This document summarizes a presentation on integrating client factors into therapy. It discusses common factors research showing that client and extra-therapeutic factors account for the majority of change in therapy. The document outlines several client and therapist factors including beliefs, styles, and resources that influence the therapeutic process. It provides two case examples to illustrate how different theories can be applied based on integrating client factors. The presentation emphasizes fitting the therapeutic approach to each unique client.

1. Matching Theory to
Client Factors:
A Framework for
Integration & Alliance
Jill C. Morris, PhD, LMHC, LMFT
Relationships Consultants International, Inc.
January 25, 2013
FAMFT Conference
Boca Raton, FL

2. Agenda and Objectives
Learning Objectives:
 Participants will be able to integrate multiple theories and
techniques while maintaining a clear therapeutic framework
 Participants will gain in-depth knowledge of Common Factors
research
 Participants will be able to adapt their clinical decision making
to include client factors and informal theories

3. Integration: The Clinician’s Dilemma
O Draws from a O Convoluted
wide range of case
resources conceptualizati
O Opportunities on
for “therapeutic
O Lack of clarity
fit” increase
and/or purpose
O Decreases
O Client’s and
clinician
boredom and clinician’s
burnout sense of hope
may be

4. 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.”

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

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

7. Common Factors
Wampold 2001
Client and Extra-
therapeutic
Factors
Therapeutic
alliance
87%
Model

8. Client & External Factors
Gender Births
Ethnicity Deaths
Age Accidents
Career Disability
Personality Job loss
Preferences Financial shifts
Culture Natural disasters
Religion Marriages
Life Experiences Divorces
Resiliency External systems
Interests Health issues
Resources Other events

9. Client Theory
 Problem
 What, Who, When, WH
Y
 Change
 What, Who, When, HO
W

10. Client Factors
Beliefs about Style & Resources
Therapy  Concrete
 Therapist listens  Goal Oriented
 Client talks
 Storyteller/Metaphoric
 Therapist gives
 Perceived Resources
advice
 Financial
 Client follows advice
 Social
 Therapist interacts
 Client collaborates  Internal/Intrapsychic
 Therapist “fixes”
 Client is passive

11. Therapist Factors
Beliefs about Style & Resources
Therapy  Concrete
 Therapist listens  Goal Oriented
 Client talks
 Storyteller/Metaphoric
 Therapist gives
 Perceived Resources
advice
 Clinical Experience
 Client follows advice
 Theoretical
 Therapist interacts
Knowledge
 Client collaborates
 Flexibility/Adaptability
 Therapist “fixes”
 Client is passive

12. Client/Therapist
Feedback Loop
RECIPROCAL INFLUENCE

13. Case Example #1

14. Georg Laura
e Theories/Techniques
(Solution-Focused/Milan)
• Joining with customer
7 5 1 • Exploring existing
resources/beliefs
Ashle Robert David • Circular Questioning
y
• Reframing (unintentional
• Ashley’s not listening
• Ashley is resistant to authority positive reinforcement)
• Sibling Rivalry • Positive connotation (linguistic
• Spousal relationship stressed shift)
• Organizational problems at • Miracle Question
work
• Family was not running as • Deframing
smoothly as they expected • Task Assignment
• Did not want Ashley
pathologized
• Responsible and achievement-
oriented

15. Case Example #2

16. • Sara’s alcohol/drug use
• “Manic-Depressive”
• Too much “thinking
time”
Ted Sar
Sara • Wants “Objective
a Opinion”
• Artistic
• Self-Help oriented
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

17. DIFFERENCES
• Parent/Child • Adult/Marital
• Family • Individual
• Dx: unwanted • Dx: self-established
• Clear goals • Vague goals
• IP-present • IP-absent
• Gender: non- • Gender: relevant
issue
SIMILARITIES
Either
• We have a sick kid •Commit to a troubled relationship
Or
• We’re lousy parents •Dismiss love and give up hope

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

19. Client Beliefs about Client
Client Beliefs about
Therapeutic Characteristics and
Problem/Change
Process Resources
Therapist Beliefs Therapist Beliefs Therapist
about Therapeutic about Characteristics and
Process Problem/Change Resources

20. 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

21. 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

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