The client's theory of change

• What is the Therapist's Role? by BOL Editor, 10/31/98
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    • What about the Maladaptive Role? by Mitchell W. Hicks, MA, 11/10/98
      
      

Mitchell's point re" the therapist's role is well taken and important. Furthermore, it gives me a chance to clarify my meaning when I talk about working together with the client to determine the role I am to play in their life. We confronted a similar problem in a case recently published in the "Case Commentary" section of the Family Therapy Networker. Briefly, a client came in for treatment of her daughter. She described her child as "biologically" depressed and cited a lengthy family history of depression to prove the point. She wanted us to convince the daughter that she was depressed and put her on medication. Of course, it made little sense (and potentially little difference) to argue with her about the paucity of evidence for a truly "biological" depression. Neither would providing her with studies showing that clinicians cannot under any circumstances actually determine which depressions are biological or psychological in nature or which treatments will work before trying them out--even though in both instances such information would be factually accurate. Additionally, we knew that trying to disuade her from having us diagnose and treat her daughter for depression would have the exact same effect that similar behavior on the part of previous therapists had had in the past--she left treatment unsatisfied and angry and sought out someone new. What we have done is use the client's "theory of the change" process as the variable to mediate our role with the client. Briefly, this is the client's idea re: the change process (e.g., how it usually happens in their life, etc.). In our case, the client's theory of change was biological in nature. We thus defined our role as working with the client to intervene biologically. We presented the diathesis-stress model to the woman, explaining that stress in life could precipitate a phenotypical expression of a genotypic tendency. What followed was a series of instructions for modifying the stress in her daughter's environment. While I cannot be sure, it seems to me that the particular "means" that the client Mitchell described has chosen (e.g., have the therapist do it) is only one of many possible ways that she can use to operationalize her theory of change. We would define the therapist's role as figuring out how the two could work together to make her theory work.

• Negotiated theory of change? by Mitchell W. Hicks, MA, 11/16/98