Client Self-Generated Pretreatment Changes: Flukes or the Real Deal?

Client Self-Generated Pretreatment Changes: Flukes or the Real Deal?

Many therapists underestimate their clients’ resourcefulness, creativity, and resilience and make the assumption that client self-generated pretreatment changes are flukes and lack staying power. The fact of the matter is, a growing number of studies and clinical practice experience indicates that clients’ self-generated pretreatment changes and self-healing processes persist well beyond the conclusion of therapy (McKeel, 2012; Selekman, 2009; Allgood et al., 1995; Weiner-Davis et al., 1987). These self-generated changes can take many forms, such as: abandoning unproductive attempted solutions and views about their situations, creative problem solving and coping strategies, having epiphanies, and unique self-empowering serendipitous practices and contexts that offer them valuable ideas and wisdom regarding how to resolve or better cope with the difficulties they are facing. As our clients have repeatedly indicated to us, their self-generated changes are the real deal, not flukes and flights into health, but useful solution-building patterns of thinking and action that can be transformative.

My colleague and friend Michele Weiner-Davis used to have a sign in her office that read: “Please solve your problems before you come in here so I can help you more.” Clients are truly the experts and our jobs are to elicit their expertise. This is why we like to routinely give our new clients the following pretreatment experiment to do before they come in for their first appointments:

“Over the years, my colleagues and I have been so impressed with how resourceful, creative, and resilient are new clients had been. Well before we saw them for the first time, they had already taken some important steps toward resolving or better coping with their difficulties.  In order for me to learn more about your strengths and resourcefulness, I would like you to pull out your imaginary magnifying glass and daily carefully observe for any responsible, respectful, and other positive behaviors you notice occurring with your partner/son/daughter/yourself that you would like to continue to have happen. Also, pay close attention to what you may be doing during the times when you and your partner/son/daughter are getting along better, and write down all of your important discoveries and bring your list to our meeting next week. I look forward to hearing what further progress you had made!”

After receiving this pretreatment experiment on the telephone, some clients call back a few days later saying, “Things are not that bad, we are going to hold off for awhile.” More often then not, clients come to their first sessions armed with lists of 5-10 self-generated changes they are eager to report. A whole hour can be devoted to amplifying and consolidating their gains, and in some cases, the one session may be all that they need to make a go of it on their own. Otherwise, the first session has become like the second session for them, lengths of stay in counseling can be greatly reduced, and the clients are further empowered to achieve the solution-determined outcomes they wish to have.

 Category: Therapeutic Alliance Building Strategies      Tags:

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