Stepping from theory to therapy - mind the gap
Presenter: Walter H Manning, University of Memphis
By Sue Rant, Wokingham Primary Care Trust

The nature of theories

Theory development is the primary goal of science. Theory is useful for providing clients and clinicians a sense of direction about where we want to go. But no matter how useful they are, theories can create problems for us if we hold on to them too tightly. For example: It is assumed that we should use the medical model to understand and treat stammering, and to demonstrate efficacy of treatment. While the medical model works well for researching the onset of stammering it does not work well for explaining the stuttering experience, the process of change and the effects of the disorder. It sees the person who stammers as the patient, the clinician as the expert and the stammer as something that needs to be fixed.

Treatment with the contextual mode

The contextual model stipulates that there are a common set of factors across treatments that result in successful outcomes. These factors include the working alliance between clinician and client, the clinician's allegiance to treatment protocol and the quality of the therapist. Often there is a gap between what a therapist may understand about the process of therapy and the client's understanding and experience of it.

Treatment protocols and techniques make a difference to the clinician but not necessarily to the client.

To understand why reasonable treatment programmes work, it is best for clinicians to learn about the principles of change. When we first start to learn something new, we stick closely to the rules and are fairly inflexible. As we develop expertise we understand when to break the rules. We develop a sense of timing and focus less on ourselves and more on others.

A rule based approach to therapy is more likely to work when the problem is relatively simple and stable or where the client is young or very motivated. A principled based approach may work better when the problem is complex. Here it is better to follow the principles of change that are responsive to the client rather than to dogmatically follow the rules.

Closing some gaps

Consider the contextual model for explaining change
Think common factors rather than specific techniques
Match client and clinician views of change
Facilitate rather than fix the client
Model a scientific approach to change
Achieve highly proficient or expert performance
Apply principles rather than rules of change

From the Autumn 2005 edition of Speaking Out