“Questions?” The trainer asked, as he took a seat on his stool. With his clean cut he looked more like a model than a wizened therapist, but anyone who’d just seen his demo with a couple couldn’t deny his mastery.
As people asked questions I sat deep in thought. I'd been banging my head against a wall trying to get this one husband to see his wife’s pain instead of blaming her. This trainer made it look so easy.
“...how did you know to say that in that moment?” Someone was asking.
I'd missed the question. But I got the gist. There was this one moment where everything changed, and somehow this trainer had caught it. He’d seen something that told him exactly what to do—and it worked. I perked up. If I could see what he saw, then maybe I could do what he did.
“Well you know, a lot of it comes down to intuition. If you do this work, like I’ve done for years, you just kind of get an intuition about these things.”
We all nodded. Of course, with years of practice he’d gained a sixth sense for working with couples. That sort of intuition isn't the sort of thing you can just train.
Or is it?
The technique that teaches you to see what trainers see: Process Coding.
Most of us have never heard of “process coding” in therapy before.
Think of “process” as the building blocks of how we do things. For example, if you were to cut down a tree for firewood, there are several building blocks you’d make sure to attend to first.
You’d spend time making sure your ax was sharp. So sharpening your blade would be one process.
You’d make sure to pick an old tree instead of a young sapling. So selecting the tree would be a process.
You’d make sure to have proper swinging form. So where you place your feet and how you hold your ax would be another process.
“Coding” is labeling different parts of a process. If a seasoned logger were to watch you cut down a tree, he'd look at your stance and “code” your swing. He'd say, “you’re not following through enough,” or “grip the ax lower to get more leverage.”
Process coders do the same thing in therapy. They look at various aspects of therapy like client motivation, experiential engagement, or level of marital conflict and label the sub-parts of each process in order to better understand it.
I’ve been working with a coach/consultant for the past few months. She’s a therapy researcher who uses process coding and it’s been an amazing journey.
As I’ve been working with her I’ve been thinking a lot about that trainer. It’s occurred to me that my coach is tuned in to the same things that trainer was, but she has something he doesn't.
My coach is able to describe what that trainer only knows intuitively.
Which process coding system is the most valuable for therapists?
Which process coding system should we learn? After all, there are dozens of different processes you could code.
I think the primary process we should be coding is client motivation because tracking motivation gives us a barometer for whether or not therapy is working.
Most of the time when we ask, “is therapy working” we want to know things like, “did this person’s anxiety decrease?” or, “was that lady able to confront her husband?” or, “did that dad stop yelling at his kid?”
While those things are important, they aren’t the most important. Not even close. The most important thing in therapy is whether or not you and the client are collaborating. As simple as it sounds, if clients are unmotivated and you're trying to get them to change, then you're not collaborating. On the flip side, if you’re collaborating, even if they are changing very slowly, eventually you’ll get where you need to go.
Think of therapy as a three legged race. In theory a three legged race is about which team gets over the finish line fastest. But if you’ve ever been to an actual three legged race, like at a work event or community fair, the reality is very different. Most teams don’t even finish the race because they focus so much on getting to the finish line that one person ends up getting dragged behind.
If you want to win, it probably doesn’t matter how fast you go, what matters most is how well you work together.
Let's do some therapy process coding.
Let’s talk about two examples of clients and therapists not collaborating. Here’s a clip from the doctor phil show.
(Watch from 1:06-1:41)
In this tape the therapist is saying, “clearly there's a connection, maybe even some blame between your issues with anorexia and your daughter's bulimia,” and the mom is saying “No, no, no!”
For many of us this is an obvious example of client and therapist NOT collaborating.
Researchers (like my coach) who code the process of motivation call non-collaboration “resistance.” Whenever the client opposes the direction set by the therapist, that’s resistance.
The question then becomes, "how do I handle resistance?" We’ll get to that in a future blog post. What I want to make clear is, according to the research, Dr. Phil proceeding this way is not only going to elicit more resistance, but that resistance is also poisoning the therapy.
Even though he’s right—there’s a clear connection between the mom’s issues and the daughter’s—his way of handling the situation is destroying his chances of helping.
You can't win the race by dragging your partner along.
Resistance, however, can also be very subtle. When you’re coding the process of motivation you can’t merely pay attention to the words. You have to also pay attention to the implied message. For example, take a look at this clip.
(Watch from 0:34-0:59)
Dr Phil : So how much do you weigh?
Client: 103
Dr Phil: And how much do you want to weigh (You can tell from the context that these aren’t merely assessment questions. These are leading questions which imply “logically you have to see this is a problem").
Client: 70-80? like that.
Dr Phil: And do you think you're overweight now?
Client: I do. I see myself that way.
Dr Phil: So at 103 you think you're 20 to 30 pounds overweight
Client: I still - even when I was 120 I still felt, I still feel so overweight.
This is resistance.
Dr. Phil is asking leading questions, and she's telling Dr. Phil, "I see where you're trying to lead me. It's not working. I still feel overweight."
If Dr. Phil keeps going in this direction, they’ll never cross the finish line.
Next steps with process coding for psychotherapy?
There’s a lot more to learn here. There’s learning to code change talk, learning to code counter change talk, learning to code change and counter change talk (ambivalence), and learning to code therapists' responses.
It sounds like a lot, and it takes practice, but it’s also totally doable {1}. This method of training is totally worth it. With process coding we can train therapists to see what trainers only intuit. With process coding motivation we can ensure therapists are always in sync with their clients.
The sad truth is most of us aren’t the therapists we’d hoped to be. With process coding that could change.
If you’d like coaching in process coding feel free to send me an email (jordanthecounselor[at]gmail.com). Coaching, of course is a paid service, but I’ll also be spending the next few blog post outlining everything I’ve learned about process coding motivation. So if you want the free education make sure to subscribe to the newsletter.
Best,
Jordan (the counselor).
Notes
{1} I learned to do it in under 16 hours. For me it’s removed the guesswork.
If you liked this post, consider reading this next. It's more about process coding for counselors.
Jordan Harris, Ph.D., LMFT-S, LPC-S, received his Doctor of Philosophy in Marriage and Family Therapy from the University of Louisiana Monroe. He is a licensed professional counselor and a licensed marriage and family therapist in the state of Arkansas, USA. In his clinical work, he enjoys working with couples. He also runs a blog on deliberate practice for therapists and counselors at Jordanthecounselor.com
Coding client motivation makes a lot of sense. Each offering from a counselor shifts the session in one direction or another. Some questions worth asking are
How flexible is the counselor?
Do the client and counselor want to cross the same finish line?