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Theories and Methods of Family Therapy: Post-Modern Models

Theories and Methods of Family Therapy: Post-Modern Models. University of Guelph Centre for Open Learning and Educational Support William Corrigan, BA, MTS Carlton Brown, MSc, M.Div. AAMFT Approved Supervisor AAMFT Approved Supervisor

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Theories and Methods of Family Therapy: Post-Modern Models

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  1. Theories and Methods ofFamily Therapy:Post-Modern Models University of Guelph Centre for Open Learning and Educational Support William Corrigan, BA, MTS Carlton Brown, MSc, M.Div. AAMFT Approved Supervisor AAMFT Approved Supervisor (519) 265-3599 (905) 388-8728 williamcorrigan@rogers.comcarl@mftsolutions.ca

  2. Day 5 Agenda • Debate • Fishbowl • Common factors • Pizza Day • More case studies from William/Carl • More video? • Q & A – written questions • Integrating PMM with other models • Final paper • Review goals from Day 1 • Course evaluations

  3. THE GREAT DEBATE • Opening statements – 2 minutes each (6 minutes) • Strengths of each approach – 2 minutes each (6 minutes) • Weaknesses of each approach – 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!!!

  4. Session Ratings from Day 4 Relationship: 85% Goals: 84% Method: 76% Overall: 80% And one comment: Awesome class! Loved it!

  5. The Fishbowl (10:00 – 10:30) • Reflecting can create new meanings • A chance for collaborative dialogue: • What was it like for you? • What did you like/not like? • What are you curious about? • Any new ideas/learnings • How are you taking this into practice? 5

  6. BREAK 10:30 – 10:45

  7. Common Factors

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. Implications • Confiding relationship = ideal therapeutic relationship? • Scheme/Myth/Ritual = model • Both are present in therapy and therefore both presumably are important

  14. 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

  15. 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

  16. 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

  17. Common Factors • What accounts for change in psychotherapy? • 40% - Extra-therapeutic change • 30% - Therapeutic Relationship • 15% - Expectancy • 15% - Model/Technique Asay & Lambert (1999) “The Empirical Case for Common Factors” In The Heart & Soul of Change. pp. 23-55.

  18. 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

  19. 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?)

  20. 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

  21. 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

  22. Conclusions • Leaves us with three options: • Continue search for specificity • Dismiss/ignore common factors evidence • Focus on specific techniques showing effectiveness • Search for common factors • Search for factors that cut across treatment modalities e.g. Transtheoretical model (Prochaska, Norcross, DiClemente) • Change the model • Search for new models with unique aspects

  23. 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

  24. 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

  25. 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.

  26. 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

  27. 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’?

  28. PIZZA DAY!12:30 – 1:15

  29. Wrap Up • More case studies from William/Carl • More video? • Q & A – written questions • Integrating PMM with other models • Final paper • Review goals from Day 1

  30. Please Complete a Final Evaluation

  31. Wrap Up • Please hand in Reflection Journals • Final Paper due: July 11th • Email to: williamcorrigan@rogers.com or carl@mftsolutions.ca • Thank you for your participation • Good luck with your studies!

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