Evidence, Outcomes and Michael White’s Positioning Ideas by Mark Hayward

Here Mark Hayward dives into considerations about practice evidence and outcomes research and then links these realms with Michael White’s ideas about the position of the therapist. As you watch this engaging video presentation, please refer to the powerpoint presentation included below.

And then please join a discussion about these matters on the forum!



More information

Evidence, Outcomes and Michael White’s Positioning Ideas powerpoint slides by Mark Hayward

Evidence, Outcomes and Michael White’s Positioning Ideas PDF by Mark Hayward

Published on August 30, 2013

This Post Has 6 Comments

  1. Olivia Henry

    Hi Mark
    Thanks for this video. I have already sent it to a number of friends/ colleagues as I know they will enjoy it too!

    I really love the fact that such bodies as the ‘National Institute for Clinical Excellence’ (no less) are recommending particular treatments (no evidence that one works better than any other) for particular diagnoses (no evidence for the value of diagnoses)… But thats just my sense of humour!

    I was interested in the evidence for ‘short term’ work and particularly wondered about different contexts- do you have any sense of the settings which this research was predominantly done? Just I am thinking, if it was done in more ‘typical’ therapeutic settings in a room, where people book an appointment and come and sit and talk with a therapist, usually for an hour, this looks very different to the therapeutic setting I am engaged in, even just the notion of three sessions alerts me to the context of the work- three hours spent talking in a room is very different to three times I might see a child/ family assisting them to move out of a hostel/ go to get benefits re-instated/ get the children to school a they missed the bus- grabbing snippets of conversation on the way!

    Also- I wonder what constitutes change- was the research measuring this change in a particular way- might it have been a change in the way the person was viewing a particular problem and their relationship to it/ a change in their acknowledgment of particular knowledges they hold/ a change in their relationships with significant people in their lives/ or a change in their body posture when they are in the sessions and immediately after…. so many more!

    Finally, I just wanted to clarify something- you mentioned there is no evidence for diagnoses, and go on to say that diagnoses don’t help- does that mean the evidence actually says they don’t help- or is there just no evidence that they do help?!

    Thanks again Mark
    Kind wishes

    1. Mark Hayward

      Thanks for everyone’s comments.
      Liv: I believe most of the quoted research is from the more clinical/1 hour session type situation but you’d have to follow up each reference to be sure. Change is measured generally by the client and the ORS form is a standard way to do this.
      Marta: I do agree about the difficulty of trying to decentre yourself when history and culture are against you! Finding someone else with a similar interest can sometimes, I think, be the most sustaining way that helps.
      Danil: I agree about the importance of the way you do narrative therapy and the SRS forms have been particularly helpful for me. However I believe they just represent one of many possible ways to elicit and monitor client experience and I use them just when I’m unclear about their experience.
      Georgios: I liked the coffee story! And agree about the difficulty of positioning yourself as a non-expert – but this is only about the right choices or directions for their lives, not about how to conduct a therapy session.
      Troy: I think that asking questions is a good way to sustain an enquiry position whilst retaining a good deal of influence over the direction of the conversation. This is maybe more than active listening.
      Thanks for watching this!
      All the best, Mark Hayward

  2. Marta Rivera Oliva

    ThanKs Mark, i found vey helpful your presentation.
    How good that all therapies work and that is the relationship more than the model what seems to do it.

    I am from torreón, in the north of México and at least where i work, diagnosis are important and in some way this goes to people and they expect that. And i am learning about narrative therapy and to be “decentered and influential”. This two things, expectations and new learning make things difficult to me sometimes. When i try too be out of the center and try to focus in the person that is with me, i can get so frozen that is difficult to find questions to make or i simply lost myself…

    I am trying to get rid of old habits of being the one “who knows”and not because i thought once that i know all, NO, but is the traditional way i learnt. I kindly use to suggest possible “solutions”. Now i think this is very arrogant from me but it slips easily. I am more aware now and tell people i don´t know or “i am not in your shoes”…

    I am learning to ask: “Is this helpful/useful?” Is still very generalized the idea that i should know, sometimes tell me: “I don´t know that´s why i come to see you”. I insist sometimes and tell them that i can sometimes go in one way that i think is useful but if not is much better for us to go in the direction they need.

    I didn´t know the SRS & ORS, just found them in the net, and i will try them, but i am afraid people is not use to them, i mean if i am the “profesionist”, the one “who studied” and my consultants no, how they would tell me, i am the one to know…i explain that they know more, or that each of us has a different knowledge, but i guess until i try and use them or any way of monitoring myself i will know. Thanks for helping me to think more.
    I agree with Danill to keep talking about this and share our experiences and thoughts

  3. Daniil Danilopoulos

    Hi Mark and thanks for your challenging presentation!

    For a few years I have been thinking, experimenting, practicing and trying to find my way about how to position myself in relation to my clients so as to establish with them good working alliances that result in positive outcomes according to their terms.

    The research you mentioned that shows that no approach is better than others is quite humbling and serves for me as a reminder that I better be aware of my ‘hype’ with narrative therapy. After all the narrative ideas are theories in which we – narrative practitioners believe that may be helpful for those who seek help from us and ideas that make sense to us – not necessary to our clients.

    Having said that, and after completing some basic narrative therapy training, I find that I am more committed to the use of maps and practices and more flexible and less prone to disappointment if there is little or no progress in therapy.

    I have found very helpful the idea and practice of monitoring – together with the client – the process and outcome of each session. I use the measures you mentioned ORS & SRS (Outcome Rating Scale & Session Rating Scale) and these help us (me and the client) see if what we do together works (in his/her terms – about his/her goals, expectations, etc) and if we are on track/the same page.

    I think that inviting the client to discuss the process and outcome of our collaboration:

    – – is a way of acknowledging his/her own expertise in dealing with the problems that brought her/him to therapy,

    – – facilitates the rich story development of her/his resistance to the problem that occurs between sessions,

    – – facilitates the rich story development of his expertise in terms of what kind of help and discussions are right for him/her in order to achieve progress.

    Examples of questions:

    You seem to indicate that things went better for you in your personal life since our last session, would you like to talk about what challenges you faced and how you dealt with them?

    Are there things that you would like to see you and me do differently in our next session, things that may be more useful for you in your effort to deal with…?

    I find these kinds of discussions helpful in:

    – – reviewing and monitoring if this particular work that I am doing with this client is on the right track and if it produces good outcomes

    – – negotiating adjustments about how to proceed.

    I know that narrative therapy – like many other forms of therapy – works. But is the kind and ways of narrative therapy (as I understand and practice it) with each of my clients works? I may think that it works or that it doesn’t. The client(s) have their own views and I am interested to discuss about them.

    This is crucial to me. It is crucial in terms of being accountable to each person who asks for my service.

    So I am willing to try to be centered and to take some responsibility about the process of our collaboration (ie: to try to ask helpful questions, to invite their feedback about the process and outcome of each session) and to try to be decentered by paying close attention and being curious and privileging their theories about what needs to change (inside and outside of the therapy room) for their efforts to have more positive outcome.

    This monitoring of process and outcome together with the client(s) is – in my mind – some kind of co-research.

    I am very interested in other people’s opinions and in continuing the dialogue (in and outside of this forum) about the issues of accountability and the use of client feedback to monitor therapy process and outcomes in narrative practices.

    Kind regards,

    Daniil Danilopoulos

  4. Georgios Vleioras

    Dear Mark,

    What an interesting start of my weekend! Thanks for the thoughtful presentation! I have already followed this presentation in Salonica, but conclusions and thoughts can be very different after the second or third reading…

    So, here are two things that I would like to comment:
    1. I recently had two therapeutic experiences that showed me how important the alliance / relationship is:
    a. I see a man with the diagnosis of “depression with paranoid elements”. In my attempts to find his strengths, once we started talking about how to prepare “Greek (or Turkish!) coffee”. Suddenly he changed focus from the fear of social relationship to explaining to me all the basics of making coffee. In the end of that meeting, he offered to bring to my office the stuff he needs to make me a cup of coffee. We drank coffee together twice so far during the session. He is very relaxed and he started taking care of his house. It may be just a coincidence, but also it may not.
    b. I see a man with no official diagnosis. He thinks he has panic attacks. As a clinician, I do not agree, while as a therapist I don’t care wink This man was very reluctant to discussing anything but (unsuccessful) exposure experiences he had had until one day I sent him an e-mail late in the evening to share some thoughts that I had. In our meeting that followed, the first thing he mentioned was that he was very happy that “somebody” (aka. myself) thought of him outside “our hour”. And then he had discovered some very interesting things about his problems that have helped him move forward. Again, it may be a coincidence, or maybe not…

    2. The second thing concerns the positions set forth by Michael White. On the one hand, I am very willing to not be the expert, but how do I deal with people who do consider me the expert? And who are seeking directions? This is pretty often the case in my work. Recently, I saw a couple whose daugther has gone “the wrong way” with stealing and other illegal activity. These people explicitly said that they have done it all wrong with their child and that for the last two years they are following the professionals’ prescriptions. And now they are looking for my ideas.
    Also, similar to Troy, I often find myself trying not to jump to the expert position (in my case, by setting a diagnosis). I think it is a step that I am realizing I do that, but realizing makes me focus on not doing this, and this may make the therapeutic process problematic.

    Any ideas or comments are welcome.

    Thanks again for the inspiring presentation!


  5. Troy Holland

    Thanks very much Mark for presenting those ideas about outcomes and evidence and positioning in such an organized way. In fact it has been a good reminder to me that presenting ideas back to people who consult me in an organized way is one of the most effective things that I have found helpful for people in therapeutic work. Your presentation has me thinking about two things.

    Firstly, one thing that has been on my mind a lot recently (and that I have been talking about with anyone who will listen) is the idea that I believe potentially therapeutic relationships start outside the ‘therapy room’. This is especially relevant to me because a large part of my work is in quite a small community and I find that actions that I take in the community that could be seen as respectful, responsive and hopeful can help generate possibilities for therapeutic work. However I think it is also very important for all contexts of my work. My initial contact with people before they come to see me is very significant I believe. In that initial contact I do my best to interact with people in the same ways as I would hope to in a therapeutic session. It also makes me wary of practices and policies that I believe can impair or impede this relationship from the start. In some contexts where I work people have had to convince someone else, potentially an intake worker or a general practitioner, that their problem is ‘severe’ enough for a service to be provided. This can have many effects including making problem stories stronger and creating doubt about the person’s own ability to make a judgement about whether they need help and what help they need. These policies and practices are difficult to avoid because of funding arrangements however it is my intention now to no longer be complicit with such practices.

    Secondly, thanks for drawing my attention to the client-focused and ineffective relationship position again. This is certainly where I find in my own practice I can have the most difficulties. I am at times so focused on not taking an ‘expert’ position or not setting the interaction’s agenda that I can fall into the position of being simply an active listener or an interviewer. I tend to have a preference for listening more than I talk and this can mean I leave little time during the session to give something back. This means I often have to present ideas back to people at the start of the next session which can be effective, if they come back. I’ve identified for a while that I need to change this – certainly I think some things I can do are to slow sessions down, be more active rather than passive in note-taking and to take a more active role in organizing the conversation.

    Thanks again Mark for your presentation, it has been very timely for me. Would love to hear other people’s thoughts.

    Warmly and respectfully


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