive
and affective memory, pausing the recording at moments
that they identified as disengagement, and exploring those
occurrences therein with the interviewer (Kagan 1975).
The reflective distance inherent in the process of describing
their experiences in the session, and the supportive envi-
ronment of the interview acted to reduce defensiveness
about their experiences. This method has been found
effective in stimulating the recollection of the clients’
experiences during the phenomenon of interest (Elliott
1986; Levitt 2002; Rennie 1994), and has been empirically
demonstrated to result in experiences and descriptions
highly correlated with those experienced in-session (Gott-
man and Levenson 1985). Video recordings and/or audio
recordings were used for the review, as dictated by each
setting.
To minimize influencing the recorded therapy session,
interviewees were not told prior to the interview the exact
focus of the interview, only that it would explore their
experiences of the session. The interview therefore began
with an orientation to the concept of disengagement,

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described broadly as lessening involvement in therapy
discussion or withholding from the therapist. The goal of
this method was to explore what the client actually was
experiencing in the recorded session rather than how they
felt as they reviewed it. For this reason, interviewees were
directed not to reinterpret the session but to describe what
took place in the moment under investigation (Rennie
1992).
The interviews were semi-structured, with questions
directed to clarify clients’ experiences preceding, during,
and following disengaged moments. While the interviewer
had general statements and questions prepared to guide the
IPR process (see Appendix A for interview questions),
questions were modified and added as needed to fully
explore clients’ experiences. Questions were designed to be
open-ended and as non-leading as possible.
Data Analysis
Grounded theory analysis (Glaser and Strauss 1967) was
chosen as the method of analysis for this study in an
attempt to generate rigorous and empirically-based theory
based on the data derived from the interviews. The version
of grounded theory used in this analysis was based upon
that suggested by Rennie et al. (1988).
The transcribed data collected in the interviews was
divided into meaning units (MUs). MUs are segments of
texts that each contain one main idea (Giorgi 1970). In the
initial stages of the analysis, the MUs were labeled in a
manner that remained very close to the language used by
the participants. The MUs were compared with each other
and organized according to their similarities, creating
descriptive categories. MUs could be assigned to more than
one category, as dictated by the meanings contained
therein. Once the initial descriptive categories were cre-
ated, a more abstract conceptualization of the phenomenon
was pursued by grouping the descriptive categories into
higher order categories based on their commonalities. This
process was repeated and, in this way, a hierarchy of cat-
egories was developed. At the top of the hierarchy one core
category was formed that represented the central interpre-
tation drawn from the analysis.
The process of collecting data continued until the cate-
gories became ‘‘saturated,’’ that is new descriptive
categories did not appear to be present in additional
interviews. This analysis became saturated at the sixth
interview—meaning that the last three interviews did not
add any new categories and that the analysis appeared to be
comprehensive.
A detailed record of the researcher’s intuitions, suspi-
cions, feelings and thoughts about the interviews and
analysis was maintained throughout the study. By noting
these assumptions via memoing, an attempt was made to
175
minimize any biasing effect they might have on the inter-
viewing and analytic process, in order to keep the
conceptualization of the phenomenon closely tied to the
data and to keep a careful record of the procedures and
theoretical developments of the analysis.
Credibility Checks
Consistent with the aim of grounded theory, to generate
rigorous theory grounded in the phenomenon of interest,
three types of credibility checks were conducted. (1) At the
end of each interview interviewees were asked about the
information gathered to assess whether the data collection
was complete and representative. (2) Consensus with the
second author was sought, as consensus has been noted to
strengthen the credibility of research findings, demon-
strating agreement regarding the interpretation of data from
multiple analysts (Hill et al. 2005). (3) After the model of
disengagement was completed participants were contacted
and asked to review a summary of the results of the study
and to provide feedback via a questionnaire. The ques-
tionnaire summarized the findings and asked participants to
rate how well each cluster and the core category matched
their experiences on a 7-point Likert scale, ranging from 1
(‘‘does not fit at all’’) to 7 (‘‘fits very much’’), as well as the
degree to which the overall summary matched and
contradicted (1 = ‘‘does not contradict at all’’; 7 = ‘‘con-
tradicts very much’’) their experiences. Eight participants
provided feedback on the summary of the disengagement
model via the feedback questionnaire. The one remaining
participant had moved and could not be located. Two
participants left one question each unanswered (one left the
overall summary questions unanswered and the other left
the cluster 5 question unanswered). Participants indicated
the overall summary matched their experiences of disen-
gagement to a high degree (M = 6.42). Participants
similarly indicated that the overall summary contradicted
their experiences to a low degree (M = 1.42).
Results
The nine in-depth interviews yielded 241 single-spaced
pages of transcripts, resulting in 833 meaning units related
to clients’ experiences of disengagement in psychotherapy.
To differentiate the levels of the higher order categories the
following lexicon will be used, the three top levels of
which are depicted in the hierarchical presentation of the
model in Fig. 1. The level above the fundamental meaning
units included ‘‘subcategories,’’ which were followed by
‘‘categories’’ of common experiences, above which were
central ‘‘clusters.’’ The core category, representing the
overarching principle of the model, was referred to as the
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Fig. 1 Hierarchical
presentation of the three top Disengagement as
levels of the model of client Communicative experimentation toward self-change:
disengagement and the number Reconfiguring self-advancement and self-protection (9)
of participants contributing to
each category
A reflex averting A deliberate Selective disclosure of A retrospective testing A conscious disruption
attention from sensitive disconnection from personal experience in of how the therapist of self-impeding
topics in order to emotions to allow full order to establish and responds to avoidance patterns toward the
protect oneself from focus on rationally maintain a safe and vulnerability (9) goal of sustained
potential pain (9) developing strategies therapeutic self-esteem,
toward resolving relationship, in which effectiveness,
problems (9) the client feels accepted and hopefulness (9)
and trusting of the
therapy process (9)

Keeping it pleasant: Moderating distress Assessment of client Observable Avoiding the dark
Avoiding toward continued acceptability and disruption and point of no return:
uncomfortable exploration of self-determination redirection: Preventing
feelings (8) sensitive within the Struggling to depression and
experiences: therapeutic remain composed in worsening life
Constructive affect relationship: Am I the presence of the functioning (6)
regulation (8) really OK just as I therapist (9)
am? (6)

Rapidly shifting Retention of reason: Facilitating Reflecting lack of Maintaining belief

behavior, speech, I’m going to lose it communication and self-confidence and in self: Improving
and mood: I can't if I don’t stop this understanding with insufficient personal self-image and self-
stay here one second (9) therapist: Do you resilience: I can’t esteem (9)
longer (7) get me? (6) handle this (9)

Unconsciously Maintaining clarity Responding to Maintaining self in Maintaining belief

preventing loss of and realistic therapist when little
control: I'm not perspective:
sure how it happens, Promoting
like a reflex just objectivity towards
shutting it down (8) increased insight (6)
Recruitment of
available resources:
Maximizing
therapeutic
potential (8)
familiar form: I am in the world:
understanding, this and nothing else Invoking hope for
support, and safety (8) better future (6)
conveyed: If you
can't handle this I
won't talk about it
(9)
Forging a new way
of being: Let's try
this another way (6)

‘‘core category.’’ The 5-level hierarchy of disengagement
experiences decreased in the number of units or categories
at each level; from meaning units (N = 833), to subcate-
gories (N = 48), to categories (N = 17), to clusters
(N = 5), which are all crowned by the core category
(N = 1). The five central clusters with their constituent
categories will first be presented, followed by the core
category. The participant, from whom illustrative quotes
originated, will be indicated by a number parenthetically
following each quote (i.e., P#).
Cluster 1. Disengagement as a Reflex, Averting
Attention from Sensitive Topics in order to Protect
Oneself from Potential Pain
All nine participants contributed to the first cluster, which
included three categories of experience. Participants
reported experiencing disengagement as a reprieve from
anticipated discomfort that seemed to happen automati-
cally, without their conscious control. Eight participants
provided feedback on this cluster via the questionnaire and
indicated a high level of agreement (M = 6, on a 7-point
Likert scale where 1 = ‘‘does not fit at all’’ to 7 = ‘‘fits
very much’’). The three categories of experience that
contributed to this first cluster are described below.
Disengagement as Keeping it Pleasant: Avoiding
Uncomfortable Feelings
Eight participants described disengaging at times by
steering the conversation toward positive elements of
experience when something uncomfortable or threatening
seemed to be looming in the horizon of the conversation.
It’s just like, sometimes [at a choice point about the
depth of discussion] you can like sense that things are
an issue, but you just, they’re not an issue yet because
you haven’t really like felt the bad feelings that you
think you’re going to feel if you think about them.
(P7)
Similarly, they reported disengaging to forestall discussion
of experiences that they anticipated could result in being
criticized or invalidated by the therapist. For example, two
participants described this experience very pointedly:

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‘‘He’s gonna be like ‘She’s in denial!’ [laughs vigorously]’’
(P5), and ‘‘I don’t want to get into a confrontation [with
therapist]’’ (P9). Thus clients reported using disengage-
ment to avoid discomfort arising both intrapersonally and
interpersonally.
Disengagement Achieved by Rapidly Shifting Behavior,
Speech, and Mood: I Can’t Stay Here One Second Longer
Seven participants described disengaging by switching
their focus to alternate activities in order to escape dis-
comfort. Six of these participants disengaged by changing
the topic of discussion.
When I’m trying to keep that mask up, um, what
happens is that my story is very disjointed, I will
jump from situation to situation, I will talk about so
and so did such and such to me, I’ll play the victim
role. And then I’ll bring in story after story as to how
I’m the victim, and I tend to stay there. (P2)
Six interviewees described disengaging by reducing their
verbal and non-verbal expressiveness, for example via a
sudden lapse of memory.
I’m sure she’s [family member] made derogatory
comments, you know, I just couldn’t remember them.
Like it’s kind of hard to focus, and…when someone
[therapist] asks you something like that…all of a
sudden I get like [disengaged]…it overwhelms again.
(P6)
Thus participants described disengaging by quickly chang-
ing the focus of their activity to evade discomfort.
Disengagement as Unconsciously Preventing Loss of
Control: I’m Not Sure How it Happens, Like A Reflex
Just Shutting it Down
Eight participants described disengagement as an uncon-
scious protection against loss of control.
I’ve dug so deep that I lose my self. I think that to
lose would mean total loss of control, being purely
emotional, getting out of control….That self-protec-
tive mechanism just turns on and it’s just a hum
upstairs. Nobody’s home. And it happens quick-
ly….It’s almost like somebody’s tripped the breaker
and I’ve got to go down and turn the breaker back on.
(P4)
Thus despite considerable determination to work through
their difficulties, some participants reported experiencing
disengagement as a kind of circuit-breaker that trips when
the specter of loss of control looms.
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Cluster 2. Disengagement as a Deliberate
Disconnection from Troublesome Emotions to Allow
Full Focus on Rationally Developing Strategies
and Improved Functioning
The second cluster was endorsed by all nine participants.
The participants reported withdrawal from intense emotion
in order to better equip themselves for overcoming the
associated difficulties. Eight participants provided feed-
back on this cluster via the questionnaire and indicated a
moderate-high degree of agreement (M = 5.9, on a 7-point
Likert scale where 1 = ‘‘does not fit at all’’ to 7 = ‘‘fits
very much’’). The four categories of experience that con-
tributed to this cluster are described below.
Disengagement as Moderating Distress Toward Continued
Exploration of Sensitive Experiences: Constructive Affect
Regulation
Eight participants described disengagement as a process
that allowed them to continue to broach therapeutic but
threatening topics in this category.
I’m trying to like switch it from like an internal thing
to like an external kind of situation…I’m switching it
from like ‘How do I feel about something?’ to like
‘Why did I do this?’ Like it feels more comfortable, I
think, to talk about [the reasons]. (P7)
In this way participants described using disengagement to
continue therapy-relevant discussions without threatening
their mood.
Disengagement as Retention of Reason: I’m Going
to Lose it if I Don’t Stop This
Nine participants described disengaging at times during
session in an effort to secure their rational capacities.
Within these, six clients discussed disengaging to prevent
being emotionally overwhelmed during the session, as one
client described succinctly. ‘‘It helps me to keep talking
[about other things to prevent] just totally disintegrating as
far as emotionally’’ (P3). Similarly, seven interviewees
described disengaging to prevent losing control of them-
selves or to maintain emotional balance in the session.
I’m not to the point where I can talk about that
[traumatic] situation so I back up when [therapist]
asks me stuff like that—‘wait ta-ta-ta-ta-ta!’—
because I don’t want to get too anxious because then
I’ll really never get where I’m going. Because if he
[therapist] gave me an answer… [to the question]
‘why, what’s the relevance?’…that seemed rational
or seemed to make sense then, you know, then I
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would uh consider uhh you know attempting to find
out at a later point, but as I see it I don’t need to know
that. (P9)
Thus, participants used disengagement to prevent becom-
ing so distraught that their ability to function in therapy
was disrupted.
Disengagement as Maintaining Clarity and Realistic
Perspective: Promoting Objectivity Towards Increased
Insight
Six participants described disengagement as sometimes
directed toward providing a broader understanding of their
experiences by taking some distance from it. They dis-
cussed disengaging to facilitate their ability to problem-
solve, which three interviewees explicitly described as a
conscious process. ‘‘I [disengaged from my feelings to]
really try to focus in on what his questions are and what
he’s after, um, so that I can try to get there’’ (P5). Simi-
larly, three participants described disengaging to provide
themselves with objective perspective.
But what it [disengagement] did was it had me…go
back and look at that insecurity…and amplify my
description of it…so I can look at it more if I pull
back and come at it from a different angle. (P4)
In these ways participants described using disengagement
to remain objective and discerning toward mastering their
difficulties.
Disengagement as Recruitment of Available Resources:
Maximizing Therapeutic Potential
Eight participants described disengaging at times in order
to rally the necessary resources (e.g., time, focus, support,
stability) to best utilize their therapy experiences. For
instance, seven clients discussed disengaging to allow time
for discussion of important topics. Four participants dis-
cussed disengaging in order to garner additional needed
strength to work with difficult material, as illustrated by
one interviewee’s experience.
I have a need a lot of times when therapy gets really
tense sometimes to step out and get a drink of water
and it’s not always just, partly it’s because I talk a lot
and I lose my voice, also it seems to me also like
there’s this need when you dig real deep to…kind of
draw back and…reassure yourself that everything’s
OK. (P4)
In these ways participants described disengaging to collect
needed resources to better benefit from their therapeutic
work.
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J Contemp Psychother (2009) 39:171–186
Cluster 3. Disengagement as the Selective Disclosure
of Personal Experience with the Therapist in Order
to Establish and Maintain a Safe Therapeutic
Relationship, in which One Feels Accepted and
Trusting of the Therapy Process
The third cluster of disengagement was contributed to by
all nine participants. Participants described disengagement
as related to their gradually sharing experiences with the
therapist in order to develop a mutual relationship of
respect and fondness. Eight participants provided feedback
on this cluster via the questionnaire and indicated a mod-
erate-high level of agreement (M = 5.125, on a 7-point
Likert scale where 1 = ‘‘does not fit at all’’ to 7 = ‘‘fits
very much’’). The three categories that contributed to this
cluster are described below.
Disengagement as Assessment of Client Acceptability
and Self-Determination within the Therapeutic
Relationship: Am I Really OK Just as I am?
Six clients described disengaging at times to assess the
extent to which therapists would respect their autonomy.
They described disengaging from therapeutic exploration
to test their therapists’ trustworthiness.
It [the disengagement] was ‘I have to keep up the
mask.’ And it was my way of testing to see ‘Am I
unconditionally accepted?’ It was a process of
establishing ‘How safe am I?’ and ‘Is this really a
sacred space?’, ‘Can I trust, how much can I trust this
person?’ And in making that judgment that I can trust
this person the flip side of that coin was ‘I can accept
what this [opinion] says if they [therapist] decide I
am not normal,’ you know, or ‘my response is not
normal,’ I can hear that from them now. (P2)
Thus participants described disengaging in therapy to
figure out their role in therapy and their relationship with
their therapists.
Disengagement as Facilitating Communication
and Understanding with Therapist: Do you Get me?
Six participants described disengaging in order to make
sure their therapists were on the same page with them. Of
these, four interviewees discussed disengaging in order to
provide their therapists with details to facilitate commu-
nication and understanding. Three participants also
described disengaging due to their confusion regarding the
therapeutic method being used.
I’ll [disengage as I] actually want to say [to the
therapist] ‘‘why do I need to know that, why do I need
J Contemp Psychother (2009) 39:171–186
that information? I think I can do this without, I don’t
need to know all the gory details, why are you asking
me to get this information?’’—that’s what I feel, you
know. I just, I would just like for him to stop or say,
umm ‘I’m sorry, I guess you’re not ready to talk
about that yet.’ (P9)
As this example reflects, disengagement can serve many
functions described in this category and the previous one
simultaneously. By pulling back from the discussion with a
vague ‘‘uh huh’’ the client expressed not only her lack of
understanding, but also her lack of personal confidence and
felt power in the relationship, and her bewilderment as to the
therapist’s understanding of her and the therapeutic process.
Disengagement as Responding to Therapist when Little
Understanding, Support, and Safety Conveyed: If You
Can’t Handle this I Won’t Talk About it
Nine participants described disengagement as stemming in
part from their understanding that the therapist was not able
or willing to respond to their experience in the way they
wanted. Participants described disengaging less under a
number of circumstances: When their therapist demon-
strated empathy (identified in eight participant’s
interviews); when their therapist assisted them in discuss-
ing therapeutically salient experiences (nine participants);
when their therapist provided sufficient structure for their
discussion of important material (three participants); when
they felt relaxed and at ease in the session (seven partici-
pants); and when their therapist allowed them to work at
their own pace (seven participants). One client, for exam-
ple, exemplified multiple circumstances in one description.
Umm, I remember her [therapist] being…concerned…
and wanting to know more about that [the ‘pushing
on’]. You know, wanting to know what that was about,
and…I didn’t call it depression…at that time I was
calling it ‘pushing on’ or something, but yeah…she
pursued it…and got me to think about what…was
causing it. I think she said ‘was it something I was not
doing or something I was doing?’ and umm I think it
was something I was not doing, not taking care of
myself, but she kind of already knew that. (P8)
As this example richly reflects, disengagement from express-
ing the full extent of his experience served as a test of the
therapist’s understanding. If the therapist had not demon-
strated that understanding—as well as the facility to pursue
the topic without the client feeling pressured or unsup-
ported—the topic would have been dropped. Regardless of
the individual concerns, participants typically reported that
understanding, support, and safety were fundamental
requirements for them to engage fully in therapy.
179
Cluster 4. Disengagement as Allowing a Retrospective
Discovery of How the Therapist Responds to One’s
Avoidance and Vulnerability
The fourth cluster was contributed to by all nine partici-
pants and included three categories of experience. Eight
participants provided feedback on this cluster via the
questionnaire and indicated a moderate-high degree of
agreement (M = 5.125, on a 7-point Likert scale where
1 = ‘‘does not fit at all’’ to 7 = ‘‘fits very much’’). The
fourth cluster centers on the expression of difficulties in the
presence of an observant other. Participants presumed their
disengagements to be apparent to therapists and thereby
providing clients with an opportunity to learn how thera-
pists respond to their difficulties. The three categories that
contributed to this cluster are described below.
Disengagement as Observable Disruption and Redirection:
Struggling to Remain Composed in the Presence of the
Therapist
Meaning units from nine participants were gathered toge-
ther in this category. Eight of these participants reported
that their disengagements were exhibited by becoming
involved in alternate activities.
I think there is probably, obviously! (laughs) some
level of anxiety that is there, uh, you know, because
my stomach just feels about like this (pushes stomach
in)…the fingers [braiding one over the other] are a
little more revealing [of the anxiety]. (P5)
Nonetheless, six participants also described their disengage-
ments as displayed in their reduced expressiveness and body
language, as succinctly described by one interviewee. ‘‘I
would have to say the less body language I gave out, maybe
the more intense [in struggling to not feel painful emotions] I
was’’ (P2). Thus these disengagements took on a commu-
nicative function as clients expected that their therapists
could readily observe such disengagements and understand
what underlies them: ‘‘I think maybe there is some, some
feedback that I probably read from Therapist…if she asks
uhh probes deeper into a into a line of questions…I feel like
maybe she’s on to something’’ (P8). Clients therefore
closely attended to their therapists’ responses to disengage-
ments in an effort to better themselves.
Disengagement as Reflecting Lack of Self-Confidence
and Insufficient Personal Resilience: I Can’t Handle this
Nine participants described disengaging at times due to self-
doubt and feeling inadequate, which they presumed was
noticeable to their therapists. Eight of the clients discussed
their disengagements as decreasing over time in therapy,
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while three experienced it as decreasing immediately once
they learned it was not an effective strategy in the long run.
These processes are reflected in clients’ reports that disen-
gagement generally was related to feeling negatively about
themselves, the environment, and the future.
I think self worth has a lot to do with what I say and
why I say it, and if I disengage in some things, one of
the things that I’m thinking is umm ‘Is it really that
important to talk about and like burden this person
with this right now?’ (P6)
Similarly, six interviewees described their disengagements
decreasing as they gained self-compassion and more ways
to self-soothe, while four participants discussed disengage-
ment as decreasing as they learned feared outcome is
usually worse than actual outcome. These two processes
were illustrated articulately by one interviewee.
I have learned [from the therapist] how to sort of
soothe, self-soothe, and I can make myself feel better.
Umm so I’m not afraid as much. Now sometimes
when I do, when I’m disengaging that’s the old part
of me trying to steer clear of the discomfort, but I’ve
learned ways to cope that help me, that I realize that
I’m not going to be a mess when I leave my therapy,
it’s going to be OK. (P9)
Thus, clients utilized disengagement in therapy to both
protect themselves from noxious experiences and to recruit
new knowledge from therapists toward better handling
them.
Disengagement as Maintaining Self in Familiar Form: I am
this and Nothing Else
Eight participants described disengaging at times in order
to prevent the loss of their known world. Seven of these
interviewees discussed disengagement as a way to prevent
encountering material contrary to previous accounts.
I don’t, I’m maybe afraid of what he’s going to say is
going to freak me out, you know, the answer to that
[question] might be disturb, might disturb me and I’d
rather not think about that. Of course, you know,
that’s the hard part and therapy is not easy and I know
that but I’m not just ready to go into, I don’t know if I
ever want to know that [about her family]. (P9)
Five participants also described disengagement as a way to
continue a previous pattern of experience. ‘‘I think in
general whenever I’ve revealed myself and talked about
something that I’m, you know, touchy about, emotional
about, uhh there’s certainly ample examples of people not
responding the way that I thought they would’’ (P4). Thus,
by using disengagement to continue their previous life
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J Contemp Psychother (2009) 39:171–186
patterns, clients enacted their difficulties in therapy. Such
observable disengagements were seen by clients to provide
therapists with opportunities to view first hand what clients
are struggling with, and thereby provided clients with an
opportunity to learn from their therapists’ responses.
Through this process clients could discover new ways of
understanding themselves and responding to themselves
through the therapists’ examples.
Cluster 5. Disengagement as a Conscious Disruption of
Self-Impeding Patterns toward the Goal of Sustained
Self-Esteem, Effectiveness, and Hopefulness
The fifth cluster was contributed to by all nine participants
and included four categories. Seven participants provided
feedback on this cluster via the questionnaire and indicated
a moderate-high level of agreement (M = 5.714, on a 7-
point Likert scale where 1 = ‘‘does not fit at all’’ to
7 = ‘‘fits very much’’). This cluster centers on the inten-
tional use of disengagement to implement new knowledge
and skills toward improved functioning outside of therapy.
The four categories that contributed to this cluster are
described below.
Disengagement as Avoiding the Dark Point of No Return:
Preventing Depression and Worsening Life Functioning
Six participants described disengaging sometimes in order
to avert the return of depression or other limiting conditions.
They all explicitly described disengagement as a way to
prevent loss of ability to function outside of session, while
five interviewees discussed disengagement also as a way to
avoid becoming depressed. One participant exemplified
both of these processes as he described deliberating the
benefit of addressing painful issues in therapy versus the
emotional, temporal, and financial costs that could result.
I don’t want to damage myself by going there [to the
pain] and want to self-destruct… it would be
destructive…it would be maybe, not that I wouldn’t be
able to, but, it would be harmful and umm it would be
time, it would be like crushing a plant or something,
you know, it would take time to regrow… I’d be uhh
withdrawing and have a uhh loss of confidence. (P8)
Thus participants described using disengagement to limit
the potential costs outside of the session of addressing their
pain in session.
Disengagement as Maintaining Belief in Self: Improving
Self-Image and Self-Esteem
Nine participants described utilizing disengagement toward
increased morale. In contrast to the category in the third
J Contemp Psychother (2009) 39:171–186 181

cluster in which clients disengaged to promote an improved again, hearing things like this [self-criticism], then I
image to their therapist, this category stresses clients’ start that [revised] tape instead of letting the nega-
disengagements toward improving their self-perception. tivity go on and then I substitute that tape for the
Eight clients described disengagement as a way to negativity and I can come to a workable under-
manage self-presentation toward increasing their self- standing. (P2)
esteem. Through a process of disengaging from their less
In these ways participants described using disengagement
prized aspects clients described working to create an
at times to end self-impeding habits and turn over a new
improved self-presentation that was more in line with how
leaf.
they would like to be seen. Similarly, eight participants
described disengagement as a way to prevent being criti-
Core category: Disengagement as Communicative
cized or invalidated and to increase self-worth. ‘‘What if I
Experimentation Toward Self-Change: Reconfiguring
reveal something and my therapist shows any sign of shock
Self-Advancement and Self-Protection
or um reacts in any way um that could be in any way
construed as negative?’’ (P2). Thus participants described
The overarching theme of clients’ experiences of disen-
disengagement as a way to increase their self-worth and
gagement was based upon commonalities among the five
self-assurance within the therapeutic relationship.
central clusters. Eight participants provided feedback via
the questionnaire on the core category and indicated a high
Disengagement as Maintaining Belief in the World:
level of agreement with it (M = 6.375, on a 7-point Likert
Invoking Hope for Better Future
scale where 1 = ‘‘does not fit at all’’ to 7 = ‘‘fits very
much’’). Participants experienced considerable awareness
Six participants described disengaging at times in order to
of their disengagement in psychotherapy, as illustrated in
feel more hopeful about their prospects. They described
clusters 2, 3, 4, and 5—sometimes observing disengage-
disengagement as a way to maintain a positive perspective,
ment ‘‘in the moment,’’ while it occurred, and sometimes
working to sustain a vision of the world that was neither
only noticing it after the fact. In both cases, clients expe-
paralyzing nor Pollyannaish.
rienced the disengagements as generally beneficial. The
I guess at this point I’m just trying to say that the disengagements could be beneficial by allowing some
[long overdue] check came, get over it, you know, I distance and protecting clients from something harmful.
can’t just live in total paranoia and let them [her They could also be beneficial by directing clients to con-
worries] take over my brain and my emotions, and sider how to best negotiate the therapy experience and
just try to think positive that they [her debtors] are moving them toward something more productive. These
going to continue to do the right thing. (P1) disengagements allowed clients to be either self-protecting
or self-advancing in a way that felt useful to them.
Similarly, two interviewees explicitly described disengage-
However, disengagement also was experienced as a
ment as a way to integrate their negative experiences with
hindrance at points. As illustrated in cluster 1, within the
their positive experiences, linking past negative experi-
context of psychotherapy—which clients viewed as a place
ences to positive experiences to remain more hopeful. In
to be completely open, disengagement sometimes made
these ways, participants described disengaging from
them unable to share or discuss thoughts, feelings, and
demoralizing perspectives in order to develop a more
experiences; or unable to act in a way they wish they could
affirming interpretation of the past toward a more encour-
act. In addition, clients sometimes found that the disen-
aging vision of the future.
gagement was involuntary and difficult to curtail at will.
Clients struggled to find ways to be both self-advancing and
Disengagement as Forging a New Way of Being: Let’s Try
self-protective at the same time, but their self-protective
This Another Way
responses could impede their progress in therapy when it
kept them at bay from important aspects of their experience.
Six participants described disengaging at times with an aim
As illustrated in cluster 4, clients sometimes expected
toward self-betterment. They discussed disengagement as a
their therapists were noticing their disengagements during
way to facilitate their problem solving, while two also
sessions and that the therapists were thereby gaining a
described disengagement as a way to discontinue past
deeper understanding and appreciation of their struggle to
disruptive ways of self-relating. These two processes were
be simultaneously self-protective and self-advancing. Cli-
exemplified in one client’s description.
ents then would look to their therapists’ reactions and
When I’m listening to myself, when I’m having this responses to their disengagements as guideposts toward
discussion or I catch myself um doing the critic thing how to manage this predicament.

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As clients became comfortable with this striving to
better guide their progress while still protecting them-
selves, they would more readily notice when their
disengagement was becoming a hindrance and remedy it.
As illustrated in clusters 2 and 5, clients could remedy
hindering disengagements (e.g., becoming self-critical, or
preventing self-assertion) by learning to recognize and
tolerate the fears that previously had them disengaging
involuntarily and stuck. They began not only to learn to be
self-advancing about less-threatening topics, but also to
learn how to confront, explore and make progress in the
face of more intense or painful concerns. In this manner,
disengagement helped clients to become increasingly
confident about their abilities to continue difficult explo-
ration in psychotherapy.
Discussion
The participants’ reported experiences during disengaged
moments in psychotherapy offer a rare view of the internal
workings of disengagement from clients’ perspectives. The
rigorous in-depth analysis of these experiences has led to a
comprehensive model of disengagement to further psy-
chotherapy practice and research. However, in interpreting
the findings a number of the study’s limitations are worth
bearing in mind. While attempts were made to recruit a
diverse sample, there are aspects of the sample that limit
generalizability. Specifically, as the participants of this
study all identified as Caucasian, and were functioning
sufficiently to receive treatment in outpatient settings,
caution is warranted when generalizing these findings to
other populations.
Nonetheless, a number of factors can strengthen confi-
dence in these findings. The large number of
disengagement experiences (47) present in the interviews,
the comprehensive grounded theory analysis, the saturation
of the model, the participants’ agreement with the findings,
and its meaningfulness to readers, all suggest that the
phenomenon was well-studied and accurately captured
clients’ experiences. Another notable strength of the pres-
ent study is its inclusion of clients from long- as well as
short-term psychotherapies (range of length three
months—four years), in contrast to most research on dis-
engagement that has tended to focus on psychotherapies of
24 sessions or less (e.g., Frankel et al. 2006).
Implications for Research
As Engle and Arkowitz (2006) recently underscored, in the
past 100 years of psychotherapy research resistance inter-
vention has received only scarce empirical attention. The
present findings offer a coherent understanding of clients’
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J Contemp Psychother (2009) 39:171–186
experiences of disengagement and a descriptive categori-
zation to assist therapists in their moment-by-moment
assessment of what may be transpiring during identified
periods of disengagement. Consistent with the combined
findings from the literatures on storytelling, silence, and
secrecy in psychotherapy (e.g., Beutler et al. 2004; Rennie
1994; Levitt 2001b; Hill et al. 2000), the present findings
partially support a differentiated view of disengagement,
which includes both ostensibly productive and obstructive
forms of disengagement in relation to clients’ therapy
goals. Disengagement experiences described in Cluster 1
tended to be automatic and to run counter to clients’ pre-
dominant therapy goals, while disengagement experiences
found in the remaining four clusters were utilized pre-
dominantly to address problems, manage therapeutic
relationships, learn about oneself, and interrupt self-
impeding patterns (for further discussion see Frankel
2007). While the present study identified many productive
processes in disengagement, additional research is needed
to enumerate the relative frequencies of productive and
obstructive disengagements, explore their relative impact,
and to relate these types of disengagement to the processes
described in those literatures. However, despite consider-
able effort to find them, no clear markers for differentiating
between types of disengagement were found in the present
study, as disengagement behaviors were seen to be simi-
larly employed for both productive and obstructive
processes (e.g., finger braiding to both distract from dis-
comfort and to signal difficulty to therapist).
That said, a number of behaviors were consistently
reported to be related to disengagement. As reflected in two
subcategory titles, clients indicated that abrupt shifts in
behavior, speech, and mood were often related to disen-
gagements. Such behaviors included obvious and frank
gestures such as leaving the therapy room to ostensibly
drink water; hand-wringing or other fidgeting; pronounced
looking away or avoidance of eye contact; and ‘‘turtling,’’
which involved a hunched posture in a form of physical
recoil. Other more subtle disengagement-related behaviors
included sheepishly voiced I-don’t-knows; rapid-fire ask-
ing of questions; bracing and stiffening of body; long self-
filtering pauses; changes in topic or tenor of discussion;
and deep breathing. Although these behaviors were neither
systematically analyzed to differentiate between productive
and obstructive aspects of disengagement nor reported to
do so by participants, upon informal observation, those
behaviors that occurred more abruptly generally appeared
more likely to be obstructive.
These disengagement-related behaviors are further sup-
ported by their high degree of consistency with those
arrived at with a different, task analytic, research method-
ology by Safran and Muran (2000) for identifying what they
refer to as ‘‘withdrawal alliance ruptures’’: denial, minimal
J Contemp Psychother (2009) 39:171–186
response, shifting the topic, intellectualization, storytelling,
and talking about other (p. 142). Although their behavioral
markers concur with those reported in the present study
their model does not differentiate between positive aspects
and negative aspects of disengagement, instead regarding
all disengagement as an alliance rupture. Thus, given the
consistently variegated nature of disengagement reported
by participants in the present study, future research might
focus on specific markers useful in distinguishing produc-
tive and obstructive aspects of disengaged moments.
Such research might begin with an in-depth exploration
of differentially effective high-disengagement psychother-
apies, to discover patterns of client disengagement and
therapist responses associated with good and poor out-
come. The use of psychotherapy coding systems might help
in this effort. For instance, the Pausing Inventory Coding
System (H.M. Levitt and Z. Frankel, Unpublished manu-
script), can help researchers to identify two types of
disengagement processes through verbal and para-verbal
markers (e.g., disengagements that are more geared to
avoid emotion and those that are more geared to safeguard
the alliance). In addition research might focus on experi-
enced therapists to learn how they conceptualize and
navigate choice points related to disengagement in the
moment. To what extent therapists are actually aware of
their clients’ disengagements has yet to be studied. In
preliminary investigations of therapists’ experiences asso-
ciated with three of the current study’s therapy sessions,
therapists’ reports of therapy events were strikingly dis-
parate from clients’ reports, raising the possibility that
therapists may be less attuned to clients’ disengagements
than clients imagine. Findings from such studies then could
be integrated to construct a training manual that could be
evaluated in controlled experimental research. Given the
centrality of disengagement experiences in the change
process, learning how to better respond to them would
greatly benefit psychotherapy training, practice, and
research. Toward those aims, the paper now briefly turns to
clinical implications of the present findings.
Relational Acts as Interventions in Disengagement
The present findings of clients’ experiences of disengage-
ment provide a phenomenological context within which
existing literature on disengagement phenomena can be
better understood and applied clinically. Central to the
present model of client disengagement is a sense of rec-
onfiguring the dance of self-advancement and self-
protection. Such a model of disengagement provides a
theoretical context for one of the most robust findings in
psychotherapy research (Orlinsky et al. 2004)—regardless
of the therapeutic technique or school, the therapeutic
alliance reliably accounts for a substantial proportion of
183
explained variance in psychotherapy outcome (meta-anal-
yses find effect sizes ranging from 0.22 to 0.29). If we
understand disengagement to entail experimentation and
non-verbal communication around core concerns then the
importance of the relationship in resolving those concerns
is clear, as is the influence of therapists’ responses to dis-
engagements on psychotherapy outcome.
This proposed model of disengagement therefore argues
for a transposition of previous understandings regarding the
nature of intervention. Safran and Muran (2000) have
emphasized that intervention is a ‘‘relational act’’ (p. 41),
communicating therapists’ attitudes and defining the tenor
of therapeutic relationships. Of course the way techniques
are introduced and used within the relationship do carry
important implications, however, it may be more helpful to
stress in regard to disengagement that relational acts are
interventions. That is to say that the way in which thera-
pists are in the relationship—how they respond on a
session-to-session, minute-by-minute basis to their clients’
difficulties and challenges—comprises the bulk of the
intervention; because those responses, that behavior, is
what provides answers to the core of clients’ disengage-
ment experiences, the communicative experimentation
toward self-change.
Thus the core category of the present model of disen-
gagement, referred to in shorthand as ‘‘communicative
experimentation,’’ suggests an intervention strategy of
contextually sensitive ‘‘mindful responsiveness’’ to meet
the needs of clients’ enacted issues. Specifically, therapist
mindful responsiveness may be benefited by orienting to
two broad themes of clients’ enacted issues common
among clients’ reported experiences of both productive and
obstructive forms of disengagement within the therapeutic
relationship: (1) Disengagement is experienced as a unified
movement aimed toward resolving difficulties, either
directly by assembling additional personal resources or
indirectly by strengthening the therapeutic relationship;
and (2) disengagement is experienced as a recruitment of
therapist feedback—communicating both clients’ fears and
hopes—regarding either clients’ difficulties or regarding
possible client changes.
The Disengagements are Friendly
Despite considerable debate (cf. Leahy 2001; Messer 2002;
Engle and Arkowitz 2006), resistance phenomena in psy-
chotherapy continue to be viewed pejoratively and,
ultimately, destructively: ‘‘The conflict, therefore, is a
conflict between the patient’s healthy wish to change and
his unhealthy resistance to change’’ (Stark 1994, p. 3).
Indeed, even in the client-centered tradition, although the
blame is placed squarely at the feet of therapists, resistance
is nonetheless viewed disapprovingly, as ‘‘it [resistance]
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grows primarily out of poor techniques of handling the
client’s expression of his problems and feelings’’ (Rogers
1951, p. 151). In the present study clients described pro-
ductive processes in disengagement, that suggest quite to
the contrary of both these perspectives, that more similar to
Mahoney’s (2003, p. 172) ‘‘compassionate’’ views of
resistance, disengagement is not only a natural part of the
change process, but can facilitate it.
Nonetheless, the findings do not recommend a laissez
faire attitude toward disengagement. Rather, just the
opposite, they suggest that in response to disengage-
ments—as Fromm-Reichmann reportedly proclaimed over
50 years ago—‘‘patients need an experience, not an
explanation’’ (quoted in Strupp and Binder 1984, p. 139).
Specifically, the findings direct our attention to clients’
enacted communications and to the multiple meanings
behind them. They direct our attention to the agentic,
aware, and invested person of the client. They direct our
attention to the responses of therapists, to which clients
closely attend and interpret on many levels. And, perhaps
most important of all, they direct our attention to the very
heart of the therapeutic encounter, the relationship.
Acknowledgement We would like to acknowledge and express our
gratitude to Dr. Robert A. Neimeyer, Dr. Sharon G. Horne, Dr. Sam
B. Morgan, Dr. Karina Koerner, and Joseph Currier for their help with
this study.
Appendix A: Disengagement Interview Questions
Statements Made Preceding Each Interview
1. I am meeting with you today to learn about your
experience in the therapy session.
2. If at any part during the interview you are uncomfort-
able with a certain question or topic please let me
know and we can move to another topic, or if you need
we can terminate the interview altogether.
3. I am particularly interested in moments where you
might lessen your involvement in the session, remove
yourself from the topic that was being discussed, or
hold back things that you are thinking or feeling. For
instance, when you feel yourself detach from the
therapy conversation or pull back from what’s being
discussed or feel less involved in the therapy process. I
call these occurrences disengaged moments. I am
particularly interested in what is happening for you in
the session rather than your reactions now, but if you
share a new reaction, please let me know that it is not
what you were feeling then.
4. Before we start are there any moments like this that
stand out for you within your last session? Because
123
J Contemp Psychother (2009) 39:171–186
we’re going to go through the whole tape—and I’ll
want to hear more about it later—could you give me a
brief description now?
5. I’ll give you the remote control and you can watch the
tape, stopping at such disengaged moments.
Questions about Each Disengaged Moment
1. What were you experiencing in this disengaged
moment?
2. How did these feelings come up for you at this point?
What was going on before?
3. What was it that prompted you to disengage?
4. Was there anything else going on for you during this
moment?
5. What do you think was going on for the therapist at
this point?
6. How would you have liked the therapist to respond to
you here? How would that have made you feel through
the rest of the session?
Questions and Statements to be Made at the End of the
Interview
1. We’realmostfinishedwiththeinterview.Iwouldliketoask
yousomequestionsaboutourinterviewtodaybecauseIwill
beinterviewingsomemorepeopleandIwouldliketomake
sure that I am asking the best questions and using the best
interviewingstylethatIcan.
2. What did these moments mean for you? Do you see a
trend in your disengagement? Do you have a theory
about disengagement after viewing your session tape?
3. Which disengaged moment felt the most important to
you?
4. Is there anything I haven’t asked that feels like it
would help me understand your experience of
disengagement?
5. Is there anything you have learned from this interview
process?
6. Is there anything you would want to share with your
therapist?
7. Do you have any questions or comments, about
anything?
8. How do you feel about our meeting today?
9. Let me remind you that I’ll be asking for your
feedback once the findings of this study are compiled.
I’ll be interested in hearing what you think about the
study’s findings. This is actually really important for
the study, as part of the assessment of my findings is
whether they are coherent and fitting with your
experience. So even if you have nothing to add to
J Contemp Psychother (2009) 39:171–186
the findings it is important to me that you return the
feedback form.
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