This article casts a critical eye upon the integration literature and asserts that, as in psychotherapy in general, the client has been woefully left out of the therapeutic process. An alternative that privileges the client's voice as the source of wisdom and solution is presented. It is proposed that conducting therapy within the context of the client's own theory of change offers ways of integrating multiple therapy perspectives. An argument is made for not only recasting the client as the star of the drama of therapy, but also giving the heroic client directorial control of the action as it unfolds.
This is a preview of subscription content,to check access.
Access this article
Asay, T., & Lambert, M. (1999). The empirical case for the common factors in therapy. In M. Hubble, B. Duncan, & S. Miller (Eds.), The heart and soul of change. Washington, DC: American Psychological Association.
Atkinson, D., Worthington, R., Dana, D., & Good, G. (1991). Etiology beliefs, preferences for counseling orientations, and counseling effectiveness. Journal of Counseling Psychology, 38, 258–264.
Bachelor, A., & Horvath, A. (1999). The therapeutic relationship. In M. Hubble, B. Duncan, & S. Miller (Eds.), The heart and soul of change. Washington, DC: American Psychological Association.
Beutler L., & Clarkin, J. (1990). Sytematic treatment selection: Toward targeted therapeutic interventions. New York: Brunner/Mazel.
Blatt, S. (1992). The differential effect of psychotherapy and psychoanalysis with anaclitic and introjective patients: TheMenninger Psychotherapy Research Project revisited. Journal of the American Psychoanalytic Association, 40, 691–724.
Blatt, S. J., Zuroff, D. C., Quinlan, D. M., & Pilkonis, P. (1996). Interpersonal factors in brief treatment of depression: Further analyses of the NIMH Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 64, 162–171.
Brickman, P., Rabinowitz, V., Karuza, J., Coates, D., Cohn, E., & Kidder, L. (1982). Models of helping and coping. American Psychologist, 37, 368–384.
Claiborn, C., Ward, S., & Strong, S. (1981). Effects of congruence between counselor interpretations and client beliefs. Journal of Counseling Psychology, 28, 101–109.
Conoley, C. W., Ivey, D., Conoley, J. C., Scheel, M., & Bishop, R. (1992). Enhancing consulta tion by matching the consultee's perspectives. Journal of Counseling Development, 69, 546–549.
Crane, R. D., Griffin, W., & Hill, R. D. (1986). Influence of therapist skills on client perceptions of marriage and family therapy outcome: Implications for supervision. Journal of Marital and Family Therapy, 12, 91–96.
Davison, G. C., & Neale, J. M. (1986). Abnormal psychology. New York: Wiley.
Duncan, B., Hubble, M., & Miller, S. (1997). Psychotherapy with “Impossible” cases: Efficient treatment of therapy veterans. New York: Norton.
Duncan, B., & Miller, S. (2000). The heroic client: Client directed, outcome informed therapy. San Francisco: Jossey-Bass.
Duncan, B., & Moynihan, D. (1994). Applying outcome research: Intentional utilization of the client's frame of reference. Psychotherapy, 31, 294–301.
Duncan, B., Solovey, A., & Rusk, G. (1992). Changing the rules: A Client-directed approach. New York: Guilford Press.
Duncan, B., Sparks, J., & Miller, S. (2000). Recasting the therapeutic drama: A client directed, outcome informed approach. In F. Datillio & L. Bevilacqua (Eds.), Comparative treatments in couples relationships. New York: Springer
Elliott, S. N., Witt, J. C., Galvin, G., & Peterson, R. (1984). Acceptability of behavior interventions: Factors that influence teachers' decisions. Journal of School Psychology, 22, 353–360.
Erickson, M. (1980). The nature of hypnosis and suggestion: The collected papers of Milton H. Erickson on hypnosis (Vol. 1). New York: Irvington.
Erickson, M. H., & Rossi, E. L. (1979). Hypnotherapy: An exploratory casebook. New York: Irvington.
Fisch, R., Weakland, J., & Segal, L. (1982). The tactics of change: Doing therapy briefly. San Francisco: Jossey-Bass.
Frank, J. D. (1995). Psychotherapy as rhetoric: Some implications. Clinical Psychology: Science and Practice, 2, 90–93.
Frank, J. D., & Frank, J. B. (1991). Persuasion and healing: A comparative study of psychotherapy (3rd ed.). Baltimore, MD: John Hopkins University Press.
Gaston, L. (1990). The concept of the alliance and its role in psychotherapy. Psychotherapy, 27, 143–152.
Gold, J. R. (1994). When the patient does the integrating: Lessons for theory and practice. Journal of Psychotherapy Integration, 4, 133–158.
Goldfried, M., & Wolfe, B. (1998). Toward amore clinically valid approach to therapy research. American Psychologist, 66, 143–150.
Goolishian, H., & Anderson, H. (1987). Language systems and therapy: An evolving idea. Psychotherapy, 24, 529–538.
Hayes, J., & Wall, T. (1998). What influences clinicians' responsibility attributions? The role of problem type, theoretical orientation, and client attribution. Journal of Social and Clinical Psychology, 17, 69–74.
Held, B. S. (1991). The process/content distinction in psychotherapy revisited. Psychotherapy, 28, 207–217.
Hester, R., Miller, W., Delaney, H., & Meyers, R. (1990, November). Effectiveness of the Community Reinforcement Approach. Paper presented at the 24th annual meeting of the Association for the Advancement of Behavior Therapy, San Francisco, California.
Hoch, P. (1955). Aims and limitations of psychotherapy. American Journal of Psychiatry, 112, 321–327.
Hubble, M., Duncan, B., & Miller, S. (1999). The heart and soul of change: What works in therapy. Washington, DC: American Psychological Association.
Kazdin, A. E. (1980). Acceptability of alternative treatments for deviant child behavior. Journal of Applied Behavior Analysis, 13, 259–273.
Kelly, G. (1955). The psychology of personal constructs. New York: Norton.
Kohut, H., Stepansky, P., & Goldberg, A. (1984). How does analyses cure? Chicago: University of Chicago Press.
Krupnick, J. L., Sotsky, S. M., Simmens, S., Moyher, J., Elkin, I., Watkins, J., & Pilkonis, P. A. (1996). The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: Findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Project. Journal of Consulting and Clinical Psychology, 64, 532–539.
Lambert, M. J. (1992). Implications of outcome research for psychotherapy integration. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 94–129). New York: Basic Books.
Lazarus, A. (1992). Multimodal theapy: Technical eclecticism with minimal integration. In J. Norcross and M. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 231–263). New York: Basic Books.
Lazarus, A. (1993). Tailoring the therapeutic relationship, or being an authentic chameleon. Psychotherapy, 30, 404–407.
Luborsky, L., Singer, B., & Luborsky, L. (1975). Comparative studies of psychotherapies: Is it true that “everyone has won and all must have prizes”? Archives of General Psychiatry, 32, 995–1008.
Martin, J. (1988). A proposal for researching possible relationships between scientific theories and the personal theories of counselors and clients. Journal of Counseling and Development, 66, 261–265.
Miller, S. D., Duncan, M. A., & Hubble, M. A. (1997). Escape from Babel: Toward a unifying language for psychotherapy practice. New York: Norton.
Norcross, J. (1997). Emerging breakthroughs in psychotherapy integration: Three predictions and one fantasy. Psychotherapy, 34, 86–90.
Norcross, J., & Goldfried, M. (Eds.) (1992). Handbook of psychotherapy integration. New York: Basic Books.
Norcross, J., & Beutler, L. (1997). Determining the relationship of choice in brief therapy. In J. N. Butcher (Ed.), Personality assessment in managed health care: A practitioner's guide. New York: Oxford University Press.
Reimers, T. M., Wacker, D. P., Cooper, L. J., & De Raad, A. O. (1992). Acceptability of behavioral treatments for children: Analog and naturalistic evaluations by parents. School Psychology Review, 21, 628–643.
Safran, S., Heimberg, R., & Juster, H. (1997). Client's expectancies and their relationship to pretreatment symptomatology and outcome of cognitive-behavioral group treatment for social phobia. Journal of Consulting and Clinical Psychology, 65, 694–698.
Saltzman, N., & Norcross, J. (Eds.) (1990). Therapy wars: Contention and convergence in differing clinical approaches. San Francisco: Jossey-Bass.
Scheel, M., Conoley, C., & Ivey, D. (1998). Assessing client positions as a technique for increasing the acceptability of marriage therapy interventions. American Journal of Family Therapy, 26, 203–214.
Tallman, K., & Bohart, A. (1999). The client as a common factor. In M. Hubble, B. Duncan, & S. Miller, (Eds.), The heart and soul of change. Washington, DC: American Psychological Association.
Torrey, E. (1972). The mind game. New York: Emerson Hall.
Tracey, T. (1988). Relationship of responsibility attribution congruence to psychotherapy outcome. Journal of Social and Clinical Psychology, 7, 131–146.
Wampold, B. E. (1997). Methodological problems in identifying efficacious psychotherapies. Psychotherapy Research, 7, 21–44.
Watzlawick, P., Weakland, J., & Fisch, R. (1974). Change: Problem formation and problem resolution. New York: Norton.
Webster's collegiate dictionary (10th ed.). (1993). New York: Merriam Webster.
Wile, D. (1977). Ideological conflicts between clients and psychotherapists. American Journal of Psychotherapy, 37, 437–449.
Wilford, J. (1986). The riddle of the dinosaur. New York: Knopf.
Witt, J. C., & Elliott, S. N. (1985). Acceptability of classroom interventions strategies. In T. Kratochwill (Ed.), Advances in school psychology (pp. 251–288). Hillsdale, NJ: Erlbaum.
Worthington, R., & Atkinson, D. (1996). Effects of perceived etiology attribution similarity on client ratings of counselor credibility. Journal of Counseling Psychology, 43, 423–429.
About this article
Cite this article
Duncan, B.L., Miller, S.D. The Client's Theory of Change: Consulting the Client in the Integrative Process. Journal of Psychotherapy Integration 10, 169–187 (2000). https://doi.org/10.1023/A:1009448200244