Gaining perspective: incidents that damage the therapeutic alliance as described by male mental health clients

This study investigated what incidents male clients found to be most detrimental to the formation or strengthening of the alliance with their mental health care providers, using an abbreviated version of the qualitative critical incident technique (a written form focusing on hindering incidents). Participants were 86 adult (M = 36.87 years old) male outpatients. Most (90.7%) were receiving individual counseling or psychotherapy at the time of the study. A total of 76 critical incident statements were extracted. After redundant statements were eliminated, 56 statements remained. The statements were sorted into categories by three participants and two researchers, according to what each sorter understood as the commonalities between the incidents in relation to what male clients saw as hindering or weakening the alliance. The consensus structure, based on the individual sort structures, contains 12 categories: Not the Right Fit, Unexpected Actions/Personality of Counselor/Psychotherapist, Communication Problems, Unprofessional, Client Needs to Build Trust, No Choice, Unsure of Therapist/Therapy, Client Not Putting in Work, Counselor/Psychotherapist Didn't Work Hard Enough on Client's Issues, Acting on Assumptions About Client, Pushy Counselor/Psychotherapist, and Time Problems. These categories can serve researchers in developing measures to better represent the male client's perspective on the alliance and can aid practitioners in providing gender-sensitive care by helping them become alert to the ways in which strains in the alliance may manifest with male clients.