Three perspectives regarding what works and does not work in therapy: A comparison of judgments of clients, nurse-therapists, and uninvolved evaluators

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. (J Am Psychiatr Nurses Assoc [2001], 7, 13-21.).