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Section 21
Using Client Positions to Increase the Acceptability
of Infidelity Counseling

Question 21 | Answer Booklet | Table of Contents | Printable Page

Isomorphism: On the basis of earlier work by Erickson (1962) and Hofstadter (1979), deShazer (1982) incorporated the concept of isomorphism as a central part of his intervention model. Isomorphism is the occurrence of identical structures or patterns in different systems. In the therapeutic application of isomorphism (deShazer, 1982), the therapist matches the presentation of an intervention to the client's perceptions. To initiate change, only one element of the therapist's presentation is purposefully not matching. The difference is planned to be an intervention that creates change (Bateson, 1972). Change does not depend on major perceptual shifts of the client toward the therapist's view of the problem. That is, the client does not need to see the problem situation as the therapist sees it before the client acts on a recommendation for change. The client can achieve his or her goal without adopting the therapist's views. The therapist adopts the client's stance except for one purposeful difference--the intervention.

Positions: Fisch et al. (1982) introduced the term position. Position was defined as the "strongly held beliefs, values, and priorities which determine how a person will act or not act" (p. 90). The term position is a more concrete construct than the concepts of utilization and isomorphism. In assessing the client's position, the therapist listens to the specific wording, tone, and emphasis used by the client. The most important positions circumscribe the client's problems, goals, and the client's self-definition (Fisch et al., 1982). Often in the brief therapy approach suggested in Tactics of Change (Fisch et al., 1982), the client will view the suggested intervention as unreasonable.

Therefore, the adoption of a procedure that gains the cooperation of the client in carrying out a seemingly unreasonable intervention is paramount. The use of the client's position in the presentation of a problem solution allows the possibility of the client's goals being met without requiring the client to perceive the therapeutic issue as the therapist perceives it. A therapist may choose any number of interventions. What makes a client view interventions positively is how well the interventions match or fit the client's self-image and perceptions of the problem. The rationale explaining the intervention given to the client is, therefore, critical in promoting client acceptance or compliance to the treatment recommendation. For example, a therapist may ask a member of a couple to be more direct about what he or she desires from his or her partner. The rationale can be based on many theories or beliefs and may utilize either the therapist's or the client's views. For example, a client may have a self-perception of being giving and caring toward his or her spouse. The client could be told, "Although asking for something directly takes a lot of energy, it is a thoughtful thing to do. Asking for something allows your spouse to demonstrate caring." From a different viewpoint, direct requests could be considered logical. "Couples never grow up in the same families or have the same personalities. You would be bored with one another if you were exactly the same. Therefore, you have to learn to state what you want. It is not logical to believe your spouse can read your mind." A client may find only one rationale compelling. Fisch et al. (1982) suggested the use of the rationale that matches the client's position.

An Integrative Outline for Matching Client Realities in Intervention Delivery
Utilization, isomorphism, and positions are entirely overlapping in meaning as applied to the procedure in this study. Each stresses using the client's cognitive structures in designing the delivery of interventions to gain the client's cooperation. In an integrative approach of utilization, isomorphism, and positions, the first step is assessing the client's structures. Cognitive structures have been defined elsewhere for couples therapy as selective perceptions, assumptions, expectations, attributions, and standards (Baucom, Epstein, Sayers, & Sher, 1989). The specific cognitive structures assessed in this procedure are the client's beliefs about individual and relationship strengths as well as each partner's views about the presenting problem. Each individual client's structures are then "utilized," "matched," or "isomorphed" in designing a rationale for why that client should accept a therapeutic suggestion. Specifically, in this study we used the following three-phase approach for delivering marital therapy interventions to clients. The three phases are assessment of client structures, creating rationale using the client's structure, and verbally delivering the intervention with the rationale to the client. Assessment of client structures involves asking each client about (a) problem definition, (b) problem severity, (c) problem attributions, (d) attempted solutions, (e) relationship strengths, and (f) client self-definition. The criterion for selecting a cognitive structure is a high level of conviction by the client. The client's cognitive structure is stated as a reason to enact the suggested intervention. This rationale is stated as nonblaming and solution focused. The interventions were standard recommendations, such as the practice of reflective listening, power sharing, and caring days (Stuart, 1980). The client is asked to accept a standard intervention or solution that did not depend on the client's problem. This is similar to the practice of solution-focused therapy (deShazer, 1985). The major emphasis of this approach is the acceptance by the couple of a standard intervention when the rationale for engaging in the behavior is based on the clients' beliefs.

Constructivism
Constructivism is the construct that guides the assumption that most often we "should" regard the beliefs of others with respect. That is, constructivism is based on the belief that we cannot know reality; we create our beliefs about reality that are restricted by our structure (Maturana & Varela, 1980; Watzlawick, 1984). Piaget (1971) emphasized the process of constructivism through the statement "no form of knowledge, not even perceptual knowledge, constitutes a simple copy of reality, because it always includes a process of assimilation to previous structures" (p. 4). The process of assimilation within counseling is engaged through this study. An assessment of existing structures is made, and then a mapping of interventions onto those structures is performed. Our goal is to perceive (as best we can) how the client's "reality" has led him or her astray and reconstrue his or her reality in a helpful way. Chiari and Nuzzo (1996) emphasized that previous structures need not be destroyed but only undergo an adaptation. Our sensitivity to the reality of others will focus us on the need to be other-culture sensitive and knowledgeable. Cultures can include nationalities, religious groups, gender, generational boundaries, socioeconomic status, and being another person (Keesing & Keesing, 1971).

Acceptability Of Treatment
Acceptability is a concept that has been used in the individual therapy and consultation literature to assess the perceived appropriateness of an intervention (Conoley, Conoley, Ivey, & Scheel, 1991; Elliott, 1988; Kazdin, 1981; Kazdin & Cole, 1981). Acceptability appears to be an appropriate measure for this study, because the purpose of matching a client's position is for the client to view the suggested intervention as fitting the problem. Acceptability of treatment was initially proposed by Wolf (1978) as an important construct for investigating the failure to implement an intervention. Kazdin (1981) asserted that although a treatment may be effective it may be viewed as inappropriate, unfair, unreasonable, or too intrusive. The concepts of treatment acceptability suggests that interventions could be viewed negatively if the intervention does not fit the client's understanding of the problem or the dynamics surrounding the problem (e.g., cause, seriousness, obvious solution). Acceptability is an important construct because it allows a conceptual measurement point between family interventions recommended by a therapist and the family's enactment of the recommendation. When a recommendation is made to a family or family member, many issues are in play. The perceptions of a couple about the fit of the recommendation to their problem are the focus of this study.

The Problem Information Questionnaire was designed to reveal the individual's position (Fisch et al., 1982). The seven questions were (1) What do you consider being the major problem in your marriage/significant relationship? (2) How serious is the problem? (3) What has caused the problem? (4) What do you think leads to your partner's behavior and your behavior related to the problem? (5) What do you and/or your partner gain by the problem existing? (6) How are you feeling toward your partner? (7) How are you feeling about yourself? Answers to the Problem Information Questionnaire were the basis for creating the matching and mismatching rationales for each individual.

Discussion
As hypothesized, the use of a rationale matching each participant's position led to greater acceptance of the recommended intervention than did a mismatched rationale or the no-rationale condition. Using the client's position (Fisch et al., 1982) by designing an isomorphic approach (deShazer, 1982) was associated with higher ratings of acceptability.

The results have implications for training therapists. Beginning therapists learn the techniques of building productive relationships, problem formulation, and constructing helpful interventions. The skill of constructing a rationale that matches the client's position would be a helpful addition to the basic therapy techniques. The therapist does not have to adhere to the strategic therapy theory to use the technique. If the type of therapy is more educational or insight oriented than strategic, the therapist can still promote the acceptance of the approach by providing rationales that match the positions of the client. The matching of the client's position requires viewing issues from the perspective of the client to be helpful. In couples therapy, matching client positions highlights the contrasting beliefs that may exist between partners. Presenting different rationales that match individual partner positions for doing the same thing (the intervention) demonstrates acknowledgment and respect for different viewpoints. It also demonstrates the coexistence of contrasting positions within a relationship.

The limitations of the study are associated with its analogue nature. The two most significant issues are participants' fabricated problems and the dependent measure. The use of a contrived problem was viewed as problematic but a worthwhile trade-off because there have been no other controlled studies of utilization, isomorphism, or positions related to marriage therapy. Caution seemed the prudent path.

The dependent measure, acceptability, falls short of behavioral enactment of an intervention. However, the literature in other fields of human change (e.g., Elliott, 1988) suggests that acceptability has merit in representing a mediating step toward behavioral enactment. Although this analogue study cannot be viewed as a definitive study of actual marriage therapy, the results indicate the utility of extending the line of research with behavioral enactment dependent measures.
Future research can refine the identification of positions and the technology of matching positions. The identification of positions was structured by the questionnaire based on the writings of Fisch et al. (1982). Further development of the techniques in positions identification is necessary.

Furthermore, the technology of matching the positions was achieved by the experimenters selecting the positions that were most strongly held by the participants. Although this is in keeping with Fisch et al.'s (1982) suggestions, the matching statements were presented to the participants individually rather than to the couple. Typically when interventions are suggested both members of a couple are present. Again, we believe that presenting differing rationales within couples therapy is beneficial. Further development of how the different rationales are presented while both individuals are present is important.

The present findings are helpful in furthering the research base of marriage therapy process. Rationales that matched a person's position increased an intervention's acceptability to the person. The importance of the findings includes possible applications by practitioners, training information for marriage therapists, applications of constructivism, and suggestions for future research.
- Scheel, Michael J.; Conoley, Collie W.; Ivey, David C.; Using Client Positions As A Technique For Increasing The Acceptability Of Marriage Therapy Interventions;  American Journal of Family Therapy, Jul-Sep98, Vol. 26 Issue 3
The article above contains foundational information. Articles below contain optional updates.

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Personal Reflection Exercise #7
The preceding section contained information about using client positions to increase the acceptability of infidelity counseling.  Write three case study examples regarding how you might use the content of this section in your practice.

QUESTION 21
According to Scheel, what is a benefit of presenting d