Confronting Stressors in the Therapy Room: Emergent Life Events in a Multiple Evidence-Based Practice Implementation Context

Life stressors, or emergent life events, have the potential to interfere with child and family therapy processes and have been cited as barriers to implementing evidence-based practices (EBPs) for child mental health in community settings. The purpose of this study is to characterize the discussion of emergent life events in therapy sessions and examine its association with therapist delivery of EBP strategies, all within the context of system-driven implementation of multiple EBPs. Data were drawn from 680 audio-recorded psychotherapy sessions in which an EBP was delivered to 274 youth receiving care from 103 community therapists in 14 mental health agencies. Emergent life events were mentioned in 143 sessions (21.0%), with 77 sessions (11.3%) containing a mild intensity emergent life event and 66 sessions (9.7%) containing an emergent life event of at least moderate intensity (moderate to severe). Multi-level analyses found that session/EBP-, child-, therapist-, and agency-related factors were associated with the reporting of emergent life events in session. In addition, the reporting of an emergent life event of at least moderate intensity (moderate to severe) was associated with less extensive observed delivery of EBP strategies within the same session, whereas the reporting of an emergent life event of mild intensity was not significantly associated with the extensiveness of EBP strategy delivery. Emergent life events can influence the delivery of EBP strategies in community mental health services.