This is the first book to fully explore a collaborative, competency-based orientation to counseling and psychotherapy. Based on 40 years of outcome research examining what works in therapy, mental health professionals are introduced to numerous ways of collaborating with clients from assessment through intervention and termination. Throughout the book, ideas are offered to illustrate how mental health professionals can promote the therapeutic relationship and facilitate positive change through respectful and effective practices. This book introduces readers to the importance of language in both the construction of problems and solutions. Readers are offered multiple ways of using language as a vehicle for promoting change. While new ideas are offered, the book also honors traditional theoretical underpinnings while challenging readers to work collaboratively with clients to find out what works for them. For counseling students, practicing counselors, social workers, etc. This book offers the new clinician and the seasoned one a perspective that honors the contributions of clients and clinicians alike while working toward the achievement of realistic and attainable outcomes.
Preface
“If you want truly to understand something, try to change it.” —Kurt Lewin In early 1997 we began talking about writing a book that would begin to move competency-based ideas into counseling, marriage and family, social work, and psychology programs. Although we both became involved in a variety of other projects, including a few together, this particular one was never far from our thoughts. For Bob this book became especially important when he found himself teaching graduate courses in four different departments at three different universities. While there was a plethora of books published on traditional counseling theories and family therapy approaches, there was nothing available to students that brought together collaborative, competency-based ideas into one succinct volume. This made the writing of this book not only important for the field, but a practicality in terms of training others to work in what we consider to be respective and effective ways.
As with traditional thinkers, unfortunately there are turf issues amongst competency-based theorists. For example, there continues to be a split between solution-based and narrative thinkers. This was no more apparent than in 1996 at Therapeutic Conversations conference held in Denver, Colorado. Although touted as a “collaborative” conference, the split between solution-based and narrative thinkers came to light with many attendees feeling as if one theory was better than another or that they had to choose one side or other (Bertolino & O'Hanlon, 1998).
During one of the group conversational processes that ended each day of the conference, a woman stood up and said that she had decided that the conference wasn't for her after participating in a small group process in one of the sessions. She had told people in her small group that she did long-term therapy and they began to tell her how incorrect that was. She had felt as if what she was doing was bad and that she wrong. Bill was very upset at hearing this and told her that even though he had an international reputation as a brief therapist, he had seen at least one client for 12 years. Interestingly, the dogmatic idea that had plagued therapy for years had invaded a “collaborative” conference and in the process had alienated some of its participants.
One of the ways that we chose to address this concern was to find how therapy approaches were similar and complemented one another as opposed to what made them distinctly different. In addition, we made it a mission of ours to support our ideas with current research on psychotherapy outcome. We believe that all mental health professionals should be interested in whether what they do in treatment contributes to positive outcomes.
We also formulated a “mission statement” that we would like to share with you. It reflects all that we do in clinical practice, teaching, training, and research:
We vow to support and promote effective and respectful approaches to counseling and psychotherapy and stand opposed to those approaches that are ineffective and disrespectful.
Notice that this mission statement does no reflect any single approach or theory. It does not suggest that we are this or that. What it does do is promise that whatever we do as clinicians, teachers, or researchers will be respectful of our clients and others. It also states that we will do our best to study the outcomes of our ideas and methods in order to determine how we can be most effective with our clients.
Throughout this text we will offer collaborative, competency-based ideas that directly reflect our mission statement. Some of these ideas are based in empirical research and some are based more on our observation of clinical results and anecdotal responses from clients and people to whom we have taught these approaches. We fully expect that time, more research, and more experience will alter our articulation of these ideas and methods, but we do not expect to alter our basic desire to be respectful and effective.
How This Book Is Arranged
We begin our journey together with an introductory chapter delving into what we refer to as the three waves of psychotherapy. We believe it is important to briefly reorient readers to the general roots of psychotherapy to gain an understanding of how collaborative, competency-based approaches developed. Following this introduction, we offer nine chapters organized within four different parts. Each part emphasizes a particular aspect of being collaborative and competency-based.
Part I, Creating a Context Through Change and Collaboration, begins with two chapters that set the tone for the entire book. Chapter One is Foundations of a Collaborative, Competency-Based Approach to Counseling and Psychotherapy. In this chapter we explore the implications of outcome research, guiding ideas, and four areas to create change. Creating Collaborative Relationships Through Attending, Listening, and Language is the second chapter. Here we introduce ways that therapists can begin to form collaborative relationships prior to the start of formal therapy. We also discuss the importance of acknowledgment and how therapists can utilize subtle changes in language to begin to create possibilities for change.
Part II, Clarifying Concerns and Complaints, Goals and Preferred Outcomes, also is divided into two chapters. In Chapter Three, Creating Change Through Collaborative, Competency-Based Conversations, we continue to explore how language can be utilized as a vehicle for creating change. In addition, we discuss how therapists' biases can affect therapy, the role of psychiatric diagnosis, and how to make use of formal assessment procedure. Creating and Clarifying Preferences, Goals, and Preferred Outcomes is Chapter Four. Here we investigate ways of collaborating with clients on their conversational and relational preferences, goals, and outcomes.
In Part III, Creating Change in the Realms of Viewing, Action, and Context, we explore different areas of intervention by devoting a chapter to each of three realms. Chapter Five, Changing the Viewing of Problems, gets us started as we define ways of helping clients to change their patterns of attention and the stories that they hold. Changing the Doing of Problems follows. This chapter focuses on ways of getting clients to change patterns of action and interaction involved with problems. Chapter Seven, Changing Contextual Propensities Associated with Problems rounds out Part III. Here we explore a variety of different influences that contribute both to and problematic patterns as well as solution patterns.
Part IV is Evaluation Progress, Planning Next Steps, and Ending Therapy. Divided into two chapters, we begin with Identifying, Amplifying, and Extending Change in Future Sessions. In this chapter we discuss how to identify and build on small changes and how to extend those changes into e future. We also describe ways of working with clients when things do not seem to be progressing in preferred directions. Chapter Nine, Planning for the End from the Beginning, is next. Here we offer ways of managing setbacks, negotiating hurdles and perceived barriers, and ending therapy.
We round out the book we a brief epilogue, Toward a Personalized Theory of Counseling and Psychotherapy. Here we discuss the importance of remaining client-informed and how theoretical perspectives can facilitate burnout or personal change.
Throughout this book we intersperse case examples, stories, and anecdotes as a way of enhancing the learning experience of readers. In addition, although there are differing opinions on the matter, we use the terms “counseling” and “psychotherapy,” and “counselor,” “therapist,” and “clinician” interchangeably. We also periodically use the term “mental health professional(s).” What we are referring to with these terms are those people who are engaged in facilitating change with human beings. We've also changed clients' and others' names to protect their confidentiality, except when they have specifically asked that we leave them unchanged.
We hope you will enjoy your journey as we now enter the world of collaboration and competency in counseling and psychotherapy!
Bob Bertolino
Bill O'Hanlon
August 2000
