Crossing the perspectives of patients, therapists, and external observers on significant events within the therapeutic process in family therapy: A qualitative study

Introduction In psychotherapy research, increasing attention has been paid to significant events (SEs), defined as identified moments within the therapeutic process that are particularly fruitful and drive change. Previous studies have examined both the immediate post-session impacts of SEs, which can be both therapist- and client-identified, and the processes that occur within them. However, to date, no study has investigated SEs within the context of family therapy. Objective This study aimed to enhance understanding of the SEs that occur during family therapy by investigating and comparing the perspectives of patients, therapists, and external observers. Method Semi-structured interviews were conducted with patients (one adolescent and at least one parent per family; n = 13), therapists ( n = 8), and external observers ( n = 12) to identify SEs, the reasons for their selection, and their associated thoughts, emotions, meanings, and perceived impacts. The Working Alliance Inventory was also administered to assess the degree of agreement between patients and therapists regarding the therapeutic alliance. Results The findings revealed both direct concordance and sequential correspondence among most of the SEs identified by participants. All three groups of participants associated SEs with emotional experiences, moments of communication, and processes of understanding. The therapists and external observers also emphasised that SEs marked a disruption in the usual course of the therapy session. Conclusion Patients and therapists hold both convergent and divergent subjective perspectives on SEs and their potential future impact on the therapeutic process. External observers provide a more distanced and systemic perspective on SEs.