psychology

A Series of Writings for Clinicians on Common Factors Research and What Promotes Change in Couple and Family Therapy, Part 1

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By Jason Briggs, MA

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.” 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, 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.

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.

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.


References

Douglas H. Sprenkle,Sean D. Davis, Jay L. Lebow. Common Factors in Couple and Family Therapy, Guilford Press, Aug 10, 2009

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The Components of Trustworthy Relationships

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By Cassandra Vogeli, Psy.D. Candidate, M.A.

“Life isn’t fair. But Relationships can be.” – Janet Hibbs (2010)

In her book, Try to See it My Way: Being Fair in Love and Marriage, Janet Hibbs outlines the importance of fair give and take within relationships. We each come into life from families with various ideas about what is fair, what we are entitled to (constructive and destructive), and how to go about getting such needs met. Unfortunately, sometimes these ideas about fairness and the ways we go about meeting our own needs can end up working against our closest relationships and us.  Nagy & Krasner (1986) suggest that in order to create healthy and balanced relationships as well as get our needs met in a way that is constructive within our relationships; we need to understand our own fairness model. Hibbs (2010) outlines four very useful and practical elements in the process of being fair within relationships; first I will outline them below and then use them in an everyday example so that you can see what they look like in action.

  • The first is a concept called, reciprocity. Reciprocity as defined by Hibbs is, “The balance of mutual care and consideration.” Reciprocity is the act of giving to a partner or relationship with trust that they will reasonably give back in some way at some time. Be aware not to mistake this with tit-for-tat giving, where one might say, “I will do this for you (ONLY) if you do this for me”; this type of giving erodes trust.
  • The second concept is acknowledgment. Acknowledgement, although often undervalued and overlooked, is kind of a one-two punch for constructively giving in a relationship. It serves to give credit to your partner, affirm their good intentions, as well as validate their reality. This means putting yourself in your partner’s shoes and recognizing their effort or positive intentions.
  • Next there are (fair) claims. Fair claims are part of an earned entitlement based on past giving within the relationship, to ask for one’s needs to be met, or to request certain destructive behaviors to end. In order for a claim to be “fair” it should: (1) be realistic (2) not take advantage of your partner’s trust and (3) it must be earned between the two relating individuals.
  • The last element outlined by Hibbs is trust. Trust is created through each of the aforementioned: reciprocity, mutual acknowledgement of efforts and intentions, as well as fair claims. Trust can be built or depleted through different acts of reciprocity, acknowledgment, and fair claims. Trust grows when needs are considered, even if they are not met, this is important to remember. The more trust that exists within a relationship, the more a healthy “closeness” can exist between the couple (Hargrave & Pfitzer, 2003). Hibbs’ summarizes trust beautifully: “In a healthy relationship, you’re able to give freely and trust that you’ll receive care in return.”

Now let’s see these four elements of fairness in action. In the first example I will outline a situation in which reciprocity, acknowledgement, fair claims, and trust are not utilized:

Consider the couple James and Sara, who have been married for 12 years.  One evening Sara is working late, so James decides to cook dinner and have it ready when Sara arrives home. Sara enters and is so pleased to find dinner on the table for her.  After the couple finishes eating, Sara enters the kitchen and James sits down on the couch to wind down from the day. Upon entering the kitchen Sara sees a gigantic mess awaiting her, dishes everywhere, food all over the floor and counter tops, pans coated with a layer of sticky residue, and all she can think is, ‘why does he always make such a mess when he cooks!’ Trying to hold it together, Sara begins to clean the kitchen silently hoping that James will join in to help her. By the time she wades through the mess by herself, she is fuming, and her attempts to curb her aggression are futile. Unable to ignore the bubbling aggression, she explodes at James. “You always make a huge mess when you cook! You never clean up after yourself!” Triggered by her aggressive outburst James retorts, “You never appreciate anything I do, nothing is ever good enough! I tried to make dinner for you as a favor and this is the thanks I get?” Sara, still fuming, shoots back, “I didn’t ask for this! I would have rather picked up a pizza on the way home then have to clean up this mess!” The fight escalates and the emotional “bank account” within the couple system is eroded.

Now let’s look at how this situation may have gone using the four elements of fairness Hibbs outlines:

This time when Sara enters the kitchen she decides to handle things a bit differently.  Using acknowledgement, she states, “I appreciate you making dinner for me, I know you did it as a favor because I had a long day.” Not disregarding her own feelings, she makes a fair claim, “I am exhausted after today. Could you clean the kitchen for me?” James tired as well, acknowledges Sara and also makes a claim, “I bet you’re tired, I apologize for making such a big mess. I’m really beat as well, would it be okay with you if we left the dishes tonight and did them in the morning?” Sara acknowledges his effort and agrees while she also makes a claim for James to be more conscious of making a mess when he cooks and the couple leaves the situation having built trust and reciprocity, instead of putting more stress on their relationship. Following these guidelines may help to ensure that we grow from mistakes and shortcomings, rather than depleting our relationships unintentionally.

If you are interested in learning more about fairness within relationships, or about your own fairness model, I recommend checking out “Try to See it My Way” by Janet Hibbs. It is a wonderful book full of great resources and hands on exercises to really help your self-awareness and your relationship with your partner grow. Happy reading!


References

Boszormenyi-Nagy, I., & Krasner, B. R. (1986). Between give and take: A clinical guide to contextual therapy. New York: Brunner/Mazel.

Hargrave, T. D., & Pfitzer, F. (2003). The new contextual therapy: Guiding power of give and take. New York: Routledge.

Hibbs, J. B., Getzen, K. J. (2010). Try to see it my way: Being fair in love and marriage.

Penguin Group, New York, NY.

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World Sickness and the Thirst for God

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By Nicolina Santoro, MA, IMF 77972

Once upon a time, in the vast kingdom of the helping professions, there lived a therapist whose thirst for knowledge and desire to aid in the process of personal and interpersonal change was unrivaled in all the land. This therapist had taken it upon herself to rewrite the story of her own history in a manner that changes the context of painful past experiences from blockages into tools that create a larger understanding and empathy for those she has chosen to serve in her work.

This constantly evolving therapist became immersed in theory and work of great minds such as Carl Rogers and William James. Realizing that human potential is vast, she wanted to understand how important stories and fairy tales were to constructing the memories that colored the landscape of reality, a reality that seemed to have the power to dictate how people see themselves and live their lives.

These dominant fairy tales permeate the fabric of our perceptions which also bump up against the lives of others we come into contact with out in the world. Personal narratives or “life styles” are filled with characters that are archetypal in nature, influencing us to play out repetitive sequences in life. These characters tend to take on the personas of stereotypical themes that are reinforced by learning them at a young age, or by the social referencing effect of our dominant culture.

William James calls the mental fatigue effect of living in an environment laden with unrealistic scenarios or fairy tales “world sickness.” It appears as though living in a world dominated by stereotypes and fairy tales could be implicated in the aggravation of many types of mental health issues.

How can we address the fatigue, depression, anxiety, and thought distortions that world sickness creates and impacts?

Let’s start with being gentle with ourselves. When we imagine a supreme spiritual being, the embodiment of certain characteristics seems to be present across many cultures. Some of these characteristics include unconditional love (a love that exists beyond judgment), a superconscious presence that never dissipates or abandons, and the ability to create out of seemingly thin air. For the scientists who have a different path, god could also be described as the picture of what we theorize as the highest human potential. We have the potential to express this in our own reality by living our lives in accordance to our deepest and strongest values while moving away from comparing ourselves to the unrealistic standards or “fairy tales” woven into the fabric of our society, loving ourselves and others through the lens of acceptance and vulnerability, a gentler version of happily ever after.


References

James. W. (1902). The Varieties of Religious Experience: A Study on Human Nature. Longmans, Green & Co. London, UK.

Miller, W.R. (2006). Integrating Spirituality into Treatment: Resources for Practitioners. Washington: American Psychological Association.

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Four Principles of Ecologically Sound Parenting in the New Age

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By Nicolina Santoro, M.A., MFTI #77792

Our modern society does not appear to be slowing down, and uncensored information is readily available, even among young children. But as technology continues to expand, so has a focus on parenting practices aimed at helping families navigate the use of digital devices in a mindful and balanced way.

More and more research reveals how family and social environments, whether in person or virtual, heavily impact the way children learn to understand the world. According to Modern Psychology and Ancient Wisdom by Sharon G. Mijares, PhD., moderating access to technology, while remaining connected to children through active participation, can positively influence the developing psychological health of youth today.

With this aim in mind, here are four principles of ecologically sound parenting in the new age that can create a more compassionate humanity in generations to come.

1. Attachment

In psychology and development theories, attachment is described as a central component of parenting because of its impact on positive pro-social behaviors in children. Secure attachment has shown to be an important aspect of a child’s developing personality and intrinsic security. Attachment-fostering activities are fairly global, such as breastfeeding, physical contact, talking, singing, playing, and attending promptly to a child’s needs. The concept of, “it takes a village,” adds to a sense of belonging and worthiness that children develop early. Fostering secure attachment in children inspires them to view the world as generally safe and to become more autonomous with less hindrance from fear.

2. Autonomy

As children begin to branch out and initiate new experiences on their own, the child benefits from his or her parent’s support in this endeavor. The encouragement of a child’s autonomy enhances creativity, imagination and wonder. In later adulthood, a child whose autonomy is nurtured will tend to feel more creative and solution oriented when presented with life on their own or with added familial responsibilities. An autonomous child is also more likely to explore the world outside of the family for a greater understanding of context.

3. Exploration

By fostering and supporting the explorative nature of a child’s experience, parents can bring new information into the family system. Children whose natural desire to explore is supported by primary caregivers and the larger family system have a natural advantage in the experience of expanding their awareness into many ways of viewing the world. The culminating experience of a truly diversified and differentiated individual that thinks beyond culture and color is the next evolution into the globalized human.

4. Globalization

A person that is globally minded has cultivated an aptitude for assimilating new information, promoting awareness, social androgyny, resource-based contribution, and creative solutions to global issues. A globalized family may creatively adopt spiritual rituals and practices from many cultures. Some tribal traditions and philosophies on family system and structures may come from many indigenous peoples and times in history with no distinction that any one way is superior to another. A globalized family may exhibit qualities that are collectivistic and individualistic depending on what would work most advantageously for the health and wellbeing of not only the family, but the larger context in which the family exists, spanning all the way out to the family’s footprint on the culture of their continent and the world.


References and Further Reading:

McGoldrick. M., Pearson, J. & Giordano, J. (2005). Ethnicity and family therapy. New York: Guilford Press. ISBN:9781593850203

Mijares, S. (2003). Modern Psychology and Ancient Wisdom. New York: Haworth Healing. Integrative Press. ISBN:0789017520

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Between Religion And Science, The Soul Gleefully Swings

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Soul Food: We All Need It! (Photo Credit: Dollar Photo Club)

By Nicolina Santoro, M.A., MFTI

Humans have contemplated the origins of the soul, and its connection to some sort of divine, omnipotent source for thousands of years. This post is not an advertisement for religion; it’s an exploration of the theme. Religion is a comforting, human way to personalize and categorize our universe. It is also the ghost in the machine, impossible to ascertain, or even quantify. The matter of divine connection as a collective species is the fire that forged worship, mysticism, philosophy, psychology, and eventually transpersonal psychology. Transpersonal Psychology is a school of thought inspired by the pioneering work of American psychologist, William James, one of the forefathers of modern psychology. It is the exploration of the highest potential of man, as defined by the Journal of Transpersonal Psychology.

According to James, the religious experience has four key components:

  1. It is short in duration
  2. It is hard to describe in words and very emotional
  3. It leaves the subject feeling as though they have learned something significant
  4. It happens to the subject usually without conscious manipulation, though the environment has shown to play a role.

Imagine a feeling that at once dissolves the individual into a place of complete connectedness and love. The religious experience is so moving that it can affect an individual for the rest of his or her life. The memory of the experience is so charged, it seems it can be recalled at will for years. A normal physiological occurrence that feels similar, albeit usually shorter, is the human orgasm.

There is nothing modern about this experience or this longing. Ancient cultures all have their unique brand of religious experience. Deep trances, speaking in tongues, dancing frenzies, and altered states of consciousness, in various forms, were common to indigenous people of almost every continent. Their purpose was to bring whole tribes of people into communion with the divine force. As time went on, this unseen force acquired many names, was worshiped in many languages, but the only constant in the matter seemed to be this shared drive to find, and have a communion with this force.

The religious experience has been known to have long-term effects on the subjects who have had them. Modern science has become increasingly interested in studying these effects, which include a new appreciation for life, better moods, inspired creative activity, increased levels of tolerance, patience, and empathy. The subject feels a part of something special, like a divine force took a moment out of infinity to validate them. We all know how good validation feels. Validation is like high performance fuel in the gas tank. The engine of the car is going to run better.

Science has some very interesting conclusions to bear on what is happening to the subject of a religious experience on a neurological level. In The Neuroscience of Religious ExperiencePatrick McNamara and collaborators describe how the neurotransmitter dopamine, when produced excessively, has been correlated with increases in religious inclination, hallucinations, and dramatic shifts in the subject’s perception.

Positive correlations between religion and health have also been noted in the research on dopaminergic neurons, and their managerial properties in relation to the autonomic nervous system. A subject in the throes of a religious experience shows high activity in the frontal and pre-frontal cortex of the brain, suggesting that higher order functions are at work, rather than the evolutionary biological reaction that would reside mostly in the limbic system. Some of the noted positive health effects on the subject include reduced anxiety, blood pressure, and pain symptoms. Subjects reported more positive mental well-being, and confidence. The lasting effects of regular spiritual practice are positively correlated to improved mental and physical health.


At Healing Pathways Psychological Services, we work with people of all faiths, backgrounds and cultures. We all have the same goal: to live a happy and purposeful life! Call us if you’d like to meet one of our talented therapists.

 

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