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Clients’ Relational Conceptions of Conjoint Couple and Family Therapy Quality: A Grounded Formal Theory


  • Ronald J. Chenail, PhD, Department of Family Therapy, Nova Southeastern University; Sally St. George, PhD, Faculty of Social Work, University of Calgary; Dan Wulff, PhD, Faculty of Social Work, University of Calgary; Maureen Duffy, PhD, Consultant to Individuals & Organizations, Miami Shores, Florida; Karen Wilson Scott, PhD, Department of Human Resource Training and Development, Idaho State University; Karl Tomm, MD, Faculty of Medicine, University of Calgary.

  • The research was funded in part by a grant from The University of Calgary, Faculty of Social Work Faculty Development Grant 20 33500 SWK000025—Project #15; Metasynthesis Project: $6300 (Canadian). The authors wish to thank Laurie L. Charlés for her assistance during the early stages of the study.

Address correspondence to Ronald J. Chenail, Office of Institutional Effectiveness, Nova Southeastern University, Fort Lauderdale, Florida 33314. E-mail:


Based upon a qualitative metasynthesis of 49 articles centered on clients’ experiences of their conjoint couple and family therapy, the investigators constructed a grounded formal theory of Clients’ Relational Conceptions of Conjoint Couple and Family Therapy Quality. The theory suggests from pretherapy conceptions to posttherapy reflections, clients’ perceptions of conjoint couple and family therapy quality appear to consist of clients’ constructed meanings regarding a series of interrelated relationships between clients and their therapists and therapy environments, between clients and themselves, between clients and other family members, and between process and outcome both inside and outside therapy. Within and across these relationships, clients appear to focus on expectations, connections, balance, and change when evaluating the quality of their clinical experiences. Based upon this theory, the investigators recommend that researchers continue to explore this clinical phenomenon and that therapists regularly seek clients’ conceptions of quality in therapy.