{"id":5218,"date":"2023-04-14T11:37:00","date_gmt":"2023-04-14T03:37:00","guid":{"rendered":"http:\/\/darylchow.com\/frontiers\/?p=5218"},"modified":"2024-07-02T15:06:11","modified_gmt":"2024-07-02T07:06:11","slug":"structureimpactseries","status":"publish","type":"post","link":"https:\/\/darylchow.com\/frontiers\/structureimpactseries\/","title":{"rendered":"Structure & Impact Series"},"content":{"rendered":"\n

Note: This is a compilation of Frontier Friday<\/a><\/strong>, a weekly Substack published, originally released on 14 Apr. 202<\/em>3<\/p>\n\n\n\n

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PART I<\/h2>\n\n\n\n
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  1. \ud83d\udcfdWatch: Nancy Duarte<\/strong>

    \"\"<\/a>

    Even though I first came across Nancy Duarte\u2019s work because of my interest in improving the way I teach, I\u2019ve found that much of her ideas cross-pollinated into the way I think about how I structure the therapy hour.
    Her book,\u00a0    Resonate<\/a>\u00a0is a good resource to have as well.
    (At the risk of offending your boss, if they are prone to go powerpoint-crazy, her older book,\u00a0    Slide:ology<\/a>\u00a0might be a good present!)

    <\/li>\n\n\n\n
  2. \ud83d\udcd5Read:\u00a0Forms of Vitality<\/a><\/strong>
    Daniel Stern was a well-known psychoanalyst from his landmark writings on mother-infant attachment.
    A less well-known book that he wrote, called\u00a0Forms of Vitality<\/em>, gave words to ideas I\u2019ve felt for a long while, stemming from my history with music.
    In this book, Stern illustrates how an understanding of vitality can help the psychotherapeutic process.
    While this book isn\u2019t about how to \u201cstructure\u201d your work, to me the relationship of structure and emotional impact are interwoven.

    \"\"

    Relationship of structure and impact.<\/strong>

    <\/li>\n\n\n
  3. \ud83d\udcc8 Read:\u00a0The Story Grid<\/a><\/strong>
    I had never come across anything quite like this.
    I came across Shawn Coyne\u2019s work because of his editing work with renowned author Steven Pressfield (author of The War of Art).
    Reading this book was like someone pulling back the curtains and revealing trade secrets to the craft of writing.
    Story Grid gave inspiration to how I would think not only about how I structure sessions, but also helped me create the\u00a0Session Impact Grid (ISG)<\/strong>, which is a way to \u201cX-ray\u201d a session recording. I use the ISG whenever I review therapy session recordings, be it from my own, others I supervise, or even watching master therapists at work.
    I\u2019ve talked about the ISG in Section III of\u00a0    The First Kiss<\/a>, and I go in-depth with this in the Structure and Impact course. Here\u2019s an\u00a0example<\/a>\u00a0based on a therapy session.

    <\/li>\n\n\n
  4. \u2b55\ufe0f\u00a0Archives From My Desk: Thinking in Thirds<\/strong>
    Part I: The Rule of Three<\/a>
    Part II: Going Deeper<\/a>
    Part III: Closing the Session<\/a>
    Here\u2019s an archive based on a 3-part series that I wrote about how we can use thinking in thirds to help you construct your sessions.

    <\/li>\n\n\n
  5. \u23f8\u00a0Words Worth Contemplating:<\/strong>
    \u201cThe higher your structure is to be, the deeper must be its foundation.\u201d<\/strong>
    ~ St Augustine.<\/li>\n\n<\/ol>\n\n\n\n

    Reflection:<\/strong><\/h3>\n\n\n\n

    In the sea of our daily-weekly busy madness, what is something that you lean on<\/strong> in your life right now?<\/em><\/p>\n\n\n\n

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    PART II<\/h2>\n\n\n\n
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    1. \ud83d\udd16\u00a0Web-Read:\u00a0Audiences Grow Weary of Stories That Never End<\/a><\/strong>

      \"\"<\/a>

      I\u2019m a huge fan of Ted Gioia\u2019s body of work on music and culture (e.g., Music: A Subversive History). He\u2019s here on Substack too, called the\u00a0      Honest Broker<\/a>.
      Gioia\u2019s highlights the issue about stories that collapse without closure, \u201cthe narrative arc reduced to \u201cone damn thing after another.\u201d
      \u201cHollywood is so obsessed with sequels, prequels, reboots, and spinoffs that they can\u2019t afford to let any good story come to an end.\u201d

      \"\"

      This is one of the reasons I tell my wife that I will not watch a Netflix television series, unless I know that that there\u2019s an ending.

      I\u2019m sharing this post because we have to think about not just how we      \u00a0close sessions<\/a>, but also how we plan for closures in therapy.

      I know therapists tend to think in terms of moving clients into \u201cmaintenance phase.\u201d Several people in my caseload are nowhere near what we call \u201cbrief\u201d therapy. Even then, we have to think about what it means to close a particular chapter in their journey.

      Delineating closure of a particular phase in client\u2019s lives helps to add a sense of order in the sea of chaos that often goes hand-in-hand with the healing endeavor.

      <\/li>\n\n\n\n
    2. \ud83d\udcfd Watch: The Rule of 3<\/strong>

      \"\"<\/a>

      Take a moment and step outside the Psychotherapy-land, and watch this video on music composition.

      Music is the perfect example of how one creates expectations and then subverts them. This is why music that pushes too far the boundaries of our expectations might sound \u201ctoo unpalatable,\u201d (think experimental jazz) and music that plays to a formula might sound cliche (think pop jingles).

      After watching this video, think about how this applies to your work in the clinical hour.

      Key Grafs:<\/strong>
      – The amount of times you should repeat the idea without over repetition.
      – Too much of a good thing is no longer a good thing.

      <\/li>\n\n\n\n
    3. \ud83d\udcfd Watch: Why Every Johnny Harris Videos Goes Viral<\/strong>

      \"\"<\/a>

      I have a knee-jerk reaction when people try to sell you a \u201cformula.\u201d (Think about all those horrific youtube ads).
      But there is something to learn from Emmy-nominated\u00a0      Johnny Harris<\/a>\u00a0and his crew who have been producing superb investigative documentaries on youtube. If you watch a handful of his videos, there is nothing\u00a0formulaic<\/em>\u00a0about them. Instead, what you might notice about the way he structures his film ends up feeling like this is his \u201cstyle\u201d of production.

      My takeaway from this explanation video and how this applies to the practice of psychotherapy:<\/strong>
      –\u00a0Structure provides guidance<\/strong>:
      You are a guide to the process, so provide the\u00a0      scaffolds\u00a0<\/a>of a. where you are, b. where you are going, and c. why you are guiding the person to go in this direction.
      –\u00a0Experience before explanation:<\/strong>
      The videographer here says, \u201cunderstanding something begins with experiencing it on some level.”
      \u201cGood explanation does not rest in our heads, but in a body of vivid experiences.\u201d
      – See related:
      Explainoholic<\/a>
      Information is Not Transformation<\/a><\/strong>

      \"\"

      Structure builds to impact.<\/strong>

      <\/li>\n\n\n\n
    4. \u2b55\ufe0f\u00a0Archives From My Desk:\u00a0\u201cI Don\u2019t Mean to be Mean, But\u2026\u201d<\/a><\/strong>
      In this article, I\u2019d walk you through not just a way to engage in deliberate practice, but how to learn from others in structuring your work.

      We take a deep analysis of a couples therapy session conducted by Esther Perel, and deconstruct the segments using a grid that I\u2019ve devised called the\u00a0Impact of Session Grid (ISG).<\/strong>
      The Impact of Session Grid of the couples therapy session.<\/strong>

      \"\"<\/li>\n\n\n\n
    5. \u23f8\u00a0Words Worth Contemplating:<\/strong>
      \u201cGreat creative minds think like artists but work like accountants.\u201d<\/strong>
      ~ journalist and author, David Brooks.<\/li>\n<\/ol>\n\n\n\n

      Reflection:<\/strong><\/h3>\n\n\n\n

      What is your relationship with structure and flexibility in the way you conduct your sessions?<\/em><\/p>\n\n\n\n

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      PART III<\/h2>\n\n\n\n
        \n
      1. Research:\u00a0Antagonism Between Achievement and Enjoyment in Learning<\/a><\/strong>I learned about this piece of research from Scott H. Young, author of Ultralearning. He listed this study in his blog as one of his top 10 favorite paper on the science of learning and thinking.

        Key Grafs:<\/strong>
        – Students often report\u00a0enjoying the method<\/strong>\u00a0from which they learn the least.<\/strong>
        –\u00a0Low ability students<\/strong>\u00a0typically report\u00a0liking more permissive instructional methods<\/strong>, apparently because they allow them to maintain a \u201clow profile\u201d so that their failures are not as visible. They will report enjoying methods which appear to them to bring maximum achievement with less investment of time and work
        – However, in order to experience maximum achievement low ability students require less permissive methods which lower the information processing load on them.
        –\u00a0High ability students<\/strong>\u00a0like more structured methods<\/strong>\u00a0which they believe will make their efforts more efficient.\u00a0High ability students<\/strong>\u00a0seem to\u00a0learn more from more permissive approaches<\/strong>\u00a0which allow them to bring their own considerable skills to bear on learning tasks.

        Implications from learning sciences to psychotherapy:<\/strong>
        – Generally speaking, it seems to me that the highly conscientious, motivated and higher-functioning clients want more \u201cstructure\u201d in treatment.
        – In turn, the less conscientious, less motivated and lower-functioning clients might not be the first ones to put up their hands for \u201cmore structure and focus\u201d in treatment. This might be a function of overwhelm and being psychologically drained by the challenges that led them to therapy in the first place.
        – The real challenge for therapists is to not only meet where the clients are at, but also to scaffold and provide \u201ca difference that makes a difference.\u201d
        – In other words, a higher-functioning clients might benefit from more open-ended guidance (i.e., \u201cGo wide\u201d), while clients who are in more distress might benefit from a more focused and scaffolded approach (i.e., \u201cGo narrow”).
        – Note: I might have run the risk of over-extrapolating from this single aptitude-treatment interaction (ATI) study.
        – The key takeaway is that we are susceptible to be poor judges on how we learn best.

        <\/li>\n\n\n\n
      2. My Weekly Therapy Learnings Notes:
        <\/strong>I\u2019ve talked about the practice of capturing your own\u00a0        weekly therapy learnings<\/a>\u00a0as a practice of weaving your encounters into potential deep learnings.

        Here\u2019s two of mine that are related to structure (and blunders):

        i.\u00a0No. 376. “Where Are You?”<\/strong>
        Date: 8 Aug 22I found myself asking clients this as an entrance to the session last week, \u201cWhere are you?\u201d”Where are you” denotes1. A placement of self, and2. where the person wants to goIt’s also not just about what’s happening on the outside, but what’s happening on the inside.<\/em>
        This is linked to the idea of\u00a0        Fuubutsushi<\/a><\/em>

        ii.\u00a0No. 369. Provide the Intent<\/strong>
        Date: 27 Apr 22.Today, I had the Session Rating Scale (SRS) rated lower by a client at 8.5\/10 for methods\/approach. I wasn\u2019t expecting this. Given that he was highly motivated and doing well, he said he would have appreciated more structure in the session today.Turns out, what he meant was that he wanted\u00a0clarity of what we were doing<\/strong>, and why.Last week, I had a similar feedback from a different client. He rated lower in methods too. He thought I was trying to address a \u201cdeficit\u201d in his interpersonal ability, but that wasn\u2019t where I was coming from. I was only trying to understand the relational context, and then go deeper into the intra-personal conflicts that he was facing in his inner-life.
        \u2026Then I realised the mistake I\u2019ve made on both occasions:\u00a0I\u2019ve not made my intentions clear.<\/strong>\u00a0Argh\u2026
        Note to self:
        –\u00a0Explicate my intentions, where we are going and why.
        <\/strong><\/em><\/li>\n\n\n\n
      3. Research<\/strong>:\u00a0The Importance of Problem-Focused Treatments: A Meta-Analysis of Anxiety Treatments<\/a><\/strong>
        This study is mentioned in our upcoming book,\u00a0The Field Guide to Better Results.<\/em>\u00a0Noah Yulish and Nick Oleen-Junk cited a meta-analysis that Yulish and colleagues conducted in 2017.
        Based on 135 studies with more than 175 comparisons, they found that regardless of theoretical orientation, addressing clients\u2019 problems with focused interventions is a key structural ingredient of all effective treatment.

        This overlaps my clinical experience, especially when working with people who come in with specific concerns like anxiety-related symptoms. At times, even at the start of therapy, a person with specific problems may report high functioning on global wellbeing scales. In part, this may be due to the specificity of the issue and that it\u2019s not bleeding into their relational and occupational life, and\/or may be due to behavioral and emotional avoidance in order to cope, which in turn makes their global functioning scores higher that when they are confronting their fears. In such instances, a focused and structured guidance of the process is likely to be more helpful than a free-flowing, unstructured therapeutic framework.

        <\/li>\n\n\n\n
      4. \u2b55\ufe0f\u00a0Archives From My Desk: Why Structure and Deconstructing Impact
        <\/strong>For those who might have missed this two essays.

        <\/strong>        \"\"<\/a>


        \"\"<\/a>


        <\/li>\n\n\n\n
      5. \u23f8\u00a0Words Worth Contemplating:<\/strong>
        “Structure in psychotherapy is the safety net that allows for exploration and growth.”<\/strong>
        ~ Irvin Yalom, Love’s Executioner.<\/li>\n<\/ol>\n\n\n\n

        Reflection:<\/strong><\/h3>\n\n\n\n

        Take a moment to map this out.<\/em><\/p>\n\n\n\n

        How do you structure your sessions?<\/em><\/p>\n\n\n\n

        What do you notice after doing this exercise?<\/em><\/p>\n\n\n\n

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        If you would like to learn more topics that can help your professional development, subscribe to the Frontiers of Psychotherapist Development (FPD). On Frontiers Friday (FPD), we serve you directly to your Inbox highly curated recommendations each week.<\/em><\/h3>\n\n\n\n
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