Gaining perspective: How men describe incidents damaging the therapeutic alliance.

Abstract

This study investigated the incidents that male clients found to be most detrimental to the formation or strengthening of the therapeutic alliance with their mental health professionals, using an abbreviated version of the qualitative critical incident technique, which focused on hindering incidents only. The Conformity to Masculine Norms Inventory was administered as a measure of participants' adherence to traditional masculine gender norms to better describe the sample. Participants were 86 adult males, almost all of whom were receiving individual counseling or psychotherapy at the time of the study. After redundant statements had been eliminated, a total of 56 unique critical incident statements were obtained. The statements were initially sorted into self-defined, conceptually homogenous categories by 3 returning participants, and a consensus classification structure (based on the participants' categorization of the incidents) was then created by the researchers. The consensus structure was modified based on feedback and reliability data gathered from a subset of participants. The final category scheme contained 7 categories describing what clients in this study perceived as detrimental to the formation or strengthening of the alliance. The categories were as follows: Not the Right Fit/Approach, Counselor/Psychotherapist Pressuring the Client, Client Uncertain or Untrusting, Counselor/Psychotherapist Acting on Assumptions About the Client, Client Unsure of What to Expect in Session, Client Not Putting in Enough Effort, and Time/Timing Problems. These categories can aid practitioners in providing gender-sensitive care by helping them become alert to the ways in which problems may manifest in alliances with male clients.