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Shared decision-making about therapeutic methods has been proposed as a way of conceptualising, and assisting, collaboration in the therapeutic alliance. However, little is known about how psychotherapists actually create concrete, moment-by-moment opportunities for clients to share their ideas about what might be therapeutically helpful. We used conversation analysis to examine psychotherapists’ questions about what might be helpful in audio-recordings of early sessions of a collaborative-integrative therapy. We examined forty-two sessions involving seven dyads and identified 28 cases of questions either inviting clients’ ideas about helpful in-therapy methods or strategies outside the therapy room. Psychotherapists could invite clients’ ideas by using simple questions, however clients could find such questions problematic. Alternatively, psychotherapists could add scaffolding: offering support to the client in terms of how they might respond. However, this could erode clients’ autonomy to respond with their own ideas. We identified a conversational practice,  de-specifying , which overcomes this dilemma: asking questions and providing scaffolding whilst also lessening the pressure on the client to go along with that scaffolding. A therapeutic style which includes scaffolding and de-specifying practices creates an opportunity for the client to contribute where clients are empathically supported, but not directed, in responding.

Therapists’ questions to clients about what might be helpful can be supportive without being directive: a conversation analysis