Tailoring Change to meet clients where they are at and Maximize Outcomes

“It will be important for therapists to consider the model of change with which they are currently working and consider what aspects of this model of change they are currently privileging. What is their overall aim during the process of therapy?”

Pote, Stratton, Cottrell, Boston, Shapiro, & Hanks, 2000: 12

One of the most powerful yet often overlooked aspects of effective therapy is how we conceptualize change. The way we believe change happens—the theory of change we operate from—shapes the interventions we choose, the conversations we have, and the way we measure progress. As therapists, we all have our own theory of change … and our clients also have their own ideas about change.  Sometimes our ideas line up with our client’s ideas, and sometimes they don’t, which can lead us to feel stuck or like we are working harder than the people we are working with.

So, what are the change pathways in therapy and what happens when a client’s theory of change doesn’t align with ours?

The Leeds Family Therapy Manual is a well-established and widely recognised resource that was initially developed by the Leeds Family Therapy and Research Centre to ensure consistency in research evaluating the effectiveness of systemic family therapy.  Today, it also serves as a resource for therapists in their practice, providing a framework and guidelines for implementing systemic family therapy. 

The manual highlights two distinct pathways to change:

1. Change through narratives – where transformation happens through insight, meaning-making, and re-storying.

2. Change through cybernetics – where change occurs through action, behavioural shifts, and system restructuring.

   
   

Neither pathway is inherently better than the other. Instead, each represents a different way people understand and engage with the change process.

In therapy, a mismatch between the therapist’s theory of change and the client’s theory of change can create frustration, resistance, and a sense of “stuckness”. But when we align with how a client naturally approaches change, therapy becomes more effective, engaging, and meaningful.

Narratives vs. Cybernetics: Two Lenses on Change

Let’s bring this theory to life by making a start with thinking about how we view change for ourselves.  Consider a change you might make in your personal life, e.g., starting a healthy eating plan, quitting smoking, joining a book club, or joining a walking group.  What is your natural inclination when making a change? 

Let’s use starting a healthy eating plan as an example.

• Are you someone who might reflect on your relationship with food, past struggles, and how eating habits are woven into your identity? Would you explore what "healthy eating" means to you and how it connects to broader aspects of self-worth, family patterns, or culture? If this is you and you lean towards change through reflection, insight, and meaning-making, then you are leaning towards a narrative approach to change.

• Or, are you someone who would dive right in and focus on practical steps like meal planning, portion control, accountability, and structured habit formation?  Would you straight away clean out the fridge and jump online to order an organic box of fruit and veg to be delivered?  If this is you and you lean towards concrete actions and strategies that directly alter behaviour, which in turn creates change, then you are leaning towards a cybernetic approach to change.

Both approaches could lead to the same outcome—healthier eating—but they take different pathways to achieve the change. The same principle applies in therapy.  Some clients need meaning as a pathway to change; others need action first and foremost.

So, now let’s shift the focus to your work with clients.  In your work, what do you fundamentally believe leads to change?

• Clients developing insight and reflective capacity?  Re-storying?  Understanding things differently?

• Or, clients taking actions, doing things differently, learning new skills, and adding to their toolkit for life, coping, parenting, and being in relationships?

And which schools, or approaches, in family therapy are you most drawn to that align with your beliefs about change?

How Do Family Therapy Schools Align with Theories of Change?

Different family therapy approaches tend to align with one of the pathways as outlined in the Leeds Manual:

Narrative-Based Change (Insight & Meaning-Making)

The Narrative Pathway to Change from the Leeds Family Therapy & Research Centre Manual aligns with family therapy models that emphasize meaning-making, re-authoring, and the role of language and discourse in shaping individual challenges and family dynamics. Some approaches that fit well with this pathway include Narrative Therapy, Dialogical Therapy, and Collaborative Therapy.

Cybernetic-Based Change (Action & System Restructuring)

The Cybernetics Change Pathway from the Leeds Family Therapy Manual aligns with family therapy models that focus on feedback loops, patterns of interaction, and systemic regulation rather than individual meaning-making. These approaches view families as self-regulating systems, where change occurs by altering patterns and structures. Some schools of therapy that fit within this pathway include Structural Family Therapy and Strategic Family Therapy.

Blending the Two: The Interconnection Between Action and Meaning

Although this model might get you thinking that people just toward one pathway of change, in reality, insight and action are interwoven. Meaning can inspire action, and action can generate new meaning.  What’s most helpful though is aligning with your client’s preference for change as a starting point and then working from there.

• A Narrative Therapy approach might first explore a family’s story around conflict, and at some point, they might get curious with the client about new ways of interacting that are consistent with the emerging preferred story.

• A Structural Family Therapy approach might begin with active interventions, and later the therapist may help the family make sense of their shifts in identity and roles.

  
  

The key is flexibility—understanding when to emphasize insight and when to emphasize action based on what resonates most with the client.  This means we have to pay attention to our clients who will give us clues about what works for them e.g., You might be working with a client to develop their insight and reflective capacity so that they can mentalise their foster child’s experiences and needs to help improve the relationship and the young person’s functioning, but, part way through the session the client says something like, “That’s all well and good, but they still need to do their chores.  They are part of this household, and it’s good for kids.”  What’s the theory of change being communicated here?  Action and behaviour change.

Alternatively, you might be working with an adult who manages the effects of anxiety and you are teaching them lots of coping skills to experiment with and practice between sessions e.g., different breathing techniques and grounding techniques.  But when they come for their next session they haven’t done any homework, haven’t practiced the strategies, and say something like, “If I could just understanding why this is happening to me.”  What’s the theory of change being communicated here?  Reflection and meaning making.

When Mismatch Happens: Why Clients Get “Stuck”

When there’s a mismatch between the therapist’s and client’s theory of change, therapy can become stalled, and the therapist can end up feeling like they are working harder than their client.

Let’s consider a few common scenarios:

• A client seeking insight works with a therapist focused on behaviour change. They feel pressured to take action before they’ve fully made sense of their experiences, leading to resistance or disengagement.

• A client who wants action-focused solutions works with a therapist who prioritizes meaning-making. They might feel frustrated, impatient, or like therapy isn’t practical enough.

• A family with different theories of change within it (e.g., one parent wanting behavioural solutions while the other wants to explore emotions) can struggle with conflicting expectations about what should happen in therapy.

  
  

When therapists recognize these mismatches, they can adjust their approach rather than assuming “resistance” or “stuckness” means that the client isn’t motivated or ready for change.

Meeting Clients Where They Are: The Key to Effective Therapy

Ultimately, therapy isn’t about imposing our theory of change—it’s about understanding the client’s. When we adapt to their natural way of change, we work in ways that enhance our therapeutic alliance by:

• Increasing engagement – Clients feel heard and understood, making them more open to the process.

• Enhancing therapeutic effectiveness – Change happens in a way that makes sense to them, making it more sustainable.

• Respecting individual and cultural differences – Different people and families have different worldviews on how change occurs. Honouring these perspectives fosters a collaborative, strengths-based approach.

Let’s take a minute to think about how these ideas about theory of change could add to or extend your practice with a self-reflective exercise.

Reflection Exercise:

1. What do you personally believe leads to change in therapy—insight and meaning-making, or action and behavioural shifts?

2. Think about a client you feel “stuck” with. What might be their theory of change? How does it match (or mismatch) with your approach?

3. How might you adjust your interventions to better align with their way of understanding change?

Final Thoughts

There’s no right or wrong way to facilitate change—just different paths. Some clients need to understand before they can act, while others need to act before they can understand. When we attune to our clients’ natural theory of change and meet them where they are, we create therapy that is not only more effective but also deeply respectful of their unique way of making sense of the world.

By staying curious, adaptable, and responsive, we move from a rigid “one-size-fits-all” model to a truly individualized and client-centered approach—one that empowers families to change in ways that feel authentic and lasting.

Leonie

Dr Leonie White

Clinical Family Therapist and Psychologist

Director Phoenix Family Therapy Academy

Helping people grow, connect and thrive in life’s unique journey.

Please note - this article is educational in nature and does not constitute therapy advice. 

Please seek help from a professional if you require support. 

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References:

Pote, H., Stratton, P., Cottrell, D., Boston, P., Shapiro, D. & Hanks, H. (2000).  Leeds Systemic Family Therapy Manual.  Leeds Family Therapy and Research Centre: Leeds. www.leeds.ac.uk/lihs/psychiatry/landt/lfrtc-research.html