mri strategic eclecticism

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Psjdiotherapy Volume 27/Winter 1990/Number 4

STRATEGIC ECLECTICISM: A TECHNICAL ALTERNATIVEFOR ECLECTIC PSYCHOTHERAPYBARRY L. DUNCANDayton Institute for Family Therapy M. BERNADINE PARKSPersonal Performance Consultants, Inc.

GREGORY S. RUSKDayton Institute for Family TherapyThe development of an eclecticparadigm has been hampered byfundamental differences in theoreticalconceptualization. This article proposesa technical eclecticism that extendsa strategic model to include thecontributions of diverse therapyapproaches. A strategic eclecticism ispresented that attempts to maximizecommon factor effects, as well as toenable the selective application of bothcontent and technique from mu ltiplemodels of psychotherapy.

The desire for a prescriptive specificity whichwould enhance the efficiency and efficacy of psy-chotherapy has fueled interest in the developm entof an eclectic paradigm for clinical practice (Nor-cross, 1986). Unfortunately, fundamental philo-sophical and theoretical incompatibilities amongapproaches may preclude the development of anintegrated, unitary model of psychotherapy theoryand practice. While theoretical integration offersthe greatest intellectual appeal, technical eclec-ticism (integration of technical procedures withina preferred theory base without requiring a con-nection between metabeliefs or theoretical under-pinnings) may provide the least obstructed routeto a broadly based prescriptive specificity (Lazarus,1967; Norcross, 1986).The authors gratefully acknowledge the invaluable input of

Barbara H eld, Mary Ann K raus, and the anonymous reviewers.Correspondence regarding this article should be addressedto Barry L. Duncan, D ayton Institute for Family Therapy, 65

W. Franklin Street, Centerville, Ohio 45459.

Ad dressing the problem of inherent content dif-ferences between theories, Goldfried and Safran(1986) suggest that integration efforts might bestbe attempted at an "intermediate" level of ab-straction, i.e., the level at which the commonprinciples of change operate. Supportive of thisargument is Lam bert's (1986) work which suggeststhat positive outcome is in large part related to"common factors." Garfield (1986) argues for aneclecticism based in these com mon or nonspecificfactors which characterize successful approachesto psychotherapy. Given the findings relative tocommon factors and orientation specific factors(technique), an eclecticism emphasizing commonfactors as w ell as the selective application of specifictechniques m ay yield promising results (Garfield,1986; Lambert, 1986).

This article offers a rationale for a technicaleclecticism that extends the strategic model of theMental R esearch Institute (MRI) (Fisch, W eakland& Segal, 1982) to include the contributions ofdiverse psychotherapy approaches. This eclecticframework has evolved from earlier efforts utilizingan MR I approach within other psychotherapy ori-entations. Held's (1984) proposal for a strategiceclecticism advocates for the use of the MRI re-sistance minimizing interventions within any ori-entation to enhance comp liance to therapeutic di-rectives. Held (1986) expands her position byasserting that the MRI problem formation modelis relatively void of specific theoretical content,thereby enab ling a strategic use of theoretical con-tent from any approach to design interventions.

Narrowing the focus of Held's strategic eclec-ticism, Duncan, Rock and Parks (1987) proposean integration between MRI strategic and cog-nitivebehavioral approaches based on their manysimilarities and complementary domains of ex-pertise. Using a behavioral view as an example,

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Strategic Eclecticismthey suggest that an MRI model may provide aflexibility which allows for the use of techniquefrom a variety of approaches (Duncan et a l., 1987).Expanding the MRI m odel, this article presentsan evolving strategic eclecticism (D uncan , 1984,1989; Duncan & Parks, 1988; Duncan, Parks &Rusk, 1990; Duncan et al. , 1987; Duncan & So-lovey, 1989), conceptually based in systems theoryand constructivism, that attempts to maximizecommon factor effects as well as enable the se-lective application of diverse psychotherapy tech-nique, languag e, and conten t. The theoretical andpragmatic assumptions underlying a process ori-ented, constructivist rationale for strategic eclec-ticism is discussed and illustrated with clinicalexamples.A Process Constructive Descriptionof Eclecticism

The theoretical foundation for strategic eclec-ticism is built upon two primary concepts, con-structivism (Von Foerster, 1981; Watzlawick,1984), and a systems view of process, derivedfrom the works of Buckley (1967), the MRI (Fischet al., 1982; W atzlawick, Weak land & F isch,1974), and Held (1986).ConstructivismThe constructivist position holds that individualsdo not discover "reality"; rath er, they invent it(Watzlawick, 1984). Reality is evident throughthe constructed meanings which shape and organizeexperience. Simply put, meaning is reality. Thecreation of meaning frames and organizes per-ception and experience into rule governed patternsthrough which individuals predict, describe, anddirect their lives.Two levels of meaning construction are positedby Buckley (1967). Initially, meaning is createdduring the ongoing interaction between an indi-vidual and the social environment. The humancapacities for symbol manipulation and selfawareness enable a second level of meaning con-struction. Humans can continue to experience atransaction entirely at a covert level, permittingthe continuous generation of meaning apart fromthe actual transaction(s). Therefore, a meaningsystem can be said to be generated by the actualtransactional experien ce, its covert rehearsal, andthe meaning constructed to organize both (Buckley,1967).

The inherentflexibilityof the constructivist viewbears implications for technical eclecticism.

Therapists, like clients, endeavor to create a pre-dictable, structured reality. Models of psycho-therapy and hum an development o rder and organizethe clinician's perception and experience regard-ing the client's presenting concerns. Paradoxically,the structure which the therapist selects also limitsthe search for solutions. From a constructivistvantage point, theoretical language and contentconceptualizations may be viewed as somewhatarbitrary metaphorical representations which ex-plain and organize the therapist's "reality." Atechnical eclecticism therefore may be facilitatedby a preferred theory base that allows for a moreflexible therapist reality.Process Level Systems

According to Buckley (1967), systems may beclassified at three levels, each applicable to a spe-cific domain, i.e., mechanical/equilibrial (inor-ganic, chemical, and mechanical systems), or-ganismic/homeostatic (biological systems) andprocess/adaptive (social system s). At the process/adaptive level, p rocess is primary; structure, whichis fluid and ever changing, is created through theactions and interactions of system members andtheir continuously developing re la t ionships.Structure is but a temporary, accomm odating rep -resentation of an ongoing process. U nlike biologicalsystems, characterized by fixed structures (e.g.,the hypothalamus) which perform recognizableand invariant functions across systems (e.g ., tem -perature regulation), social systems are possessedof no immediately identifiable structures of in-variant function.

Inherent to process level systems is a capacityfor evolution and elaboration; these systems arenot only sensitive to change (variation), but areessentially dependent on chang e to remain via ble.Individual and shared meanings constructedthrough the interaction surrounding the variationboth guide and are shaped by the ongoing inter-actional process. Variation stimulates the inter-actional process, construction of meaning, andthe continual movement toward greater complex-ity, flexibility, and differentiation.

Buckley's process view of systems provides aflexible theory base for technical eclecticism(Fraser, 1986). The emp hasis on the interactionalprocess surrounding variation and its importanceto mean ing construction and growth of the systemcan be applied to the process of psychotherapy.The therapist offers variation through conversationand behavioral prescriptions. Both avenues of

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B. L. Duncan et al.variation stimulate interactive process and meaningconstruction, thereby enabling change and clientgrowth.Problem Process

It is when adjustment or adaptation to a vari-ation is perceived as a difficulty that problemsdevelop. The MRI posits two conditions as nec-essary for problem development: 1) the mis-handling of the difficulty and 2) upon failure ofthe original solution attempt, more of the sameis applied, resulting in a vicious cycle (Wat-zlawick et al., 1974). The inter/intra personalinteraction which surrounds the difficulty, theprocess by which individual and shared meaningrelated to the difficulty is constructed, and theinterplay of both are seen as significant to theproblem process. Constructed meanings bothinfluence and are influenced by the difficultyitself, c rea t ing a prob lem-o r i en t ed sy s t em(Goolishian & Anderson, 1987), or one in whichinterpersonal interaction and meaning construc-tion are organized around the problem.

According to the M RI , problems develop fromchance or transitional circumstances encounteredby individuals and families evolving through thelife cycle. While presenting complaints and con-cerns m ay b e highly content-laden and idiosyncraticto the individual or the situation, the problem isdefined in terms of the interactive process. Sig-nificant etiology resides in the process itself, ratherthan in related factors such as personality or history.Although the MR I does not present its approachas compatible with other theoretical orientations,Held (1986) argues that the MRI approach cansubsume other individual and interpersonal modelsand therefore may be utilized as a basis for eclec-ticism.Process versus Content

Building upon the work of Prochaska andDiClemente (1982), Held (1986) argues that theMRI problem process model is a general and in-clusive view of problem formation and mainte-nance. It posits no particular theoretical "truemaintainer" or "real cause" of the presentingproblem (e.g., fixated psychosexual development,confused hierarchy, existential anxiety, irrationalbeliefs) other than redundant solutions. While allmodels of psychotherapy are built upon theoreticalcontent, they vary in the degree to which contentis emphasized and elaborated (Held, 1988). Al-though variation exists in the extent to which the

therapeutic proces s is ordered by theoretical "real-ity," most therapies fall to the content-orientedpole of the content-process continuum. For ex-ample, a psychodynamic clinician may view thepresenting complaint as a result of fixated psy-chosexual development. The therapist may pursueinformation from the specific stage of developmentunder question and mak e interpretations to allowthe client to integrate unconscious material.An MRI therapist may view the presentingcomplaint as a vicious cycle of unsuccessful so-lution attempts by the client and others attemptingresolution. The therapist m ay pursue an interruptionof the problem maintaining process. The psycho-dynamic approach posits a particular content path(psychosexual fixation) to follow, while the MRIattends to the process surrounding the problem.Accordingly, H eld (1986) has identified the MRIas a process oriented, rather than content oriented,approach to psychotherapy.

Held's process/content distinction bears impli-cations related to decisions regarding treatmentgoals. The theoretical reality of the therapist nec-essarily structures problem definition as well asoutcome criteria. The more content oriented theapproa ch, the m ore content directed are the goals.Client focus m ust necessarily be content orientedand value laden. For a client to articulate a com-plaint requires that it be framed in a content-richmeaning system; even the most general and non-specific of client articulated goals (e.g., "I justwant to feel better") m ust be ordered by the contentof an idiosyncratic meaning system. The MRIchange model shifts therapist focus from contentordered goals to process-based goals and outcomecriteria. The only goal which this model dictatesis that of changing the interactive process whichpermits the problem. A process-oriented approachsuch as the MRI ' s can provide a foundation fora technical eclecticism in which the content struc-tured goals of the client are facilitated by theprocess structured goals of the therapist.Pragmatic Assumptions

The conceptual foundations discussed abovesuggest several assumptions regarding people,problems, and the practice of psychotherapy. Theresult is a process oriented, eclectic approach whichseeks change rather than cure as the ultimate ther-apeutic goal. Although not all-inclusive, thesethree assumptions represent the basic premiseswhich characterize a process constructive frameof reference for strategic eclecticism.

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Strategic EclecticismAssump tion 1: Problem s, and their solutions,are embedded in the interactive process.

Despite its relationship to the past, or to in-dividual factors, all behavior is continually be ingshaped or maintained by ongoing interaction inthe social system (Watzlawick et al., 1974). Theevolving biopsychosocial unit (e.g., individual,couple, family, group) will inevitably encounterchance or transition al/dev elopm ental difficultiesas it mov es through the life cycle. Problems resultfrom the interaction of the developing/evolvingunit and its constructions of the en vironme nt: theyare maintained and/or exacerbated by a viciouscycle of attempts to adjust to the difficulty. W hat-ever their origins, problems are amenable to changethrough intervention in the ongoing interactiveprocess (Watzlawick et al., 1974). Therapy focuseson the interaction among system members andbetween the meaning-creating individual and theenvironment.

Since therapy focuses on process variables , in-dividual or systemic pathology is not em phasized ,nor are symptom s seen as necessarily functionalto the individual or interpersonal system (D uncan,1984). People are g enerally view ed as possessingthe necessary resources and skills for problemimprovement to occur unless overwhelming evi-dence to the contrary is presented. At the veryleast, this nonpejorative and nonjudgmental per-spective encourages the creation of a change en-hancing therapeutic con text, given the th erap ist'sconstructed meaning that change will occur.

Although this is a health based rather than amedical/disease view , psychopatho logy is neitherdiscounted nor ignored. However, the constructof psychopathology m ay not nec essarily focus thecontent of the therapeutic endeavor; rather, it isthe client's meaning system and content formulationthat order the therapeutic focus. The informationthat accompanies diagnostic nomenclature is at-tended to by the therap ist, but m ay n ot be utilizedto direct the therapeutic conversation or interventiondesign.For example, a client presenting himself as amessenger from God was arrested for disturbingthe peace, because he was awakening strangersin the middle of the night to spread God's word.

The therapist included the diagnostic informationfrom "schizophrenia" in the formulation of theproblem. However, the client's complaint of beingunable to spread God's word was accepted andthe therapeutic conversation and intervention werefocused on the difficulties inherent in being a

messenger from Go d, rather than sole reliance oncontent taken from a psychopathological view ofschizophrenia. It is the intent of strategic eclecticismto enable the informed and pragmatic use of his-torical, diagnostic, and personality knowledgebases w ithout the restrictions of their sole reliance.The problem process, or the interaction betweenthe client and others attempting resolution, andthe interaction between the meaning constructingclient and the environment is the "problem" pri-marily attended to by the therapist. The clientcontent ordered description of that problem processoffers the entry point for intervention.Assump tion 2: The client presentation, ratherthan the therapist's orientation, determinestherapy goals, the content of the therapeuticconversation, and intervention strategies.

It is the client 's construction of meaning aroundthe problem that is of importance to the problemprocess, as well as to the intervention selected.To the extent that it emphasizes the primacy ofthe client's subjective reality, strategic eclecticismis phenomenological and client-centered. A ssess-ment focuses on establishing a consensual un-derstanding of the complaint from the client'sperspective; it is the client's presentation of theproblem which establishes the entry point forchange. Presentation involves the client's verbaland nonverbal description of and beliefs regard ingthe nature and meaning of the complaint as wellas the affective experience which attends theproblem. Explicit empathy not only validates ex-perience, but also provides the therapist with in-valuable information for effective intervention.

A major contribution of both constructivismand Held's process/content distinction is the sug-gestion that reality exists only as a construct ofeach participant in the problem process. As amem ber of the problem oriented system, the ther-apist participates in the ongoing, interactive de-velopment of individual and consensual realitiesregarding the presenting complaint. Ho wever, thetherapist's "reality" is just as but no more "real"and "true" than the client's version.Therapist allegiance to any particular theoreticalcontent involves a trade-off w hich simultaneously

enables and restricts intervention option s. Processoriented therapists walk a tightrope, balancingthemselves between the flexibility and un certaintyof process and the directionality and limitationsof content (Held, 1986). Since a process orientedapproach focuses on changing the interaction which

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B. L. Duncan et al.maintains the complaint or concern, establishingThe One True Reality is neither a function nor agoal of strategic eclecticism.A purpose of the therapeutic conversation is tomake explicit the client's reality related to theproblem process. The content of the therapeuticconversation provides a meaningful frameworkwhich m ay allow the client to reorganize perceptionand experience, thus shifting the problem-enablingmeaning system. The therapist may respond tothe client's complaint with content selected froma number of sources: 1) generic response patterns;2) specific clinical content areas and techniques;and 3) specific theoretical or philosophical ori-entations.

Generic response patterns [e .g., the grief process(Kubler -Ro ss , 1969) ; rape trauma syndrome(Burgess & Holmstrom, 1979)] describe culturallytypical patterns or phases of response to devel-opmental transitions or incidental crises, and mayprovide the basis for an intervention strategy whichshifts the meaning system surrounding the prob-lematic respon se. Like wise, content derived froma specific clinical area (e.g ., anxiety, AID S, etc.)may provide an organizing framework for thetherapeutic conversation and intervention. Thisnew information may provide a reorganization ofthe solution patterns or a rationale for the inter-vention.

Sometimes clients present with discrete, clearlydelineated concerns. With some complaints theliterature strongly indicates the efficacy of a par-ticular approach, specific conceptualization, ortechnique (e.g., performance anxiety, relaxationtraining ). Attending to the literature and selectinginterventions associated with documented, suc-cessful outcomes serves the client by extendingthe options for intervention and enhancing ther-apeutic flexibility. Content drawn from this sourcemay be utilized as a primary framework for in-tervention or as an adjunct to other interventions(Duncan & Parks, 1988).

By the sam e token, should the presentation ap -pear congruent with a particular theroetical ori-entation, the therapist may utilize that content tostructure the intervention. Presenting the concernin the language of a particular approach (e.g.,framing client complaints of depression, malaise,and meaninglessness from an existential perspec-tive) may enable a reorganization of the meaningsystem which supports the problem process.The selection of content is not data based orempirically driven and is not directed by a concrete

prescriptive specificity because the matching de-cision operates at a level of abstraction that viewscontent as metaphoric. Content is selected to matchthe client's worldview and circumstances, ratherthan the theoretical predilection of the therapist:content is only the vehicle through which theproblem process is influenced. While the contentmatch ing decision is not determined by diagnosis,symptom complexity, client coping style (Beuder,1986), or other content based decision trees, in-tervention may incorporate any of these factors.The matching decision is based entirely in thecontent laden description of the presenting concernoffered by the client. Therefore, any client orproblem quality could be relevant if directed bythe idiosyncratic content focus of the client.Assumption 3: Problem improvement occurs byinfluencing the context of the problem via theactual interaction and/or its acquired meaningsystem.

W hen a deve lopmen tal transition or chance cir-cumstance is experienced as a problem, the currentmeaning system somehow lacks the informationnecessary to organize resolution of the problem.The meaning system limits the available solutionpatterns that the client can employ; consequentlythese limited solutions are repetitively applied,thus exacerbating the problem (W atzlawick et al.,1974).Change may be facilitated at either of the twolevels at which meaning is constructed (Buckley,1967). A t the first lev el, interaction generates themean ing w hich organizes perception. Influence atthis level entails changing the interactional context,thereby challenging the limits of the client's con-structed meanings. Placing clients and the prob-lem proce ss in a different context creates a situa-tion through which new meaning m ay be ascribed(Erickso n, 1980), as well as interrupting the currentproblem-maintaining solution attempts.

Level I strategies, which are action-oriented,involve changing the pro ble m 's interactional con-text. These strategies include prescribing differentbehaviors based on an accepted client meaning,and prescribing tasks and current behaviors. Thenew context competes in a behavioral, cognitive,or affective way w ith the prevailing meaning sys-tem, enabling the formation of a different (andpossibly helpful) meaning. T his emergent, revisedmeaning is constructed by the client, rather thanthe therapist. The therapist only suggests change

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Strategic Eclecticismin the context; change in the m eaning system occursin the course of the actual interaction.Level II strategies are meaning-oriented andseek to alter, revise, o r replace a particular meaningsystem. Since individuals can recall and reviewan interaction following its term ination, acquiredmeaning systems can be influenced independentlyof the actual transaction. Direct exploration of theclient's problem-oriented reality may prom ote theconstruction of alternate ascriptions by the therapistor the client. Level II interventions include em-powering client ascribed meaning and ascribingdifferent meanings to problem situations.

The distinction between Level I and II inter-ventions is somew hat arbitrary given the inherentreciprocity of meaning and behavior. The dis-tinction represents an attempt to delineate avenue sby which the problem process m ay be influencedand to illustrate the salient features of the differentstrategies.Level I InterventionsIntervention 1: Prescribing Different B ehaviorsBased on an Accepted Client Meaning

To varying degrees, clients possess firm meaningsystems which must somehow be altered if changeis to occur. Direct confrontation which cha llengesthe meaning system risks further entrenchm ent ofthe problem-maintaining process. Instead, thetherapist may elect to utilize the existent meaningsystem as the basis for prescribing different be-haviors). Utilizing the existent meaning systemto generate new/altered and competing behaviorsis seen as a useful, as w ell as respectful, stanc e.Change in behavior may result in a change inttie contingencies surrounding th e proble m, en-

abling new or different behaviors to occu r in placeof the old problem behaviors. The com peting be-haviors may generate the construction of a newmeaning system tha t does not include the presentingcomplaint: the particular change in meaning isconstructed by the client's behaviorally alteredinteraction with the environme nt (D uncan , 1989).Case Illustration

L, a 43-year-old wom an, presented with concerns regardingher nine-year-old daughter's irritability and unhappiness, whichL viewed as possible signs of a genetically transmitted depres-sion. L cited her own history of depression, as well as herown mother's depression history, as evidence for an inherited,genetic depression in her daughter. S he stated that her effortsto comfort, reassure, and cheer the child w ere ineffective andfeared that these early signs would exacerbate, dooming her

daughter to the bouts of depression which had characterizedthe two previous generations. Given the strength of the client'sbeliefs regarding the biological, genetic risk to her daughter,as well as the client's implicit values regarding a mother'srole, the therapist ch ose to intervene w ithin the parameters ofthe client's meaning system, and accepted the client's viewof depression. Accordingly, the therapist utilized clinical contentderived from literature on biological/genetic depression, andlinked it to a diathesis-stress paradigm (Davison & Neale,1986). The therapist suggested that, given the familial pre-disposition to depression, environmental factors could be criticalin the expression of the predisposition. Since the depressivetendency appeared to be a given, perhaps the mother couldassist her child in learning how to cope with her depressionby simply acknowledging and validating the child's complaints.This would implicitly encourage the child to "work through"her feelings and develop com petence in coping.

This intervention wa s specifically d esigned to influence themother to back off and lessen her involvement in her daughter'severyday activities. The problem w as view ed as embedded inthe interactive process surrounding L's attempts to help herdaughter. The therapist b elieved that directly suggesting thatL withdraw her involvement from her depressed child wouldbe met with noncompliance, and lessen the therapist's cred-ibility. The therapist did not assess anything other than normalnine-year-old behavior, but also did not believe that L wouldrespond to a su ggestion that her daughter wa s normal and notdepressed, and therefore could be left to her own devices.

Accepting L's meaning o f her daughter's behavior enabledthe therapist to prescribe different behaviors based upon thatmeaning. Such an acceptance and utilization of a stronglyheld client meaning not only provides the direction for inter-vention , but also enhances com pliance and therefore the like-lihood of outcome success. The selection of the content forboth the therapeutic conversation and intervention was directedby the client's idiosyncratic presentation of genetic depression.L returned for two more sessions following the interventiondescribed above. She reported that her daughter seem ed happierand was complaining less. L reported that although it wasdifficult for her, she was not attempting to rescue her daughterfrom her depression any more. She also added that perhapsher daughter was only mildly predisposed to depression.Intervention 2: Prescribing Tasks and CurrentBehaviors

The common thread which unites the prescriptionof tasks and current behaviors is an experiencethat competes behaviorally, affectively, or cog-nitively with the presenting concern, thus permittingthe construction of a different meaning. Taskschallenge the limitations in ascribed meanings,and force a re-evaluation of the meaning system.Prescriptions can take many forms, ranging fromgeneral and vague to specific. T hey can b e directedto affective and cognitive levels as well as thebehavioral level. Their particular form is limitedonly by the creativity of the therapist and theproblem oriented system.The goal of prescribing current behaviors is toprovide a competing experience so that current

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B. L. Duncan et al.solution attempts are interrupted and/or the clientascribes a different meaning to the complaint.Prescription of the symptom/current behavior altersthe problem 's context, enabling clients to explorealternative solutions on their ow n because of theirnewly constructed meanings (Duncan, 1989).Case Illustration

J, a 32-year-old business executive, was recently promotedand was now required to fly to regional meetings. Her firsttrip was scheduled and she presented her flying phobia to thetherapist with opportunities for two sessions before her trip.J reported that she had successfully avoided flying for manyyears, to the point of even leaving situations in which flyingwas discussed. She also stated that although her fear existed,she knew that most people were not fearful and that she wasprobably overreacting. The therapist ended the first sessionwith both a task and symptom prescription. The client wasinstructed to go to the airport and observe ten people waitingto get on airplanes and rate their anxiety levels on a scale ofone to ten. The therapist also suggested that J spend at leastIS minutes, but not more than 30 minutes, considering thedangers offlyingand experiencing her fears intensely. J returnedfor session two and had complied with both suggestions. Shereported surprise that seven of ten people observed had ratingsof six or more and that she w as pleased to see that not everyonetook flyin g in stride. J wa s able to think about the dangers offlying, but the fears seemed to be more manageable. Theclient was instructed to repeat the rating exercise o n the airplane.The therapist also taught J a relaxation exercise in sessiontwo.The prescription of the symptom and the task had twopurposes: 1) to create an experience that interrupted thecurrentsolutions (problem process) and/or competed affectively, be-haviorally, or cognitively with the experience of the primarycomplaint; and 2) to construct a n ew context that enabled theclient to ascribe a different m eaning to the problem. J's solutionattempts of avoidance and willpow er w ere interrupted and hermeaning system that her fear was an ovcrrcaction was chal-lenged . The content o f the therapeutic conversation w as directedby the clien t's d escription of her flying fear; the interventionswere designed from that content laden description. The re-laxation strategy was selected as an obvious alternative forthe attenuation of arousal caused by the flying phobia. Bytelephone fo llow -up, the therapist learned that although J feltanxious, she was able to fly to her meeting. She also addedthat she believed she was not the most uncomfortable personon the flight.

Level II InterventionsIntervention 3: Empowering Client-AscribedMeaning

It is not uncommon for clients to report newperceptions regarding themselves or the complaintas a result of their attempts to follow a hom eworkassignment. Created by the client, this reconstructedmeaning reinforces or empow ers continued change ,and vice versa.

Client-ascribed meaning is distinguished frominsight in two ways (for a full discussion, seeDuncan & Solovey, 1989). Insight is therapistgenerated, i. e. , the clien t's response to the carefullyselected interpretations offered by the therapistand directed by the thera pist's frame of referenceor orientation. Client-ascribed meaning, on theother hand, is client generated, i.e., the client'sinterpretation of a prescribed task or event. Whileinsight has traditionally been held to be a necessaryprecondition for change, client-ascribed meaningdevelops either during th e process of change itselfor as a postcondition of chang e. Through questionswhich encourage the client to articulate and em-bellish the reasons behind the changes of circum-stances or h eart, the therapist punctuates the changethat has transpired. Further change is empoweredthrough the client's own positive ascriptions,without the therapist taking responsibility for thechange or assuming the cheerleader role. In itsessence, the use of client-ascribed meaning topromote change is a growth-enhancing interven-tion.Case Illustration

B , a 41-year-old management consultant, described himselfas depressed, w hich he presented as listlessn ess, fatigue, anda general lack of motivation and happiness. B described hisfrustrations with his job and the lack of romance in his marriageas possible factors. He also reported that he felt as if therewere no point to life most of the time. T he therapist and clientdiscussed the problems inherent in midlife transition and thepursuit of personal meaning. A task was assigned in whichB was asked to monitor his depression, rate it, predict hisrate for the next day, and then compare the actual versuspredicted rate (see de Shazer, 1985).

Tasks are assigned to promote change by offering a vehiclethrough which clients may actively construct meanings thatorganize their perceptions and exp eriences in a manner con-ducive to problem improvement. B returned and reported thathe had contacted an employm ent recruiter and had discussedthe lack of romance in his m arriage with his wife. He addedthat as he looked at the events of the day and rated his depression,he became certain that as long as his job and marriage remaineddull, he would stay depressed and unfulfilled. The therapistresponded with surprise, amazement, and a sequence of ques-tions that encouraged the client to articulate what had happenedthat such changes could occur. The client continued to ascribeself-enhancing meaning to the changes, which culminated toan expression of a belief that he had discovered that his pursuitof happiness was under his control only.

This case illustrates the use of client-ascribedmeaning to empow er and encourage change. Fol-lowing a discussion of content selected from ageneric response pattern (midlife crisis) a home-work assignment was suggested w ithout a rationale.


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Strategic EclecticismThe client gave meaning to the task and was ableto do something different (contact employmentrecruiter, talk to wife) in relation to his problem .After making a behavior change, he continued toascribe self-empow ering mean ings to the task andto the changes he w as m aking.Intervention 4: Ascribing Different Meaningsto Problem Situations

The therapist's ascription of different mean ingsto problem situations is a somewhat extended ver-sion of refraining, i.e ., cha nging "the conceptualand/or emotional setting or viewpoint in relationto which a situation is experienced and to plac eit in another frame that fits the facts equally aswell or even better, and thereby ch anges its entiremeaning" (Watzlawick et al., 1974, p. 95 ). Unlikeinterpretation, which emerges from the the rapis t'sorientation/frame of reference and seeks to offera particular, and perhaps inherently better or m ore"correct" view of the prob lem, therapist ascribedmeaning is intended to present alternative waysof viewing the client's concerns. Whereas thegoal of interpretation is to promote insight whichultimately results in behavior change, therapist-generated reframes seek to promote immediatebehavior change (Duncan & Solovey, 1989).The meaning ascribed is dependent upon theclients' observations about themselves and theirconcerns, as well as the specific clinical situationand its historical presentation. The p articular as -cribed meaning is collaborative in the sense thatit emerges from the interaction between the therapistand the client. Since no particular theoretical orcontent path must be exclusively utilized, meaningmay be ascribed from any content area as longas it is consistent with the emergent reality thatis constructed in the therapeutic conversation. Thegoal of meaning ascription is not to establish a"true" or "better" meaning, but to encourage achange in meaning which will permit clients toreorganize the experience that maintains the pro b-lem.Case Illustration

H, a 42-year-old married female , entered therapy fo llow inghospitalization for depression. She presented as passive andsomewhat affectively flat as she described her depression often years' duration. She reported that her husband, w hom sheloved, was impotent, yet refused to seek treatment, despitethe fact that she very much missed sexual intimacy. Using astructural frame (Minuchin, Rosman & Baker, 1978), thetherapist suggested that perhaps her depression functioned to

protect her marriage from conflict or other serious consequences.Were it not for her depression, she would think enough ofherself to find a partner capable of providing the desired in-timacy , and to have an affair w hich cou ld threaten her maritalrelationship. The client returned with her husband, statingthat she had giv en him the ultimatum (for the first time) thathe would enter therapy or she would leave.

This case illustrates the significance of theclient's content laden description of the presentingcomplaint to the selection of different meaningsascribed by the therapist. The therapist-ascribedmeaning of "protecting the marriage" was notbased in the belief in any given theoretical ori-entation (i.e., structural family therapy) or viewedas representing an ultimate truth or better way ofunderstanding her depression. Rather, the therapistdesigned the ascribed meaning based upon theidiosyncratic content focus of the client in thehope of influencing the client to take immediateand different action (i.e., confront her husband)which enabled her also to shift her view of herdepression from something totally out of her controlto something which she could proactively address.This case also illustrates the selection of contentfrom a specific theoretical orientation.Discussion

It has long been recognized that the therapeuticprocess may be hampered by the limitations ofany single theoretical reality. For many practi-tioners, efforts at matching techniques and pro-cedures to individual clients has been likewisehampered by content related incompatibilities. Aconstructivist and process oriented perspective mayprovide a framework for the selection of inter-ventions matched to the client's worldview andgoals. W hile strategic eclecticism offers freedomin choosing intervention options, it also imposeson the therapist a responsibility to broaden contentand procedural repertoires, since no one or twotheories are seen as sufficient to explain and ef-fectively address the diversity of presentationsclinicians routinely encounter. Acceptance of theprocess/content distinction largely challenges theneed for an integrative meta-theory to guide eclecticpractice , becaus e language and theory are view edas metaphors which structure and organize thetherapist's reality.

The primacy of the client's worldview wouldappear justified in light of Lambert's (1986) con-clusions regarding outcome variables. Based onhis review of the psychotherapy outcome literature,

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B. L. Duncan et al.Lam bert suggests that only 15 percen t of positiveoutcome appears to be related to specific technique;expectancy (placebo) variables likewise accountfor 15 percent of the improvemen t. Com mon fac-tors, those variables which cut across therapies(e.g., warmth, respect, empathy, acceptance,identification with the therapist, pos itive relation-ship, insight, rationale, cognitive learning, realitytesting, risk taking) appear to be related to 30percent of positive outcome; spontaneous remissionfactors (i.e., client variables, social support, out-of-therapy events) account for 40 percent of th eimprovement. A constructivist, process orientedstance empowers common factor effects throughexplicit recognition of the client's meaning systemas hierarchically superior to the content-basedtheoretical frame of reference of the therapist.Working within this context fosters client iden-tification with the therapist and the developmentof a relationship which encourages clients to riskreordering the m eaning system w hich supports theproblem process.

The selection of techniques and rationales whichare congruent with the client's unique meaningsystem would appear to implicitly enhance theeffect of placebo variables, creating a cognitiveset which expects change. Those factors whichLambert characterizes as spontaneous remissionvariables are significant in a process orientation.Remission (i.e., improvement) from a processperspective may not be truly spontaneous, butrather one possible result of the inevitable re-sponsiveness to variability. Empowering client-ascribed me aning utilizes the effect of those vari-ables which clients identify as significant to theirimprovement, w hether directly o r indirectly relatedto in-therapy events.

This article has presented a technical eclecticismwhich extends an MR I oriented strategic approachto include diverse clinical and theoretical con tents.A process constructive perspective of strategiceclecticism (Held, 1984) was described as a der-ivation of Buc kley's schema of systems and con-structivist philosophy. The suggestion that theo-retical content is but a metaphorical representationthat should be placed secondary to the client'spresented content may offend some theorists andclinicians. Rather than alienate, it is hoped thatthese ideas will stimulate continued dialogue am ongeclectic practitioners w ho recognize and value thecontributions and theoretical realities of multiple,diverse approaches.

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