Training Systems Therapists to Match Theory to Client Variables: A Framework for Integration and Alliance
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Training Systems Therapists to Match Theory to Client Variables: A Framework for Integration and Alliance

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Presented at the European Family Therapy Association Conference

Presented at the European Family Therapy Association Conference
Istanbul, Turkey 2013

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  • Introductions – self- struggle with this issue while in doctoral programAudience - Beginning (5 or less years), Seasoned, (licensed and practicing for 5+ years)Go over the idea of integration and common factorsDiscuss the notion of client’s informal theory of changeDiscuss therapist role in allianceBriefly Present a couple of casesProvide decision-making model worksheet
  • Lewis Carroll (1865/1962) tells thestory of a race that was run to help the animals dry off after they weresoaked by Alice’s tears. The animals ran off helter-skelter in differentdirections, and the race was soon stopped. The dodo bird was asked, “Whohas won?” And he finally exclaimed the now famous verdict, “Everybodyhas won, and all must have prizes.” – Cited by Barry Duncan
  • Clients’ theory of the problem, clients’ theory of change
  • This needs to be considered for each therapy participant, both as an individual and considered within the context of the entire client system. Establishing overarching systemic goals/belief is essential.
  • In Italy the big question was about timing –when do we choose certain techniques? When do we shift and/or combine theories?Evolving over time – interwoven with client’s unfolding story, caring curiosity, plus TIME = Change
  • Introduce worksheets – include things to be curious about – initial questions
  • Exploring existing resources and beliefs are part and parcel of the joining process, essential to developing a sense of the next steps. It’s client feedback woven into the process from the first moment of meeting.
  • Objective opinion is hard for me . . . How to I find this part that can connect within a theoretical framework that will orient me?

Training Systems Therapists to Match Theory to Client Variables: A Framework for Integration and Alliance Training Systems Therapists to Match Theory to Client Variables: A Framework for Integration and Alliance Presentation Transcript

  • Training Systems Therapists to Match Theory to Client Variables: A Framework for Integration and Alliance Jill C. Morris, PhD, LMHC, LMFT Relationships Consultants International, Inc. October 27, 2013 European Family Therapy Association Istanbul, Turkey
  • Agenda and Objectives Learning Objectives:  Participants will gain in-depth knowledge of Common Factors research  Participants will understand how integrating multiple theories and techniques while maintaining a clear therapeutic framework also helps build therapeutic alliance.  Participants will be able to adapt their supervisory style to help trainees develop clinical decision making skills by incorporating client factors and informal theories
  • Trainee’s Predicament
  • Integration: The Clinician’s Dilemma O Draws from a O Convoluted wide range of resources O Opportunities for “therapeutic fit” increase O Decreases clinician boredom and burnout case conceptualizati on O Lack of clarity and/or purpose O Client’s and clinician’s sense of hope may be
  • TheSaul Rosenzweig,Verdict Dodo Bird M.D. “Everybody has “Some Implicit Common Factors have won, and all must in Diverse Methods of Psychotherapy” 1936 prizes.”
  • “ . . . Similarities rather than differences between models account for most of the change that clients experience across therapies” Miller, Hubble & Duncan, 1995
  • Common Factors Lambert 1992 15% 40% 15% 30% Client/Extratherapeutic Factors Patient-Therapist Relationship Model/Technique Placebo/Hope/Expectancy
  • Common Factors Wampold 2001 Client and Extratherapeutic Factors Therapeutic alliance 87% Model
  • Client & External Factors Gender Ethnicity Age Career Personality Preferences Culture Religion Life Experiences Resiliency Interests Resources Births Deaths Accidents Disability Job loss Financial shifts Natural disasters Marriages Divorces External systems Health issues Other events
  • Client/Trainee Theory  Problem  What, Who, When, WH Y  Change  What, Who, When, HO W
  • Client/Trainee Factors Beliefs about Therapy  Therapist listens  Client talks  Therapist gives advice  Client follows advice  Therapist interacts  Client collaborates  Therapist “fixes”  Client is passive Style & Resources  Concrete  Goal Oriented  Storyteller/Metaphoric  Perceived Resources  Financial  Social  Internal/Intrapsychic
  • Supervisor/Trainee Factors Beliefs about Therapy  Therapist listens  Client talks  Therapist gives advice  Client follows advice  Therapist interacts  Client collaborates  Therapist “fixes”  Client is passive Style & Resources  Concrete  Goal Oriented  Storyteller/Metaphoric  Perceived Resources  Life & Clinical Experience  Theoretical Knowledge  Flexibility/Adaptability
  • Client/Trainee/Supervisor Feedback Loop Supervisor Traine e Client RECIPROCAL INFLUENCE
  • “You are multidimensional – you are already many things to many people (friend, partner, parent, sibling ). Use your complexity to fit clients” Duncan & Sparks (2004)
  • Trainee Experience Supervisor Experience
  • Client Beliefs about Therapeutic Process Client Beliefs about Problem/Change Client Characteristics and Resources Therapist Beliefs about Therapeutic Process Therapist Beliefs about Problem/Change Therapist Characteristics and Resources
  • Case Example #1
  • Laura Georg e 7 • • • • • • • • Theories/Techniques 5 1 Ashle Robert David y Ashley’s not listening Ashley is resistant to authority Sibling Rivalry Spousal relationship stressed Organizational problems at work Family was not running as smoothly as they expected Did not want Ashley pathologized Responsible and achievementoriented • • • • • • • • (Solution-Focused/Milan) Joining with customer Exploring existing resources/beliefs Circular Questioning Reframing (unintentional positive reinforcement) Positive connotation (linguistic shift) Miracle Question Deframing Task Assignment
  • Case Example #2
  • • • • Ted Sar Sara Sara’s alcohol/drug use “Manic-Depressive” Too much “thinking time” • Wants “Objective Opinion” Artistic Self-Help oriented a • • • • • • • • • Theories/Techniques (Bowen Family Systems/Strategic Family Therapy/SFT) Therapist’s dilemma – “objective opinion”: Genogram Therapeutic Double Bind Recontextualizing Thinking/Feeling Individuality/Togetherness Systemic Psychoeducation Miracle Question
  • DIFFERENCES • • • • • • • • • • • • Parent/Child Family Dx: unwanted Clear goals IP-present Gender: nonissue Adult/Marital Individual Dx: self-established Vague goals IP-absent Gender: relevant SIMILARITIES Either • We have a sick kid •Commit to a troubled relationship Or • We’re lousy parents •Dismiss love and give up hope
  • Web Resources Outcome Rating Scale (ORS) and Session Rating Scale (SRS) are available at www.talkingcure.com The Legacy of Saul Rosenzweig: The Profundity of the Dodo Bird http://www.personal.kent.edu/~dfresco/CRM_Readi ngs/Duncan_dodo_2002.pdf
  • References Duncan, B. L., Solovey, A. D., & Rusk, G.S. (1992) Changing the rules: A client-directed approach to therapy. New York: Guilford. Duncan, B. L. & Sparks, J. A. (2004) Heroic clients, heroic agencies: Partners for change- a manual for client-directed outcome-informed therapy and effective, accountable, and just services. E-Book: ISTC Press. Lambert, M.J. (1992). Psychotherapy outcome research: Implications for integrative and eclectic therapists. In J.C. Norcross & M.R. Goldfreid (Eds.) Handbook of psychotherapy Integration. (pp. 94-129). New York: Basic Books. Miller, S. Hubble, M., & Duncan, B. (1995, March/April). No more bells and whistles. The Family Therapy Networker, pp. 52-58, 62-63 Robinson, B. (2009). When therapist variable and the client’s theory of change meet. Psychotherapy in Australia, 15 (4), 60-65. Wampold, B. E. (2001). The great psychotherapy debate: Models, methods, and findings. Hillsdale, N.J.: Erlbaum
  • http://ctiv.alexanderstreet.com.ezproxylocal .library.nova.edu/view/1778986/play/true/