ENTERING THE POST-‐
THEORETICAL ERA
Is it time for a paradigm shift?
Participants will be able to
1. Articulate the need and evidenced based rationale for a new paradigm shift in counseling theory and training.
2. Describe ways in which traditional theoretical approaches in counselor training programs can
evolve into more contemporary evidence-‐based and common factors approaches
§ The paradigm of a traditional theoretical orientation
may no longer be useful, as the use of evidence-‐ based counseling approaches support:
§ common factors
§ neurobiology advances
§ The presenters envisions a new era in counseling
and provide a rationale for shifting the paradigm from a theory–based to an evidence-‐informed/ common factors model cutting across theoretical boundaries.
§ Brainstorm how the shift to the post theoretical era
Basic Premises About
Most Theories
q
They represent the evolution of the science
of human behavior and rePlect the time in
which they developed
q
They were created to describe a wide range
of human behavior, including what we now
know as human development
q
They provide little or no guidance on how to
Many theories…
q
were created without regard for, or recognition
of the neurobiological basis of emotional distress
that now has scientiPic and medical evidence
q
are
not
evidence based or evidence informed,
relying on “lore” rather than speciPic client data
q
seem to be grounded in the psychodynamic past
q
view providing clients with an explanation of
WHAT THE RESEARCH
SAYS ABOUT WHERE
Think of our view of clients:
People struggling
q
We still use the term resistance
q
Motivational Interviewing uses terms
such as readiness, contemplation,
preparation & ambivalence
q
We still use the terms transference &
countertransference
q
Common factors and the therapeutic
alliance negate them
q
We say clients drop out
q
Maybe we should say they were
smart consumers and didn’t see
what they came looking for
q
If YOU came for “what’s next”,
you’d be looking for a theory
q
We don’t know what is “next”
Why does an understanding of neuroscience
matter to therapists?
(Cozolino, 2010)
Neuroscience provides for:
-‐the construction of an “owner’s
manual” for each client’s brain
-‐a non-‐shaming explanation for human
difPiculties
-‐a matrix for the integration of multiple
forms of therapy theory and practice
Why does an understanding of
neuroscience matter to therapists?
(Cozolino, 2010)
-‐common language
for psychological,
biological and the
social sciences
-‐a brain-‐based
measure of
Percentage of Improvement in
Psychotherapy Patients as a Function of Therapeutic Factors
Extratherapeutic Change
40%
Techniques 15%
Positive
Expectancy (HOPE) 15%
Therapeutic Relationship
Relational Components of Therapy
75% of Therapist InRluence on Treatment Outcomes Lies in Relational Factors
Therapeutic Relationship +
Hope 75%
Active Ingredients for Positive
Outcomes
(Gentry, 2009)
• Self-‐regulation
• Self-‐validation
• “Excellent” prognosis
• Develop and maintain MINIMAL safety and
stabilization
• Rogerian Core Characteristics (Warmth, Caring,
Authenticity, Transparency)
• Tolerance of symptoms
Some Suggestions for Positive Outcomes
www.scottdmiller.com
1. Collect empirical data evaluating the quality of the
therapeutic relationship
2. Generate honest feedback from client on methods to
improve therapy (i.e. relational)
3. Be willing to change toward what works best for
Session Rating Scale
Miller (2007)
I did not feel heard, understood, and respected.
I felt heard, understood, and respected.
We did not work on or talk about
what I wanted to work on and talk about.
We worked on and talked about what I wanted to work on and talk about.
The therapist’s approach is not a
good fit for me.
The therapist’s approach is a good
fit for me.
There was something missing in the session today.
Overall, today’s session was right
Brief Mood Survey
Developed by David Burns, M.D. (1997; 2002) Mini scales: Depression; Suicide; Anxiety; Anger; Relationship Satisfaction
[and side 2]
Evaluation of the Therapy Session:
Positive Feelings During Session; Helpfulness of Sessions; Satisfaction With Today’s Session; Your Commitment; Negative Feelings During Session; DifPiculties With The Questions;
What did you like least about the session? What did you like best about the session?
WHAT DOES THE
ü
In training, provides less emphasis on
stand alone theories, micro skills
ü
more emphasis on case conceptualization
ü
Doesn’t use one theory to address all
problems
ü
Uses Common Factors
ü
More practice driven
ü
Faster to intervention by addressing
client’s problem ASAP
ü
Uses rapid case conceptualization at
intake to establish the essential
relationship
ü
Empowers the client
ü
Uses 100% valid interventions,
Maybe Carl Rogers was right
“
There is only one best school of
therapy. It is the school of
therapy you develop for yourself
based on a continuing critical
examination of the effects of
your way of being in the
INITIAL SURVEY RESULTS
1. It is important to provide an informed consent document for
clients so that they understand the theoretical approach to be used.
2. It is important to use a Subject Units of Discomfort scale (SUDs) to determine the client’s level of distress with a speciPic concern.
3. It is important to address strategies and techniques that match client concerns.
4. It is essential to address the therapeutic relationship within the Pirst few sessions.
5. Counselor graduate training need to place less emphasis on the teaching individual theories (e.g., Psychoanalytic/ Psychodynamic, Gestalt, Adlerian, Behavioral, Person Centered, Cognitive, etc.).
6. To treat clients effectively it is important for the counselor to have a primary theory.
7. It is important to receive regular client feedback about the progress of treatment at each session.
8. The counselor’s theoretical orientation drives the course of treatment.
9. Master’s level counseling programs need to place more emphasis on the teaching of case conceptualization.
10. Master’s level counseling programs provide sufPicient training in a single theory to use it in practice.
11. Neurobiological advances have reduced the need for counselors to identify themselves with a single theory.
12. It is unethical to address a range of client problems using a single theory.
13. A Subject Units of Discomfort scale (SUDs) is important to use in determining the degree of progress with a client’s
speciPic concern.
14. My theoretical orientation(s):
TEACHING IDEAS BRAINSTORM
u Theory texts and courses start with Freud-‐-‐-‐(Do we
need a history and systems course?)
u Common factors as core for a Counseling Practices
course(s)
u Begin with “what works”, current effective
treatments with common factors as the essential base.
u Is it pedagogically sound not to spend time on
