The document summarizes a training framework for integrating different therapeutic theories and techniques while maintaining a clear framework and building a strong therapeutic alliance. It discusses common factors research showing similarities across therapies are more important than differences. The framework focuses on understanding client variables, beliefs, characteristics and incorporating the client's perspective to develop a theory of the problem and path to change. Case examples demonstrate how to match theories and techniques to each client's unique situation. The goal is to help trainees develop clinical decision making skills that provide the best "therapeutic fit" for each client.

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. 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. Trainee’s
Predicament

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. 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.”

7. “ . . . Similarities rather than
differences between models
account for most of the
change that clients
experience across
therapies” Miller, Hubble & Duncan, 1995

8. Common Factors
Lambert 1992
15%
40%
15%
30%
Client/Extratherapeutic Factors
Patient-Therapist Relationship
Model/Technique
Placebo/Hope/Expectancy

9. Common Factors
Wampold 2001
Client and Extratherapeutic
Factors
Therapeutic
alliance
87%
Model

10. 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

11. Client/Trainee Theory
 Problem
 What, Who, When, WH
Y
 Change
 What, Who, When, HO
W

12. 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

13. 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

14. Client/Trainee/Supervisor
Feedback Loop
Supervisor
Traine
e
Client
RECIPROCAL INFLUENCE

15. “You are multidimensional –
you are already many things to
many people
(friend, partner, parent, sibling
). Use your complexity to fit
clients”
Duncan & Sparks (2004)

16. Trainee Experience
Supervisor Experience

17. 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

19. Case Example #1

20. 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

21. Case Example #2

22. •
•
•
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

23. 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

24. 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

25. 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

26. http://ctiv.alexanderstreet.com.ezproxylocal
.library.nova.edu/view/1778986/play/true/