Phillip's take on things

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It seems to me that change in a person is facilitated mainly in the context of a safe emotional environment, where there is as much affirmation and acceptance as possible.

Research points to the existence of four main factors common to all forms of psychological therapy regardless of any special theoretical orientation (dynamic, cognitive, etc.), mode (individual, group, couples, family, etc.), dosage (frequency and number of sessions), or specialty (problem type, professional discipline, etc.).

Extra-therapeutic [40%] i.e. elements outside of the counselling situation are of great influence.  Actually, counselling is a humbling experience and many times I have had a sense of helplessness in my experience as a change facilitator. It is the person who makes the changes and the counsellor simply facilitates the process.  The up-side of it all, though, is that a client is empowered to find her own way through and as a result new pathways and attitudes are taken on board with a boosting to self – esteem.

Quality of the Therapeutic Relationship [30%], where in this context, the sharing of words and experiences in a safe environment make for change, bringing new meanings about one’s life to awareness, especially when recovering from trauma.  Words shared in conversation can put unmentionable pain into context and help us grow as we not only feel emotionally safe enough to explain what is going on in our lives, but when explaining it to another person (“Iron sharpens iron”), we can obtain feedback in the process so as to come to new conclusions and directions in order to avoid repeating negative reactions in the future.  Therapists need to be experienced as genuinely caring, showing that each person matters – offering something ‘over and above’ the problem, with hopefully relaxed warmth, openness and adaptability as well as competence and safety.  Clients want to know that what they want from therapy is respected, so that there is a growing desire to finally do the work of change.

Placebo, hope, and/or expectancy [15%], an element once again generated within the person but which can be enhanced through support and encouragement.

Structure, model, and/or technique ([15%].  The theory of the presenter actually only counts for about 15% of change and this is where what we think we can do to a person to bring about change pales into insignificance compared with the myriad of other influences coming from elsewhere, including the person’s own efforts.  The final factor to consider, then, is that the individual client has the last say in the change process, as quoted in the following: “There is evidence that self – help therapies can do as well as or almost as good as a therapist/client relationship.  Also, the therapeutic relationship is not determined by the therapist alone – it is what the client puts in that is a major factor.  The way a client attaches to the process and other factors from the client are things to consider.  The therapist is more a catalyst than a cause and the active journey of the client is a very important factor”.  The question is, does the therapy work or does the client work?

  1. Each person is an individual and we can only work with what is in the person and what is already at work – a person tends to hear what already resonates in him and he will reject what appears to be personally irrelevant to him.  However, the stimulus that a counsellor gives can expand the health that is already there in order to work together for new perspectives.
  2. A client’s view of the presenting complaint, potential solutions, and ideas about the change process form a ‘theory of change’ that could be used as the basis for determining which approach would be the most effective for each person and by whom it can be delivered, in relation to that specific problem, under that particular set of circumstances.  The ‘Client’s Theory of Change’ is best understood as an “emergent reality” that is unfolded through conversation structured by a therapist’s curiosity rather than a static entity such as a psychiatric diagnosis.  In a therapeutic relationship that honours the client’s theory of change, therapist and client work together to implement the solutions required or they select ideas and techniques from available treatment approaches that provide possibilities for change unique to the person.  I continually find that there is a mystery as to how this works but there are principles involved that can be clearly followed.  Curiosity about peoples’ hunches not only provides access to their ideas of the change process, but gives extra clues about each individual’s uniqueness while encouraging active participation. This requires a sensitive ongoing relationship above all.  As a Christian, I believe this will mean that the person and their own complexity needs to be respected and taken into consideration if significant help and influence can take place, with patience and the consideration that there is always a Bigger Picture than my own when dealing with my fellow humans.
  3. People often take on board ideas about themselves and reality through the small focus of their childhood experience and unless this focus is examined, questioned and changed for the better, inaccurate and dysfunctional beliefs about life can remain unnoticed and unchanged for a lifetime.  In other words, the inner ‘child’ continues to control the adult and in the light of a safe relationship, change is slowly encouraged.
  4. Finally people will do what they will do. We see the world the way we are, not the way the world is and we filter information according to our prejudices and mindset.  So influence comes out of going along the path with a person and then at the same time adding the difference in collaboration.
  5. Finally, a central principle for change is that of the need to come to an acceptance of that which is. A counsellor’s work is often to gently invite the person to face what is, to grieve, hurt and also to laugh and then to move to new perspectives.  Through all of this mysterious process called counselling and psychotherapy, people who persevere with the process of change usually get places, either to solve or resolve their challenging issues until light and joy returns.  There are no guarantees but the good outcomes I have seen encourage me to persevere as well!

Much of the above comes out of the work of Scott Miller (http://scottdmiller.com/wp-content/uploads/What%20Works%202010.PDF) and Barry Duncan (https://heartandsoulofchange.com/ )