The Substance and Process of Change
Often in the training received by therapists, there is little differentiation made between a theory of psychotherapy and the intervention strategies for manifesting change. We are taught skill-sets for listening, empathic responding and being attentive, but, for instance, no attention is made to just what the “mind” is that we’re supposed to be working with. More difficult is an almost complete lack of appraisal concerning a Worldview and how it then relates to the particular Theory being considered.
Why is it important to understand or at least minimally contemplate Worldview and Theory? Because the embedded assumptions within each guide the relational practice of therapy. Without getting into which parts or wholes of theories are more or less accurate, how a therapist interacts with their clients is determined largely by their views concerning human nature, how change occurs, and the qualities of the roles taken in the therapeutic relationship.
Further, by understanding better the underlying assumptions one brings to the work of therapy, it becomes easier to talk with the client about the change desired and the means of approaching it. Talking past one another, misunderstandings of content and “resistance,” are often the result of unconscious assumptions about the nature of the world and the process for change. Taking the time to see how one’s worldview connects to the practicing theory of therapy will then help in identifying which strategies for intervention will be most helpful.
“By ‘appropriate matching’ I refer to an ability on the part of the two participants to communicate meaningfully, not only verbally but also empathically, by means of mutual identifications the existence, integration, and comprehension of which need initially be a task of the analyst and not of the patient” (Olinick, 1977).
A brief structure for looking at how these items relate, follows:
Wordview / Paradigm
Q: what characterizes human nature?
Q: how does change occur at the personal and social level?
Q: what characterizes the working relationship between client and therapist?
Q: what role does each play leading to change?
Q: how does it relate to my theory?
Q: in what way does it encourage change?
To be honest, the above assumes that change is the central point of therapy. I find that, while analysis and the “deep stuff” can be exhilarating and at times helpful, it is so largely because it helps the person direct their attention and move towards their change-goals. A person comes to therapy because situation x is a significant struggle for them. If life were without stress, there’d be no need to seek help to build new ways of coping and/or moving forward differently.
The first two sections of questions concern Worldview and Theory because what change is possible and how it is judged will be determined by these. A client may come in with a worldview that only allows for change to occur between A and C. The therapist may believe the client has the space to change between A and E. The potentially problematic difference between these two is fueled by views concerning the power and influence of culture, the nature of self, will and ego, and the nature of relationships. Freud, Rogers, Skinner, Systems and Feminist Theory, to name but a few, all have assumptions providing a structure for how and what type of change will occur.
“The popularity of simplistic trade books in psychology probably stems as much from our own illegibility as from the lay public’s insatiable appetite for confident promises. If we are really intent on making psychology more life-relevant and understandable, it is imperative that we rescue scholarship from obscurantism” (Mahoney, 1981).
Intervention strategies come last because they are the means for generating change, which occurs within the context of worldview and theory. There are very few strategies incapable of being cannibalized by different theories. The strength of an intervention to generate change is linked to the level of belief in its ability to promote that change. If an intervention is attempted without knowing how Worldview and Theory provide the foundation for Intervention however, the confusion can and will be felt by the therapist and client. More so, the resulting behavior may be detrimental to the client and therapy.
Thankfully, knowing every connection between Worldview, Theory and Intervention is not necessary for the practice of good and helpful therapy. What expanding the understanding will accomplish is the building of a greater therapeutic relationship to effect more powerful and easier change. Just as the dynamics shift with each new client, comprehending the process of therapy is constantly evolving. Working with humanity requires that it be this way.
© David Teachout
Mahoney, M. J. (1981). Clinical psychology and scientific inquiry. International Journal of Psychology, 16(1-4), 257–274. doi:10.1080/00207598108247420
Olinick, S. L. (1977). Psychotherapeutic Instrument (Classical Psychoanalysis and Its Applications). New York: Jason Aronson Inc. Publishers.