BACKGROUND: Uninvolved evaluators have primarily determined the effectiveness of therapeutic interventions in outpatient mental health therapy whereas participant perspectives have been missing in the literature.
OBJECTIVE: The focus of this study was to compare the perspectives of participating nurse therapists and clients with those of uninvolved marriage, family, and child therapists (family therapists) regarding effective interventions.
DESIGN: A phenomenological study of eight matched pairs of clients and nurse-therapists, in which participants critiqued effective and ineffective therapeutic interventions seen in videotaped outpatient sessions, was completed. In this follow-up study, the videotapes were shown to family therapists, and their perspectives were compared with those of the nurse-therapists and clients.
RESULTS: Evaluative commentary from nurse-therapists and clients consistently agreed in content and scope as well as degree of conviction. Reflections of the family therapists frequently differed from those of the clients or nurse-therapists.
CONCLUSION: Participants in a therapy session are best able to evaluate the effectiveness of therapeutic interventions.
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References
1.
Barrell, L. M., Merwin, E. I., & Poster, E. C. (1997). Patient outcomes used by advanced practice psychiatric nurses to evaluate effectiveness of practice. Archives of Psychiatric Nursing, 11, 184-197.
2.
Benner, P. (1994). Interpretive phenomenology: Embodiment, caring and ethics in health and illness. London: Sage.
3.
Bishoff, M. M., & Tracey, T. J. (1995). Client resistance as predicted by therapist behavior: A study of sequential dependence. Journal of Counseling Psychology, 42, 487-495.
4.
Conoley, C. W., Padula, M. A., Payton, D. S., & Daniels, J. A. (1984). Predictors of client implementation of counselor recommendations: Match with problem, difficulty level and building on client strengths. Journal of Counseling Psychology, 41, 3-7.
5.
Cuffel, B. J., Goldman, W., & Schlesinger, H. (1999). Does managing behavioral health care services increase the cost of providing medical care? Journal of Behavioral Health Services Research, 26, 372-380.
6.
Cummings, A. L., Martin, J., Hallberg, E., & Slemon, A. (1992). Memory for therapeutic events, session effectiveness and working alliance in short-term counseling. Journal of Counseling Psychology, 39, 306-312.
7.
Elliott, R., James, E., Reimschuessel, C., Cislo, D., & Sack, N. (1985). Significant events and the analysis of immediate therapeutic impacts. Psychotherapy, 22, 620-630.
8.
Goldman, W., McCulloch, J., Cuffel, B., & Kozma, D. (1999). More evidence of the insurability of managed behavioral health care. Health Affairs, 18(5), 172-187.
9.
Heppner, P. P., Rosenberg, J. I., & Hedgepeth, J. (1992) Three methods in measuring the therapeutic process: Clients’ and counselors’ constructions of the therapeutic process versus actual therapeutic events. Journal of Counseling Psychology, 39, 20-31.
10.
Hill, C. E. (1989). Therapist techniques and client outcomes: Eight cases of brief psychotherapy. Newbury Park, CA: Sage.
11.
Hill, C. E., Helms, J. E., Spiegel, S. B., & Tichenor, V. (1988). Development of a system for assessing client reactions to therapist interventions. Journal of Counseling Psychology, 35, 27-36.
12.
Llewelyn, S. (1988). Psychological therapy as viewed by clients and therapists. British Journal of Clinical Psychology, 27, 223-238.
13.
Mahalik, J. R. (1994). Development of the Client Resistance Scale. Journal of Counseling Psychology, 41, 58-68.
14.
Patterson, G. R., & Forgatch, M. S. (1985). Therapist behavior as a determinant for client noncompliance: A paradox for the behavior modifier. Journal of Consulting and Clinical Psychology, 53, 846-851.
15.
Peck, M., Gitterman, D., & Scheffler, R. (2000, June). Expanding access: Mental health parity in California. Paper presented at the Mental Health Parity conference: The implementation of AB88, Sacramento, CA.
16.
Raingruber, B. (1999). Recognizing, understanding, and responding to familiar responses. The importance of a relationship for therapeutic effectiveness. Perspectives in Psychiatric Care, 35(2), 5-17.
17.
Raingruber, B. (2000). Being with feelings as a recognition practice. Perspectives in Psychiatric Care, 36(2), 41-50.
18.
Regan, A. M., & Hill, C. E. (1991). An investigation of what clients and therapists do not say in brief therapy. Journal of Counseling Psychology, 39, 168-174.
19.
Rennie, D. (1990). Toward a representation of the client’s experience of the psychotherapy hour. In G. Lietair, J. Rombouts, & R. Van Balen (Eds.), Client-centered and experiential therapy in the nineties (pp. 155-172). Leuven, Belgium: Leuven University Press.
20.
Ryden, M. B., McCarthy, P. R., Lewis, M. L., & Sherman, C. (1991). A behavioral comparison of the helping styles of nursing students, psychotherapists, crisis interveners, and untrained individuals. Archives of Psychiatric Nursing, 5, 185-188.
21.
Watson, J. C., & Rennie, D. L. (1994). Qualitative analysis of clients’ subjective experience of significant moments during the exploration of problematic reactions. Journal of Counseling Psychology, 41, 500-509.
