Integrative Theory of Change: An SEO-Optimized Title

Running head: INTEGRATIVE THEORY 1
Integrative Theory of Change
John Royse
Abilene Christian University

INTEGRATIVE THEORY 2
Introduction
Change is, to say the least, complex. It looks different depending on who is providing the
definition. For instance Simon, Stierlin, and Wynne (1985), “Individual parameters change in a
continuous manner but the structure of the system does not alter, this is known as ‘first-order
change’” (p. 33). What this means is that depending on who you ask, change can have multiple
levels and parts. Change and its meaning can also be different depending on the type of
therapeutic model being utilized; this is because each model has a different therapeutic outcome.
This paper will take a look at what the literature says about change, the theoretical considerations
of change, the author’s theological considerations of change, a theory that integrates these things,
and finally a case example demonstrating said integration.
Literature Review on Change in Therapy
Systemic Change
Marriage and Family Therapy (MFT) is a field that is focused on the process of systemic
change. Each system, be it a family, couple, or individual, comes with two different dimensions
which Hanna (2007) refers to as stability and flexibility (p. 12). Stability is when a system
attempts to maintain homeostasis when it is under the duress of change, and flexibility is the
system’s ability to adapt to change as it occurs. Another way to conceptualize flexibility and
stability is to view them as a type of feedback loop. Feedback loops are defined by General
Systems Theory and can be described as either positive or negative (Whitchurch & Constantine,
1993, p. 334-335). Negative feedback loops seek to maintain a dynamic equilibrium, or
homeostasis, within the system (stability). Positive feedback loops seek to encourage those
behaviors that differ from what the norm has been (flexibility). It is worth noting that a system’s

behavior is not positive or negative on its own, rather the feedback (be it positive or negative) is
found within the structure of the loop itself (Constantine, 1986). By viewing the loop’s
construction as positive or negative as opposed to the behavior itself, therapists are able to view
clients’ behaviors in a more neutral position.
Systemic change can also be viewed in terms of ceasing a certain set of behaviors.
Weakland, Fisch, and Segal (1982) state, “If problem formation and maintenance are seen as
parts of a vicious-circle process, in which well intended ‘solution’ behaviors maintain the
problem, then alteration of these behaviors should interrupt the cycle and initiate resolution of
the problem” (p. 18). Having change lie in behavior is something that is echoed in the Cognitive
Behavioral Therapy (CBT) model. One main difference is that CBT views the behaviors in terms
of schemas, or cognitive structures; change can only occur once these schemas have been altered
(Dattilio, 2010). Once this change has occurred then clients are instilled with techniques that
prevent them from relapsing into their old behaviors.
Threats to Change
Resistance. Change is rarely easy to accomplish. If it were, MFTs would not have a large client
base. One of the threats to change that therapists encounter most often is resistance. Erickson and
Hogan (1981) explain:
Any threat to the equilibrium of the family tends to bring out resistance. The threats may
be to the structure (good-bad child axis, marital and other dyadic relationships), as well
as to existing family pacts and family myths. The major form of resistance, as in all
therapy, is staying away from all sessions. (p. 189)

Resistance is something that therapists will always encounter to some degree or another, so it is
something that must be addressed from the beginning. Therapists should remember that change
is not something that comes easily to any individual, therefore therapists should be empathetic
towards their clients when it comes to the process of change.
Readiness to Change. Another threat to change comes in the form of the client’s readiness for
change itself. Prochaska and Norcross (2001) identified six stages of change: precontemplation,
contemplation, preparation, action, maintenance, and termination. Prochaska and Norcross go on
to note that at each stage of change there are different processes that will produce the most
optimal results for change (Prochaska & Norcross, 2001). As individuals and families move
through each stage, the therapeutic relationship evolves, thus it is important for the therapist to
be aware of when they have moved from one stage to another and adjust the therapeutic
relationship accordingly. Therapists who do not adjust therapy to match with the stage of change
the client is in run the risk of sabotaging their own treatment plan (Prochaska & Norcross, 2001).
Factors that Nourish Change
Empathy. Perhaps one of the most important factors for change is empathy. It is a part of
therapy that cannot ever be overestimated due to the fact that humans have a great need to be
understood and accepted (Nichols, 2013, p. 104). Before true therapy can begin, the therapist
must first make an empathetic connection with the clients that they are seeing. Without empathy
therapists would wind up seeing clients as objects, or parts, of a mechanical system in which
certain things just need to be moved around in order for the problem to be solved. Empathy felt
from therapists towards clients can be viewed as a spectrum, with both extremes being harmful
to the therapist/client relationship. While it is important to maintain a healthy distance from

clients, we - as therapists - should not do so at the expense of invalidating or diminishing their
humanity (Nichols, 2013).
Hope. One of the first things that students in the MFT department at ACU are told at the
beginning of the program is that hope is a strong force that can help a client achieve success in
the therapy room. For a field that is focused on work backed by research, there is surprisingly
little literature on the role that hope plays when it comes to change. However, hope has been
found to be one of the common factors that influence therapeutic outcome (Lambert, 1992).
What this should tell MFTs is that despite the lack of research, hope should be the one thing that
a therapist never loses as long as he or she is seeing a client system. Therapists should also strive
to increase the hope within the client system; this will allow for a greater chance at success in
therapy.
Therapeutic Alliance. Creating an alliance with client systems is another factor of change.
Connecting with family members takes both skill and attitude. Developing an alliance can also
be a task when dealing with difficult clients (Hannah, 2007, p. 89); at times it might benefit the
therapist to only join with certain members of the family. This is known as selective joining
(Colapinto, 1991). Selective joining can be utilized when the way into the family system is
guarded by one of the family members (e.g., the family patriarch or matriarch). Rather than force
his or her way into the family system the therapist joins first with the prominent family member.
He or she is then allowed to enter into the family system which then allows the therapist to talk
about things that he or she would not otherwise have access to.
Theoretical Considerations
Narrative Therapy

Theoretical assumptions. Narrative therapy is a postmodern therapy model which views
dysfunction as coming from an overarching story that dominates a client’s life. Carr (1998)
explains the source of dysfunction:
Within a narrative frame, human problems are viewed as arising from and being maintained by
oppressive stories which dominate the person’s life. Human problems occur when the way in
which people’s lives are storied by themselves and others does not fit significantly with their
lived experience. (p. 486)
If individuals are viewed from this narrative frame then they themselves are not seen as the
problem, rather the problem itself is seen as the problem. This externalizes the problem outside
of the person and thus allows them and other members of the system to view the problem from a
different perspective. These overarching and oppressive stories have influenced individuals to
ascribe some form of meaning to major life events, and these stories also are a part of people’s
daily lives (Freedman & Combs, 1996, p.32).
Another assumption from the narrative model comes from its postmodern roots. Narrative
therapy adopts a social constructionist view which should not be confused with a constructivist
view. Hoffman (1990) explains, “Constructs are shaped as the organism evolves to fit with its
environment, and that the construction of ideas about the world takes place in a nervous system
that operates something like a blind person checking out a room” (p. 2). A blind person entering
a room cannot say that he is in a room immediately, rather he must feel out what is around him
and then come to that conclusion as a summation of external experience. While this example
illustrates how the interactions and operations of a system are important, social constructionists
place a greater emphasis on social interpretation and the use and influence of language

(Freedman & Combs, 1996, p. 26). One way to articulate the difference between constructivism
and structuralism is to look at how narrative therapy views listening to a client. Narrative therapy
does not listen to clients with the intent of making an assessment or formulating a diagnosis.
Theory of Change. Since narrative therapy views dominant discourses as the source of client
problems, the theory views change as being the re-authoring of these discourses. White and
Epston (1990) explain:
The identification of unique outcomes can be facilitated by the externalization of the
dominant “problem-saturated” description or story of a person’s life and relationships. .
.By achieving this separation from the problem-saturated description of life, from this
habitual reading of the dominant story, persons are more able to identify unique
outcomes. (p. 16)
Thus the therapist and the client work collaboratively to liberate the other stories from the
dominant discourse that is currently overshadowing them. This change can be accomplished by
looking for unique outcomes - outcomes that run contrary to the overarching narrative. Freedman
and Combs (1996) describe unique outcomes as, “anything that wouldn’t have been predicted in
light of a problem-saturated story” (p. 89). Clients are then invited to reexamine, and
subsequently re-describe, themselves and their relationships in light of these unique exceptions
(Carr, 1998). These unique outcomes can then be expanded and developed into new stories that
help the client overthrow the dominant discourse. When clients achieve separation from their
dominant discourse and begin to develop these unique outcomes, they begin to experience a
sense of personal agency (White & Epston, 1990). When these unique outcomes are discovered

and identified, clients can then be invited to ascribe meaning to them; this begins the process of
re-authoring (White & Epston, 1990).
Change, in narrative therapy, can be challenged by the fact that the dominant discourse is
persistent and it is something that clients have lived in for a long time. Freedman and Combs
(1996) note, “It is not at all unusual for an alternative story to fade between therapy
conversations” (p. 195). Thus it is not enough to merely provide the client with a new narrative,
it needs to be thickened and nourished in order for it to remain with the client. This nourishment
comes in the form of mapping the new narrative within the client’s preexisting story using
questions that plot sequences of events as well as the client’s motives, beliefs, intentions, hopes,
and values (Carr, 1998). Plots can also be thickened by linking them into the past as well as
extending them into the future. During this time clients are invited to excavate forgotten or
trivialized aspects of their experience: aspects that share the same consistency as their preferred
story (Carr, 1998). Parry and Doan (1994) suggest that since stories are things we tell to people,
finding an audience - be it members of the family system or friends - to tell the new story to is
something that can strengthen the new narrative. It is important to note that through the entire
process of change the old narrative does not just die out or go away. Odds are the old story will
always be there, constantly extending bids for power to the client (Parry & Doan, 1994 p. 157).
However if change has occurred then clients will have the ability to use their new narratives to
gain control of their lives back from their previous dominant discourse.
Role of the Therapist. In narrative therapy the therapist takes on the role of an editor. An
editor, as described by Parry and Doan (1994), is one who is very interested in story lines,
character development, story composition, the motivations or purposes of the author, and clarity.

If we continue with this metaphor the therapy process is something that can be viewed in terms
of editing an individual’s story (Parry & Doan, 1994). It is not the job of the therapist to become
the main author of this story, rather the therapist is simply providing a space where the client can
begin to re-author their story in a manner that fits them better. It needs to be noted that even
though the therapist takes on the role of an editor that does not mean the therapist becomes an
expert on the client or the story. During therapy the therapist also needs to maintain neutrality;
they need to be able to listen to multiple stories and engage in many, sometimes contradictory,
conversations without invalidating a single one of them. This means that they cannot accept or
chose one story to be more true than others. Neutrality in contrast to acceptance means that the
therapist is willing to listen to stories that are told from a variety of perspectives (Parry & Doan,
1994, p. 122).
Therapists also take on the role of not-knowing, which does not mean that they know
nothing. Not-knowing implies that the therapist will ask questions without having any pre-
understanding nor will the therapist ask questions that they want a particular answer to
(Freedman & Combs, 1996, p.44). By taking a stance of not knowing the therapist creates an
atmosphere of curiosity which then encourages people to more fully develop their stories. For
some clients the very notion that someone is listening to their story with a great deal of curiosity
can enhance the therapy process. Anderson and Goolishian (1988) speak of not-knowing as
fostering a conversation that loosens and opens up rather than constricts and closes-down (p.
381). This opening up of conversation allows the therapist to ask questions.
Collaborative Language Systems

Theoretical assumptions. Collaborative Language Systems (CLS), much like narrative,
is a postmodern model. CLS views dysfunction, or problems, as residing in language. As Harlene
Anderson (1997) describes:
Problems no longer exist in such spatially or socially defined units as an individual, a
family, a work group, or a community. What seems to be an identifiable objective reality
—a problem—is only the product of descriptions, the product of social construction. (p.
73-74)
Viewed from this perspective, problems only exist based on the language that we use to describe
them as well as the meaning that we ascribe to them. This means that problems are nothing more
than a socially constructed reality that finds its sustenance through individuals’ behaviors. This
behavior is mutually coordinated in our language (Goolishian & Anderson, 1987). Meaning and
reality are intersubjective and are created and evolve through conversation and dialogue with the
self and with others (Goolishian & Anderson, 1987). It is worth noting that from a CLS
perspective clients are not the only ones that come up with the problem definition. Both client(s)
and therapist are involved in the creation of the problem definition. This is done through
conversation and communicative agreement (Anderson & Goolishian, 1988). Through this
strategy, both therapists and clients have equal participation in the creation of the diagnosis/
problem definition. Problem definitions, much like the members of a system, have some fluidity
to them. Just because a problem definition is identified does not make said problem definition
static. Problem definitions can take many forms and they change over the course of therapy as
therapists and clients continue in a dialogue with one another.

Another assumption with CLS is that the problem distinguishes the system rather than the
system distinguishing the problem. Another way to phrase it is that systems do not create
problems but rather problems create systems (Anderson, 1997, p. 82). A problem system is
simply one kind of relational system and for each member in that relational system there is
another view of the problem that is just as valid and true as the next one. All that is required for
membership in these problem systems is to have language about that which is being described as
a problem (Goolishian & Anderson, 1987). These problem determined systems only exist in
language; they have no bearing or existence in social objectivity, structure, or role (Goolishian &
Anderson, 1987).
Finally, CLS also has the assumption that clients are the experts on themselves and that
the therapist is only an expert in maintaining a conversation on the problem definition. Since the
therapist takes this one-down approach there can multiple interpretations or meanings given to
the same observations or experiences (Goolishian & Anderson, 1987). This also means that the
therapist cannot be outside of the system and still work with the system; the therapist must
become a part of the system. This means that the therapist joins and becomes another member of
the system itself and must include himself or herself in any understanding of the system as well
as any communication that happens within the system (Goolishian & Anderson, 1987).
Theory of Change. In CLS, change is nothing more than a change in meaning that is
derived through dialogue and conversation (Anderson & Goolishian, 1988). While other models
might view change as having to occur in behavior CLS is only concerned with providing a space
in which individuals are allowed to explore their current fixed meanings or behaviors. Another
way to view this is in terms of problem organizing and problem dis-solving (Anderson &

Goolishian, 1988). Problem organizing happens in the beginning of therapy; the therapist and
client(s) get together and strive, through language, to organize the problem in terms that
everyone will agree on. However, that problem will, eventually, need to be dis-solved else
therapy continue on indefinitely. With the dis-solving of the problem the therapy system itself
also becomes dis-solved, this leads to the natural termination of therapy. Harlene Anderson views
therapy as something that is not forever - the therapist is considered a guest within the client
system (Anderson, 1997, p. 99). While the course of the dialogical conversation might change
throughout therapy, the goal of providing a space in which clients are able to talk about their
problem definition remains the same.
Role of the Therapist. In CLS, the first role that the therapist takes is one of participant
observer. Problem systems are considered to be one kind of observing system and each member
of the system are seen as participating members of that system (Anderson & Goolishian, 1988).
Thus since the therapist joins with the system there is no power dynamic between therapist and
client. The therapist does not sit on a pedestal nor is he or she considered to be an expert on the
client system. This makes the therapist position a collaborative one, one where the relationship
between therapist and client are more egalitarian. With this model the therapist does not enter
into the client system with preconceived notions about psychology, social theory, or human
interactions. Nor does the therapist look for a place to plot the client system on a map within
those domains, both therapist and client seek to create those maps together and out of this they
co-create the therapeutic reality (Anderson & Goolishian, 1988). Therapy is not a place where
the therapist is reflecting back a more accurate version of reality, nor is the therapist a blank slate
or a tabula rasa (Anderson, 1997, p. 97). Therapy is, much like life itself, a place where there is

an opportunity to discover, develop, and explore new descriptions, themes, and plots that can
then be organized around ourselves (Anderson & Goolishian, 1988).
The therapist also takes on the role of a participant manager of conversation. This does
not put the therapist on a higher plane that the rest of the clients, the therapist is simply viewed as
an architect of conversation (Anderson & Goolishian, 1988). With this view the therapist finds
their expertise in the ability to create and maintain a dialogical conversation, which then creates
space that opens up the maximum potential for communication about the problem. Anderson and
Goolishian (1988) explain that out of this communication space there is the potential for new
descriptions to arise, new meanings to be generated, which will then lead to new social
constructions around these narratives (p. 9). By being a participant manager of the conversation
the therapist becomes only one part of the interactive system, the therapist does not control the
conversation nor does he or she guide the conversation in a particular direction. Also the
therapist is not responsible for the direction of change that occurs in therapy. All the therapist is
responsible for is creating a space in which dialogical conversation can occur and for keeping
that conversation in that dialogical space (Anderson & Goolishian, 1988).
Theological Considerations
The creation account in Genesis beings by having God create both earth and the heavens
and it ends by saying, “God saw all that he had made, and it was very good” (Genesis 1:31 New
International Version). God sees his creation as good, and earlier in the text it tells us that we are
created in the image of God. From this the theologian Reinhold Niebuhr (1941) makes the
connection that because God is good and he created humans in his image then humans must also
be inherently good. This view of humanity stands in stark contrast to that of John Calvin who

viewed human beings as being corrupted by original sin, a corruption that has, according to
Calvin, extended into all parts of our souls (Calvin, 1960). For therapy, how one views human
nature has an effect on how therapy progresses as well as the therapist/client relationship. If
humans are viewed as depraved and corrupt their very soul then what sense of hope can there be?
Sure there might be some positive change in the client but ultimately they are still depraved,
which negates any positive change that they might have achieved. This view does not mix well
with a narrative or collaborative theory, nor does it mix well with my integrated theory. Hope is a
factor that is crucial for therapeutic success and therapists should be the absolute last people
giving up hope. However if humanity is viewed from Niebuhr’s perspective as being inherently
good then that allows hope to flow freely. It also provides more agency, if one is destined to be
corrupt and depraved then what is the point of doing anything? If the only definitive statement
that is made is that humanity is good that opens up new avenues and provides endless
possibilities for what can be done.
With this theological lens providing a hopeful view of human nature advocating for
change becomes more and more possible for both therapists and clients. Also if humanity is
viewed as inherently good then that means the change that they want to achieve is something that
is good for them. Change from a theological perspective is turning to God and leaving our past
sin behind, and this is something that has a certain equifinality to it. Multiple paths lead to
change which is good for those who are seeking that change. Change is, according to Nichols
(1987), what happens when members of a system develop new perspectives that then lead them
to new actions - what those perspectives are is up to those within that system. Perhaps God has a
role in the creation of those perspectives and perhaps he does not. What matters to me as a

therapist is that I view people as inherently good, regardless of God’s influence on their
perspective.
Integrative Theory of Change
My integrative theory of change eschews the traditional format of therapeutic phases
(e.g., assessment, interventions, and termination). Harlene Anderson describes therapy as a
purposeful conversation which seeks to create an environment that lead both the client and the
therapist to a new narrative which then leads to new agency (Anderson, 1997, p. 68). Rather than
have traditional therapeutic phases, engagement with the client system begins from the onset of
therapy and only ends when therapy has concluded. For interventions the dialogical conversation
of therapy itself constitutes the intervention. Finally termination occurs when the clients feel that
they have finished with the therapeutic process. Therapy first begins with the identification, and
subsequent deconstruction of, the dominant narrative within the client system. All of this takes
place within the framework of a dialogical conversation, I do not assume to know anything about
the clients nor do I try to map what their dominant discourse might be. Both the client and
myself are responsible for creating and, subsequently, defining what this dominant discourse is.
My only goal in the beginning is similar to Anderson’s, I am creating a space in which clients
can begin to loosen and examine their views upon the dominant discourse (Anderson &
Goolishian, 1988). Change begins to occur when clients begin to change the manner in which
they talk about their dominant discourse, which might look different for each member of the
problem system. Rather than look at the process of therapy as being divided into phases and
coming into each session with a plan in mind the goal of each session is to become a part of the
problem system and entering into a dialogical conversation about the dominant discourse. It is

crucial that the discussion of the dominant discourse take place within a dialogical conversation,
that ensures that the members of the problem system have agency, which allows them to easily
begin the process of re-authoring their story.
The process of re-authoring highlights the second aspect of my integrative theory, once
clients have a new conceptualization of their dominant discourse it needs to be nurtured so that it
can reside more comfortable within their language. This is key because we construct our realities
through our language, so it is not enough to simply provide clients with a new dominant
discourse (Freedman & Combs, 1996). That new dominant discourse must also then become a
part of their language so that, in essence, they speak it into existence. Speaking things into
existence is something that has a tremendous effect. Think back to how the bible recounts the
creation of heaven and earth, God speaks these things into reality. While our words might not
have the capability of creating a planet or new life they do have the power to create the direction
that our lives take. By having the new dominant discourse become solidified in the client's
language they then change how they view multiple aspects of their own lives. Anderson and
Goolishian (1988) said it best when they said, “In dialogue, nothing remains the same. Change in
therapy is no more than changing meaning derived through dialogue and conversation.” If
therapists do all of the creation for their clients then clients never have the chance to speak and
the new narrative will not become a reality for them. If, however, client systems co-author their
new narrative with the therapist then they can begin to create the change that they want. That
change might lead to a change in behavior or it might not, what it does do is dis-solve the
problem. Dis-solving of the problem through the construction of a new dominant discourse

through a dialogical conversation is the goal. After this the therapist, who is liken to a guest at a
dinner party, takes their leave of the system and therapy is terminated.
Case Application
Scott (29) and Becky (26) are a couple living together their relationships has been going
on for 21 months. They moved from the Dallas area after Scott finished treatment for cancer.
Becky describes Scott as depressed and angry, she also says that he gets upset when Becky’s
child does not do what Scott wants. Scott describes himself as guilty, his mother committed
suicide and his last interaction with her resulted in an argument. He also feels guilty for having
Becky come with him from Dallas. They both agree that they have different views on parenting
and what the definition of the problem is in their relationship.
During the first session my approach was to enter into a dialogical conversation with
them, listening to both of their views with the goal of coming up with a problem definition. After
hearing them both talk about their differences in parenting Scott described feeling guilty and he
began accepting responsibility for the problems in their relationship. This revealed an dominant
discourse of guilt which permeated their relationship. From here I would want to speak with both
of them and, still through dialogical conversation, deconstruct this dominant discourse and what
it means to Scott and Becky. Once this deconstruction has occurred we can then begin to co-
construct a new narrative, one that is a better fit for them. During this co-creation I would have
less input as to what defines a better discourse for them, this is something that they have to agree
upon between the two of them. While I am a part of the construction of this new discourse it is
something that they will be assimilating into their language once they have left the therapy room,
as a result the majority of the burden of this creation must be on them mores than me.

Termination will occur once Scott and Becky feel that have constructed a new dominant
discourse and have successfully integrated it into their language. This is important because if the
new discourse is used in their language then it will become a reality for them, something that
they can begin to organize around. I have no input in the termination of therapy, I can voice
whether or not I think that it is a good direction but I cannot steer them away from, or toward,
termination.

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