Matching Theory to Client Factors:

A Framework for Integration & Alliance

Jill C. Morris, PhD, LMHC, LMFT

Relationships Consultants International, Inc.

January 25, 2013

FAMFT Conference

Boca Raton, FL

Agenda and Objectives

Learning Objectives:

Participants will be able to integrate multiple theories and

techniques while maintaining a clear therapeutic framework

Participants will gain in-depth knowledge of Common Factors

research

Participants will be able to adapt their clinical decision making

to include client factors and informal theories

Integration: The Clinician’s Dilemma

O Draws from a

wide range of

resources

O Opportunities

for “therapeutic

fit” increase

O Decreases

clinician

boredom and

burnout

O Convoluted

case

conceptualizati

on

O Lack of clarity

and/or purpose

O Client’s and

clinician’s

sense of hope

may be

impaired

Saul Rosenzweig, M.D.

“Some Implicit Common Factors in Diverse

Methods of Psychotherapy” 1936

The Dodo Bird Verdict

“Everybody has

won, and all must have

prizes.”

“ . . . Similarities rather than

differences between models

account for most of the

change that clients

experience across

therapies” Miller, Hubble & Duncan, 1995

Common Factors

40%

30%

15%

15%

Lambert 1992

Client/Extratherapeutic Factors

Patient-Therapist Relationship

Model/Technique

Placebo/Hope/Expectancy

Common FactorsWampold 2001

Client and Extra-therapeutic Factors

Therapeutic alliance

Model87%

Client & External Factors

Gender

Ethnicity

Age

Career

Personality

Preferences

Culture

Religion

Life Experiences

Resiliency

Interests

Resources

Births

Deaths

Accidents

Disability

Job loss

Financial shifts

Natural disasters

Marriages

Divorces

External systems

Health issues

Other events

Client Theory

Problem

What, Who, When, WH

Y

Change

What, Who, When, HO

W

Client Factors

Beliefs about

Therapy

Therapist listens Client talks

Therapist gives

advice Client follows advice

Therapist interacts Client collaborates

Therapist “fixes” Client is passive

Style & Resources

Concrete

Goal Oriented

Storyteller/Metaphoric

Perceived Resources

Financial

Social

Internal/Intrapsychic

Therapist Factors

Beliefs about

Therapy

Therapist listens Client talks

Therapist gives

advice Client follows advice

Therapist interacts Client collaborates

Therapist “fixes” Client is passive

Style & Resources

Concrete

Goal Oriented

Storyteller/Metaphoric

Perceived Resources

Clinical Experience

Theoretical

Knowledge

Flexibility/Adaptability

Client/Therapist Feedback Loop

RECIPROCAL INFLUENCE

Case Example #1

Ashle

y

Robert

7

David

Georg

e

5 1

Laura

• Ashley’s not listening

• Ashley is resistant to authority

• Sibling Rivalry

• Spousal relationship stressed

• Organizational problems at

work

• Family was not running as

smoothly as they expected

• Did not want Ashley

pathologized

• Responsible and achievement-

oriented

Theories/Techniques(Solution-Focused/Milan)

• Joining with customer

• Exploring existing

resources/beliefs

• Circular Questioning

• Reframing (unintentional

positive reinforcement)

• Positive connotation (linguistic

shift)

• Miracle Question

• Deframing

• Task Assignment

Case Example #2

Ted Sar

aSara

• Sara’s alcohol/drug use

• “Manic-Depressive”

• Too much “thinking

time”

• Wants “Objective

Opinion”

• Artistic

• Self-Help oriented

Theories/Techniques

(Bowen Family Systems/Strategic Family Therapy/SFT)

• Therapist’s dilemma – “objective opinion”: Genogram

• Therapeutic Double Bind

• Recontextualizing

• Thinking/Feeling

• Individuality/Togetherness

• Systemic Psychoeducation

• Miracle Question

• Parent/Child

• Family

• Dx: unwanted

• Clear goals

• IP-present

• Gender: non-

issue

• Adult/Marital

• Individual

• Dx: self-established

• Vague goals

• IP-absent

• Gender: relevant

DIFFERENCES

SIMILARITIES

Either

• We have a sick kid •Commit to a troubled relationship

Or

• We’re lousy parents •Dismiss love and give up hope

“You are multidimensional –

you are already many things to

many people

(friend, partner, parent, sibling

). Use your complexity to fit

clients”Duncan & Sparks (2004)

Client Beliefs about

Therapeutic

Process

Client Beliefs about

Problem/Change

Client

Characteristics and

Resources

Therapist Beliefs

about Therapeutic

Process

Therapist Beliefs

about

Problem/Change

Therapist

Characteristics and

Resources

Web ResourcesOutcome Rating Scale (ORS) and Session Rating Scale

(SRS) are available at www.talkingcure.com

http://www.personal.kent.edu/~dfresco/CRM_Readi

ngs/Duncan_dodo_2002.pdf

The Legacy of Saul Rosenzweig: The Profundity

of the Dodo Bird

ReferencesDuncan, B. L., Solovey, A. D., & Rusk, G.S. (1992) Changing the

rules: A client-directed approach to therapy. New York:

Guilford.

Duncan, B. L. & Sparks, J. A. (2004) Heroic clients, heroic agencies:

Partners for change- a manual for client-directed outcome-informed

therapy and effective, accountable, and just services. E-Book: ISTC

Press.

Lambert, M.J. (1992). Psychotherapy outcome research:

Implications for integrative and eclectic therapists. In J.C.

Norcross & M.R. Goldfreid (Eds.) Handbook of psychotherapy

Integration. (pp. 94-129). New York: Basic Books.

Miller, S. Hubble, M., & Duncan, B. (1995, March/April). No

more bells and whistles. The Family Therapy Networker, pp.

52-58, 62-63

Robinson, B. (2009). When therapist variable and the client’s

theory of change meet. Psychotherapy in Australia, 15 (4),

60-65.

Wampold, B. E. (2001). The great psychotherapy debate:

Models, methods, and findings. Hillsdale, N.J.: Erlbaum

http://ctiv.alexanderstreet.com.ezproxylocal

.library.nova.edu/view/1778986/play/true/