You ask your client how things are going — maybe after a deep, emotional session — and suddenly, the energy shifts. Their shoulders tighten, they smile politely, and say, “It’s fine.” But you can tell something isn’t.
That’s one of the reasons the Outcome Rating Scale (ORS) is designed to be administered at the start of the session — it gives clients a voice before the work begins, helping them express feelings they might otherwise hold back.
And that’s okay.
Feedback is one of the most powerful therapeutic tools available, yet it can also feel like one of the most delicate. When clients seem resistant to giving feedback, it’s rarely because they don’t care. More often, it’s because of how feedback feels — vulnerable, uncertain, or even risky.
Let’s explore why clients hesitate to share honest feedback and how you can create a safer, more collaborative space for these conversations.
Resistance isn’t rebellion — it’s protection.
Clients often hold back for reasons that make perfect sense when you look closer:
- They fear disappointing you. Many clients see their therapist as a safe or even parental figure. The idea of expressing dissatisfaction can feel disloyal or uncomfortable.
- They worry about confrontation. For clients with a trauma background or conflict-avoidant tendencies, giving feedback can feel like stepping into danger.
- They don’t want to seem “difficult”. Especially in North American cultures, where politeness often replaces honesty, clients might suppress their true feelings to maintain harmony.
- They misunderstand the purpose. Some believe feedback evaluates them, not the therapy process.
Understanding these dynamics allows you to meet resistance with curiosity rather than correction — a stance that builds trust rather than tension.
Feedback-Informed Treatment (FIT) rests on one simple principle: therapy is most effective when clients feel heard, respected, and engaged.
Validated tools such as the Outcome Rating Scale (ORS) and Session Rating Scale (SRS) — both available through MyOutcomes® — allow clinicians to measure therapeutic progress in real time. These tools help therapists identify when clients feel disconnected or when sessions aren’t meeting their needs.
According to Dr. Scott D. Miller, founder of the International Center for Clinical Excellence (ICCE) and pioneer of FIT, integrating client feedback consistently can double engagement rates and significantly reduce dropouts. His research emphasises that what heals isn’t just the technique, but the relationship — and feedback is the compass that keeps that relationship on course.
The American Psychological Association (APA) has also highlighted the “therapeutic alliance” as one of the strongest predictors of positive outcomes, often surpassing even the specific modality of therapy itself.
So, feedback isn’t just data — it’s dialogue that deepens trust and fosters change.
The way you introduce feedback often determines whether clients embrace it or retreat. Here are some tested strategies that work:
1. Frame Feedback as Empowerment
Let clients know that feedback is their way to shape the experience.
“This helps me understand what’s working best for you — so we can make every session as meaningful as possible.”
Framing it this way puts control back in their hands — and clients often relax once they realise feedback isn’t a test; it’s teamwork.
2. Normalise It Early
Introduce ORS/SRS from the very first session. When feedback becomes part of the process rather than a sudden request, clients are less likely to interpret it as a sign that something’s wrong.
3. Model Openness
Show your own willingness to hear feedback — even when it’s tough.
“I really value honesty, even if it’s about something that didn’t work for you. That helps me learn and makes our work stronger.”
This model’s vulnerability reinforces equality in the therapeutic space.
4. Use Gentle Curiosity
If clients hesitate, back off the pressure. Try soft, permission-based language:
“Would it be okay if we explored what parts of today’s session felt most useful for you?”
This reduces defensiveness and turns the question into a conversation.
5. Keep It Simple
Tools like MyOutcomes® make feedback less intimidating through short rating scales. For many clients, circling a number feels safer than verbalising discomfort.
Therapist: “Now that the session has ended, let’s take a quick look at this Session Rating Scale. It helps us check how the session felt for you — whether we focused on the right things and how connected you felt.”
Client: “Oh, I’m not sure how to rate that.”
Therapist: “That’s totally fine — there’s no right or wrong answer. Think of it as a quick reflection, not a judgment. It just helps me understand what’s working best for you as we move forward.”
North America’s cultural diversity means no single approach to feedback fits all.
- Cultural humility is key. Some clients come from cultures where questioning authority is seen as disrespectful. Clarify that feedback is a partnership, not a critique.
- Be trauma informed. For clients who’ve experienced emotional invalidation, asking for feedback too soon can feel unsafe. Build trust before diving deep.
- Stay transparent. Explain clearly how feedback is stored, protected, and used to enhance care. Transparency builds confidence and ethical credibility.
When handled with care, resistance can become a turning point rather than a roadblock.
By creating a culture of curiosity and shared responsibility, you teach clients that their voice has power — both inside and outside the therapy room.
Feedback tools like MyOutcomes® turn that principle into practice, transforming subjective experiences into measurable insights that enhance both care quality and client satisfaction.
Talking about feedback with resistant clients isn’t about persuasion — it’s about partnership. It’s about showing clients that therapy isn’t something done to them but created with them.
And in that shared space, trust deepens, outcomes improve, and healing truly begins.
Ready to make feedback a natural part of your sessions?
Learn how MyOutcomes® empowers clinicians to strengthen client engagement and outcomes through Feedback-Informed Treatment.