Mutuality in Psychotherapy: A Meta-Analysis and Meta-Synthesis

This article presents a systematic review of mutuality in psychotherapy, including meta-analysis of quantitative and metasynthesis of qualitative studies. A search with specified keyword combinations yielded 21 studies, including 10 quantitative studies with 1,071 participants and 11 qualitative studies with 81 participants. Researchers calculated effect sizes, conducted homogeneity tests, and assessed potential variables moderating the relationship between mutuality and therapeutic variables from quantitative studies; they analyzed qualitative studies to identify and synthesize themes related to mutuality in psychotherapy. Meta-analysis showed a large weighted mean effect size with a statistically significant overall relationship between mutuality and therapeutic variables (r =.51, 95% CI [0.37, 0.66], p =.001). The relationship between mutuality and session quality was strongest of the six relationships analyzed (r =.70, 95% CI [0.43, 0.97], p =.001). Qualitative metasynthesis of studies produced six themes: (a) lack of mutuality/strategies for disconnection, (b) cocreated relational process, (c) metacommunication and misunderstanding, (d) therapist congruence/being real, (e) mutual impact and client agency, and (f) asymmetric role power and boundaries. These findings suggest that mutuality is worthy of further research in psychotherapy, particularly in relation to its strong relationship with session quality.