The Art and Science of Therapy as Craft, Part 1: Foundational Skills

Topics covered:  What is a craft?  How therapy falls somewhere between art and science.  A systems therapy view of outcomes, measures, and linguistic interactions.  Becoming a master therapist.  Foundational skills for mastery:  validating, empathizing, summarizing, and client language.  Length:  1 hour, 1 minute.



Class Notes


About AnnaLynn

Dr. AnnaLynn Schooley, Ph.D. LMFT, LMHC, is a family therapy and mental health professor therapist, professor, and supervisor.  She is a soon to be author on the nano skills that make-up the micro skills of systemic therapy.  AnnaLynn practices and lives in South Florida.  She is a full-time professor for Capella University.


KEY TAKEAWAYS

AnnaLynn's take on feeling and doing

  • What are my clients going TO DO--we want different behavior.  

  • To Therapists:  It’s what we do in the room.  Our doing involves talking.  Becoming a good therapist is about the craft of using what we say, as well as nonverbal communication.  It’s about what do I bring into the room?, because I can’t control what the client brings into the room.  My attitude, my behavior, my questions, my thinking.

  • Feelings:  How do my feelings get in the way, as opposed to being helpful.  Part of the craft of the therapist is being able to have the skill to utilize both what the therapist is feeling as a vehicle (Douglas Flemons, Of One Mind) of doing something in the room, and to work with clients about their feelings as to how they're helpful or unhelpful for desired behavior.  If it’s not helping, why have it?  How do we move the feelings aside (therapist and clients)?

  • "I tend to think feelings change as a byproduct of doing and thinking differently."

Basic Therapist Skills

  • There are basic skills that enact all models--skills everybody has to use and models--those models are only useful as they conform to the common factors (systems theory common factors were developed by Sprenkle and Blow).

  • The progression toward mastery is basic skills--model--common factors, or backwards:  common factors--which models enact the common factors--skills.

  • Using your own thoughts or feelings as a vehicle to take you someplace different.  If I’m getting really annoyed with a client, the thing to do with that is wonder, “Huh, they’re making me really annoyed, I wonder who else in their life gets annoyed."--use my experience (as the therapist) as a way to ask as a question about their world.

  • Family therapists are the hired help--the janitors:  What have you been hired for?  Wash the windows, then enough light comes in they can see the floor is dirty, and then maybe they’ll hire me to do the floor.  (An example of staying with the client’s stated problem.)

Art, Science, and Craft

  • Jay Haley--the importance of teaching the craft of therapy. Teaching skills.

  • Think about craft--plan what you want to do and how you want to do it.

  • Natural inclinations can lead to burnout.  Having a craft and model to draw upon can help you know what’s next, so that you don’t get stuck.

  • Philosophies versus techniques.  It’s important to know the underlying philosophy of your model, in order to be good at the techniques--at the model.

  • If more people used the foundational skills in their lives, there would be less need for therapists.  But, “misery is an expanding industry.” 

  • You do the skills to do the model--but the model is more than just techniques--it’s the philosophy underneath those techniques.  Model founders read philosophy: Liechstenstein, Derrida, Von Bertalanffy, Foucault.  

  • Common factors--we shoud do what works.  Evidence-based.  Research challenge:  How does your favorite model actually enact the common factors?

    • I’m doing it (the technique) because I am looking for a certain outcome.  

    • The common factors include:  therapist factors, client factors, combined factors.  What we are doing has to make sense for the client, and usually involves a change in thinking, feeling, and/or doing.  Sprenkle and Blow added the systemic perspective--the view is not of the individual, but of the entire system; eliciting multiple perspectives.

    • 7 Things that Steve DeShazer says makes a good goal.

Basic Skills:  Micro Skills and Nano Skills

  • Microskills originally proposed by Allen Ivey
  • Schooley and Hibel are now writing about how to take these same skills, but use them in a systemic perspective--use multiple perspectives in order to make sense of what’s going on.
  • Nano skills:  Smaller than micro skills; little tiny behaviors

How do the skills relate to the crafting of questions?

  • Malcolm Gladwell, Outliers, based on Dr. Anders Ericsson's research at FSU: 10,000 hours of practice with a coach in order to develop mastery.  
    • Doing therapy is performance, not practice.  Practice in order to get better at the performance.  Practice outside of the performance of the session.
    • Don’t only learn from clients--without practicing, we are experimenting with our clients.
  • Take seriously your craft.  Fall in love with your craft.

Nano-skills:  Back Channeling and Joining

  • Micro analysis reserach bring us “back channeling”--the nonverbals that encourage the person to keep talking.
  • Nonverbal and verbal “back channeling”
    • Verbal--linguistics call them “introjects”
  • Audiotape and videotape your work, to get a sense of your back channeling
  • A problem of therapists, especially beginning therapists:  Thinking about the next thing I am going to do.  Thinking about the next question I want to ask. As opposed to being right with the client.
  • Use back channeling (and all skills) with therapeutic purpose, in order to affirm only what is relevant for therapy.  The model tells us what is purposeful.
    • An example:  Steve DeShazer interpreting “I don’t know,” as “Shut up.  I’m thinking.”  Or, looking expectantly after asking the miracle question.
  • Things that tend to go out the window once questions begin are validating, empathizing, summarizing, using client language.
    • We have to do these skills to prove our credentials.  We have to do all the joining, and if we don’t our interventions will fall flat.
  • Know your therapist position:  Are you an expert, collaborator, one-downer?  What is your position in this work, and what nano-skills do you use to express that?
  • Bill Doherty video--therapy as a linguistic craft.  "Yes, but."
    • Never argue with a client.  Never say no to a client.
  • Questions are built on that which you’ve established with the joining skills.  Question types:  Open, Closed, Linear, Relational, Circular (next masterclass)
  • According to AnnaLynn:  Do not say “feel.”  You need to be joined enough to understand how it would have made them feel.  Being able to assess for the client’s natural way of communicating is part of our job.

Nano-skills:  Summarizing and Joining

  • Summarizing is to echo back--echoing client language, summarizing in order, using client language.  You can add a question for clarification, after the summary.
  • To say back with accuracy what the client just told you.  Don’t let the client talk too long, so that you can’t summarize.  Summarize frequently.  If you summarize frequently, you are getting the client language.  Capturing client language is the building block of other skills.  Using client language is a foundational skill--one of the first skills.
  • Feedback students give to AnnaLynn:  They had no idea that they had to listen differently as a therapist.  Don’t paraphrase willy nilly.  Capture client language.  
  • Member-checking--did we get this correct?  They may give it to you before you ask.
  • Interrupt verbally--but use back channeling.
  • Joining--I pace with the client.  I match their beat.  I have to join before they will accept the interruption.  Back channeling helps--the tiny skills help clients feel joined with the therapist.
  • Summarizing is relevant at the small level and at the advanced level.  Each tiny skill has a basic and advanced level.
  • The delivery matters--it can be experienced as an interruption/disruption or as a validation.

Nano-skills:  Empathizing and validating

  • What not to say:  “I understand”--it actually emphasizes the disconnection between you and the client.
  • Validating statements-”Of course it makes sense."  Essentially, with validation, your saying, "You’re right to do this, feel this, think this."  It makes sense to me.  The foundation of the "It makes sense" message is the Milan systemic therapy model.
  • Empathy goes into the emotional realm.  Can be a statement, or a voice inflection.
    • Exercise:  Take a back channeling word--and find a dozen different ways to say the same word.
    • AnnaLynn's empathy is in the command, not in the report (she uses voice inflection)

A Summary

  • In order to join with a family, use the basic skills.  
  • Also, where can we practice these things?  Interact with everyone.  Practice in life with your hair dresser, with the waiter, with the cashier.  
  • How to handle "trigger clients":  If you're thinking, "I don’t like that person,” you have to join on purpose with these folks.  A set of skills that help you do this on purpose is a back up plan.  Using the skills will lead you to like the person--”therapeutic magic” happens if you rely on skills.  A set of skills that allows me to set aside the things that would get in the way, and through that set of skills, that therapeutic magic that we call joining happens.  And, if it doesn’t, then you’re missing something found again in the skills.  
  • If you’re thinking pejoratively about a client, you need to lay down until that goes away.  

RESOURCES

AnnaLynn is writing a book with Jim Hibel on systemic nano skills, titled Microskills for Effective Therapy and Counseling:  A Systemic Perspective.  Stay tuned for more information.

Also mentioned (in no particular order):

Jay Haley,  Problem Solving Therapy

Bill Doherty video, Treating Therapy as a Conversational Craft

Carl Whitaker

Dancing with the Family

The Family Crucible

Douglas Flemons, Of One Mind

David Bohm, On Dialogue

The systemic common factors approach, by Sprenkle and Blow:

Common Factors and Our Sacred Models

Common Factors Across Theories of Marriage an Family Therapy

Allen Ivey, microskills (find information via Google search)

Dr. Anders Ericsson (find information via Google search)

Download:  Microskills Checklist (also found in The Library)