Building a therapeutic alliance in brief therapy: the experience of community mental health nurses.

Current mental health trends in brief therapy require a new understanding of the nurse--client relationship. This qualitative focused ethnography explored the perceptions and actions of community mental health nurses in building a therapeutic alliance in the context of brief therapy and the factors that facilitate or impede its development. Informants were 11 nurses with at least 3 years of experience in community mental health nursing primarily providing brief therapy or consulting practice. Participants described therapeutic alliance as the point at which the clients recognize that the nurse is fully attuned to "being in the moment" as they connect to their own issues in a positive way. Building an alliance consisted of three nonlinear overlapping phases: "establishing mutuality," "finding the fit in reciprocal exchange," and "activating the power of the client." Implications include recommendations to enhance intentional alliance building and directions for further research to explore differing world views among nurses on alliance formation within the context of brief therapy and consultations. Crown