Turning Points in Therapy: Discursive Analyses and Therapist Comments

Re-visioning a Model of Clinical Judgment for Systemic Practitioners

“…The results of this study are consistent with the work of others conducting qualitative clinical process research on couple and family therapy (e.g., Harvie et al, 2008;Rober et al, 2008aRober et al, , 2008bStrong et al, 2006). In a way, their work provides a form of triangulation (Stake, 2005) with our work that lends credibility to our respective descriptions.…”

“…Research on the processes of couple and family therapy is needed (Heatherington, Friedlander, & Greenberg, 2005), and detailed descriptions of the processes of systems therapy have begun to emerge (e.g., Harvie, Strong, Taylor, Todd, & Young, 2008;Rober, Elliott, Buysse, Loots, & De Corte, 2008a, 2008bStrong, Zeman, & Foskett, 2006). However, it seems to us that, as Wampler (2010) noted, couple and family therapy research simply has not kept pace with research in the other clinical disciplines.…”

A Recursive Frame Qualitative Analysis of MFT Progress Note Tipping Points

“…They also provide some evidence as to the content, process, and outcome of progress notes constructed by master's students learning to become competent discursive therapists. Future research on (a) progress notes from a variety of programs and levels of therapists and different presenting problems and client configurations; (b) tracking the development of individual therapists' documentation competencies; and (c) comparing and contrasting progress notes with recordings of the corresponding sessions, therapists and clients' self-reports (e.g., Harvie et al 2008), and/or objective measures all seem to be viable next steps in the process of learning more about documenting therapeutic progress.…”

“…In positive resolution cases such as this one, the research team observed that the therapist noted times when the focus shifted from problem to solution-focused discourse, and that these ''tipping points'' (Gladwell 2000) or ''turning points'' (Harvie et al 2008) seemed to continue on through the case as a positive resolution ultimately was recorded by the therapist. In these cases, even if the problem came back up in conversation, the focus on a solution seemed, as Gladwell would term it, ''sticky'' enough to allow therapists to encourage clients to keep looking for the positive exceptions and the next steps towards the miracles and to help the flow of the session to tip back towards a solution point.…”

“…In the remaining seven of the 10 cases coded as negative or unclear (i.e., Cases 14,15,18,21,23,29,and 30), it seemed from the team's review of the case documentation that either solution-focused techniques were not used (e.g., Cases 14, 18, 29, and 30) or if they were (i.e., Cases 15, 21, and 23), the therapists' noted that the exception assignments and scaling questions appeared to be focused on the problems, so the researchers could find no tipping point (Gladwell 2000) or turning point (Harvie et al 2008) (i.e., when the flow of progress appeared to turn on a solution-focused course to positive resolution). For example, in Case 15, Sessions Two and Five, the therapist chronicled what appeared to be multiple unsuccessful attempts to encourage the clients to try new things instead of trying to notice more of the positive things they might already be doing: Session Two: ''Issue of communication was explored, areas where complication pattern could be improved was identified and will be attempted in the home;'' and Session Five: ''Therapist discussed alternate ways of managing their anger and feelings of frustrations.''…”