A Review of Collaborative Therapy
Psychology has been known to use different approaches in the discovery and mitigation of psychological problems that include stress and mental disorders. These approaches largely follow both theoretical and philosophical premises in the exploration of solutions to the psychological problems. Among the approaches used in mental therapy is collaborative therapy, which in essence refers to therapist collaboration with a number of other organizations and individuals in relation to find a solution to a client’s problem (Sanders, 2011). The idea of collaborative therapy is therefore to employ medical therapies fashioned in such a way that they help the patient, and which are undertaken using combined efforts, such as several specialists working with a doctor in helping a patient. The purpose of collaborative therapy, therefore, is largely within the auspices of developing and promoting high-quality recovery-focused mental healthcare (Castle & Gilbert, 2006). With such a profound aim, collaborative therapy looks into conversations, dialogue processes, and relationships as the core tools, which the therapy employs in its approach to treatment (Vazquez, 2011). The belief in this approach is that with cooperation and good practices among the partners involved in the treatment of the patient, it is possible to achieve more and at a faster rate, and most importantly make the therapy easier for the patient (Castle & Gilbert, 2006). The collaboration among different parties involved in the treatment of the patient therefore makes it possible for a deeper involvement in the treatment by the therapist given that the therapist gleans information about the patient from other parties involved in the treatment. On the other hand, such information may not be readily available for the therapist through the patient. The additional information and the agreement on collaboration towards the interest of the patient therefore offer an encouraging point of departure for both the therapist and the client. Collaborative theory, however, contrasts with other postmodern therapies, such as narrative and solution-focused therapy. In exploring collaborative therapy, it will therefore be necessary to contrast its underpinnings with other postmodern approaches, especially given that at one point these postmodern approaches exude a commonality with a social constructionist epistemology (Monk & Gehart, 2003; Anderson & Gehart, 2006).
The development of collaborative therapy stems from family therapists through commonly shared practices. Among these practices are the ideas of egalitarianism (not-knowing position), a generation of compound perceptions on creation of new meaning and the non-interventionist objectives in therapy (Monk & Gehart, 2003). These therapists, therefore, ground their ideas in the constructionist take that therapists do not indeed possess intrinsically superior knowledge. This assumptionis founded on family therapy’s longitudinal and close association with cultural anthropology. The aforementioned association foreshadows the “emphasis upon the curious posture of the therapist/anthropologist to learn more about the cultural meanings attached to human behavior” (Monk & Gehart, 2003, p. 20).
Collaborative therapists therefore insist that the therapist must take a not-knowing stance in the therapeutic interactions. This is in line with the postmodern thought in which therapists are required only to observe, describe, and explain human behavior with objectivity, consequently only relaying the story of the client as as it is supposed to be (Sanders, 2011). The role of the therapist in the treatment is therefore that of inviting client’s views and elucidation into the dialogue to encourage democracy; in essence, fostering a two-way exchange of ideas and expanding on possibilities (Monk & Gehart, 2003). The stance here is therefore nonhierarchical, in which both the therapist and the client are at the same level, with one having more knowledge than the other, especially the therapist.
The interest here is largely on the working affiliation between the client and the therapist. Important for this is particularly the change in the power affiliation between the two. Specifically, this points to the change in power—of the client understanding his/her position of either authority or equity within the framework of the therapeutic intervention. The stress in the new relationship is that of collaboration between the therapist and the client in shaping the mode of the treatment together. Even in such a renewed relationship, however, the therapist must remain interested and curious of the client’s plight, while maintaining aloofness to his/her knowledge on solving the patient’s problem (Gehart, 2010).
The association between the two will largely be based on conversation. The idea and assumption in the development of a close and peer type of relationship between the client and the therapist is that by having these normal conversations, the dialogues in their own right will lead the client to where he/she is required to explore. The argument here is that instead of the therapist analyzing what the client has provided, the dialogue in essence allows for the natural analysis of the situation by the client, through the client’s own personal knowledge of his/herself, which is far more in depth than what the therapist knows of the client (Gehart, 2010).
What sets collaborative apart therefore is the emphasis and weight they give to these conversations. Collaborative therapists consider dialogical processes as their principal tools, distinguishing them from other therapists, who, while also do employ the use of dialogue, do not put trust on the generative capacity of the conversations between the client and therapist as collaborative therapists do (Vazquez, 2011). This is in addition to collaborative therapists’ emphasis on the importance and significance of the therapeutic relationship that they cultivate with the clients. Thus, collaborative therapists stand out in their practice by not putting their confidence in the procedures and models used in psychotherapy, but in the relationship that they establish with the client (Vazquez, 2011).
Breaking down hierarchy and taking the no-knowing stance opens an invitation to multiple incongruous views into the therapeutic conversations. Such freedom and giving voice allows the generation of arid and exploration of new perspectives meaning as a group (Monk & Gehart, 2003). Thus the invitation of multiple voices within conversations opens a dialogue regarding the therapy process, and eventually creates a problem-determined system, one which organizes itself within the precincts of definition, linguistically, of the problem. Therefore, “As differing understandings and perspectives about the problem are exchanged in a dialogical process that is not aimed at generating a single problem description, the participants’ construction of the problem(s) shifts, allowing for new thoughts, emotions, and actions in relation to the problem” (Monk & Gehart, 2003,p. 21). The result of the procedure is the dissolution of situational interpretation of the process as a problem.
Approaches to getting multiple voices into the conversation also include the solicitation of reflecting teams for the generation of multiple perspectives on the client’s condition. Such approaches include letter-writing sessions with conjectural descriptions, which provide room for expression of inner thoughts (Monk & Gehart, 2003). Additionally, like narrative therapies, using stories, narrative, and jokes help remove the fixation of meaning within the whole process. While these approaches may really not be interventions per se that help the client, they form avenues through which therapists can invite new perspectives into the conversation, with the hope that in being in the new voice and perspective, there are possibilities of gaining new understanding into the situation.
The approach into collaborative therapy in this case, therefore, delves into the collaborative efforts of different professionals within the medical field and the establishment of a relationship between the client and the professional (Sanders, 2011). Among the most common collaborations, in this case therefore, occur amid therapists and counsellors. Given the propensity to see a therapist for psychopharmacological clients, both the psychiatrist and the therapist can have a successful working relationship towards the support of the client. Such collaborations follow the recognition that recovery for the client and chronic healthcare models are not separate entities, but rather that as an individual process, it is possible to facilitate recovery through the deployment of a model of care espousing the reality of mental illness and incorporating both the management of chronic episodes with longitudinal health need (Castle & Gilbert, 2006).
Through collaborative therapy, it is therefore possible to undertake medication therapies as a collaboration, with a number of doctor’s offices offering a diverse range of experts to help clients. Such collaborations may therefore involve the working of a psychiatrist and nutritionist, for instance, working with the same client. These, therefore, both work within the framework of collaborative therapy, and may include other services working methodically towards the realization of optimum mental health outcomes (Castle & Gilbert, 2006). Such a collaborative is particularly advantageous to the client professionals within a facility to have access to the client’s records, fluidly aiding in the excellent flow of information among the practitioners. That said the purpose for the sharing and collaboration “is to deliver, within mainstream services, comprehensive psychosocial treatments that are evidence-based and individually tailored. The ability to individually tailor treatments thus allows for the incorporation of personal definitions of recovery” (Castle & Gilbert, 2006, p. 467).
Allowing access to client’s information among different practitioners allows, as earlier mentioned, generation of alternative measures in finding solutions to the client’s situation (Gehart, 2010). Within a practitioners’ office, therefore, it is possible to hold team meetings for experts’ collaboration on a patient’s case in determination of the best medical course. Noteworthy, however, is the fact that such measures are less commonly practiced, yet they have shown high rates of patient satisfaction among specialist practitioners employing it. In such cases, the three collaborative therapy components become the focal point of the therapy (Lester & Gask, 2006).
According to Castle and Gilbert (2006), engagement of the three components first involves the comprehensive screening in an attempt to find matters that may be hurdles to the access of treatment. The screening in this case also involves psychiatric comorbidity. Secondly, mapping of partners for collaboration is done, especially those in agreement for involvement in client’s care (Castle & Gilbert, 2006). The list of collaborative partners is long and requires vetting to provide the best collaboration for the client’s welfare. The partners therefore in this case include the general practitioners, family members, counselor, vocational workers, and psychiatrists. The partners essentially work together and openly towards the planning of the client’s healthcare (Castle & Gilbert, 2006).
Even in its involvement of other actors in the care and therapy of clients, collaborative therapy remains trained towards the individual. Indicators to the commitment of the therapy is evident in the fact that even with the possibility of conducting the therapy in a group or on a one on one basis, all the diagnostic tools and processes are held by the client (Castle & Gilbert, 2006). It is possible, therefore, that the therapy could last up to 12 weeks followed by booster sessions running over a 9-month period. Through this period, the models adopted (self-efficacy and self-reliance) both aim at providing the client with self-stability. Collaborative therapy, therefore, provides the client with mediation components that have beneficial and provided efficiency to other fields and intervention areas, such as coping and relapse prevention approaches and psychoeducation (Castle & Gilbert, 2006).
Such intervention measures continue to present the uniqueness and efficacy of collaborative therapy. The measures do not however stop there, but go further to the fact that the therapy’s framework is sensitive to “the structure, resources, and staff-mix of particular services, and meets all consumers’ needs” (Castle & Gilbert, 2006, p. 467). Such a mix ensures optimum likelihood in the development of components within the framework of the therapy, and that the components are infused within regular service delivery structures.
The fascination of collaborative theory goes beyond the conversation between the client and therapist and between the therapist and other players within the whole therapeutic process. Collaborative therapists remain curious of the types of conversations that generate possibilities for individuals: the very elements of conversations with the ability to transform the life of the client (Vazquez, 2011). Therefore, although other therapies also work from conversations, the collaborative approach goes to the basic of the conversation. According to Vazquez (2011), the part played by language and meaning exuded from language in individuals is essential for collaborative therapists who view individual’s woes as being entrenched in their language, chronicles, and relationships. Under such an assumption, therefore, therapy becomes a mangle of dialogue and relationship (Gergen, 2006). The mode of the therapists’ participation in dialogues and the building of these dialogues thus become the resources for widening and creation of possibilities: the very fundamental component of collaborative therapy (Vazquez, 2011).
Given the discovery in the dialogical process, collaborative therapy views the difficulties and quandaries faced by most couples as attributes of the kind of dialogues that such couples have sustained. In providing interventions to such a couple, therefore, “the task of therapists would be to establish a collaborative process as a generative space where couples can have new conversations, retake old ones, or transform them” (Vazquez, 2011, p. 49). The therapy therefore begins by the exploration of the clients’ peculiar comprehensions and theories on the difficulties that drove them to the therapy. Such a dialogue is absent of psychological problem reviews, analytical classifications or approaches for change (Vazquez, 2011). Vazquez’s (2011) contention on collaborative therapy herein is that it is through conversations that individuals create and model life experiences and events, in addition to building and rebuilding the realities, relationships and the individuals themselves. From this, it is true to consider the idea of possibilities emerging through conversations. New openings for the relationship consequently also emerge via the conversation, and not particularly through preconceived approaches formulated by an author or ideal. The couple, through collaborative therapy, hence creates the possibilities for the relationship with assistance from the therapist (Vazquez, 2011).
The essence of collaborative therapy,for that reason, is not on influencing or making sense out of the narrative of the clients. Instead, collaborative therapy only offers a new way for people, especially couples, to understand their life tussles and relationships (Vazquez, 2011). All these come, not from the therapist perspective or preconceived models, but through out of a natural consequence of the new way of dialoguing (talking and listening) (Sanders, 2011). The inquiries, a formulation of the therapist, are therefore an integral part of the conversation, and are hinged upon the necessity of knowing more about what has been uttered or the unknown factors in the relationship thus far (Vazquez, 2011).
Such thoughts on the importance of dialogue for collaborative therapy, especially when dealing with couples are shared by Anderson. For Anderson (2007), language creates the connotations and comprehension of life’s experiences. For that matter, Anderson argues that language is the vehicle for the transformation of meaning and experience. The standpoint of this argument is that through collaborative therapy, couples find an avenue for communication. Engaging in meaningful conversations in which they not only talk to one another and between one another, but also with themselves. Such dialogues have a transformative effect on the couples, providing an interactive process of interpretation of interpretation (Anderson, 2007).
Collaborative therapy presents compelling observations and ideas of the relationship between the therapist and the client, as well as between the client and the team responsible for undertaking the therapy. Noteworthy however is the fact that the fundamental ideas of collaborative therapy are replicated, or similar to those of other postmodern therapies. The replication of the ideas is visible in both narrative and solution focused brief therapies. Perhaps the similarities in the fundamental bases of the three therapies stems from the fact that they are based upon social constructionist epistemology (Monk & Gehart, 2003). Noteworthy, however, is the fact that even in their commonality within social constructionist epistemology, there are also fundamental differences among the three that set each of the theories apart from the others. It is imperative therefore to note the differences and similarities among the three therapies. Even in looking at the similarities and difference among the three, it is important to state that there are an even larger proportion of similarities between narrative and collaborative approaches than there are with the two and solution focused brief therapy (Monk & Gehart, 2003).
Putting importance on the narratives of the client for collaborative therapy is largely similar to the tenets of narrative therapy. The pivotal tenet of narrative therapy, like collaborative therapy, is the essence of stories of an individual and the fact that the stories are a representation of the experience of the individual in life (Monk & Gehart, 2003). Narrative therapy, therefore, agrees with collaborative theory over the pivotal role of individuals in the creation of their realities, even as the realities may as well be subject to the different experiential interpretations.
However, while collaborative therapy sees these narratives as an avenue through which individuals can discover themselves, and in the case of a couple find new way of conversing (Vazquez, 2011), narrative therapy considers the narratives, which are a version of reality as a “double-edged sword.” Thus, each version of the reality that individuals discover has the potential of giving beneficial meaning, but also put the individual in danger of having negative connotations.
Narratives also in a way form the starting basis of the solution focused based therapy. Therapists using this approach allow narration from the clients, although to a minimum level, as a way of minimizing pre-set ideas (Stalker, Levene&Coady, 2009). According to these therapists, focus on the past largely translates to “problem talk” having no consequence on the future, and should therefore be kept to the minimum. The therapists’ idea of keeping narrations to a minimum are in line with collaborative therapy, which sees new opportunities for the client emerging through the conversation, and not particularly through preconceived strategies formulated by an author or ideal.
The epistemological premises of both collaborative and narrative theories are evident in their assumptions on reality and knowledge. Having foundations in social constructionist perspective, both narrative and collaborative therapies see reality not as a singular or objective, but rather as an individual production, which can in fact be changed (Monk & Gehart, 2003). This is a belief that is also present among solution focused based therapists who believe in the creation of meaning for aspects of presenting a problem, and that solutions are indeed harbored in changing the context of interactions, within the peculiar constrains of the situation (Stalker, Levene & Coady, 2009). The relativity of reality therefore cuts across the board for the three therapies. This is largely based on their foundations in social constructionist perspective. On the same stance, collaborative and narrative therapies underscore the intricacy and diversity of human functioning, thereby contending the inability of obtaining essential comprehensions on transcendence. Through social constructivism, the two therapies (collaborative and narrative) therefore seek to recognize the contextual and interpretive understanding of existence through the therapeutic processes (Monk & Gehart, 2003).
A comparison between collaborative and SFBT therapies further shows similarities in the belief of the approaches. Through dialogue between partners and within each partner, there is the possibility of finding solution to the problems that partners have in their relationship. Of similar opinion is SFBT, which according to Stalker, Levene & Coady (2009), contend that clients have the necessary resources within themselves to change. The role of the therapist, and this is where it contrasts with collaborative therapy, is to know where to look and give solution to the client. Collaborative therapy sees the role of the therapist as only a facilitator to self-discovery, a resource for widening and creating possibilities, and not as a pointer to the solution as SFBT therapy suggests (Stalker, Levene&Coady, 2009;Vazquez, 2011).
The idea of language is yet another similarity between collaborative and narrative theory. Their assumption stems from the social constructionist attention on language as a principal means of the construction of meaning. The contention here relays Social constructionist epistemology, which underscores the role, as an intermediary, of language on human action and experience (Monk & Gehart, 2003). The two therefore consider language as an “active relational process with real effect, rather than a passive representational medium” (Monk & Gehart, 2003, p. 25). Falling in line with the idea of language is SFBT, which sees therapy as a task that involves several language game. The game in this case is simply a system of shared meaning and behavior, from which the therapist assist the client in finding solutions to the problems (Stalker, Levene & Coady, 2009). The idea of language for SFBT comes from the evolution of the therapy, which has moved from the consideration of changing a client’s behavior, to the language, interactional and conversational features of conducting therapy (Stalker, Levene & Coady, 2009).
Relatedly, with the idea of language as the core for construction of meaning, both narrative and collaborative therapy see the construction of language in creation of meaning as relayed within a sociocultural and relational context, and not within an individual. Attempts on performing therapy therefore concentrate on the socially constructed conversations, and the chronicles presented by clients (Monk & Gehart, 2003). The two also emphasize on the effects of the society and relationships that one has on the development of a person’s identity. Thus, the very identity that a person presents is a result of the transformation, sustenance, and development of the identity by relationships with both close proximity to the individual and within the society at large (Monk & Gehart, 2003).
When broken into its bare minimum, SFBT is in fact a collaborative therapy. It is for this matter that although the founding philosophers did not see the necessity of an observing team, they considered a break necessary for the therapist to consult with a team (Stalker, Levene & Coady, 2009). Thus, although the team may not come into direct contact with the client, it does help the therapist prepare compliments for the client, basing them on the useful actions by the client. The idea of a team is present in collaborative therapy, where several specialists have sessions with the client, all working towards the betterment of the client (Castle & Gilbert, 2006).
In accepting the use of a team, as is the case of collaborative therapy, SFBT goes further than just involving other specialists in assisting the client. Evolving therapists in subscribing to the ideas of SFBT also accept the concept of building a relationship between the client and the therapist. As a concept known as “fit,” SFBT acknowledges the need for developing an appropriate connection between the client and the therapist (Stalker, Levene & Coady, 2009). This is an idea that is already in practice in collaborative therapy, which insists on the importance of building a relationship between the client and the therapist, as well as the team of people who include specialists and family members working towards total recovery of the client (Gehart, 2010).
In its practice, collaborative therapy insists on the claim of non-commitment to a particular therapeutic stance or direction. Critics, however, point out that the practice is indeed both purposeful and deliberate (Monk & Gehart, 2003). The premise within which collaborative therapy is founded (social constructivist epistemology) has a dedication to facilitating the production of diversity in voices, and therefore has a motivation to follow a singular direction for the therapeutic process. Further critique of the therapy indicates the intentional and purposeful placement of the conversational partner in the therapy. Additionally, the fact that the therapy does not acknowledge the sociopolitical aspects of life and its effect on people is a concern of many collaborative therapy critics. Critics’ concern for the disinterest is thus profound in that they argue, “at best, it restricts the therapist’s option to assist the client, and at worst, it adds to the client’s oppression” (Monk & Gehart, 2003, p. 28).
Collaborative therapy encompasses the combination of different medical and therapeutic strategies in its attempt to promote recovery and wholesome mental health. It encourages building relationship between the client, the therapist, and other individuals involved for a supportive therapeutic regimen. The approach follows the social constructivist perspective within the auspices of postmodern thought on therapy, which presents the role of the therapist as a catalyst to conversation, and not necessarily an authority in knowledge on the clients concerns. The therapy, therefore, insists on the therapist helping the clients to find solution on their own, and in case of couples, initiate dialogues in which the couples discover the sources of their conflict themselves and hopefully come to terms with their own realities. By taking a not-knowing stance, therapists are able to understand the experiences that the clients live and in so doing, avoid the prediction, interpretational, and pathology efforts. Further, collaborative therapy displays several similarities between it and other postmodern therapies, largely founded in social constructionist perspectives. Narrative and SFBT therapies thus share commonalities with collaborative therapies that include the acknowledgment of the intricate nature of human existence, and therefore an attempt to find meaning through language, interactions, and conversations. An expanded inquiry into collaborative therapy reveals more similarities between collaborative and narrative therapies.
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