Lassie * A new Lassie film for the 21^st century?5 What do we mean by process? * Any activity involving change * A sequence of events taking place * Set of factors that promote or inhibit therapy * Humanistic idea of process as a flow of experience * (Csikszentmihalyi 1992) * The work that clients and therapists do in finding meaning in emotion * naming them, expressing them, reflecting on their meaning * All are concerned with therapy as being about change Units of analysis * Elliot (1991) suggests: * The speaking turn – brief process of discrete utterance * Episode or event – series of speaking turns over several minutes about a topic * The session * The treatment * Can also draw on wide range of qualitative and constructionist epistemologies / methodologies from conversational analysis onwards Beginnings, middles and endings Egan (1994), and others, structure in this way * Beginnings * Negotiating expectations - People may have models that are directive and authoritarian e.g. based on medicine, religious guidance, parental advice * Assessment * Psychodynamic assessment of psychological mindedness * Psychometric tests – but is diagnosis useful? * Key questions – Is therapy needed? Am I competent? My personal reaction? Are they comfortable with me? * Establishing a working alliance * Bonds, goals tasks Counsellor’s images of the process of therapy * Najavits (1993) found 7 clusters of metaphor – or meaning systems * Task oriented, professional: - like teaching, acting or science * Primal, fantasy: - play, spiritual quest, handling wastes * Taking responsibility: - hard labour, parenting * Alteration of consciousness: - meditation, intuition * Travel: - voyage, exploration * Unrelated to theoretical position or job satisfaction etc. Very divergent views. Middle part of counselling * Where most learning and changes occurs * (McLeod 2003) * Assimilation model (Stiles et al, 1990 +) * Individuals have cognitive schemas or a model of the world * Problematic experience needs to be assimilated or accommodated to * Transtheoretical / integrative stage model (7 stages from ‘warded off’ to ‘mastery’) relating to Piagetian ideas * Recently re-formulated in terms of ‘voices’ Stages of assimilation of problematic experience in counselling Barkham et al 1996 * Warded off * Unwanted thoughts * Vague awareness * Problem statement / clarification * Understanding / insight * Application / working through * Problem solution * Mastery Multiple Processing Model (Bucci 1993) * Verbal and non-verbal modes of information processing * Clients may have phases when talk is suffused with emotion conveyed non-verbally, and phases of rational reflection, with insight and understanding expressed * Need to make journey from 1^st (subsymbolic) to 2^nd (symbolic) form of processing * Link is achieved through referential activity – use of language to bring together abstract, symbolic ideas and gut feelings – often into a story. * Another integrative, transtheoretical model, links to stage 3 of assimilation model What do counsellors do? Process in terms of therapist behaviour & intention (Hill 1989) * Approval – emotional support etc. * Information – data / resources, also arrangements * Direct guidance – directions, advice * Closed questions – to gather data * Open questions – probes * Paraphrase – mirrors, summarises, reflects * Interpretation – going beyond paraphrase * Confrontation – pointing out discrepancies, contradictions * Self disclosure – sharing feelings, experiences What clients say (Hill 1986) * Simple response * Request * Description * Experiencing * Exploration of client-therapist relationship * Insight * Discussion of plans * Silence * Other Ending therapy * May be unplanned and haphazard but issue of attachment, loss and grief needs attention * Consolidation and maintenance of what has been achieved * Working with loss and disappointment * Opportunity to relate to how dealt with elsewhere * Referral * Relapse prevention The covert dimension what is going on behind the scenes * Both parties monitor what they say and conceal much * basic concepts such as transference, counter-transference, resistance, genuineness, congruence rooted in this reality * E.g. client may talk about something less important while rehearsing / testing the water / working up to something important * Interesting to look at what is not said Bringing process together * Can be to train therapist / enhance therapy and to research how process works * Elliott (1984) – Comprehensive Process Analysis (CPA) * What events were most / least helpful? * Maher et al (1987) – therapists choice of ‘good moments’ * Angus & Rennie (1989) – beneficial use of metaphor in therapy * Focus on critical incident, use of interpersonal process research