Introduction
Theories of change have broadened since 1970s to include family and society as integral components of psychotherapy. Like other therapists, I have realized that therapies should be responsive to the needs of individuals, families, and communities for clients to change according to their social and physical environments.
Research has proved that therapies are effective if they are applicable at family levels since social and physical environments are significant determinants of the outcomes of a given therapy (Fuller, 2004). Hence, I suppose that by targeting families as social environments that catalyze changes is a critical step towards effecting changes among family members.
According to Fuller 2004, “when family members are desperate, they change, but when they are not desperate, they stay the same” (p.178). Since clients are family members who are desperate, they are in dire need of change, which lies deep within theories of change.
Therefore, in this view, I am interested in applying theories of change in families to address problems and issues that family members are struggling to resolve.
The theory of change comprises a series of interventions that help clients to recover in a gradual process. Anderson (2005) states, “Theory of change is the product of a series of critical thinking exercises that provide a comprehensive picture of the early and intermediate-term” (p.12).
A comprehensive theory of change outlines the assumptions of the change process and describes the steps through which change occurs.
As a therapist, I tend to apply change theories such as the solution-focused family therapy, narrative therapy, and structural family therapy in resolving problems within families because they are effective in causing required change.
Additionally, since these theories have common assumptions and functions, I have developed an interest of implementing them during therapy because they provide necessary tools and skills, which are of great importance in family therapy.
Therefore, this essay focuses on the theory of change by examining goals, assessment strategies, assumptions, principles, and views of therapists.
Goals of Therapy
The central goal of therapy inside a therapy room is to empower clients to be strong and overcome trauma. Clients usually seek therapy when problems that they face in life become too heavy for them to endure alone.
Hence, the major objective of therapy is to relieve the clients’ emotional and psychological burdens using appropriate psychological interventions. The goal of the solution-focused therapy is to enable clients to resolve problems using their own strengths.
Greenberg, Ganshorn, and Danilkewich (2001) posit, “Solution-focused therapy recognizes that even in the bleakest of circumstances an emphasis on individual strength is empowering” (p.2289). Despite the fact that an individual may be too weak to endure and resolve a given problem in life, solution-focused family therapy maintains that, an individual has residual energy to overcome problems in life.
By use of coping questions in the therapy room, clients can recognize their strengths and use them effectively. Therefore, as aforementioned, the cardinal goal of therapy is to revive the inherent latent strength within an individual and encourage one to overcome the problems that he or she is facing.
Another goal of the solution-focused therapy is to enable clients to focus their on solutions when resolving issues that affect their lives. Clients have inherent solutions, but the problem is that they cannot focus on the solutions to resolve their problems effectively.
Given that solutions to a given problem or an issue are many and diverse, lack of focus on the part of clients complicates the process of resolution. Therefore, the goal of the solution-focused therapy is to enable clients to focus their perceived solutions towards resolutions of the problems.
The major work of a therapist in solution-focused therapy is to guide clients into focusing solutions towards resolution of their problems, because they cannot resolve them on their own. According to Greenberg, Ganshorn, and Danilkewich (2001), clients understand their lives for the only thing that they require from therapists is guidance on how to resolve problems that affect them.
In this case, the exception questions encourage clients to utilize their strengths, thus amplifying the probable solutions. Hence, the goal of therapy is to support clients in implementing interventions that they perceive as effective solutions to their problems.
Moreover, the goal of therapy inside a therapy room is to make clients to forget about their past and dwell on the present and future. By focusing on the present and future, clients can develop strength and overcome negative feelings that weigh them down.
The reason why many people are unable to resolve issues affecting their lives is that they utilize a great deal of their energies in focusing about the past, which cannot change. In this light, solution-focused therapy enables clients to focus on the present and future, thus promoting resolution of problems.
Greenberg, Ganshorn, and Danilkewich (2001) assert that the use of accolades in solution-focused therapy has multiple effects of encouraging patients, setting expectations, fostering confidence, maintaining rapport, and facilitates building of relationships. The utilization of accolades forms the foundation of therapy in a therapy room, since they create rapport, which is critical in initiating a solution talk.
The goal of therapy is to examine the impacts of problems on people rather than examining problems as an integral part of people. In essence, the process of examining problems as different entities that affect people amounts to externalization.
Externalization reduces stigmatization and victimization of clients according to the nature of a problem that they are struggling to overcome. Stigmatization and victimization of clients slows down the process of recovery. Shapiro and Ross (2002) posit, “A narrative approach advocates for externalizing the patient’s problem by locating it outside the individual and within the culture” (p. 97).
In the narrative therapy, the goal of a therapist is to externalize problems that clients face. Successful externalization of problems allows patients to perceive their problems as external entities, which do not form a permanent part of their lives.
Externalization is applicable outside the therapy room because it enhances the ability of clients to cope with the stigma associated with their problems. Such perception relieves stress from clients and reduces responsibility of therapists in the process of delivering therapy.
Since families exist as systems within the society, the goal of therapy outside the therapy room is to enhance functionalities of families. Families that function well have the capacity to solve problems that affect family members, while dysfunctional families are ineffective in addressing such problems.
Structural family therapy holds that problems in families occur due to dysfunctional nature of the systems in a family setting. Nichols and Schwartz (2004) assert, “The goal of structural family therapy is to facilitate the growth of the system to resolve symptoms and encourage growth in individuals, while also preserving the mutual support of the family” (p.187).
Therefore, therapists must ensure that families of the clients are functioning well for any therapy to be effective in resolution of the prevailing problems.
Assessment Strategies and Process of Therapy
After taking clients through the process of therapy, therapists expect them to show some significant changes. As the objective of solution-focused family therapy is to enable clients to acquire strengths essential in resolution of problems, the capacity of clients to resolve problems on their own provides an effective assessment parameter.
In the application of solution-focused therapy, therapists can assess the progress of their clients as the therapy enhances optimism on the part of patients. According to Greenberg, Ganshorn, and Danilkewich (2001), solution focused therapy provides for the assessment of behavior changes with time in response to therapy.
Hence, assessment of client’s behavior in terms of the ability to solve problems on his or her own is imperative in assessment of behavior change.
As the objective of the solution-focused therapy is to assist clients to forget about their past and dwell on the present and future, assessment of their perception of problems enables therapists to monitor the course of therapy.
The progress of clients in therapy falls in the continuum that ranges from those who have negative thoughts to those who harbor positive thoughts. Solution-focused therapy employs scaling questions in assessing the nature of thoughts that clients harbor.
Greenberg, Ganshorn, and Danilkewich (2001) posit, “Scaling questions measure problem severity, progress toward a goal, confidence, and commitment to a goal” (p.2292). Hence, scaling questions provide means of assessing the progress of patients during therapy.
The goal of narrative theory is to externalize problems that affect clients. Since the extent of externalization determines how clients perceive problems that affect them, assessment of clients’ perception is critical. The way patients perceive their problems in terms of “good” or “bad” underscores externalization (Shapiro & Ross, 2002).
Clients who still perceive their problems as an integral part of their lives can see themselves as hopeless. In contrast, clients who have managed to externalize their problems would perceive life with an optimistic attitude.
Therefore, assessment of the elements associated with externalization of the problems under consideration gives an accurate way of ascertaining the impact of therapy on clients.
According to structural family therapy, family problems are inherent in structural organization and functions of a given family. Since the family is a system with structural organization, which shows a form of power distribution, functionality of the family is critical in showing the impact of therapy.
The assessment of the impact of structural family therapy focuses on both organization and functionality aspects of a certain family. Nichols and Schwartz (2004) argue, “A structural assessment is based on the assumption that a family’s difficulties often reflect problems in the way the family is organized” (p.189).
Poor organization of the family complicates resolution of problems, while good organization eases resolution of problems. In the aspect of functionality, families that function well can easily address their problems when compared to dysfunctional families.
Assumptions about Family and Change
One assumption of solution-focused therapy is that change is constant. In the family set up, often changes occur in response to challenges. Greenberg, Ganshorn, and Danilkewich (2001) posit, “Change is constant, inevitable, and contagious” (p.2290).
Since change is constant, solution building is a dynamic process that therapists should understand when they are providing therapy to clients. When clients face problems, they respond by seeking change. The response of change is critical for change is constant in families.
The relationships that exist in families play a central role in facilitating change because they are dynamic and subject to changes in the family level.
Another assumption of therapy is that clients have inherent abilities to overcome the problems that they encounter in life. Given that problems that require therapeutic interventions to address are very complicated for clients to resolve without any assistance, therapy is helpful for it amplifies the inherent abilities of clients to deal with the problem.
Greenberg, Ganshorn, and Danilkewich (2001) explain that the role of therapists is to amplify expertise that clients have in addressing issues affecting them. Although clients have expertise in resolving of their problems, they need motivation so that they can gain the courage to address complex problems.
The assumption of solution-focused therapy is that family members have strengths to overcome problems that seem complex in their lives. In this assumption, the role of therapists is to enhance strengths of clients so that they can solve problems on their own.
Greenberg, Ganshorn, and Danilkewich (2001) reveal, “Patients have strengths, resources, and coping skills that drive change while generating optimism and hope” (p. 2290). Resources and strengths that clients have are enough to overcome problems and challenges that affect them.
Hence, for therapists to deliver their therapies effectively and bring change, they must utilize resources and strengths that are inherent in clients.
At the family level, therapy assumes that problems that families face originate from structural organization and functionality of family.
According to Nichols and Schwartz (2004), the assumption of structural family therapy is that the nature of problems that family members face is dependent on the structural organization and functionality of a given family.
Well-organized families promote good interaction among members, thus reducing incidents of disagreements and conflicts associated with complex relationships that exist in different families. Additionally, families that function properly have reduced problems because family members work in a concerted manner.
Therefore, for therapists to optimize the impact of their therapies, they must ensure that families have proper organization while functioning in an effective manner.
Since families and individuals exist in society with diverse cultural and social factors, they tend to adopt these factors to suit their needs. In this view, narrative therapy assumes that social and cultural aspects that surround clients in society have a significant role in causing change.
Shapiro and Ross (2002) argue, “The basis of narrative therapy is a social constructionism or the idea that the way people experience themselves and their situation is constructed through culturally mediated social interactions” (p.96).
As people attach meanings to different concepts in society, the narrative therapy utilizes these meanings in eliciting certain changes of behavior in therapy.
Therefore, therapists should utilize narratives that have social and cultural elements for clients to decipher symbols used and attach meanings, thus bringing about change during therapy.
Major Interventions
The intervention of using the miracle question is effective is family therapy because it enables clients to examine their situations from different perspectives, thus enhancing the perception of their problems. As clients normally analyze their problems from a single perspective, they find it difficult and impossible to resolve problems in their lives.
In this view, miracle questions aim at expanding perspective and enhancing understanding of problems, thus enabling clients to resolve their problems. Application of miracle questions in therapy is an effective way of probing clients to initiate resolution of problems that they face in their families.
Greenberg, Ganshorn, and Danilkewich (2001) assert that miracle questions facilitate in the development of goals in therapy since solution-focused therapy is a goal-oriented therapy. Hence, the intervention of applying miracle questions during therapy is critical in effecting changes among clients.
Providing homework tasks is an intervention, which ensures that clients continue with the process of resolving their problems despite the fact that they are away from therapists. Since different clients have different abilities of coping with problems that influence their lives, some clients are too weak to cope well during the process of therapy.
In this view, homework tasks are necessary so that they can remain active throughout the process of therapy. Homework tasks enhance coping process as they engage clients in focusing on present and future aspects of their problems rather than the past, which is the major objective of solution focused therapy.
Greenberg, Ganshorn, and Danilkewich (2001) advise therapists to provide homework tasks to clients who have a clear focus on what they expect from therapy, but not those who have no clear focus. Such classification of clients enables therapists to assess the needs of clients and provide a customized therapy.
Externalization of the problems among clients is another intervention, which is essential in reducing stigmatization and victimization of clients. The stigma that clients have during the process of therapy has considerable impact in reducing the effectiveness of therapy.
Although therapy may be effective, stigmatization, and victimization, which occurs during therapy negates the progress that therapists make. Hence, for therapies to be effective in resolving problems that clients face, therapists should apply interventions that seek to externalize the problems from individuals and families.
According to Shapiro and Ross (2002), externalization reduces self-blame and stigma that patients face in society. Therefore, externalization is a critical intervention in reducing the stigma associated with problems that clients face, particularly in the family set up.
Utilization of family therapies is another intervention that is essential in creating a friendly environment. The nature of social and physical environment where therapy occurs determines the success of a given therapy.
Other therapies such as psychoanalysis and art therapy have some setbacks because clients do not feel free when interacting with therapists.
Hence, the application of therapies that consider needs of family members creates rapport, which promotes interactions between clients and therapists, thus enhancing the effectiveness of the therapy.
Fuller (2004) argues that a therapy that meets the unique needs of clients “is not merely centre-based therapy displaced into patients’ homes, but rather requires the therapists to integrate different rules of conduct and, at times, different forms of intervention” (p.179).
The integration of interventions that provide for the needs of clients creates a friendly social environment where clients can share their problems freely without any reservations that are usually associated with the process of therapy.
Restructuring family set up to enhance organization and functionality of families is an intervention that is applicable in families. Problems that occur in families or among family members originate from structural and functional aspects of a family.
This aspect means that therapists should restructure families with the aim of enhancing their functions and relieving conflicts. Fundamentally, structural family therapy seeks to bring changes in family by modifying the family structure.
Nichols and Schwartz (2004) insist, “The therapist produces a change by joining the family, probing for areas of flexibility, and then activating dormant structural alternatives” (p.187). Hence, restructuring of families to enhance efficiency of its functions is critical in resolution of problems that clients face.
Person of Therapist
As a therapist, I believe that therapy enables clients to overcome problems that they face in the family or society. Hence, I perceive that a therapist has a role of helping clients to overcome their problems because they already have solutions to their problems.
Evidently, since solution-focused therapy is a proven effective tool in resolution of problems in families, the intervention of optimizing solutions is imperative. According to the assumption of solution-focused therapy, I concur that clients are experts in resolution of problems that affect them because they are in contact with the problems.
In this view, my role as a therapist is to optimize solutions that clients have concerning the problems that affect them. Additionally, I also support the assumption of solution-focused therapy that clients have inherent resources, coping skills, and strengths, which are important in resolution of problems.
Therefore, I should take advantage of resources, coping skills, and strengths that patients have when delivering therapy.
Given that the nature of therapy and environment under which therapy occurs determine the effectiveness of therapy in resolution of problems, I hold that customization of therapies according to the needs of customers is critical.
Therapies that consider unique needs of clients are effective because clients can freely interact with therapists due to friendliness of the environment. Unfriendly atmosphere usually makes clients to become unresponsive to therapy.
Fundamentally, therapies that are sensitive to the needs of clients provide means of creating good relationships with clients so that they can respond to therapy in a positive manner, hence promoting efficiency of the therapy. The application of family interventions in therapy has been effective in enhancing the outcome of a therapy.
Ample evidence shows that clients are more responsive to family interventions than interventions that are applicable out of family set up due to friendliness of the therapy process. Hence, as a therapist, I think that the incorporation of family interventions has a significant role in enhancing therapy outcomes.
Additionally, I think that families have significant influence in determining the therapy progress and outcome. I support the principle of structural family therapy that organization and functionality of a family determines the resolution of problems.
In essence, well-organized families experience fewer conflicts and have high coping abilities. In contrast, poorly organized families experience a great deal of problems as disorganization complicates resolution of conflicts. Moreover, the manner in which families function predicts their susceptibility to problems.
I perceive that families that do not function efficiently are prone to problems as compared to families that function well.
On this basis, I think that my responsibility as a therapist is to restructure families well with the view of enhancing their functions. How families function is dependent on their structure, hence, an appropriate target for therapists.
Since stigma associated with the problem has negative impacts on the process of therapy, I believe that externalization of problems provides means of reducing impacts of stigma. Problems differ in families and society, and thus they have different levels of stigma.
In this view, a therapist should assess fears and reservations that clients have with a view of ascertaining the levels of stigma. Effective externalization of the problems will enhance coping skills of clients, as they will not be struggling with negative feelings, but having optimism in resolution of their problems.
Thus, I think that externalization is central in enhancing the effectiveness of a therapy.
Conclusion
In theories of change, family and society play significant roles in determining the impact of therapy on clients. Since families comprise inherent systems in society, problems that people face emanate from family relationships or social environments in society.
In this paper, I have noted that theories of change such as solution-focused therapy, narrative therapy, and structural family therapy are proven effective tools in resolution of problems that clients face within the context of family and society.
Moreover, I have realized that different assumptions and principles concur that clients and their families have inherent strengths, expertise, resources, and abilities that are paramount on tackling problems.
In this view, I seek to apply principles and assumptions associated with these theories of change in guiding clients through the process of therapy, thus enabling them to resolve their problems.
References
Anderson, A. (2005). An introduction to the theory of change. The Evaluation Exchange, 11(2), 12-13.
Fuller, A. (2004). Crisis: Home-based family therapy. Australian & New Zealand Journal of Family Therapy, 25(4), 177-182.
Greenberg, G., Ganshorn, K., & Danilkewich, A. (2001). Solution-focused therapy: Counseling model for busy family physicians. Canadian Family Physician, 47, 2289-2295.
Nichols, M., & Schwartz, R. (2004). The essentials of family therapy. New York, NY: Allyn & Bacon.
Shapiro, J., & Ross, V. (2002). Applications of narrative theory and therapy to the practice of family medicine. Family Medicine, 34(2): 96-100.