By David
S. Prescott, LICSW & Kieran
McCartan, Ph.D
Mick Cooper, John Norcross, Brett
Raymond-Barker, and Thomas Hogan just published a study in which
they sought out what treatment providers believe is important in psychotherapy
and how their answers compared with what clients felt was most helpful. Asking,
“Whose therapy is it?”, the authors found that, “Robust
differences were found between laypersons’ and professionals’ preferences on
these two dimensions: Mental health professionals wanted less therapist
directiveness than did laypersons … and more emotional intensity … These findings
suggest that psychotherapists should be mindful of their own treatment
preferences and ensure that these are not inappropriately generalized to
patients.”
To
some degree, these findings call to mind those of Beech & Fordham (1997), who found that professionals providing treatment to clients who
had sexually abused often believe themselves to be more helpful than their
clients perceive them to be. A common theme across the entire Criminal Justice
sector, not just in respect to people who have been suspected or convicted of
sexual offences are that we often don’t fully take into account the service users (our client’s) perspectives in developing and delivering services. We (David & Kieran) with Danielle
Harris, and have just published a study in this same area, finding that specific themes of problematic
client experience emerged in three areas of their interface with the criminal
just system. These include: (a) Interactions with the
formal criminal justice system (police, courts, and custodial corrections), (b)
Interactions with community corrections (probation and parole), and (c)
Interactions with treatment providers (rehabilitation, therapists, and
evaluators). They reflect broader issues in the “criminogenic” and social care
systems where clients can best be characterized as “do to”, not “done with”;
which reflects a position of expert knows best and that can contravene the
therapeutic alliance. As just one example from his week, David and Kieran
visited Bredtveit, an all-female prison in Oslo (Norway), and saw what a more
empathetic, supportive and consideration system looked like; there was a balance between the clients’ voices, social care, understanding where they were
coming from (in terms of past trauma and offences they committed) and how they
could move forward,
From all of this, logical question
follows: If one goal of treatment is to reduce risk, doesn’t it make sense to
ensure that our understanding of our clients’ experiences is in line with
theirs? Shouldn’t we take action to make sure that we are, in fact,
understanding their experience so that we can better tailor our services to
become more accessible to clients (in line with the responsivity principle of
effective correctional treatment)?
If your answers to these questions
is yes, then more questions follow: To what extent do we pay lip service to
client experiences in treatment and supervision? Do we as individuals believe,
as Beech and Fordham found, that we are more effective with our clients than we
actually are, and therefore don’t need to be concerned with seeking out their
feedback and input into treatment? Would we as individual professionals
actually be able (first) to establish the environment where this kind of
feedback is possible and (second) to handle the feedback that we might get? Are
we afraid that the feedback we might get would be impossible to act on? Do we
believe we already get feedback? And perhaps most importantly, do we harbor the
belief that some feedback is not worth listening to? If the answer to this last
question is yes, what does that say about us? Are we willing to admit that – in
line with the research – that we are missing something?
These are not easy questions to
answer. It often seems that our training in providing treatment can be a
hindrance as well as a help. Many of us are trained to think in terms of adopting
specific models or techniques and become so focused in these areas that we lose
focus on whether or not these same approaches are actually working with our
clients.
Bruce Wampold and Zac Imel have written
extensively about the mechanisms by which
treatment work. Central to all effective approaches to treatment is the
therapeutic alliance itself. Brandy Blasko and Faye Taxman have found that this same alliance works with probation officers as well.
This leaves us with even more questions. Perhaps it’s time to consider more
deeply that our most cherished models and techniques work because they are
delivered in the context of an effective alliance? Perhaps it’s also time to
explore the many ways that we are not maintaining an alliance or truly
listening to our clients’ experiences at the very times we are focused on
implementing our models and techniques?
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