Child, parent, and therapist (dis)agreement on target problems in outpatient therapy: The therapist's dilemma and its implications

A minimal requirement for success in child psychotherapy is arguably that child, parent, and therapist agree about which problems to address. How often is this the case? Following clinic intake, the authors asked 315 children, parents, and therapists, separately, to identify target problems. More than 3/4 of child-parent-therapist triads began treatment without consensus on a single problem; nearly half failed to agree on even 1 broad problem domain (e.g., aggression vs. anxiety/depression). Therapists agreed more with parents than children for most child problems, but for family and environmental problems the reverse was true. Findings highlight the therapist's dilemma in identifying treatment foci when clients disagree and may help explain the poor effects of clinic-based therapy reported in previous research.