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

Jill C. Morris,...
Agenda and Objectives
Learning Objectives:
 Participants will gain in-depth knowledge of Common Factors
research

 Parti...
Trainee’s
Predicament
Integration: The Clinician’s Dilemma
O Draws from a

O Convoluted

wide range of
resources
O Opportunities
for “therapeuti...
TheSaul Rosenzweig,Verdict
Dodo Bird M.D.

“Everybody has
“Some Implicit Common Factors have
won, and all must in Diverse
...
“ . . . Similarities rather than
differences between models
account for most of the
change that clients
experience across
...
Common Factors
Lambert 1992

15%
40%

15%
30%

Client/Extratherapeutic Factors
Patient-Therapist Relationship
Model/Techni...
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...
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 follow...
Supervisor/Trainee Factors
Beliefs about
Therapy
 Therapist listens
 Client talks

 Therapist gives

advice
 Client fo...
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 compl...
Trainee Experience
Supervisor Experience
Client Beliefs about
Therapeutic
Process

Client Beliefs about
Problem/Change

Client
Characteristics and
Resources

Thera...
Case Example #1
Laura

Georg
e

7

•
•
•
•
•
•
•
•

Theories/Techniques
5

1

Ashle Robert David
y
Ashley’s not listening
Ashley is resist...
Case Example #2
•
•
•

Ted

Sar
Sara

Sara’s alcohol/drug use
“Manic-Depressive”
Too much “thinking
time”

•

Wants “Objective
Opinion”
Ar...
DIFFERENCES
•
•
•
•
•
•

•
•
•
•
•
•

Parent/Child
Family
Dx: unwanted
Clear goals
IP-present
Gender: nonissue

Adult/Mari...
Web Resources
Outcome Rating Scale (ORS) and Session Rating Scale
(SRS) are available at www.talkingcure.com

The Legacy o...
References
Duncan, B. L., Solovey, A. D., & Rusk, G.S. (1992) Changing the
rules: A client-directed approach to therapy. N...
http://ctiv.alexanderstreet.com.ezproxylocal
.library.nova.edu/view/1778986/play/true/
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
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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
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

    1. 1. 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
    2. 2. 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
    3. 3. Trainee’s Predicament
    4. 4. 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
    5. 5. 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.”
    6. 6. “ . . . Similarities rather than differences between models account for most of the change that clients experience across therapies” Miller, Hubble & Duncan, 1995
    7. 7. Common Factors Lambert 1992 15% 40% 15% 30% Client/Extratherapeutic Factors Patient-Therapist Relationship Model/Technique Placebo/Hope/Expectancy
    8. 8. Common Factors Wampold 2001 Client and Extratherapeutic Factors Therapeutic alliance 87% Model
    9. 9. 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
    10. 10. Client/Trainee Theory  Problem  What, Who, When, WH Y  Change  What, Who, When, HO W
    11. 11. 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
    12. 12. 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
    13. 13. Client/Trainee/Supervisor Feedback Loop Supervisor Traine e Client RECIPROCAL INFLUENCE
    14. 14. “You are multidimensional – you are already many things to many people (friend, partner, parent, sibling ). Use your complexity to fit clients” Duncan & Sparks (2004)
    15. 15. Trainee Experience Supervisor Experience
    16. 16. 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
    17. 17. Case Example #1
    18. 18. 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
    19. 19. Case Example #2
    20. 20. • • • 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
    21. 21. 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
    22. 22. 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
    23. 23. 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
    24. 24. http://ctiv.alexanderstreet.com.ezproxylocal .library.nova.edu/view/1778986/play/true/
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