Problem, Pattern and Process levels of change
I wrote this reflection for our pre-practicum class at the University of Rochester. The professor asked us to reflect on our readings regarding treatment planning.
This week, I reflected on treatment planning as covered by our assigned readings. The materials I used were Chapter 10, "Diagnosis and Treatment Planning", in Sommers-Flanagan & Sommers-Flanagan's (2015) Clinical Interviewing, with a specific focus on the treatment planning section, and Chapter 4 in Marquis' (2007) The Integral Intake, "Putting it All Together", with a specific focus on Integral Treatment planning and a case study. Sommers-Flanagan & Sommers-Flanagan begin by explaining how client problems and a case conceptualization can inform treatment planning. It covers the "Psychosocial" and the "Biomedical" treatment planning modules, along with noting the differences between each. Biomedical focuses on mental illness as a disease with the treatment team as experts. Psychosocial puts more emphasis on psychological and sociocultural experiences, as well as more collaboration and less diagnosis. The chapter then looks at evidence-based treatment and the pros and cons of these, then, in contrast, looks at the therapists themselves and the therapeutic relationship as primary in treatment. The chapter then went through a case study and described the necessity for multicultural competency.
Marquis begins by describing the types of goals individuals may have for therapy, from solving a problem to working on a pattern to transforming an entire process. Marquis then describes that for deep change, we need more than surface-level changes and CBT as a tool; instead, we may need an Integral Life Practice (ILP). An ILP has a persistent focus on wholesale life changes to enable deep pattern and process development. Developing an ILP can begin with self-esteem development, via physical, emotional, mental, and spiritual activities. Not only within oneself, but within one's community and social environments, placing focus on service, harmony with nature, and relationships. We then focus on a case study of Gary, a 25-year-old gay and Caucasian identifying man. We go through a complete "AQAL" (All Quadrants All Levels) Integral Intake, then documentation of his case narrative and treatment plan.
The first question that came to mind for me emerged from reading Sommers-Flanagan & Sommers-Flanagan. What do we do if a client has multiple interrelated problems? How do we decide in which order to treat them? It seems the best approach is to follow the lead of the client and address them in the order the client wishes to. Marquis also describes three different types of change, “Problem vs Pattern vs Process” change. "Process" change sounds the most exciting, these are clients who wish to change at a deeper level. Yet we may need to start with problem or pattern level change until the client is ready for deeper process level change.
As a counselor I aspire to work work more holistically and use techniques from the psychosocial and biopsychosocial school of thought rather than just problem diagnosis and symptom treatment. “Pattern" and "Process" is deeper and more complex that "Problem" work. It also seems more interesting to work across all quadrants with a client and not be limited to just inner quadrants, or upper left, where it seems most psychology lives. Process work seems like it takes a lot more skill and therefore would require more time to successfully do.
