DOCUMENT RESUME ED 398 513 CG 027 305 AUTHOR Gerber, Sterling K. TITLE Responsive Therapy: An Integrational Approach. PUB DATE [96] NOTE 19p. PUB TYPE Information Analyses (070) EDRS PRICE MF01/PC01 Plus Postage. DESCRIPTORS *Counseling; Counseling Effectiveness; Counseling Psychology; *Counseling Techniques; Counseling Theories; Helping Relationship; *Intervention; Psychotherapy; *Theory Practice Relationship; Therapeutic Environment; Therapy IDENTIFIERS *Responsive Therapy ABSTRACT Responsive therapy is an integrative model that uses a variety of intervention models, each in its own theory-pure context. This article addresses some major misdirections in the counseling profession and discusses ways that responsive therapy can help correct these misdirections. For at least two generations, counseling has professed that the client is important, knowledgeable, and capable of change. But due to a professional shift, these assumptions are no longer apparent in training or practice. Emphasis on a fulfillment bias has switched back to a medical model, seemingly dictated by the Diagnostic and Statistical Manual of Mental Disorders and third-party payment restrictions, which has been accompanied by a certain rigidity in counseling practices. Responsive therapy permits intentional responsiveness to unique client circumstances and styles while delivering service in a theory-pure, maximally effective manner. This integrational approach answers both the criticism of inflexibility of unidirectional discipleship approaches and the lack of consistency in theory-poor eclecticism. Similarly, this approach removes diagnosis from therapy, allowing for its importance in accounting, research,-and in staffing cases, while avoiding the ills of pejorative labeling and categorical treatments. (RJM) *********************************************************************** Reproductions supplied by EDRS are the best that can be made from the original document. *********************************************************************** Responsive Therapy: An Integrational Approach Sterling K. Gerber Eastern Washington University The author revisits the disciple versus eclectic Abstract: issue in the present context of a professional shift from emphasis on a fulfillment bias back to a medical model, seemingly dictated by DSM IV and third-party payment An alternative approach is presented which restrictions. permits intentional responsiveness to unique client circumstances and styles while delivering service in a theory-pure, maximally effective manner. This integrational approach answers both the criticism of in discipleship and the lack of consistency in inflexibility Similarly, this approach removes theory-poor eclecticism. diagnosis from therapy, allowing for its importance in accounting, research, and in case staffings, while avoiding of pjorative labelling and categorical treatments. ills the PERMISSION TO REPRODUCE AND U.S. DEPARTMENT OF EDUCATION Office of Educational Research and Improvement DISSEMINATE THIS MATERIAL EDUCATIONAL RESOURCES INFORMATION HAS BEEN GRANTED BY CENTER (ERIC) This document has been reproduced as S Cerbe,r, received from the person or organization originating it. Minor changes have been made to improve reproduction quality. TO THE EDUCATIONAL RESOURCES Points of view or opinions stated in this document do not necessarily represent INFORMATION CENTER (ERIC) official OERI position or policy. .tfTei 1sLIE EST COPY AVAILA 2 This article addresses some major misdirections in the One is not likely to arrive where he or she counseling profession. is no less true that wishes to be unless a direction is chosen. It specifying a goal is useless its articulation is followed by if procedures that lead in mutually exclusive directions. For at least two generations, counseling has professed an identity with the client; the client is important, knowledgeable, and capable of movement from self-defeating to self-enhancing actions. No longer is that apparent in training nor in practice. The profession appears to have moved full circle from reliance on a medical model-- assess, diagnose, prescribe, treat--to a fulfillment model of establishing a facilitative environment in which the client engineers his or her own change, and finally right back to a medical model. The strengths and weaknesses of a medical model remain much as they were in the 1930's; the strengths and weaknesses of the fulfillment It makes no sense for the profession model also continue, unchanged. to cycle between the two when a superior option is available. This paper begins with some assertions--statements that Unlike formal logic, these are establish a point of departure or a bias. not givens to be accepted; they are postulations to be supported. 3 3 Some pertinent assertions are: To be eclectic is to be irresponsible. 1. Diagnosis is not a part of therapy. 2. The DSM IV is a potentially dangerous diversion. 3. Technique follows understanding. 4. Responsive Therapy is a superior approach. 5. is an integrative model that What is Responsive Therapy? It purports to structure the use of a variety of intervention models, each is firmly based in phenomenology. its own theory-pure context. It in Beginning with a phase that relies on critical, universal therapy skills, therapy proceeds through a highly active, hopefully It espouses avoidance of the DSM collaborative, intervention phase. The underlying theory, universal skills, and a frame for IV trap. identification of client style and circumstance, as well as a nomenclature for categorizing extant therapeutic models, are presented in Gerber (1986). The Irresponsibility of Eclecticism What is eclecticism and why are its practioners irresponsible? To be eclectic is "not following any one system, as of philosophy, medicine, etc., but selecting and using whatever is considered best in 4 4 all systems" (The American College Dictionary). In counseling, eclecticism can be seen as the practice of drawing a mixture of techniques from any/all theoretical persuasions and combining them in unique, creative, or comfortable ways. The rationale for labelling such a practice as irresponsible is that, by its very nature, an eclectic approach is not integrated by theory. is technique rich, It theory poor. A Gestalt principle says that meaning comes from the context; an extension of this principle suggests that the power of an intervention technique comes from the theoretical context in which it is embedded. To take the technique out of context is to weaken or In practice, the most frequent manifestation of disable it. in the following up of a potentially effective irresponsibility is technique with another which counters the first. Examples include verbal encouragement or even statements of disappointment when a client fails to achieve a reinforcer in a contingency management program or when progress is being made with a cognitive therapy confrontation only to be destoyed by the direction to descend back into the depression in response to, "Tell me what you are feeling now." Some personal professional history will serve to elucidate the issue and set the foundation for the earlier description of the 5 5 profession coming full circle. For the graduate student in the fifties, the therapeutic training mileu had three prongs. Williamson's Directive Therapy was firmly established and was, perhaps, the It was basically the medical model applied to traditional approach. The therapist is wise and knowing; clients need direction counseling. to overcome their problems; the process is assess--diagnose-- Rogers presented a different frame for interpreting prescribe/treat. the client and the dynamics of therapy. Given a facilitative emotional environment--genuine, non-restrictive--clients non-judgmental, would martial their own resources in their own behalf and "cure" A third option was available for therapists who themselves. couldn't/wouldn't conform to either of the other two choices: Thorne's In reality, my training program was somewhat Eclectic Therapy. its emphasis on non-directive techniques and theory base schizoid in while requiring considerable facility in psychometric skills. In essence, the message was to be eclectic, yet one particularly strong- spoken, and apparently influential faculty member, said, "Do not be Be a disciple and learn well your chosen It's theory-weak! eclectic! way." 6 6 The dilemma for me and for other students of therapy was that we were being trained in a mixed model, taught to call ourselves Rogerian and to avoid eclecticism, and turned loose on a practical world that provided even less consistent expectations. There were When there are major many "closet eclectics" at that time. deficiencies in the two major approaches and an even larger weakness in the eclectic alternative, there is a high degree of cognitive The resolution to the dilemma of avoiding eclecticism dissonance. is ineffectual and avoiding restriction to any one because it is unnecessarily limited is to adopt an discipleship because it integrational model, Responsive Therapy, one that structures the use of many intervention models, each in a theory-pure context. Appearances suggest a similar condition today to that of the fifties, but with the poles reversed. The increasing expectation/demand for accountability coupled by a questionable priority for doing labels over doing therapy has re-established the is no longer permissable to be preference for the medical model. It non-directive; such does not establish the therapist as accountable. Of course the major theoretical and philosophical base of the to leave the accountability to traditional client-centered approach is 7 the client; the counselor's function is to create the environment that There appears to be a clinging to the relationship supports change. principles and the "active listening" techniques of the recent professional past while, at the same time, a premium is placed on intake assessment and DSM IV determinations. Diagnosis is not a part of therapy. If the objective is to gather "objective" data in order to select the most appropriate diagnostic category in order to assign the related therapeutic answer, why spend time in mapping the client's The two activities are philosophically opposed. phenomenal space? A further manifestation of the new schizoid nature of counseling is the maxim to "Make your client a partner in the therapeutic process." If diagnosis truly is a professional function based on assessment and decision, then use of psychometric devices and lengthy intake forms that cover all of the possibilities (the traditional clinical approach) This is underscored by the nature of a is the only defensible position. There is no need litigious society which necessitates "CYA" tactics. to invest hours in finding what the client thinks, feels, or believes; to do so works against another pressure, that of the third-party payor that frames therapy in ten session episodes. 8 An alternate perceptual frame may be useful in sorting out this confusion. If diagnosis and therapy are seen as different functions, separate and related, then both can be accomplished more effectively. In diagnosis mediated therapy there are two stages: (1) intake and assessment directed at identifying a diagnostic category, and (2) treatment appropriate to the assigned diagnostic category. In contrast to the two stage treatment model, Responsive Therapy involves two or three sessions where the counselor and client explore progressively more specific examples of client experience, arriving at descriptions of client circumstance and style. Intervention is an extension of those descriptions, applied in ways that are most responsive to the unique and special conditions pertaining to each particular client. This permits or enhances a client-counselor all aspects of therapy. partnership in Diagnostic categories are most useful as a relatively descriptive summary of condition and treatment. Such categorical descriptions make accounting and research less cumbersome. They are useful in educational and case staffing proceedings, though not as powerful as client experiential vignettes, which provide primary data rather than processed data. 9 The DSM IV is a potentially dangerous diversion. There are two problems arising out of an emphasis on diagnostic One is the tendency to lose sight of the category-driven therapy. client's uniqueness, to distort perception of circumstance and style. fit clients Another is the economically driven tendency either (1) to if accurate at all, into categories which are marginally appropriate, in order to justify payment from third-party payors, or (2) to create progressively more and broader categories in order to accomodate a wider population of treatable (pay-for-able) clients. The latest revision of the DSM has an increased number of categories which incorporate a population of clients whose "maladies" reach closer to normality than was true with previous iterations. Relative to the first problem of diagnosis mediated therapy, in the 1995 Evolution of Psychotherapy Conference sponsored by the Milton Erickson Foundation, prominent leading therapists said things like, "The DSM is 90% nonsense," "When I'm in therapy with a client, I don't pay much attention to categories and structures. focus on I client dynamics," and "When it doesn't work, do something else--even if you don't believe in These statements underscore the it." importance of responsiveness to the immediate client interaction 10