Dr Mary Harris has worked as a psychotherapist, supervisor and trainer for almost thirty years and is co-author – with Dr Anne Brockbank – of the new book An Integrative Approach to Therapy and Supervision: A Practical Guide for Counsellors and Psychotherapists.
Here, Mary answers some questions about the new book and the FIT Model – an innovative and flexible model for therapy and supervision practice.
How did you get started in supervision, and what kind of clients do you work with?
I started practicing as a psychotherapist in the 1980’s and have worked with clients dealing with a wide range of issues and in a number of different settings. What I noticed early on was that ‘one size didn’t fit all.’ A humanistic approach, which could prove effective with the client who had the time and resources to explore personal concerns on an open-ended basis in private therapy was not necessarily the treatment of choice for the client who was being seen in an agency setting which confined the treatment to a limited number of sessions and to a single approach. In responding to the various issues brought by clients, I trained in and began to use different approaches, and to adapt them to the individual client’s needs and personality, as well as to the setting where the treatment was provided.
I currently work with clients dealing with depression, Post Traumatic Stress, childhood abuse, addictions and relationship problems, both in private practice and in agency settings. Much of my work now also involves teaching and training psychotherapists and supervisors to apply an integrative approach to their work, which is described in An Integrative Approach to Therapy and Supervision.
What is the FIT Model and how was it developed?
FIT is an acronym for Feeling, Initiating (or acting), and Thinking and is used to describe the three domains of human functioning. This approach arose out of my need to develop an integrative and flexible method of treating clients. As I began using different approaches in my work, I sometimes felt that I was applying them haphazardly. I wanted to find a consistent and organised way of assessing the clients’ concerns, and to then adapt the work to the approach which was most effective for them, and which could be used in a thoughtful and comprehensive manner. I also value working holistically and wanted the work to recognise and address the whole person, rather than responding to one area of his or her life. The FIT Model allows the therapist to quickly identify the major concerns brought by the client, the domain they fall within, and to then discuss and agree the direction of the work with the client. I have found that this method can be used to determine where to begin working with the client both within a single or beginning session as well as within the context of ongoing sessions. The therapist utilising the FIT approach first identifies the primary or initial concern/s, and then uses it to select which approach to use with the client, i.e. Person Centred, Gestalt, Transactional Analysis or Cognitive Behavioural Therapy. As the work progresses and other issues emerge, the same method is used to renegotiate the direction of the sessions. Throughout the work, the client actively participates in the decision-making process, and decides, along with the therapist, which approach and direction the sessions take.
How does the FIT Model benefit the therapist or supervisor who adopts this approach, and their clients?
The FIT approach can be used by therapists as well as by supervisors to focus and structure the sessions. Additionally, the Model provides a framework for exploring the interactions between the client and therapist and between the client, the therapist/supervisee and the supervisor within each of the three FIT domains. In the first instance, the therapist identifies the client’s current position within the three realms, ie. feeling, initiating and thinking, and then identifies his or her own position within the three realms in relation to a particular client. These insights can then be used by the therapist to identify areas of dissonance between him or herself and the client; i.e. the client’s desire to focus on behaviours versus the therapist’s desire to focus on feelings, and to then negotiate the direction of the sessions. Within the context of supervision, the therapist/supervisee identifies the client’s placement within the FIT model as well as his own placement within the model; i.e. the feelings, behaviours and thoughts experienced towards the client. This material is then presented in supervision, where it is used to explore the transference and countertransference issues taking place with the client. These insights are then used to inform and enhance the supervisee’s work with their clients.
How does FIT work in practice? Are there scenarios in which it is particularly effective?
I find that this approach is very effective in enabling the therapist to identify the client’s needs quickly and easily, and to then adapt the work accordingly. For example, a client came to me because she was out of work and was also experiencing the breakup of her marriage. During the initial session, she expressed feelings of sadness and also of fear regarding the loss of her income. She also stated that she needed to become more confident so that she could gain new employment, and that this needed to happen quickly. By using the FIT method to explore and focus her concerns, she decided that her need to find employment overrode the other issues. With this in mind, we agreed to spend the first few sessions using CBT techniques to help her develop the ability to ‘sell herself’ to prospective employers, and for her to learn how to perform successfully in interviews. This goal was met when she found employment. Staying with the FIT approach, she next chose to explore her feelings of sadness at the breakdown of her marriage, which was explored using Person-Centred and Gestalt techniques. As the work progressed, she eventually decided to explore unresolved feelings from her childhood which continued to affect her in the present. Again, the FIT method was used to negotiate the treatment at this stage of her therapy. By working in this manner, the client consistently identified the issues and approaches which she needed to use at any given point in the therapy. The work was determined by her needs and preferences, rather than by my biases as the therapist.
Why this approach and why now?
Therapists today often find an integrated approach more practical and efficient than using a single approach in their work with clients. Therapists are increasingly required to learn and work using an approach which is unfamiliar to them; this is the case for many therapists seeking employment within the NHS, where CBT is often the treatment of choice. The FIT approach meets the current need to incorporate additional or new approaches within their work, and to utilise an integrative approach which is flexible yet clear and consistent, rather than confusing to the client. Similarly, this integrative approach towards supervision allows for flexibility and incorporates the needs of supervisors tasked with working with multiple approaches and within a variety of settings.
Tell us about the book – how will it help readers to learn and apply the FIT approach?
Therapists and supervisors wanting to use the FIT Model need to be familiar with Person-Centred Therapy, Gestalt, Transactional Analysis, and Cognitive Behavioural Therapy. The book includes sections on each of these approaches, which also serve as a starting point for students to begin working with the various different approaches. The book provides detailed suggestions for using each of the different techniques and provides examples of each approach, both within the context of therapy and supervision. The book also forms the basis for a Post Graduate Diploma in Clinical Supervision, which teaches the methods and allows students to engage with the FIT Model in different scenarios and to practice its use in real-life situations. Additional information regarding the training programme may be found by contacting me through my website, www.PsychSupervision.com.
Copyright © Jessica Kingsley Publishers 2011.