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The Voices Within, Part 1

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The Voices Within, Part 1

 

By Paul Hubbard, MA

 

Voice Dialogue work is a psychotherapy modality developed by Drs. Hal and Sidra Winkelman Stone. It has roots in Jungian psychology and involves accessing different sub-personalities like the inner child and the inner critic, among many others. Most people go through their lives more strongly identified with particular sub-personalities, or primary selves, while generally dis-identifying from other, more opposite sub-personalities, or disowned selves (Stone & Winkelman, 1989).

In Voice Dialogue work one learns to identify both their primary selves, and their disowned selves. The primary selves are the part of the personality that one tends to be more identified with. For example, the selves that help one to better fit into and/or be more successful within a social circle or in the world in general that one moves in (Stone & Winkelman, 1989).

In Jungian terminology, the disowned selves are a part of the shadow (Stone & Winkelman, 1989). The shadow represents the aspects of “ourselves that we do not know or refuse to know, both dark and light. It is the sum total of the positive and negative traits, feelings, beliefs, and potentials that we refuse to identify as our own.” It is the “part of us that is incompatible with who we think we are or who we are supposed to be” (Richo, 1999, p. 1). 

In our relationships, we tend to attract others who reflect the disowned aspects of ourselves. The more these various aspects have been disowned or more deeply buried in the unconscious the stronger the reaction tends to be when we encounter others who live out more overtly the disowned parts of ourselves. “We can be helpless victims to the multitude of relationships in our lives that reflect our disowned selves or we can accept the challenge of these relationships and ask: ‘How is this person or this situation, my teacher?’” (Stone & Winkelman, 1989, p. 32).

What is common to all sorts of relationships is that people get in bonding patterns which are parent-child energetic dynamics wherein one person tends to be more heavily identified with a parental role and the other person tends to be more heavily identified with a child role. Bonding patterns happen in all types of relationships, including, but not limited to romantic relationships and actual parent-child relationships. The parental sides tend to be more power oriented and the child sides tend more towards vulnerability (Stone & Winkelman, 1989).

One of the goals in therapy using voice dialogue work involves accessing the aware ego, which is the part of oneself that has some separation from the sub-personalities and can even, through increased awareness, be aware simultaneously of two or more very different parts of oneself, like parental and child aspects, or our power and vulnerable sides. This is not necessarily an easy process and can be hard work at times, but it is possible even though generally one is not aware of a bonding pattern until after it expresses. With development of the aware ego, one can avoid getting into bonding patterns as intensely and then get out of them more quickly when they do occur. A key to this awareness is understanding the role of vulnerability in a relationship and how a disowned or unconscious vulnerability can be a trigger for going into a bonding pattern. If only one of the two people in the bonding pattern has some awareness that a bonding pattern is happening then it is much easier to avoid it being so painful. Having a sense of humor and being able to laugh is a good indicator of accessing the aware ego (Stone & Winkelman, 1989). 

 

Acknowledgements

Richo, D. (1999). Shadow Dance. Boston, MA: Shambala

Stone, H. & S. Winkelman (1989). Embracing Our Selves. San Rafael, CA: New World Library

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Mental Health Access and Equality: 3 Steps to Freedom!

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Mental Health Access and Equality: 3 Steps to Freedom!

By Dr. Leona Kashersky, PsyD

 

According to the U.S. Department of Health and Human Services, as many as one in five Americans will experience a mental health issue at some point in their lives. This report is likely an underestimation of how many Americans experience mental health challenges during a lifetime. Of the nearly 60 million Americans who experience mental health concerns each year, many will never seek treatment for a variety of reasons including social stigma, cultural norms, and lack of access. In fact, a recent report published in the journal Psychological Science and the Public Interest found that an estimated 40% of individuals with serious mental health concerns either never receive care or start an intervention program without completing it.

The stigma surrounding mental health issues can be a significant barrier to care. Unfortunately, many people unknowingly contribute to the stigma simply with their everyday language choices. A poor choice of words not only stigmatizes, stereotypes, and creates unrealistic assumptions about certain people, but also can trivialize serious mental health conditions and their accompanying experience. As we move forward into a more enlightened future where mental health access and needs are considered just as normal and standard as the need to address a flu or more chronic physical health challenges, let’s dream of this brighter and more hopeful world together here!

In this new and more beautiful world our hearts know is possible, we would accept mental health hygiene and seeing professionals as part of living a normal and healthy life. Acknowledging and discussing symptoms wouldn’t be secretive or shame-based. Just as our communities gather to support those with physical illness, we would gather to do the same for those with depression, anxiety, and neurological differences. We would have more open dialogue about how this gathering would look different because the needs of these individuals are different than those suffering from flu or other chronic physical health challenges. This more beautiful world would allow us to come together armed with education and support to face life’s most challenging mental health setbacks without the shame and judgement we often face in our world today.

In this more beautiful world our health plans would adequately cover inpatient and partial hospitalization, intensive outpatient, and outpatient programs. All of us would have access to appropriate levels of care when we need it. Communities and families would know how to embrace and integrate individuals who are struggling with appropriate and supportive boundaries. Substance abuse treatment would be easy to access and affordable, saving countless lives. If we really want this beautiful new world, we can begin this journey by taking 3 simple steps.

  1. Accept what is! All of us need mental health maintenance. All of us grieve. All of us suffer. It IS the human condition. Let’s accept it and help each other.
  2. Suspend judgement! Judging ourselves or others in their mental suffering only serves to extend the duration of suffering. LET GO of the should’s and other criticisms.
  3. Dream of the life you want and believe it is possible! Imagine how you will feel when this happens. Allow yourself to experience the full emotion and somatic sensation of those emotions. Allow your mind to fully appreciate all that is there for you.

These steps will allow you to magnetize to your ‘More Beautiful World’ tribe. This community will be the seeds to this more beautiful world in our hearts we all know is possible. These roots are already growing and taking hold, so let’s keep dreaming together. We are manifesting our hearts desire and creating a new reality together!

 

References:

  1. Corrigan, Patrick. (September 4, 2014). Stigma as a Barrier to Mental Health Care. Association for Psychological Science. Retrieved from: http://www.psychologicalscience.org/index.php/news/releases/stigma-as-a-barrier-to-mental-health-carhtml
  2. Mental Health America. Mental Health Information. Retrieved from: http://www.mentalhealthamerica.net/mental-health-information
  3. Eisenstein, Charles. (November 5, 2013). The More Beautiful World Our Hearts Know is Possible. North Atlantic Books.
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Come Get Your Pride On With Healing Pathways Psychological Services On June 3rd!

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Pride Festival

PRIDE FESTIVAL

The festival is on Saturday June 3rd from 11am-5pm, costs $10 per person (children 10 and under are free), and is located on the Capitol Mall between 3rd and 7th streets. More about the festival…

ABOUT SACRAMENTO PRIDE

Sacramento Pride 2017 is the 33rd annual local commemoration of a pivotal moment in civil rights history, the Stonewall Riots of New York in June, 1969. This moment represented the start of a movement to bring lesbian, gay, bisexual, and transgender (LGBT) Americans out of the shadows and into everyday society. More recent achievements along these lines have included the repeal of the military’s “don’t ask don’t tell” policy as well as court victories to equalize marriage rights.

The event has evolved into a high profile celebration and cultural festival, both on the national and local levels. Pride was moved from Southside Park in 2010 to the streets along Sacramento’s symbolic Capitol Mall, with the State Capitol building on one end and the iconic Tower Bridge on the other. Pride 2017 will build upon our successes and continue to grow and improve.

Sacramento is already nationally known as a city with a relatively high gay population. The City of Sacramento is estimated to have a gay population of 9.8%, the sixth highest in the nation. The larger metropolitan area comes in at 5.5% which is still higher than the national average of 4.1%.

Pride is more than just a great parade and festival, however. It is produced by the Sacramento LGBT Community Center and is the largest source of funding for the Center’s programs and services. The Center provides unique services for at-risk youth, a free weekly legal clinic, HIV/AIDS prevention and support services, transgender support, and numerous discussion groups and other activities for LGBT adults. The Center is a 501c(3) charitable organization.

OUR COMMUNITY

Healing Pathways Psychological Services is excited to join the celebration of Sacramento Pride 2017. Our contribution to the event not only educates people about what we’re up to in our city, but we will be putting smiles on their faces with fun activities and prizes. We are so delighted to share these festivities with all of you and look forward to sharing this rare opportunity…

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The Healing Power of Sound

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The Healing Power of Sound

Photo credit: Blue Heron Crystals and Minerals

by Dr. Leona Kashersky & Nicolina Santoro, MA

The crystal bowls can assist in reducing stress, anxiety, and pain, promote happiness, peace of mind, and help you hear the music of your life-purpose.

The next class is on May 27th at Healing Pathways Psychological Services. 

For registration call: 916-595-7233
Email soundhealinghpps@gmail.com for registration details
Cost $140 3 hour instruction and experiential didactic

Please enjoy the following snapshot of some of the theory and practice used in the facilitation of sound healing at Healing Pathways! 

The Chakra System, in yogic practice

The seven chakras, in the yogic tradition are the centers in our bodies in which life sustaining energy flows through.It is thought that blocked energy in our seven chakras can often lead to illness, so it’s important to understand what each chakra represents and what we can do to keep this energy flowing freely.

The Chakras In Summary

  • Root Chakra — Represents our foundation and feeling of being grounded.
  • Location: Base of spine in tailbone area.
  • Emotional issues: Survival issues such as financial independence, money and food.

 

  • Sacral Chakra — Our connection and ability to accept others and new experiences.
  • Location: Lower abdomen, about two inches below the navel and two inches in.
  • Emotional issues: Sense of abundance, well-being, pleasure and sexuality.

 

  • Solar Plexus Chakra — Our ability to be confident and in control of our lives.
  • Location: Upper abdomen in the stomach area.

Emotional issues: Self-worth, self-confidence and self-esteem.

  • Heart Chakra — Our ability to love.
  • Location: Center of chest just above the heart.
  • Emotional issues: Love, joy and inner peace.

 

  • Throat Chakra — Our ability to communicate.
  • Location: Throat, just above the collar bone.
  • Emotional issues: Communication, self-expression of feelings and the truth.

 

  • Third Eye Chakra — Our ability to focus on and see the big picture.
  • Location: Forehead between the eyes (also called the Brow Chakra).
  • Emotional issues: Intuition, imagination, wisdom and the ability to think and make decisions.

 

  • Crown Chakra — The highest chakra represents our ability to be fully connected spiritually.
  • Location: The very top of the head.
  • Emotional issues: Inner and outer beauty, our connection to spirituality, wonder, and pure bliss.

 

EMDR 

EMDR is an acronym for Eye Movement Desensitization Reprocessing, a tool to process traumatic experience. EMDR works through bilateral neural stimulation or brain stimulation to integrate traumatic material. The singing crystal bowls create a sense of bilateral stimulation, while the meditation focuses on reprocessing, and altering core belief patterns. The bilateral processing is not only possible using the eyes; we can use sound, touch, and movement of any bilaterally moving body parts with a split timed rhythm. Some psychologists conceptualize EMDR as a form of ‘Exposure Therapy’, desensitizing people to traumatic material and thus relating it to exposure therapy. A more accurate description would be that it integrates the traumatic material.

“Memories evolve and change. Immediately after a memory is laid down, it undergoes a lengthy process of integration and reinterpretation—a process that automatically happens in the mind/brain without any input from the conscious self. When the process is complete, the experience is integrated with other life events and stops having a life of its own. As we have seen, in PTSD this process fails and the memory remains stuck—undigested and raw.” ~ by Bessel Van Der Kolkata, M.D. In The Body Keeps the Score chapter entitled Letting Go of the Past: EMDR

 

Three summarizing factors about EMDR:

  1. EMDR loosens up something in the mind/brain that gives people rapid access to loosely associated memories and images from their past. This seems to help them put traumatic experience into a larger context or perspective.
  2. People may be able to heal from trauma without talking about it. EMDR allows them to observe their experiences in a new way, without verbal give-and-take with another person.
  3. EMDR can help even if the patient and the therapist do not have a trusting relationship. This is intriguing because trauma, understandably, rarely leaves people with an open, trusting heart.

 

 

Physiological and Therapeutic Effects of Drumming

Recent studies have shown physiological benefits to drumming meditation practices such as, the reduction of the physical symptoms of anxiety, stress, the body’s immune system, brainwave activity, dual cerebral hemisphere activation, and connection with the present moment.

Because of the deep sense of tranquility that the act of drumming facilitates within the Central Nervous System, the effects of stress, and the accumulation of trauma stored within our cellular memory can be processed and integrated through this non-confrontational and deeply personal act even in group settings. This form of mindfulness based attention has also shown to activate the cells themselves, allowing for deep trauma to be released from cellular memory with little interference from the mind’s protective measures and defenses as the trauma is engaged and released by group participants. The chemical messengers of the brain or neurotransmitters reinforce this practice by stimulating alpha wave activity, inducing feelings of well-being and happiness.

The shared experience of drumming in groups is observed to facilitate a shared space of connection and consciousness among its members, alleviating common feelings of isolation, social fear, and inhibition.

Drumming seems to provide a platform for people to experience religious or spiritual connection through a universal practice that has been used by all cultures in some form or another. Through this connection, a space is created to access the deepest parts of our human condition.

 

 

References

  • The Body Keeps the Score science grounding in sound, breathe, and movement as a healing modality. Bessel Van Der Kolkata, M.D
  • R. Damasio, The Feeling of What Happens: Body and Emotion and the Making of Consciousness (New York: Random House, 2000) 28
  • K. Holzel, et al., “Mindfulness Practice Leads to Increases in Regional Brain Grey Matter Density,” Psychiatry Research: Neuroimaging 191, no. 1 (2011): 36-43.
  • K. Holzel, et al., “Stress Reduction Correlates with Structural Changes in the Amygdala,” Social Cognitive and Affective Neuroscience 5, no. 1 (2010): 11-17.
  • W. Lazar, et al., “Meditation Experience Is Associated with Increased Cortical Thickness,” NeuroReport 16 (2005): 1893-97. Pesso
  • N. Demos, Getting Started with Neurofeedback (New York: W.W. Norton, 2005).
  • J. Davidson, “ Affective Style and Affective Disorders: Prospectives from Affective Neuroscience,” Cognition and Emotion 12, no. 3 (1998): 307-30.
  • J. Davidson, et al, “Regional Brain Function, Emotion and Disorders of Emotion,” Current Opinion of Neurobiology 9 (1999): 228-34.
  • Bittman, M.D., Barry, Karl T. Bruhn, Christine Stevens, MSW, MT-BC, James Westengard, Paul O Umbach, MA, “Recreational Music-Making, A Cost-Effective Group Interdisciplinary Strategy for Reducing Burnout and Improving Mood States in Long-Term Care Workers,” Advances in Mind-Body Medicine, Fall/Winter 2003, Vol. 19 No. 3/4.
  • Winkelman, Michael, Shamanism: The Neural Ecology of Consciousness and Healing. Westport, Conn: Bergin & Garvey; 2000.
  • Bittman, M.D., Barry, “Composite Effects of Group Drumming…,” Alternative Therapies in Health and Medicine; Volume 7, No. 1, pp. 38-47; January 2001.
  • Winkelman, Michael, Shamanism: The Neural Ecology of Consciousness and Healing. Westport, Conn: Bergin & Garvey; 2000.
  • Friedman, Robert Lawrence, The Healing Power of the Drum. Reno, NV: White Cliffs; 2000.
  • Mikenas, Edward, “Drums, Not Drugs,” Percussive Notes. April 1999:62-63.
  • Diamond, John, The Way of the Pulse – Drumming with Spirit, Enhancement Books, Bloomingdale IL. 1999.
  • Winkelman, Michael, “Complementary Therapy for Addiction: Drumming Out Drugs,” American Journal of Public Health; Apr 2003, Vol. 93 Issue 4, p647, 5p
  • Mikenas, Edward, “Drums, Not Drugs,” Percussive Notes. April 1999:62-63.
  • Friedman, Robert Lawrence, The Healing Power of the Drum. Reno, NV: White Cliffs; 200

 

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A Series of Writings for Clinicians on Common Factors Research and What Promotes Change in Couple and Family Therapy Part 2

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A Series of Writings for Clinicians on Common Factors Research and What Promotes Change in Couple and Family Therapy

Part 2

by

Jason Briggs, MA

JBII

(photo credit: www.shutterstock.com)

What motivates a client to change and what are the processes therapists can use to help?

 

In the last writing, in this series on Common Factors research, the discussion was on aspects of two Common Factors used to promote effective outcomes in therapy.  They were client factors and therapist factors. These two Common Factors will be addressed in this second writing as well, along with how they interrelate with a third Common Factor called the therapeutic alliance, all within the Stage of Change known as Contemplation. I will also discuss what some of the change processes I use are and how they are also supported by Common Factors researchers. I will begin with what Common Factors researchers find is essential to Motivational Interviewing, since this was not discussed in my last post. Again, as with all my writings on Common Factors, I am reviewing three Common Factors researchers’ work, authored by Douglas H. Spenkle PhD, Sean Davis PhD and Jay L. Lebow, PhD, referencing information found in their book Common Factors in Couple and Family Therapy, The Overlooked Foundation for Effective Practice.

Motivational Interviewing has elements that when brought together in the context of our clients’ lives, can help therapists join with clients, inviting them to engage in and explore change in whatever Stage of Change they might be experiencing. Common Factors researchers contend and I agree with them, that “within the Motivational Interviewing approach there is no such thing as an unmotivated client. There are only therapists that are out of sync with a client’s motivation” (Spenkle, Lebow and Davis, 2009). So, working systemically, it is often the case that each member in an individual, couple or family system, is in varying Stages of Change and thus motivated at different levels with the different issues they might wish to address. Common Factors suggests part of the therapist role is to shift homeostasis within an understanding of each person’s motivation and the there are five principles to consider, to help us form a better connection with our client and help them move through whatever Stage of Change they are in. We can “(1) express empathy, (2) develop discrepancy, (3) avoid argumentation, (4) roll with resistance, and (5) support self-efficacy” (Miller and Rollnick, 2002) (Spenkle, Lebow and Davis, 2009). These five principles are suggested to fall into three broad therapeutic alliances, which therapists can use three interventions within each stage and they are: “(1) building motivation for change, (2) strengthening commitment to change, and (3) the follow-through (Spenkle, Lebow and Davis, 2009). So what exactly do Common Factors researchers know about the value and importance of these five Motivational Interviewing principles?

“Unpacking” what these Motivational Interviewing principles ignite in our clients, is a great way to motivate therapists to learn these concepts both intellectually and experientially with their clients. As noted above, these Motivational Interviewing principles inherently ask each therapist to embody a sort of attitudinal stance in therapy that helps facilitate a client’s movement toward change. They are (1) expressing empathy and is particularly effective with client ambivalence and is promoted by a listening stance and abandoning a superior/inferior stance, typically embodied by telling a client what meaning we give to their story. Common Factors researchers describe the Therapists’ Alliance in this way: (to be) “a supportive companion and knowledge consultant, (rather) than a forceful instigator of change” (Spenkle, Lebow and Davis, 2009). (2) Developing discrepancy, the second Motivational Interviewing principle is reflected in understanding that most, if not all humans’ emotional and psychological pain exists in direct proportion to the disparity/discrepancy between where they are now and where they want to be, “and when they know better, they will do better” ( BJ Davis, 2012). Common Factors researchers point out, “Depending on which Stage of Change the client is in, the therapist focuses on gently amplifying the discrepancy that is already there (for those in contemplation or preparation stages) or developing a discrepancy (for those in the pre-contemplation stage)” (Spenkle, Lebow and Davis, 2009). Here, we see an emphasis on the therapist knowledge about the Stage of Change in general and needing to know where one’s client is in terms of each Stage of Change and on differing issues, exploring the likelihood of a client having varying levels of motivation to change depending on any given issue and the Stage of Change the client is in with each issue. (3) Avoiding argumentation is the third principles used in helping a client experience the motivation to change. Expecting a client to embrace a certain protocol type therapy, a label, etc. is one way an unsuspecting therapist can invite arguments  against, instead of for change (with us or within the client and likely both). Helping to understand a client’s point of view regarding their preferences in therapy, how they have experienced labels, even “mental health issues” can be one way we can allow their meaning to be held up to unequivocal predominance and then join with the meaning our clients make about how they identify this meaning, amplifying, and reflecting it to them. Closely related Motivational Interviewing principle (4), rolling with resistance, which is an essential facet of Motivational Interviewing and the idea of accepting and not rejecting a client’s ambivalence to change. Emphasis is placed on joining with the client not on any particular interventions, trusting a solution will, if acceptance is present, naturally emerge within the client in the space created for them to explore their problems. This assumes an intention on behalf of the therapist, which trusts the client has their own answers within them, assuming a stance of psychological and emotional safety around any issues the client is considering facing. If the therapist achieves this stance and creates emotional safety for a client to explore what they need, want, and are willing to do based on the clients view, their therapist is seen as an “enlightened witness” (Alice Miller, 97). Supporting this safe emotional and psychological space means supporting the next principle in Motivational Interviewing, (5) supporting self-efficacy, the belief that a client can change and unless this empowering attitudinal stance is demonstrated by the therapist in relationship with their client, “a discrepancy crisis is likely to resolve into defensive coping (e.g., rationalization, denial) to reduce discomfort, without changing behavior” (Miller, 1995, p.5) (Spenkle, Lebow and Davis, 2009).  

The therapeutic alliance, another essential Common Factor, will be given its proper weight in understanding how client and therapist factors unite within the processes of change during the Stage of Change known as Contemplation. The therapeutic alliance is defined by Common Factors as both/and, what it is, and what it is not. “It is collaborative. The alliance can be misunderstood as a quality that the therapist brings to the client. However, the alliance is fully interactional and systemic, an operation between one or more clients and the therapist (Spenkle, Lebow and Davis, 2009).” This is a foundational therapeutic Common Factor. It establishes emotional bonds between a therapist and a client to form a connection and assists with providing effective outcomes in therapy. So, helping a client see choices for healing that the therapist sees the client may identify with and find helpful is only half of the picture, the other half is seeing what our clients are contemplating and helping them negotiate the changes they seek to make within all the Stages of Change and processes of change they are in and viewed as meaningful. Stated in another way, “On more careful examination, (our) successful alliance formation is better viewed as a dance in which everyone participated as the alliance co-evolved between the clients and the therapist” (Spenkle, Lebow and Davis, 2009). I will add that a felt understanding by the therapist of the clients’ worldviews are essential, along with a sense of therapist “okay-ness” about the clients’ interactions within the therapy room. These perceptions and interactions the therapist has in turn, will impact the client in therapy, whether the client is in therapy with their family, in a couple, or individual unit of treatment. When the therapist creates psychological and emotional safety in the relationship to their clients’ ambivalent interactions, and helps the client contemplate what it might be like doing inner work using certain stage specific processes of change, the client will reveal more of their ambivalence and ideas to contemplate that which will promote change.  

In the Stage of Change known as Contemplation, clients are intending to act “within the next six months.” (Prochaska, 1999) (Spenkle, Lebow and Davis, 2009).  Clients seeking to make a change in this stage are expressing discontent with their problems, want to overcome it, want to see themselves living a life without their problems, but also see why they shouldn’t try to change. Clients in Contemplation “are not very good candidates for behaviorally focused, action-oriented programs. Their motivation is not yet at the level where they will put all of their heart into behavioral change efforts. They are better suited for more passive insight-oriented approaches that help them explore their problem, weigh the pros and cons of changing and so forth” (Spenkle, Lebow and Davis, 2009). Like in the previous Stage of Change the suggestion for this stage is to continue to weigh the pros and cons of changing and decrease the number of cons. The only additional processes of change aside from three mentioned in Pre-Contemplation is self-reevaluation, to assist in transitioning to the next Stage of Change Preparation. So, the therapist is supporting the client in evaluating themselves without the problem. Aside from active imagination, guided imagery, self-acknowledgement of healing and growth, help consolidate steps the therapeutic alliance has made and clarify steps one still might make in the therapeutic alliance to successfully transition to the Preparation Stage of Change. “Values clarification, encouraging congruence between one’s own values and behaviors and the like can be helpful in this stage” (Prochaska, 1999) (Spenkle, Lebow and Davis, 2009).

A therapist being willing to build a foundational relationship with their client depends to a large extent, on a therapist’s ability to listen, explore, and respect the worldview of their clients, not as an intervention, but more as an attitudinal stance toward their shared humanity, a facet of which was addressed above in the therapeutic alliance discussion. Understanding Common Factors research is important and then applying it in our therapeutic practices can help our clients regain a sense of connection often ruptured in their past and current relationships. Common Factors research can help therapists and clients move through change in their own and their clients’ lives in a much more empathetic and meaningful way. Remembering there is always motivation present is essential, and it is the role of the therapist to identify what motivates our clients to bring about effective change, and to “stay with them” as they contemplate ways to move forward while having a timing and pacing that works for them. See the first writing in this series on Common Factors (CF), wherein I discussed what CF researchers suggested as helpful processes of change in the Stage of Change Pre-Contemplation. Doing so will enhance your focus on the processes of change you can use to help clients focus on increasing insight about moving from Contemplation to begin working in the next Stage of Change known as Preparation, our next blog topic.

Acknowledgements

Douglas H. SprenkleSean D. DavisJay L. Lebow. Common Factors in Couple and Family Therapy, Guilford Press, Aug 10, 2009

Alice Miller. 1/7/1997. http://www.alice-miller.com/en/the-essential-role-of-an-enlightened-witness-in-society-2/

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A Series of Writings for Clinicians on Common Factors Research and What Promotes Change in Couple and Family Therapy

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A Series of Writings for Clinicians on Common Factors Research and What Promotes Change in Couple and Family Therapy

by

Jason Briggs, MA

jb-blog2

(Photo saved from nubbsgalore.tumblr.com)

What motivates a client to change and what are the processes therapists can use to help?

If you’re like me, most therapists have a period in their learning curve where they have spent countless hours being ahead of their clients’ abilities to promote effective change because we aren’t seeing what stage of change our clients are in, and aren’t sure what processes could help motivate our clients in therapy. We (therapists) can also be less skillful about being transparent with each other about our own work with clients and how we promote change and challenges to this process we call psycho (mind/soul) therapy (treatment used to treat issues, problems and symptoms one feels conflicted about). This series is  an homage to Common factors research (CFR), that points to common factors which underlie all therapy models that work together to promote change in therapy. The three Common factors researchers work I will be summarizing are authored by Douglas H. Spenkle PhD, Sean Davis PhD and (last but not least) Jay L. Lebow, PhD, which can be found in their book Common Factors in Couple and Family Therapy, The Overlooked Foundation for Effective Practice. Sean Davis is in private practice, a supervisor in the Roseville, CA area, and a local Professor at Alliant International University, Sacramento Campus. Dr. Davis was my past academic advisor and admittedly an “at a distance” self-selected role model.

In the age of having many models of therapy to choose from its helpful to know two Common Factors (CF) that help promote effective change in Common factors research (CFR), that being the ‘client factor’ and ‘therapist factor’ both, in connection with each other. What is it specifically about the client that lends itself to change and what is the role of the therapist in supporting this change, that both the therapist and client might have an effective therapy outcome?  Many therapists and clients assume it is what the therapist does that is the most important aspect of therapy, but Common Factors Research asserts that it’s not only what the client does in therapy, but what the client does in response to the therapist, or how a client uses and focuses on the information the therapist presents. Ultimately it’s a collaborative venture.

As is often the case, I will invite my clients to share in what is called a “here and now” time, at the end of our sessions to explore our shared experiences in the session. In the “here and now”, I invite my clients to share what they found was helpful, worked or what didn’t work, or just to relate their experience in our session and in particular, with me; their answers never cease to amaze me, often citing something I felt was just a passing comment, experience or interaction or some other very important aspect of their experience. Using this “here and now” time, it is a both/and way of interacting, the focus is on the client but the therapist is wise to find ways to work with clients’ perceptions, being curious about them, and helping them identify what works for them. This should include what they struggle with in sharing their own experiences, cultivating a focus on what a client may feel is “ok” in therapy according to their worldview, and then seek ways that help promote a motivation to expand their worldview and promote change.

The Common Factors researchers do note that an extreme view of Common Factors research may engender a therapist to say “even a poor therapist can do therapy” but in their book they actually say quite the opposite and tend to place great value and importance in their role, but not by placing their own role above the clients’ role. They note, that the therapist who places such extreme value on client factors, to the exclusion of the therapists’ own involvement and development, may run the risk of discouraging themselves to think they have nothing to offer to help the client change and a thus engender a “why try” attitude that could encourage therapist laziness and a lack of a sense of accountability to clients (p71).” The Common Factors research discusses the nature of clients’ and therapists’ factors as being reciprocal (giving and receiving in balance) and further discusses how the therapist can motivate a client to change also asserting that a client motivated to change can then impact the therapist’s motivation and behavior! That’s reciprocity! So, it is clear that their emphasis is on the value and importance of matching our own behaviors as therapists with the client’s motivation to change, and what processes will help them engage in such a change.

It seems all humans pass through Stages of Change (SOC-a common behavioral health model) and have various levels of motivation. Known by therapists as Motivational Interviewing (MI), MI has typically been thought to be helpful to only substance abusers, but it has been used successfully with individuals, couples, and families with other issues as well. Motivation is always present according to the researchers (Miller & Rollnick’s (SOC) and Prochaska’s (MI), but that it looks differently depending on each stage, and that each client is motivated by different things. There are 6 stages of change (SOC) and they are Pre-Contemplation, Contemplation, Preparation, Action, Maintenance, and Termination. There are 9 processes of change which are Consciousness Raising, Dramatic Relief, Environmental Re-evaluation, Self-Re-evaluation, Self-Liberation, Contingency Management , Helping Relationships and Counter-Conditioning and finally Stimulus Control (Prochaska, 1999) (Spenkle, Lebow and Davis, 2009).

This will only focus on clients in the SOC called Pre-contemplation, the helpful process and interventions that Common Factors research has shown will help clients at this particular motivation level in their process of change. These clients it would seem are not intending to change anytime in ‘the next 6 months’ and they are either unaware of or uninformed about the severity of their problems. Clients who wish to successfully move from this stage to the next, Contemplation, “need to increase the number of pros (versus cons) they see in a life without the problem.” The Common Factors researchers suggest helping clients focus on increasing insight, suggesting that using the Consciousness Raising processes are ideal during this (SOC). A couple of Consciousness Raising processes offered that I find effective in my practice are, bibliotherapy (book therapy) and psychoeducation (education of the psyche, and how it becomes rigid and flexible in its structures). Another is making a list of what the positive effects of living life without the problem and envisioning a life without the problem.  Another I enjoy is helping clients experience guided imagery that focuses on adaptive information they may need to make a shift or change.

Another process of change that may prove helpful during the Pre contemplation SOC is Dramatic Relief, which much like guided imagery, it activates emotions that are felt during the problem. Interventions using this process could be role plays, guided imagery that focuses on a life with the problem in the future, and experiential interventions, such as empty chair/Gestalt, sculpting, inner dialog, etc.

The last process of change Common Factors researchers note that is helpful during this SOC is Environmental Re-evaluation. These interventions include helping the client to accept the perceptions of their family members by carefully exploring each person’s readiness to give and receive feedback, and when ready (can manage emotions), preparing the client to lean into the perceptions of their family, and helping the client experience understanding (not necessarily agreement). Another process is to use any experiential technique that will allow the client to cultivate empathy for those impacted by their behaviors, how it affects the system’s environment, and to see how those behaviors are experienced by others in the system (Prochaska, 1999), (Spenkle, Lebow and Davis, 2009).

Being willing to explore, understand, and apply Common Factors research can help therapists and clients move through change in life in a much more empathic way. There is always motivation to be found and it is the clinician’s role to see what motivates our clients so they can bring about effective change in their lives.

Coming soon,  my next writing in this Common Factors blog series is on Contemplation, the next stage of change following Pre-contemplation and helpful processes for the therapist to help clients embrace their own limitless potential for healing and growth.

 

Acknowledgements

Douglas H. SprenkleSean D. DavisJay L. Lebow. Common Factors in Couple and Family Therapy, Guilford Press, Aug 10, 2009

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