Evidence, adaptations
and limits.
Promising, not yet proven.
What research shows about pluralistic therapy, how it might be adapted for disabled clients, and where the gaps are.
What this is: a summary of the evidence on pluralistic therapy.
Why it matters: claims about an approach should match what’s known.
The honest summary: early results are encouraging, and the evidence base is small.
The biggest gap: we found no studies designed around disability, or reporting results by disability.
The short version
Pluralistic therapy is a young approach, and its evidence base is small. An uncontrolled multisite study found encouraging outcomes for depression. A pilot randomised trial with young people found that a trial was feasible, but found no significant difference from counselling as usual on its main measure. A wider body of research supports one of its core ideas: accommodating people’s preferences is linked to fewer dropouts and somewhat better outcomes. Our targeted searches did not find studies of pluralistic therapy designed around disability, or reporting results by disability. Its fit with disability-informed practice rests mainly on its principles, not on outcome data.
What the research shows
Research findingPluralistic therapy for depression
Cooper and colleagues (2015) offered up to 24 sessions of pluralistic therapy to adults with depression across several sites. Of 42 people assessed, 39 attended two or more sessions. Among those 39 completers, 28 (71.8%) showed reliable improvement and 17 (43.6%) reliable recovery. These figures come from an uncontrolled study, so they describe what happened in this sample, not a success rate other people can expect. Effect sizes from start to end were large (d = 1.83 for depression, 1.16 for anxiety). Clients valued the therapists’ flexibility and collaboration.
Limits: there was no control group, so the study can’t show that pluralistic therapy caused the improvement or that it is better than another therapy; the sample was small, and most participants were white and female.
Young people with addiction issues
Joyce, Cooper, McLeod and Vos (2023) randomly allocated 64 young people presenting with addiction issues to pluralistic counselling (31) or counselling as usual (33). Running the trial was feasible and acceptable. There was no statistically significant difference between the groups on the main measure of distress, at the end of counselling or three months later. At the three-month follow-up, results on a measure of young people’s difficulties (the SDQ) favoured counselling as usual.
Limits: as a pilot, it wasn’t designed or powered to show a difference. Fewer than half the young people provided follow-up data, which the authors described as a significant problem. They called for work on retention and on counsellors sticking to the approach.
Primary care counselling
Murphie and Smith (2025) compared before-and-after scores for 45 clients of a counselling centre offering pluralistic counselling. Most clients who started above clinical thresholds showed reliable improvement or recovery. Recovery on one measure was lower than in the services used for comparison.
Limits: there was no control group and the sample was small.
Accommodating preferences
A meta-analysis by Swift and colleagues (2018) found that clients who received a preferred treatment were less likely to drop out (odds ratio 1.79) and had somewhat better outcomes (d = 0.28) than those who didn’t. This supports an idea at the heart of pluralism, but it isn’t a test of pluralistic therapy itself.
The general point: evidence for parts of the approach, such as accommodating preferences, routine feedback or particular methods, isn’t the same as evidence for pluralistic therapy as a whole.
How much weight to give it
Our frameworkPromising
Early studies suggest pluralistic therapy is acceptable to clients and can be followed by real improvement.
Not yet proven
There is no large randomised trial in adults showing it works better than other therapies.
Supported in part
Its emphasis on preferences and collaboration draws on wider research.
Silent on disability
Our searches did not find studies reporting results for disabled clients.
Adaptations for disabled clients
Our frameworkOur searches did not find published adaptations of pluralistic therapy for disabled people. The suggestions below are this site’s synthesis, drawn from the approach’s principles and from wider disability-informed practice.
Access before preferences
Agree format, pace, communication and session length first. These are requirements, not choices to weigh.
Make the options accessible
Pictures, examples, written summaries, or trying a method briefly before choosing.
Check the cost of methods
Some methods use energy, movement, writing or sustained talk. Ask what they cost the person.
Make feedback easy
Offer ways to say something isn’t working that don’t rely on saying it face to face.
Don’t treat realism as distortion
Some fears about health, services or discrimination are realistic.
Know your limits
Being open to many methods isn’t the same as being trained in them. Refer on when needed.
Measuring change, in context
Our frameworkPluralistic therapists often use short tools to review therapy. They do different jobs: the Goals Form tracks progress on the person’s own goals, while the C-NIP asks about preferences for how therapy is done. The C-NIP doesn’t measure whether someone is getting better. For disabled clients, these need reading in context.
- Some items overlap with impairment. Questions about energy, sleep, concentration or activity may reflect a condition, pain, medication or circumstances, not only mood. Talk about what an answer means before drawing conclusions.
- Keep validated wording. If a standard questionnaire is used, don’t reword its items. If someone needs help to complete it, or it is given in another format, record that openly.
- Look beyond symptoms. A score can stay flat while the person reaches a goal that mattered: a difficult conversation, a decision, a relationship that changed.
- Review three things. Outcome, process and access. More on Talking About How Therapy Is Working.
For therapists: deliberate practice
Feedback can also guide a therapist’s own development: choosing a specific skill, getting feedback on it, practising, and checking whether practice makes a difference. Examples relevant to disability include explaining options clearly, waiting for someone using a communication aid, receiving criticism without becoming defensive, and noticing when a formulation has become too narrow. This is the therapist’s work, supported by supervision and training. Clients shouldn’t be made responsible for training their therapist.
Limits and critiques
Critique- Unfocused eclecticism. Without clear goals and reviews, pluralistic work can drift into trying a bit of everything.
- Breadth of skill. It asks therapists to be competent in several methods, which takes training and supervision.
- Choice can be a burden. Not everyone wants to make decisions about therapy, especially when tired, unwell or in crisis. Choosing to let the therapist lead should be an option too.
- Hard to research. Because each therapy is different, it is harder to say exactly what was tested.
- Collaboration can be superficial. Asking about preferences, then carrying on as before.
- Preferences can conflict with evidence, with what is feasible, or with what the therapist is trained to offer.
- Honest feedback is hard to give, especially to someone you depend on.
- Flexibility has limits. Services, money and access constrain what can actually be offered.
- Accommodation can avoid disagreement. A very accommodating therapist may avoid a disagreement that needed to happen.
Pluralism’s fit with disability-informed values is a reason to explore it. That fit doesn’t show it works better for disabled people.
What we don’t know yet
Not yet knownIt helps to be precise about what is missing. A targeted search failing to find something doesn’t prove disabled people were absent from the research. We looked for four different things:
- Studies designed around disability: we have not located any study of pluralistic therapy designed specifically with or for disabled adults.
- Studies reporting disability characteristics: the studies we found did not report how many participants were disabled, as far as we could see from the published summaries.
- Results reported by disability: we did not find any analysis comparing outcomes for disabled and non-disabled participants.
- Evaluations of particular adaptations: we did not find research testing specific access adaptations within pluralistic therapy.
We also have not located a large randomised trial of pluralistic therapy in adults.
Evidence & sources
Sources checked in October 2026, using targeted searches rather than a systematic review. “We have not located” means our searches did not find it.
Cooper, M., Wild, C., van Rijn, B., Ward, T., McLeod, J., Cassar, S. & Sreenath, S. (2015), “Pluralistic therapy for depression: Acceptability, outcomes and helpful aspects in a multisite study”, Counselling Psychology Review, 30(1), 6–20.
Joyce, P., Cooper, M., McLeod, J. & Vos, J. (2023), “Pluralistic counselling versus counselling as usual for young people presenting with addiction issues: A pilot randomised controlled trial”, Counselling and Psychotherapy Research, 23(1), 74–83. doi:10.1002/capr.12514.
Murphie, M.-C. & Smith, K. (2025), “The effectiveness of pluralistic counselling in a primary counselling setting”, Pluralistic Practice Journal.
Swift, J. K., Callahan, J. L., Cooper, M. & Parkin, S. R. (2018), “The impact of accommodating client preference in psychotherapy: A meta-analysis”, Journal of Clinical Psychology.
Cooper, M. & McLeod, J. (2007), “A pluralistic framework for counselling and psychotherapy: Implications for research”, Counselling and Psychotherapy Research, 7(3), 135–143. doi:10.1080/14733140701566282.
The weighting of the evidence, the adaptations and the guidance on measures and deliberate practice are this site’s synthesis.
The Goals Form and the Cooper-Norcross Inventory of Preferences (C-NIP) are listed on the pluralisticpractice.com tools and measures page.
Our targeted searches did not find studies of pluralistic therapy designed around disability, or reporting results by disability.
Last reviewed: October 2026.
How to cite this page: Donaghey, C. (2026). Evidence, Adaptations and Limits. Disability in Psychotherapy. Available at: https://disabilityinpsychotherapy.online/what-is-psychotherapy/pluralistic-psychotherapy/evidence-adaptations-and-limits/ (Accessed: [date]).
Shared under CC BY-NC 4.0, with an extra permission to teach from it on fee-paying courses. Credit the site. See Reusing This Material.