For decades, therapists have been developing ever more sophisticated models and increasingly refined techniques, but in doing so they risk losing sight of the person who, more than anyone else, guides the therapeutic process: the client.
This article explores the Client’s Theory of Change proposed by Barry Duncan and Scott Miller (2000), offering an interpretation that values the client’s active role and its impact on the effectiveness of therapy.
In their article “The client’s theory of change: Consulting the client in the integrative process,” Duncan and Miller state that “in psychotherapy in general, the client has been sadly excluded from the therapeutic process.”
Often, therapists’ love for their own orientation blinds them to the fundamental role that clients play in determining change. As a result, there is a tendency to apply the model rigidly to the client, instead of adapting it to their characteristics and needs.
As clinicians, we often forget that the model and techniques we apply affect therapy outcomes to a relatively limited extent (about 15%), leaving ample room for extra-therapeutic factors and the client’s active contribution.
People’s Capacity for Self-Recovery
People possess an extraordinary capacity for self-recovery. In the absence of any treatment, individuals are able to resolve or significantly improve their problematic situations, even in the face of severe clinical conditions such as alcohol dependence, borderline personality disorder, or antisocial disorder (Bohart and Tallman, 1999).
Furthermore, 60% or more of clients report improvements in their situation in the time that elapses between the first phone contact with the therapist and the appointment. Even before entering the therapist’s office, the simple act of contacting a specialist triggers a process of change in many people.
These data suggest that we are constantly coming into contact with capable individuals who, in their daily lives, are taking steps toward the change they desire.
The Therapist as Co-Constructor of Change
Recognizing the client’s intrinsic capacity for change entails a shift in the way we work: from experts who guide the process to facilitators who make it possible.
This means knowing how to tailor our theory to the characteristics of the person in front of us. Our knowledge remains valuable, but it must be used in the service of the person’s understanding, goals, and resources.
Some Questions That Explore the Client’s Theory of Change
Here is how we can explore the Client’s Theory of Change in session, placing the person at the center:
“What would you need in order to solve the problem?”
“In what way do you think this meeting can help you reach your goals?”
“What, in your opinion, is preventing you from reaching your goal/solving your problem?”
“What would you have to do, in your opinion, to reach your goal?”
These questions reposition the therapeutic conversation as a dialogue between experts: the therapist, expert in techniques and theory; the client, expert in themselves and their reality.
Through this inquiry, we will notice that not all clients come in with the same degree of clarity regarding their change.
Here are some typical scenarios we may encounter:
The client who knows exactly what to do
Sometimes the person already knows what they should do. They possess the awareness, the direction, the resources. In this case, our task is to amplify what is already working. We must help the client recognize the solutions they already possess and bring to light their resources in the service of change.
The client who senses the direction
Other times the person has an idea of the direction to take, but does not know how to get there. They see the finish line but not the path. In these cases, we must be a little more prescriptive. We do not tell the client what to do, but we walk together, exploring possibilities, testing small steps, observing what works.
The client who struggles to understand what they need
Still other times, the person may be confused, disoriented, perhaps overwhelmed by the problem itself. Here our intervention will need to be evocative. We must ask questions that help the client discover within themselves hidden resources, positive experiences, and the moments when things went better.
The Client’s Theory of Change in TSS
In TSS, it becomes essential to start from what the person considers useful, possible, and meaningful for their own change.
TSS is a resource-based method, and therefore holds that there are only interventions that are effective for that person, at that moment. Exploring the Client’s Theory of Change allows the therapist to orient the work from the very beginning, avoiding superfluous hypotheses and interventions that are not aligned with the client’s expectations and resources.
Vanessa Pergher
Psychologist, Psychotherapist
Italian Center for
Single Session Therapy Team
References
Bohart, A. C., & Tallman, K. (1999). How clients make therapy work. Washington, DC: American Psychological Association.
Cannistrà, F., & Piccirilli, F. (2018). Terapia a Seduta Singola. Principi e Pratiche. Giunti.
Duncan, B. L., & Miller, S. D. (2000). The client’s theory of change: Consulting the client in the integrative process. Journal of Psychotherapy Integration, 10(2), 169-187.
Lambert, M. J. (1979). Psychotherapy outcome research. American Psychologist, 34(1), 91.