Running Head: CLIENT’S THEORY OF CHANGE
The Client’s Theory of Change:
Consulting the Client in the Integrative Process
This article casts a critical eye upon the integration literature and asserts that, like psychotherapy in general, the client has been woefully left out of the therapeutic process. An alternative that privileges the client’s voice as the source of wisdom and solution is presented. It is proposed that conducting therapy within the context of the client’s own theory of change offers ways of integrating multiple therapy perspectives. An argument is made for not only recasting the client as the star of the drama of therapy, but also giving the heroic client directorial control of the action as it unfolds.
THE CLIENT’S THEORY OF CHANGE: CONSULTING
THE CLIENT IN THE INTEGRATIVE PROCESS
We feel that it would be fruitful to explain patient’s
own ideas about psychotherapy and what they expect from it.
Many therapists have made the disappointing discovery that any given model that purports to ameliorate human suffering is limited. One size does not fit all. The field’s response has been rival schools, brand names, and high fashion in the therapy boutique of techniques. Thus, therapists have not suffered a dearth of models from which to choose; indeed, there are now more choices than Baskin and Robbins and Howard Johnson’s combined.
The up side, of course, is that under certain circumstances a given flavor may really hit the spot. The lure of increasing the efficiency of therapy through the selective application of disparate models has fueled interest in integrative strategies for practice. Eclectic theorists have sought to find relevant client characteristics beyond diagnosis to guide the selection process (e.g., the groundbreaking work of Beutler & Clarkin, 1990). Recent efforts have added an emphasis on matching relational methods (e.g., Blatt, 1992; Lazarus, 1993; Norcross & Beutler, 1997) looking for “relationships of choice” (Norcross & Beutler, 1997, p.44). While the eclectic movement has not suffered from the “dogma eat dogma” (Saltzman & Norcross, 1990) mentality of warring factions of therapy, it is beginning to resemble the field as a whole with its immense heterogeneity. Norcross (1997) summarizes:
We have the prescriptive eclectics, pragmatically blending methods; we have the theoretical integrationists, actively smushing theories; we have the common factorists, relentlessly searching for underlying commonalities; and we have the system complementarists, astutely sequencing psychotherapy systems to maximize their domains of expertise… (p. 87).
Despite significant advances, Norcross (1997) suggests that the integration field invites confusion and irrelevancy unless the immense differences are defined, and the “me and not me” are established (p.87). In the spirit of addressing this concern, this article casts a critical eye upon the integration literature and asserts that, like psychotherapy in general, the client has been woefully left out of the therapeutic process. An alternative that privileges the client’s voice as the source of wisdom, solution, and model selection is presented. A Tale of Two Dinosaurs
While the intellectual appeal of theoretical integration is compelling, the search for a unified metatheory is reminiscent of the rapid-fire development of models in search of the Holy Grail. The field has “been there, done that.” Given that model and technique only account for 15% of outcome variance (Assay & Lambert, 1999; Lambert, 1992; Miller, Duncan, & Hubble, 1997), theoretical integration efforts focus on the weakest link in the chain of factors accounting for change.
The love affair with models blinds therapists to the roles clients play in bringing about change (Duncan, Sparks, & Miller, 2000). As models proliferate, so do their specialized languages, systems of categories, and arsenal of techniques. All such articulations take...
References: Asay, T., & Lambert, M. (1999). The empirical case for the common factors in therapy. In M. Hubble, B. Duncan, & S. Miller, (Eds.), The heart and soul of change. Washington D.C.: APA Books.
Atkinson, D., Worthington, R., Dana, D., & Good, G. (1991). Etiology beliefs, preferences for counseling orientations, and counseling effectiveness. Journal of Counseling Psychology, 38, 258-264.
Bachelor, A., & Horvath, A. (1999). The therapeutic relationship. In M. Hubble, B. Duncan, & S. Miller, (Eds.), The heart and soul of change. Washington D.C.: APA Books.
Beutler L., & Clarkin, J. (1990). Sytematic treatment selection: toward targeted therapeutic interventions. New York: Brunner/Mazel.
Blatt, S. (1992). The differential effect of psychotherapy and psychoanalysis with anaclitic and introjective patients: The Menninger Psychotherapy Research Project revisited. Journal of the American Psychoanalytic Association, 40, 691-724.
Brickman, P., Rabinowitz, V., Karuza, J., Coates, D., Cohn, E., & Kidder, L. (1982). Models of helping and coping. American Psychologist, 37, 368-384.
Claiborn, C., Ward, S., & Strong, S. (1981). Effects of congruence between counselor interpretations and client beliefs. Journal of Counseling Psychology, 28, 101-109.
Conoley, C. W., Ivey, D., Conoley, J. C., Scheel, M., & Bishop, R.
Crane, R. D., Griffin, W., & Hill, R. D. (1986). Influence of therapist skills on client perceptions of marriage and family therapy outcome: Implications for supervision. Journal of Marital and Family Therapy, 12, 91-96.
Davison, G.C. & Neale, J.M. (1986). Abnormal psychology.
Duncan, B., Hubble, M., & Miller, S. (1997). Psychotherapy with “Impossible” Cases: Efficient treatment of therapy veterans. New York: Norton.
Duncan, B., & Miller, S. (2000). The heroic client: Client directed, outcome informed therapy. San Francisco: Jossey Bass.
Duncan, B., & Moynihan, D. (1994). Applying outcome research: Intentional utilization of the client 's frame of reference. Psychotherapy, 31, 294-301.
Duncan, B., Solovey, A. & Rusk, G. (1992). Changing the rules: A Client-directed approach. New York: Guilford.
Erickson, M. (1980). The nature of hypnosis and suggestion: The collected papers of Milton H. Erickson on hypnosis (Vol, 1, E.L. Rossi, Ed.). New York: Irvington.
Erickson, M. H., & Rossi, E. L. (1979). Hypnotherapy: An exploratory casebook. New York: Irvington.
Fisch, R., Weakland, J., & Segal, L. (1982). The tactics of change: Doing therapy briefly. San Francisco: Jossey-Bass.
Frank, J.D., Frank, J.B. (1991). Persuasion and healing: A comparative study of psychotherapy (3rd ed.). Baltimore: John Hopkins University Press.
Frank, J.D. (1995). Psychotherapy as rhetoric: Some implications. Clinical Psychology: Science and Practice, 2, 90-93.
Gaston, L. (1990). The concept of the alliance and its role in psychotherapy. Psychotherapy, 27, 143-152.
Goolishian, H. & Anderson, H. (1987). Language systems and therapy: An
538.Gold, J. R. (1994). When the patient does the integrating: lessons for
theory and practice
Goldfried, M., & Wolfe, B. (1998). Toward a more clinically valid approach to therapy research. American Psychologist, 66, 143-150.
Hayes, J., & Wall, T. (1998). What influences clinicians’ responsibility attributions? The role of problem type, theoretical orientation, and client attribution. Journal of Social and Clinical Psychology, 17, 69-74.
Held, B.S. (1991). The process/content distinction in psychotherapy revisited. Psychotherapy, 28, 207-217.
Hester, R., Miller, W., Delaney, H., & R. (November, 1990). Effectiveness of the Community Reinforcement Approach. Paper presented at the 24th annual meeting of the Association for the Advancement of Behavior Therapy. San Francisco, CA.
Hoch, P. (1955). Aims and limitations of psychotherapy. American Journal of Psychiatry, 112, 321-327.
Hubble, M., Duncan, B., & Miller, S. (1999). The heart and soul of change: What works in therapy. Washington, D.C.: APA Books.
Kazdin, A. E. (1980). Acceptability of alternative treatments for
deviant child behavior
Lambert, M. J. (1992). Implications of outcome research for psychotherapy integration. In J.C. Norcross & M.R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 94
Lazarus, A. (1992). Multimodal theapy: Technical eclecticism with minimal integration. In J. Norcross and M. Goldfried (Eds.), Handbook of psychotherapy integration. New York: Basic.
Luborsky, L., Singer, B., & Luborsky, L. (1975). Comparative studies of
psychotherapies: Is it true that "everyone has won and all must have prizes"? Archives of General Psychiatry, 32, 995-1008.
Martin, J. (1988). A proposal for researching possible relationships between scientific theories and the personal theories of counselors and clients. Journal of Counseling and Development, 66, 261
Miller, S.D., Duncan, M.A., & Hubble, M.A. (1997). Escape from Babel: Toward a unifying language for psychotherapy practice. New York: Norton.
Norcross, J., & Beutler, L. (1997). Determining the relationship of choice in brief therapy. In J.N. Butcher (Ed.), Personality assessment in managed health care: A practitioner’s guide. New York: Oxford University Press.
Norcross, J. (1997). Emerging breakthroughs in psychotherapy integration: Three predictions and one fantasy. Psychotherapy, 34, 86-90.
Norcross, J., & Goldfried, M. (Eds.) (1992). Handbook of psychotherapy integration. New York: Basic.
Reimers, T. M., Wacker, D. P., Cooper, L. J., & De Raad, A. O. (1992).
Acceptability of behavioral treatments for children: Analog and
Safran, S., Heimberg, R., & Juster, H. (1997). Client 's expectancies and their relationship to pretreatment symptomatology and outcome of cognitive
behavioral group treatment for social phobia
Saltzman, N., & Norcross, J. (Eds.) (1990). Therapy wars: Contention and convergence in differing clinical approaches. San Francisco: Jossey Bass.
Scheel, M., Conoley, C., & Ivey, D. (1998). Assessing client positions as a technique for increasing the acceptability of marriage therapy interventions. American Journal of Family therpay, 26, 203-214.
Tallman, K., & Bohart, A
Torrey, E. (1972). The mind game. New York: Emerson Hall.
Tracey, T. (1988). Relationship of responsibility attribution congruence to psychotherapy outcome. Journal of Social and Clinical Psychology, 7, 131-146.
Wampold, B. E. (1997). Methodological problems in identifying
Watzlawick, P., Weakland, J., & Fisch, R. (1974). Change: Problem formation and problem resolution. New York: Norton.
Webster’s collegiate dictionary (10th ed.). (1993). New York: Merriam Webster.
Wile, D. (1977). Ideological conflicts between clients and psychotherapists. American Journal of Psychotherapy, 37, 437
Wilford, J. (1986). The riddle of the dinosaur. New York: Knopf.Witt, J. C., & Elliott, S. N. (1985). Acceptability of classroom interventions strategies. In T. Kratochwill (Ed.), Advances in school psychology (pp. 251
Worthington, R., & Atkinson, D. (1996). Effects of perceived etiology attribution similarity on client ratings of counselor credibility. Journal of Counseling Psychology, 43, 423-429.
Please join StudyMode to read the full document