<p>The commonly invoked opposition between the medical model and the contextual model continues to shape what is given primacy in psychotherapy research on client change. In the present paper, we develop an epistemically informed analysis of the medical-contextual binary, arguing that it functions as a sensitising heuristic that implicitly frames change through an interventionist stance. Echoing a critique raised by other scholars, we argue that this stance locates the primary source of change in the therapist’s actions, in turn obscuring clients’ agentic efforts and capabilities. To move beyond this constraint, we draw on empirical work that (a) alters the personal perspective from which change is studied, granting interpretive authority to the client, and (b) broadens the contextual scope of analysis to include clients’ everyday practices. Together, these shifts offer a broader understanding of how change unfolds across the diverse contexts of everyday life, while also underscoring the need for epistemological reflexivity and agency-attuned approaches in research and practice.</p>