This is no pleasing some folk, is there? Here is another Robin-rant, and it may say little about small, safe experiments. However, it is a page that seeks to restore some balance to the working relationships of those people seeking change in their lives.
Some readers may well find my focus on the client, and their ability to design and implement small, safe experiments, rather over-eggs the pudding; that is, overstates the case. if you think I am bad, then please keep in mind that I am not the most ardent disciple of this point of view.
Focusing attention on ‘clients’; how to do that?
Consider the perspective of Barry L Duncan and Scott D. Miller. They wrote an interesting Paper entitled:
The Client’s Theory of Change: Consulting the Client in the Integrative Process
This article had the stated aim of
“cast[ing] a critical eye upon the integration literature and asserts that, as in psychotherapy in general, the client has been woefully left out of the therapeutic process”.Journal of Psychotherapy Integration, Vol. 10, No. 2, 2000
Privilege or Right?
Immediately afterwards, the authors talked about their intention to “privilege the client’s choice as the source of wisdom and solution“. They proposed that practitioners conducted therapy without regard for the client’s own theory of change.
I may not take to the extravagant language they used, but I do take a similar view, do I not? We agree that many therapists have discovered the hard way that any given model that purports to ameliorate human suffering is limited. No one size fits all. We agree that it is not enough to examine the ‘common factors’ between models of change.
They criticise the searches of vast number of models of therapy to identify the Holy Grail able to offer some harmony in the system. Helpfully, they expose this move as hiding another unspoken value that Dialectical Behaviour Therapy (DBT) has helped us to challenge!
There is no privilege involved in negotiating change. It’s not essential to do it as long as you are OK with the consequences of staying put. Equally, there is no right to have access to change. If you choose to go down the scenic route, it is a decision, often it is a hard one to make, and sustain.
Star or participant?
Duncan and Miller do demonstrate that there is still much unspoken compliance expected of clients. This is one typical element that needs to be eradicated or transformed if our profession is to improve its success rates.
That said, my own perspective, however, is that both parties to therapy are a “source of wisdom” and the “solution” emerges from their conversation and the quality of the negotiation each bring to their relationship.
I could turn a blind eye to Duncan’s values given we share so much – but for the words in the article when they assert (rather than argue) that:
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.2000, Journal of Psychotherapy Integration Page 169
I am OK with their efforts to highlight how ‘old hat’ this issue around misuse of power may be; they point out that “it would be fruitful to explain patient’s own ideas about psychotherapy and what they expect from it” (citing, in support, Hoch’s paper from 1955). Even so, some of their extravagant words come over as some form of over-compensation still diverting energy from neglected inequality in relationships.
I am aware that over-stating a case is often used by politicians and innovators to ‘make’ people listen and to accept change, but ‘swings and roundabouts’ come to mind. Is this the way to highlight how most integrative efforts focus on the therapist’s frame of reference? Replacing the ‘stardom’ of the practitioner, with the ‘stardom’, or assertions, of researchers over-states the place of the client?
So I struggle with ‘star’; I prefer ‘participant’. Both parties participate.
It does not remove the client from the role of “pathological monster of epic proportions” simply by asking them to become the ‘superperson’ in the relationship.