Transcript Dialogue and Collaboration

Theories and Methods of
Family Therapy:
Post-Modern Models
University of Guelph
Centre for Open Learning
and Educational Support
William Corrigan, BA, MTS
AAMFT Approved Supervisor
(519) 265-3599
[email protected]
Carlton Brown, MSc, M.Div.
AAMFT Approved Supervisor
(905) 388-8728
[email protected]
Day 5 Agenda













Debate
Common factors
Break
Eclectic vs. Integrative
Modern vs. Postmodern reprise
Lunch
Helping Styles Inventory
Tammy – Six Nations + Video
More MW video
Break
Final Paper Questions
Play Time
Final Evaluation
THE GREAT DEBATE




Opening statements – 2 minutes each
(6 minutes)
Strengths of your approach – 2 minutes each
(6 minutes)
Weaknesses of the other approaches – 4 minutes
each (12 minutes)
Huddle for rebuttal (2 minutes)
• Defend your approach against the others



Rebuttal – 4 minutes each (12 minutes)
Closing arguments – 2 minutes each (6 minutes)
Have fun!!!
Common Factors
Fred Fiedler 1950a
•
•
Therapists, regardless of training,
have the same concept of an ideal
therapeutic relationship
Clients, when asked, identified the
same qualities as what they were
most looking for in therapy
Fred E. Fiedler (1950) The concept of an ideal therapeutic relationship.
Journal of Consulting Psychology 14(4), 239-245
Fred Fiedler 1950b
•
•
•
Therapists right out of school practice
according to the model they learned
(not the same as the ideal
relationship)
Experienced therapists practice more
similarly to one another, not to model
The practice of experienced therapists
approaches the ideal therapeutic
relationship
Fred Fiedler 1950b
“Any component which is necessary for
successful therapy must not only be
present in all types of psychotherapy which
lead to successful outcomes, but must also
be influential in proportion to the success of
the therapy.... This investigation, in other
words, supports the theory that
relationship is therapy, that the
goodness of therapy is a function of the
goodness of the therapeutic relationship.”
Fred E. Fiedler (1950) A comparison of therapeutic relationships in psychoanalytic, nondirective and Adlerian therapy.
Journal of Consulting Psychology 14(6), 436-445
Implications
•
•
•
The model(s) we learn in school
provide a jumping-off point
In clinical practice we modify our
work until it approaches the ideal
For some reason, this can’t be
taught
Jerome Frank (1961 - 1991)
Common factors in psychotherapy:
•
•
•
•
•
An emotionally charged, confiding relationship
with a helping person
A healing setting
A conceptual scheme or myth that explains the
patient’s symptoms and prescribes a ritual for
resolving them
The ritual requires the active participation of both
patient and therapist and is believed by both of
them to be the means of restoring the patient’s
health
Jerome D. Frank and Julia B. Frank (1991) Persuasion & Healing: A comparative study of psychotherapy (3rd ed.)
Baltimore: Johns Hopkins
Implications
•
•
•
Confiding relationship = ideal
therapeutic relationship?
Scheme/Myth/Ritual = model
Both are present in therapy and
therefore both presumably are
important
Michael J. Lambert (1992)
•
Psychotherapy outcome research
•
•
A lot of people improve “spontaneously”
without psychotherapy (median 43%,
range 18 - 67%)
Psychotherapy is beneficial
•
•
Effect size approximately 0.85 (large
effect!)
Generally as or more effective than
medication
In: John C. Norcross and Marvin R. Goldfried (1992) (eds.) Handbook of Psychotherapy Integration. New
York: Basic Books, pp. 94-129
Little Evidence for Model Specificity
•
•
No difference in outcome regardless of
model used
Possible explanations:
•
•
•
Different methods achieve the same
result through different mechanisms
Measurements are wrong
Common factors
Miller, Duncan & Hubble (1997)
•
•
Forty years of outcome research
•
Psychodynamic, object-related
•
Client-centered
•
Marriage and family therapies
All the data:
•
All models work equally well
•
All models take the same amount of time in
treatment
from: Escape from Babel (1997) by Miller, Duncan & Hubble
Common Factors
What accounts for change in
psychotherapy?





40%
30%
15%
15%
-
Extra-therapeutic change
Therapeutic Relationship
Expectancy
Model/Technique
Asay & Lambert (1999) “The Empirical Case for Common Factors” In The
Heart & Soul of Change. pp. 23-55.
Extratherapeutic Change (40%)


Client variables and factors in the
client’s own life
Includes such influences as:
• motivation, personality, social supports,
self-help, other life events

Spontaneous remission
• Between 18 – 67% of clients improve
without intervention
Therapeutic Relationship (30%)
•
Client-centered approach
•
empathy, genuineness & unconditional
positive regard (Rogers, 1957)
•
Collaboration vs. conflict
•
May include: listening, caring,
respect, acceptance, affirmation,
self-disclosure (sound familiar?)
Expectancy (15%)




Expectation that the client will be
helped
Placebo effects
The greater the felt distress, the
greater the likelihood of
improvement
Developing hope through new goals,
pathways, or sense of agency
Model/Technique (15%)
Professional training, theory, and
practice are increasingly oriented
toward specific techniques and
treatment approaches
However:

Majority of research evidence on
training and treatment suggests
that all therapies appear to be
equal in effectiveness

Conclusions
• Leaves us with three options:
1.Continue search for specificity
•
Dismiss/ignore common factors evidence
•
Focus on specific techniques showing
effectiveness
2.Search for common factors
•
Search for factors that cut across treatment
modalities
e.g. Transtheoretical model (Prochaska, Norcross,
DiClemente)
3.Change the model
•
Search for new models with unique aspects
Conclusions

More emphasis on maintaining a
positive therapeutic relationship than
on what model you use
“Learn your theories as well as you
can, but put them aside when you
touch the miracle of the living soul.
Not theories, but your own creative
individuality alone must decide.”
- Carl Jung
Conclusions

Scott Miller (2005)
• Engagement is the best predictor of outcome
• Outcome Rating Scale


Measures outcome, use at beginning of session
Focus on what client wants to talk about
• Session Rating Scale



Measures alliance, use at end of session
Only concerned with scores below 9 (or 36 total)
If no change within 6 sessions, ask each question
directly to help shift alliance
References
Duncan, B., Hubble, M., & Miller, S. (1997). Psychotherapy with “Impossible”
Cases: The Efficient Treatment of Therapy Veterans. New York:
W.W. Norton
Duncan, B., Solovey, A. & Rusk, G. (1992). Changing the Rules: A Client-Directed
Approach to Therapy. New York: Guilford.
Duncan, B. & Miller, S. (2004). The Heroic Client: A Revolutionary Way to Improve
Effectiveness Through Client-Directed, Outcome-Informed Therapy
(revised). San Francisco: Jossey-Bass/Wiley
Duncan, B., Miller, S., Wampold, B. & Hubble, M. (Eds.) (2009). The Heart & Soul
of Change (2nd ed.). Washington, DC: APA.
Miller, S., Duncan, B., & Hubble, M. (1997). Escape from Babel: Toward a Unifying
Language For Psychotherapy Practice. New York: W. W. Norton
Miller, S., Hubble, M. & Duncan, B. (Nov/Dec 2007). “Supershrinks: What's the
secret of their success?” Psychotherapy Networker.
BREAK
11:00 – 11:15
INTEGRATION
VS.
ECLECTICISM
Integration vs. Eclecticism


Integration is like choosing raw
ingredients to make a balanced and
nutritious meal, from a recipe to be used
again
While eclecticism is like visiting the salad
bar to select prepared food for just that
meal, equally nutritious, and a different
selection can be made next time
Integration vs. Eclecticism

Integration
• elements are part of one combined approach to
theory and practice
• fusion of one or more theories
• may be a hybrid approach but has consistent
theoretical basis
• practiced the same by different practitioners
• assimilation of thoughts from one school into
another
• more concern for internal consistency
• should be consistent with the therapist’s values
• use theory to drive decisions on which techniques
to use
Integration vs. Eclecticism

Eclecticism
• draws ad hoc from several approaches for a
particular case
• not bound by theories, dogma, or methodology
• different therapies work better for different people
• focus on what works best to serve individual cases
• may vary from case to case, therapist to therapist
• different practitioners will draw from different
theories
• a “bag of tricks”; jack-of-all-trades, master of none
• flexible; quickly adapts to new ideas
• choose interventions because they work, without
need for theoretical basis
Integration vs. Eclecticism

General points:
• FT seems to be following the same path as
individual psychotherapy re. integration
• Both have advantages and disadvantages

Modern vs. post-modern:
• One belief under modernism is that science will
eventually unify psychology; one grand theory of
everything
• Postmodernism embraces psychology’s pluralism
• Important for new approaches to be in dialogue
with each other; focus on mutual understanding
and growth vs. comparing/competing
Styles of Integration
1.
Common factors approach:
• emphasis on therapeutic actions that have been
demonstrated to be effective
• may overlook specific techniques that have been
developed within particular theories
2.
Technical eclecticism:
• guided primarily by data that indicates what has
worked best for others in the past
• encourages the use of diverse strategies without
being hindered by theoretical differences
• may not be a clear conceptual framework
describing how techniques from divergent theories
fit together
Styles of Integration
3.
Theoretical integration:
• requires integrating theoretical concepts from
different approaches
• tries to bring together different theoretical
approaches and then develop a unified theory
4.
Assimilative integration:
• favors a firm grounding in any one theory and
a willingness to incorporate or assimilate
perspectives or practices from other models
• therapist has a commitment to one theoretical
approach, but also is willing to use techniques
from other therapeutic approaches
Reprise – Modern vs.
Postmodern
• What is the difference?
• What is the advantage/disadvantage?
• What is your comfort level?
• What do you still need to know?
• How will you go about getting this
knowledge?
Lunch!
12:15 – 1:00
The Helping Styles Inventory




Introduced in 1988, P. Van Katwyk
Both a conceptual teaching model and
practice tool in supervision
Two continua:
• Use of Power [from Facilitative (bottom)
to Directive (top)]
• Focus of Attention [from Task oriented
(left) to Person oriented (right)]
Useful orientation to describe models of
therapy
The Helping Styles Inventory

Pin-the-Tail on the HSI!
• Where do the following FT models fit:

Bowen, Strategic, Structural, Experiential,
Psychoanalytic, Cognitive-Behavioural
• Where do the Post-Modern Models fit?
• What are you most comfortable with?
• What are you least comfortable with?
• Where is your ‘growing edge’?
Tammy


Six Nations
Video
Michael White

More video
Break

2:30 – 2:45
Final Paper Questions
Play Time
Case Study 1

A couple presenting with 15 years of
conflict, each feeling betrayed and
abandoned by the other, each unable to
forgive the other for past wrongs. Each
wants to be happy which can only happen
if the other didn’t do all those terrible
things they have done over the years.
Every time you talk to them about moving
forward you hear a new story beginning
with “You won’t believe what he did this
week”.
Case Study 2

John has just found out that his wife
Mary, to whom he has been married
five years, has lied to him about
every detail of her past: her family,
where she grew up, her childhood
friends, where she went to school,
even her name.
Case Study 3

Jack and Jill met each other when Jack
was married to Mirella and Jill was married
to Anthony. Jack and Jill used to meet on
the hill, pretending to go for water, until
they were caught one night when Jack
came home with a broken crown after
taking a tumble with Jill. But that’s all
history. The presenting issue is that Jack
and Jill have been a couple for ten years
now, and Jill is beginning to suspect Jack
of having an affair.
Case Study 4

Bruce, 18, has been accepted to the
University of British Columbia to
study biology and will go there in
September. He is very bright and
socially awkward. He comes to you
complaining that because he has
never had a relationship, he never
will. “I’m tired of being told to wait,”
he says.
Case Study 5

. Referral from an EAP (up to 8 sessions) for a
new mom recently separated from her husband
of seven years. She left him after discovering he
was having an affair. Now living with her mother
and her 6 mo. old son. Describes her husband as
a “self-centered alcoholic man-child”. She’s
coming for therapy because he keeps calling her,
trying to get her back, says he’s depressed and
suicidal. She feels angry, guilty, sad and
overwhelmed.
Case Study 6

Referral from an EAP (up to 8 sessions) for an
insurance salesman, early 30s, married for 5 yrs.
is coming for help because he is worried about
getting cancer again. He has been 5 yrs. cancerfree, and his annual check-ups show no concerns.
His wife is supportive and helps “calm him down”
when his worry becomes obsessive. He talks to
other survivors about it, does research on the
internet, and calls his doctor when he notices
something that may be a symptom (aches, pains,
rashes, etc.).
Case Study 7

17 yr. old girl presenting with depression and panic attacks.
Difficulty getting along with peers, and states “no one likes
me” and “I can’t keep friends”. Outwardly seems cool,
distant, and smug but inside describes herself as full of
shame and self-loathing. Will do anything to fit in and be
liked, including compromising her own values (e.g.
drinking, drugs, promiscuity). States that she wants to be
“independent” however shows pattern of dependency on
parents for emotional, financial, and psychological support.
Bullied in gr. 9 for being overweight.
Case Study 8

Young couple with a 10mo. old daughter argue about
household chores. She describes him as “lazy,” states he
doesn’t listen, and she is tired of “being his mom”. He
argues that he tries to help out but nothing is ever good
enough for her, he thinks she’s constantly criticizing him,
and when he does do something, he gets no
acknowledgment for it. She’s angry and he feels defeated.
He spends his spare time playing video games online with
his friends, usually late into the evening on weekends, then
has difficulty getting up in the morning to help out with
their daughter.
Please Complete a Final Evaluation
Wrap Up


Please hand in Reflection Journals
Final Paper due: April 17th
• Email to: [email protected]
or [email protected]


Thank you for your participation
Good luck with your studies!