The Guiding Role Of Practice Theories

How problems are structured is a key part of clinical decision-making. Assessment frameworks differ in what is focused on, the kinds of assessment methods used, and how closely assessment is tied to selection of intervention methods. Preferred practice theories influence what clinicians look for and what they notice as well as how they process and organize data collected. Practice theories favored influence beliefs about what can be and is known about behavior and how knowledge can be developed. Dimensions along which theories differ include the following:

• Unit of concern (individual, family, community)

• Goals pursued (e.g., explanation and interpretation alone or understanding based on prediction and influence)

• Clarity of goals pursued

• Criteria used to evaluate the accuracy of explanations (e.g., consensus, authority, scientific)

• Range of problems addressed with success

• Causal importance attributed to feelings, thoughts, and/or environmental factors

• Range of environmental characteristics considered (family, community, society)

• Causal importance attributed to biochemical causes

• Attention devoted to past experiences

• Degree of optimism about how much change is possible

• Degree to which a perspective lends itself to and encourages empirical inquiry (finding out whether it is accurate)

• Degree of empirical support (evidence for and against a theory)

• Attention given to documenting degree of progress

• Ease with which practice guidelines can be developed

• Degree of parsimony

Clinical Assessment

Practice frameworks differ in the value given to observation of interactions in real-life settings, in whether significant others are involved in assessment, and how directive clinicians are. They differ in degree of attention paid to cognitions (thoughts), feelings, environmental characteristics (such as reactions of significant others), genetic causes, and/or physiological causes. Different frameworks are based on different beliefs about the causes of behavior. Beliefs about behavior, thoughts, and feelings, and how they are maintained and can be changed influence what data are gathered and how data are weighted and organized. History shows that beliefs can be misleading. For example, trying to assess people by examining the bumps on their head was not very fruitful. However, for decades many people believed that this method was useful.

Problems can be viewed from a perspective of psychological deficiencies or from a broad view in which both personal and environmental factors are attended to. For example, a key point of feminist counseling is helping clients to understand the effects of the political on the personal, both past and present. Frameworks that focus on psychological characteristics are based on the view that behavior is controlled mainly by characteristics of the individual. In interactional perspectives, attention is given not only to the individual but to people with whom he or she interacts. The unit of analysis is the relationship between environmental events and psychological factors. It is assumed that both personal and environmental factors influence behavior. Interactional views differ in how reciprocal the relationship between the individual and the environment is believed to be and in the range of environmental events considered. In contextual, ecological perspectives, individual, family, community, and societal characteristics are considered as they may relate to problems and possible resolutions. A contextual framework decreases the likelihood of focusing on individual pathology (blaming the victim), and neglecting environmental causes and resources. Practice perspectives that focus on individual causes of personal problems may result in "psychologizing" rather than helping clients. Assessment frameworks differ in the extent to which they take advantage of what is known about behavior, factors related to certain kinds of problems, and the accuracy of different sources of data.

Forming a new conceptualization of presenting problems, one that is shared by both the clinician and the client that will be helpful in resolving problems is an integral aspect of assessment. The kind of conceptualization suggested will depend on the theoretical orientation of the clinician. It is important to arrive at a common view of the problem, as well as agreement as to what will be done to change it. This common view is a motivating factor in that, if clients accept it and if it makes sense to clients, there will be a greater willingness to try out procedures that flow from this account. Mutually agreed-on views are fostered in a variety of ways, including questions asked, assessment procedures used, and rationales offered. Focused summaries help to pull material together within a new framework. Identifying similar themes among seemingly disparate events can be used to suggest alternative views.

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