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of
Chan ge
Overview
This presentation will review new evidenced-based approaches to the change process in counseling, with practical tools for improving therapeutic services to clients.
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INTRODUCTION
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Introduction
Lets humanize the topic a little
(Hand exercise)
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Introduction
Change = mysterious, ephemeral, abstract, temporal, phenomenological Change = difficult to quantify How can we standardize the mysterious?
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Introduction
Evidence-based practice has been misguided Saying Treatment X works for Disorder X misses the point entirely, because
This research is time-limited and often biased One size fits all It doesnt describe why change occurs Meta-analyses have provided contradictory findings
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Maintenance
Action
Planning
Contemplatio n
Pre-contemplation
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Confused?
Lets make a simpler graphic. Time for some basic math:
Therapist = 46-69 % of 13% 8% Alliance = 38-54% of 13% 7% Expectancy/Allegiance = 30%+ of 13% 4% + Model/Technique = 8% of 13% 1%
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6-
5-
0-
A Simpler Graphic
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Extra-therapeutic factors
My own experiences as a client
Practical Tools Recruit feedback Provide an explanation of your approach, and offer the client choices & options Self-monitoring (weight, thoughts, moods, budget) A strengths-based approach
Resiliency Competence
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When considering confronting the client: What is the cost to the relationship?
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Practical Tools The first session = crucial Average # of sessions per client = ? Your belief in your services has a direct effect on the client
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Practical Tools Remember, the belief (allegiance/expectancy) in the model/technique is more powerful than the actual intervention itself Clients will resist explanations that are not compatible with their attitudes/values
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The client, as primary agent of change, directs treatment. The counselor listens, empathizes, and validates the clients experience. The counselor s central tasks are to
form a collaborative alliance with the client be responsive to the clients culture, value and preferences assess the clients expectancy of change occurring support the clients goals and beliefs about change provide the client with choices and options about treatment foster the clients autonomous decision-making seek out areas of resilience and strength demonstrate allegiance and belief in the chosen myth and ritual of intervention www.thomfield.com
References
Anker, M., Duncan, B., & Sparks, J. (2009). Using client feedback to improve couples therapy outcomes: A randomized clinical trial in a naturalistic setting. Journal of Consulting and Clinical Psychology, 77, 693-705. Baldwin, S. A., Wampold, B. E., & Imel, Z. E. (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75, 842-852. Conners, G. J., Carroll, K. M., DiClemente, C. C., Longabaugh, R., & Donovan, D. (1997). The therapeutic alliance and its relationship to alcoholism treatment participation and outcome. Journal of Consulting and Clinical Psychology, 65, 588-598. Duncan, B. L., Miller, S. D., & Sparks, J. A. (2004). The heroic client: A revolutionary way to improve effectiveness through client-directed, outcome-informed therapy (Rev. ed.). San Francisco: Jossey-Bass.www.thomfield.com
References
Duncan, B. (2010). On becoming a better therapist. Washington, DC: American Psychological Association. Echterling, L. G., Presbury, J. H., & McKee, J. E. (2005). Crisis intervention: Promoting resilience and resolution in troubled times. Upper Saddle River, NJ: Pearson. Frank, J. D., & Frank, J. B. (1991). Persuasion and healing: A comparative study of psychotherapy. Baltimore, MD: Johns Hopkins Press. Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd Ed.). New York, NY: Guilford. Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research, and Practice, 19, 276-288. Robinson, L. A., Berman, J. S., & Neimeyer, R. A. (1990). Psychotherapy for the treatment of depression: A comprehensive review of controlled outcome research. Psychological Bulletin, 108, 30-49.
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References
Rosenzweig, S. (1936). Some implicit common factors in diverse methods of psychotherapy. American Journal of Orthopsychiatry, 6, 412-415. Shapiro, D. A., & Shapiro, D. (1982). Meta-analysis of comparative therapy outcome research: A critical appraisal. Behavioural Psychotherapy, 10, 4-25. Wampold, B. E., Minami, T., Baskin, T. W., & Tierney, S. C. (2002). A meta-(re)analysis of the effects of cognitive therapy versus other therapies for depression. Journal of Affective Disorders, 68, 159-165. Wampold, B. E., Mondin, G. W., Moody, M., Stich, F., Benson, K., & Ahn, H. (1997). A meta-analysis of outcome studies comparing bona fide psychotherapies: Empirically, all must have prizes. Psychological Bulletin, 122, 203-215. Yalom, I. D. (2002). The gift of therapy. New York, NY: Harper Collins.
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