Collaborative therapy

"Developed by Dr. Harlene Anderson, along with Dr. Harold A. Goolishian (1924-1991), in the USA, collaborative therapy could be especially useful for those clients who are well educated in any field or for those that have distrust of therapists due to past negative experiences with one or moreCollaborative Therapy gives the client the option to have a ‘non-authoritarian’ counsellor. This could greatly benefit clients who are

a) not heteronormative

b) GID (Gender identity disorder)

c) ‘transgender’

d) choose to live an Alternative lifestyle."(page 1)

This is because it is often they that are most subject to heteronormative evaluation, which simply is inappropriate for them and indeed can cause further harm and distress. Anderson used Collaborative Therapy in family and marriage therapy too, with great success, which could help families and partners to understand the client better should the client find that they cannot adhere to social ‘norms’ any more (such as ‘coming out’ as trans or SGR (same gender relationship)).(page 63).

Collaborative therapy is a treatment primarily for adults, and can help those suffering with dual-diagnosis,(i.e. more than one mental health issue usually due to substance abuse such as alcohol and non-prescription drugs); Bipolar disorder, Chronic Schizophrenia and Parents with Psychosis(page 20) Body Dysmorphic Disorder(page 1) . Seen as a branch of Narrative therapy and also attributed to Michael White and David Epson (page 1) this model is a postmodernist approach that maintains that human reality is created through social construction and dialogue, and avoids "the traditional Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) used to diagnose individuals". This model uses the idea that the clients become subject to mental pain when they have tried to apply " oppressive [']stories['], which dominate the person’s life. Problems occur when the way in which peoples’ lives are storied by themselves and others does not significantly fit with their lived experience. In fact, significant aspects of their lived experience may contradict the dominant narrative in their lives. The client internalizes ludicrous societal standards, and believes that in doing so they are aspiring to ideals of fulfillment and excellence. This leads to, for example, self-starvation and anorexia, extreme self-criticism in depression, or a sense of powerlessness in the face of threat and anxiety;"(page 1)Obsessive Compulsive Disorder (OCD), and Trichotillomania (hair pulling). These last two mental health issues as well as anorexia can often symptoms of BDD-Body Dysmorphic Disorder. Cognitive Behaviour Therapy (CBT) can also be useful to treat this last condition.)(page 2)

Theory

“A collaborative therapy is one in which:

a) The expertise of clients is given at least as much weight as the expertise of therapists

b) Clients are regularly part of the treatment planning process:

1. Clients are consulted about goals, directions and responses to the process and methods of therapy

2. Diagnostic procedures, conclusions and case notes are available, transparent and understandable to clients (no jargon or theoretical or technical terms which aren't explained in plain, simple language).

c) The therapist asks questions and makes speculations in a non-authoritarian way, giving the client ample room and permission to disagree or correct the therapist. Therapists give clients many options and let them coach the therapist on the next step or the right direction. If the therapist has an idea and is keeping it as a hidden agenda, he or she makes it public, putting it out in the conversation not as the truth or the right direction, but as an idea, a personal perception or an impression.

d) The therapist is wary of "theory countertransference. Theory countertransference is evident when the therapist continues to "discover the same kinds of problems in client after client (e.g. "unresolved losses, or Multiple Personality Disorder). This also means not imposing one’s beliefs and therapeutic values on clients, lives. The therapist claims no special knowledge about the best way for the client to live after resolving his or her therapeutic concerns (e.g., that it is best for clients to use "I messages or always express their feelings).

e) Other helpers are given respect and no attributions of bad intentions or wrong approaches are implied regarding their treatment. They are invited into cooperative relationships by inquiring about what their views of the situation are and what the outcomes they expect from treatment are. If they are willing to say, you can ask them about how you might help with or at least not interfere with their treatment. This does not mean that one has to accept or support everything other helpers do. The first loyalty is to the client(s). So, as usual, stories of impossibility, blame, invalidation and determinism are gently and subtly challenged by acknowledging their possible validity and introducing alternate possibilities.

f) Clients (consumers) are given the opportunity to comment on the process of helping (critiquing, appreciating or coaching) and to share their expertise with others, thereby elevating their status from passive needy recipients to active expert contributors.”

Process

“It is run over 8–12 weeks, followed by booster sessions over a further 9 months, is based on an adaptation of the stress vulnerability model (stress vulnerability–self efficacy) and utilises self-efficacy and self-reliance as part of the process. It provides core components of the therapeutic interventions that have established efficacy across a wide range of diagnosis, including psychoeducation, coping and relapse prevention strategies. An allied tool is the collaborative treatment journal, a small pocket journal that can chart stressors, early warning signs, coping strategies, supports and other factors that influence the course and management of an individual’s health. It is held by the consumer and places them at the centre of their treatment.” Using the principle of 'not-knowing'- Harold (Harry) Goolishian and Harlene Anderson's term for the recommended approach that therapists should have towards their clients. In this approach therapists avoid taking dogmatic postures and try to remain flexible to have their perspectives altered by their clients. In her book, Conversation Language and Possibilities: A Postmodern Approach to Therapy,Anderson says, "The meaning that emerges [in therapy] is influenced by what a therapist bring into conversation and their interactions with each other about it. The issue of new meaning relies on the novelty (not-knowing) (click here for more on not-knowing.) Fred Newman and Lois Holzman talk about something quite similar when they speak about the "end of knowing." Also consider looking at Fred Newman's concept of non-knowing in his book, The End of Knowing; A New Developmental Way of Learning

The issues for the therapist to consider and aim for are: (Primary Outcomes)

1. Retention in study (establish reasons for drop-out)

2. Time to relapse

3. Level of Functioning

4. Quality of Life

5. Medication Compliance

(Secondary Outcome)

1. Symptoms

2. Locus of Control

3. Occupation status

4. Relationship status – social relationships

5. Service utilisation – GPs, Case Managers, Hospitalisation (pages 33–34)

Problems with/Criticisms of this method

1. When there is a "Serious lack of and need for community-based rehabilitation programmes, including behavioural and psychosocial treatment programmes" (page 5) it is difficult for the client to get medical back-up for the therapy which can makes the treatment less effective. However, this is a critical reflection on government spending on social care rather than this method of therapy. Thus in the case of more serious mental issues such as schizophrenia there is a likelihood that 30% of clients will have a poor long term prognosis, as stated by Linzen in 2003.(page 6)

References