Perceptions of Good Psychotherapy in a Community Mental Health Setting: Exploring the Contextual Nature of Treatment


Lisa Phillips

Defense Date


Graduation Date

Spring 1-1-2006


Campus Only

Submission Type


Degree Name



Clinical Psychology


McAnulty College and Graduate School of Liberal Arts

Committee Chair

Russell A. Walsh

Committee Member

Stephen Scrimenti

Committee Member

Bruce Fink


Community Counseling Psychotherapy, Community Counseling Research, Community Counseling Systems, Psychotherapy Research, Psychotherapy Systems, Qualitative Psychotherapy Research


The present study explored employee perceptions of what constitutes good psychotherapy in a community mental health environment across the perspectives of a number of professional groups, including the Board of Directors, administrators, and secretarial and fiscal staff. If good therapy arises out of a context far broader than current psychotherapy research reflects, looking at the multiple systemic levels within which psychotherapy may occur in a community counseling center provides an important facet of what is missing in both psychotherapy research and community mental health literature.

This study utilized a hermeneutic, phenomenological method of interpretation, where the participants' responses to four questions were audiotaped and then transcribed. These interviews were read for a general sense of the individual's perspective, and then read again with attention to identified words and phrases where I could draw out the participant's values with respect to psychotherapy. Preliminary interpretations of the therapy values that these words and phrases implicitly or explicitly reflected were arrived at, followed by organization into themes, after which attempts were made to seek disconfirming data within the transcript. The process of organizing and articulating themes, and then seeking disconfirming data was continued until a subjective sense of confidence was achieved. Narrative accounts were then drafted to characterize each participant's values with respect to psychotherapy. Comparisons and contrasts across participants holding similar positions, and between participants holding different positions were then made, and the results were summarized in narrative form.

The results showed that from the participants' perspectives, therapy occurs not only during a therapy session, but also prior to and following the session in this community counseling setting. Support staff were found to have therapeutic relationships and alliances with clients that play an important role in the clients' treatment. To thoroughly know and treat the client was found to require much time, and must include knowledge of the client's family, influences, and outside world. The atmosphere, which includes staff morale and the way in which staff interact with one another and with administration, was also found to play an integral role in psychotherapy. People skills, or the way in which the staff interact with clients, appeared to have as significant a part as therapy skills, if not more significant, when providing quality treatment services. The business and economic aspects of community mental health were also found to play a considerable role in psychotherapy.

The present study sought to more thoroughly understand a contextual approach to psychotherapy research that takes into account different perspectives on the meaning of treatment outcomes, as an alternative to the existing medical model. This study has shown that many of the multifaceted aspects of therapy that are often not taken into consideration factor significantly into the values of participants.





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