I am reading The Gift of Therapy by Irvin Yalom - really great book, highly recommend it - and he says Ts should create a new therapy for each patient. Because everyone is different. Something could help one patient but distress another.

For example, if I start talking about something that's obviously important, my T sometimes asks questions in quite a demanding way. I once started this whole conversation about the therapist in Good Will Hunting breaking boundaries and quietly added something about how my dad spent time in the care system. T realised that was the real reason I brought up the film and said, quite forcefully: "Tell me about your dad being in care." Some people would hate that. I loved him for it. I needed him to realise it was important and not just let the conversation move on.

I don't think the client always knows what they need. Or rather they may not consciously know it.