I believe you are inherently resourceful and are seeking the best life for yourself and those you care about. I’m here to help you tease out your theory of change. These are your own theories about your problems, how they developed and how to solve them.
I help you use your abilities and your preferred ideas of working to co-create a tailor-made treatment plan for you. Together we create your map to help you steadily work towards your goals. You are the most important contributor to the outcomes of therapy. Outcomes are the results that you wish to get from therapy.
The first few minutes of each session
Your ideas about your issues and what it may take to fix them are my main focus in each session. You’re hiring me as a thinking partner to co-create ideas, help you develop skills and grow your strengths so you can achieve what you believe will be helpful to you and your life.
I always ask you about your expectations and hopes about the changes you wish to make. At the start of each session I ask you to fill out a brief four question scale called the ORS, the Outcome Rating Scale, to provide feedback on your view of your progress in achieving your therapeutic goals.
The resources you bring into the therapy room are the biggest influence on what happens in your life. Your individual qualities like your persistence, faith, hope; as well as a supportive friend, co-worker, family member, membership in a spiritual community or sports group all exist in your life external to therapy. These are what you go back to at the end of every therapy session. The interplay between your inner strengths, external supports and events outside of therapy, like a new job or successfully navigating a tricky situation, play a big role in bringing about change in therapy.
Your theory of change
Your theory of change is the key to success, regardless of the methods used by me or any therapist. This is especially true if you’ve had unsuccessful therapy beforehand. Your feedback to me is critical to your improvement. My aim is to fit my ways of working to your ideas, expectations, strengths and goals. I’m the one that has to change and adapt to help you bring about the changes you want. This 5 minute video with Scott Miller explains how I use Feedback Informed Treatment in working with your theory of change.
Your ideas about your issues and what it may take to fix them are my focus throughout treatment. If you accept and agree with the treatment tasks and goals that we co-create, and the relationship between us is comfortable enough for you, these are major components of successful therapy, as shown in the three legged stool image above.
Some questions I ask you in each session
To help you figure out your goals and your theory of change, I’ll ask you questions like:
- What are your ideas about what needs to happen for improvement to occur?
- Many people have fairly good ideas about what is causing a problem and what will resolve it. What’s your theory of how change is going to happen here?
- How do you see me and this process might help you to attain your goals?
- How does change usually happen in your life?
- What do you and others do to initiate change?
- What have you tried so far to help the problem/situation? Did it help? How did it help? Why didn’t it help?
As your theory of change evolves, we implement your identified solutions or seek an approach that both fits your theory and provides possibilities for change.
Your map of how to change your situation/problem provides the best guide to the therapy territory we are crossing together. I’m a co-adventurer with you, and together we explore the landscape and view it from multiple perspectives while crossing the territory of your theory of change. When stuck along the way, I join you in looking for and exploring alternate routes on your own map. In the process, we uncover paths neither of us knew existed beforehand.
The last few minutes of each session
To make sure we’re on track, I get feedback from you at the end of every session about how you rate me and the work we did together during that session. I do this by asking you to complete a brief four question scale called the SRS, the Session Rating Scale. This is to get your honest feedback about your relationship with me, whether the goals and topics covered what you feel you need, how well my approach fits your needs, and an overall general assessment of the session we just had.
The take-away message
From everything I’ve said, the take-away message is: You are the leading character in your life, as well as the editor and director of the action as it unfolds. I’m your assistant, hired by you to help you get where you want to go.
The research about what REALLY causes change
Professor Michael J. Lambert summarized decades of psychotherapy outcome research and grouped the factors of successful therapy into four areas, showing the percentage of change they each contribute:
- Extra therapeutic change (40%) – these are your own unique qualities combined with factors in your life outside of therapy that help you reach your goals. That’s why they’re called “extra” therapeutic – they are “in addition to” your therapy. They exist in your life outside the therapy room and are the backdrop of therapy, what supports you. They set the scene. You, your life & your daily environment have the most impact on what happens inside the therapy room.
- Common factors (30%) – these are found in most therapy approaches, and include the therapist’s empathy, ability to listen to and respect you. Most important are your perceptions of the therapeutic relationship. The relationship with you and your therapist has to feel right for you. If it doesn’t, read 7 tips on how to find a therapist that’s right for you.
- Techniques (15%) – the methods unique to specific therapies and tailored to treatment of specific problems. Research repeatedly shows that any coherent treatment procedure brings about change, if you feel the relationship between you is good enough. The therapist’s techniques plus their comfort in using the techniques allow the common factors to emerge.
- Expectancy/hope (15%) – this part of improvement comes from your expectation of help or belief in the rationale or effectiveness of therapy in general.
This diagram says it all:
Adapted by Vivian Baruch from “The Client’s Theory of Change: Consulting the Client in the Integrative Process” by Barry L. Duncan and Scott D. Miller.