Multiple Contingencies Management (MCM) in Clinical Practice

Research has showed that no single system of psychotherapy is consistently superior to others across all clinical conditions, and the system of therapy used explains less variance in terms of positive outcome than the common factor of therapeutic alliance; therefore, adopting a more eclectic stance that combines elements from different systems of therapy seems to make sense.

In the increasingly globalized context in which there are rapid movements of people, and the ideas, practices, goods and services asociated with them, the clients we work with are increasingly diverse. Intersecting diversities related to place of origin, ethnicity, culture, gender, sexual orientation, religion, class and ability introduce new challenges to clinical practice. Clients are unlikely to respond to any system of psychotherapy in predictable, uniform patterns. Most clinicians share the view that one size probably does not fit all. We can always think of clients who just do not respond to our chosen system of therapy, be it cognitive therapy, psychodynamic therapy, or emotional focus therapy. My position is that we cannot expect clients who are different to fit in to our preferred treatment model, but instead we have to be able to address their diverse needs, characteristics, and circumstances.

In my own experience in direct practice, supervision, teaching, and research, I have noticed that if we look at the moment by moment processes and the decisions made by clinicians, the system of therapy supposed to be applied is usually not the sole determinant of actual clinical decisions and performances. In response to the complex challenges we encounter in clinical practice, we often bring in other sources of knowledge, including our experience in practice, learning, and professional development both within and outside of psychotherapy. What we actually say and do in clinical practice is also conditioned by our social location, personal experiences, values, and beliefs. In short, there are multiple contingent factors and processes to be considered in each clinical decision. The more we can make these contingencies explicit, and offer a coherent and parsimonious framework for conceptualizing them, the more it can assist us in charting our courses with our clients.

The MCM model can be considered a meta-theoretical framework that enables clinicians to bring together useful elements from different systems of psychotherapy, research knowledge, practice wisdom, and their own personal experiences, values and beliefs to address diverse and complex client realities.

I began articulating the MCM model back in 2003, and have presented the model to varied audiences in different parts of the world. I am generally encouraged by the feedback, and I am now in the process of writing it down as a book, to facilitate further exploration, discussion, and research. I am now posting brief write-ups and powerpoints that I have used, and I welcome comments and feedback from you by email.


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