Academic journal article Journal of Marital and Family Therapy

An Ethnographic Study of Client and Therapist Perceptions of Therapy Effectiveness in a University-Based Training Clinic

Academic journal article Journal of Marital and Family Therapy

An Ethnographic Study of Client and Therapist Perceptions of Therapy Effectiveness in a University-Based Training Clinic

Article excerpt

The purpose of this study was to explore client and therapist evaluations of direct practice in a university-based training center using an ethnographic research methodology. Client and therapist perceptions about the strengths and limitations of ethnographic practice evaluation were also analyzed. A domain analysis was performed on postsession interviews with both clients and practitioners over a 4month period. Six core categories of client and therapist perceptions of therapy effectiveness emerged from a domain analysis: (a) changes associated with counseling, (b) important practitioner qualities, (c) effective interventions or techniques, (d) ineffective interventions or techniques, (e) recommendations for future sessions, and (fl strengths and limitations of ethnographic practice evaluation. Implications of this study for clinical practice, training, and future research are discussed.

Increasingly, family therapy practitioners and researchers have called for methods to systematically assess, monitor, and evaluate practice (Andreozzi, 1985; Atkinson & Heath, 1987; Calam & Elliot,1987; Gurman,1987; Liddle,1991a; Reiss,1988; Steier,1985,1988; Wassenaar, 1987; Wynne, 1988). However, Gurman (1987) and others (Andreozzi, 1985; Liddle, 1991a; Pinsof, 1988; Steier, 1988; Wynne, 1988) have emphasized that existing research on this issue is scant. In the past, practice evaluation has largely consisted of outcome research designs that compared the overall effectiveness of two or more different therapy models but failed to provide information on areas within the particular model that produced change (Gurman, 1987; Liddle, 1991a). These "comparative- competitive" or

"who won" studies that pit one approach against another have not been very helpful in convincing clinicians to change their treatment methods based on empirical evidence or to participate more actively in research (Liddle,1991a; Pinsof,1988). Additionally, clinicians have lamented that findings from outcome studies do not provide them with usable information about specific families prior to termination (Andreozzi,1985; Wamboldt, Wamboldt, & Gurman, 1985). Bednar, Burlingame, and Masters (1988) reviewed over 140 family therapy studies from 1980 to 1987 and concluded that rigorous experimental outcome studies were premature for a discipline that had not yet operationalized essential areas of effectiveness within existing family therapy models. This situation calls for exploratory, discovery-oriented research studies to understand what factors within a therapy session are associated with improvement or deterioration (Moon, Dillon, & Sprenkle, 1990; Pinsof, 1988; Wynne, 1988).

To answer this challenge, writers have primarily advocated research methods from one of two positions: (a) quantitative process research (Greenberg & Pinsof, 1986; Gurman, Kniskern, & Pinsof, 1986; Johnson & Greenberg, 1988; Pinsof, 1988) or (b) qualitative research methods (Atkinson & Heath,1987; Moon et al.,1990). Although there are several examples of quantitative process research (cf. Benjamin, Foster, Roberto, & Estroff, 1986; Pinsof, 1986; Pinsof & Catherall, 1986; Szapocznik, Kurtines, Santisteban, & Rio, 1990), qualitative studies of practice evaluation are still in their infancy (cf. Newfield, Kuehl, Joanning, & Quinn, 1991; Todd, Joanning, Enders, Mutchler, & Thomas, 1990).

Additionally, there has been a call for research that includes multiple perspectives from both clients and therapists (Lebow, 1981; Moon et al., 1990; Pinsof, 1988). Participants' experiences of therapy, and their thoughts and feelings about therapy, are as legitimate and valuable as observable behaviors (Pinsof,1988). Ideally, client perspectives would include not just the identified patient but all family members, or what Pinsof (1984) calls "indirect patient systems." The basic rationale for multiple perspectives is the self-evident notion that there is no single "objective" reality but rather multiple realities that contain unique perceptions and views of treatment (Gurman et al. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.