When Being Heard Changes the Shape of Care

There is a quiet grief many people carry out of therapy spaces: the sense that something important was spoken, but not truly received. That a story was shared, but not integrated. That care was offered, yet something was still missing.

I’ve sat on both sides of that experience.

Before becoming a therapist, and long before founding Cultivating Capacity, I worked in advocacy and other contexts where service users were not treated as afterthoughts, but as collaborators. While studying neuroscience at King’s College London, I had the privilege of learning within systems that actively integrated lived experience into research, theory, and practice through the Service User Research Enterprise (SURE). That model stayed with me—not as an abstract ideal, but as a felt sense of what becomes possible when people are invited into the shaping of the care they receive.

When Systems Speak About People Instead of With Them

Many of the most influential therapeutic models if my profession were developed with minimal input from the very people they sought to help. Structural and Strategic Family Therapy, for example, emerged from the instincts and authority of charismatic clinicians, later validated through controlled research environments. While these models contributed meaningful insight, they also reflect a broader pattern in mental health: theory created about people, rather than with them.

Even now—despite our profession’s stated commitment to collaboration, consent, and systemic awareness—service users are rarely invited into the process of shaping theory, training, or service delivery.

But therapy is not merely a set of interventions; it is a relationship that requires reciprocity.

Therapeutic Alliance as a Living System

Research consistently shows that the therapeutic alliance is the strongest predictor of therapeutic outcomes, regardless of modality or model. This is not new information. What is less explored is how service users themselves understand what strengthens or erodes that alliance over time. Yet, we have an abundance of research on how clinicians perceive this alliance. Again, the absence of service user experiences is concerning, yet goes largely undetected in real practice.

When feedback mechanisms are opaque, optional, or purely administrative, we miss vital relational data. We miss opportunities for repair. We miss the nervous system cues that tell us whether someone feels safe, respected, and genuinely partnered in their therapeutic journey. As I mentioned before, I've been on both sides of this dynamic, and I think it's crucial we own it as clinicians.

Inviting client voice is not about evaluation or performance. It is about ethics and continuous consent in a sacred relationship guarded by law, ethics, and respect for human dignity and privacy. It is about acknowledging that those receiving care hold wisdom about what helps them feel met.

From Feedback to Co‑Design: Expanding Our Imagination

Including service users can take many forms:

• Transparent, accessible feedback systems that invite honesty rather than compliance
• Conjoint client–clinician reflections that honor multiple perspectives
• Co‑designing treatment plans and interventions with those who will use them
• Integrating lived experience into the training of future therapists

These are not radical ideas! They're relationally attuned and deeply ethical.

When we move beyond tokenized feedback toward genuine collaboration, therapy becomes less extractive and more integrative.

Power becomes visible rather than hidden. Capacity expands on both sides of the relationship.

My own investment in this work is both professional and personal. I have benefited from therapy, and I have been harmed by it. I have felt deeply held, and I have felt profoundly unheard. As a survivor of sexual violence, I am particularly attuned to how systems respond (or fail to respond) to those who are already carrying rupture and deep mistrust.

Lived experience does not contaminate clinical insight. It contextualizes it.

When mental health systems make room for service users to shape services, research, and training, we move closer to care that is ethical, responsive, and genuinely systemic.

An Invitation, Not a Demand

This is not a call to discard theory, research, or clinical expertise. Instead, it is an invitation to widen the circle. What would therapy look like if feedback were woven into the relationship itself, rooted in transparency, curiosity, and mutual respect?

At Cultivating Capacity, this question sits at the heart of the work. Because therapy that honors voice is therapy that builds trust. And trust is where healing has room to unfold.