A practice element is a discrete component of an active therapeutic intervention applied to the achievement of one or more specific therapeutic aims or intentions. The concept of a practice element is based on the idea that therapeutic interventions are comprised of numerous discrete and separable elements that can be combined in various ways. The practice elements listed here are comprised of two main types of therapeutic content:
Techniques – specific, discrete, intentional actions performed by the practitioner (e.g. reflective listening, functional analysis, instruction, modelling, reinforcement, exception seeking, validation), and
Processes - emotional, cognitive, behavioural and social actions and experiences taking place within, or actioned by, the client that unfold over a period of time as the client engages in a therapeutic encounter (e.g. exploring ambivalence, developing self-awareness, identifying feelings, recognising strengths, self-soothing, reframing problems).
Therapeutic techniques and processes are conceptually independent, but in practice they have tended to evolve in close relationship with one another. Theoretically, techniques can be applied to a very wide range of therapeutic processes, but in practice some techniques are highly specific to particular processes. In the tables below most of the names or labels given to the practice elements refer to processes, and the description may include reference to one or more techniques that are frequently applied to the aim of initiating or facilitating that process. The names of other elements refer to particular techniques or sets of closely related techniques, and the description may refer to particular types of processes to which they are applied. Theory and practice wisdom shape how processes and techniques are combined, and how they are applied to meet individual client need.
Conceptualising practice elements as comprised of varying combinations of techniques and processes enables, hypothetically at least, a vast array of practice elements to be assembled. In practice, the theories from which they are derived, the practical purposes to which they have been applied, and the evidence base that has been generated from research and critical reflection on practice have worked to generate and refine a limited set of therapeutic practice elements. These influences are apparent in the names, definitions and descriptors of the practice elements listed here.
Different therapeutic interventions or approaches tend to share practice elements, with similar approaches sharing more elements, and divergent approaches sharing fewer elements. As new therapeutic interventions evolve they tend to build on and recombine elements from older approaches in addition to developing new elements.
The practice elements associated with particular therapeutic approaches as set out in the tables below represent therapeutic techniques and processes that are relatively specific and unique to those approaches, that originated within that approach, or which are given particular prominence within that approach. Elements that are shared among most of the therapeutic approaches such as the foundational techniques of counselling are not included here. An exception is made for some elements that involve ‘listening’ and ‘goal setting’ because there are distinct nuances across the different approaches. Most of the therapeutic approaches drawn from here contain or describe greater numbers of practice elements than are described here. Only those assessed as highly relevant to agencies serving young people with multiple and complex needs, are included.
Modularity is an approach to design that has long been applied in many fields such as engineering, architecture and computing. It is used to promote product qualities such as customisation, scalability, resilience against faults or damage, and to increase efficiencies in product development and innovation. The application of modularity to the design of therapeutic interventions has been elaborated by Chorpita, Daleiden and Weisz (2005).
Generally, modularity refers to breaking complex activities or structures into simpler parts that can function independently. Modules are self-contained units that can connect with other self contained units, but do not necessarily rely on those other units for their own stable operations (Chorpita, Daleiden, & Weisz, 2005). Each module must have a specified purpose or function, and can be expected to produce the desired result on its own without being connected to additional modules. Sometimes the term ‘module’ is used to refer to simple subdivisions based on other considerations such as convenience (e.g. 50-minute sessions within a program that runs over six weekly sessions). This is not the same as a functional module.
In contrast to modular designs, treatment protocols involving highly cumulative and sequenced sets of procedures that build steadily upon previous activities are ‘integral designs’. The industry standard for EST protocols tends towards a highly integral design. Because it is difficult to neatly separate the various components from one another, highly integral designs can be difficult to adapt to therapeutic encounters that do not fit into regular sessions and which do not go to plan.
Practice elements and modularity
There is a clear distinction between practice elements and modules. Practice elements are defined in terms of the processes and techniques of therapeutic interventions, and they can be combined equally well within integral or modular designs. In contrast modules are defined primarily in terms of functions or the purposes they are intended to achieve.
However, effective modularity in treatment design is greatly assisted by the definition and use of practice elements. “[A] module is best thought of as a structured ‘container’ that can contain one or more practice elements” (Chorpita et al., 2005; p145). Because modules are distinguished by functionality, a module would contain practice elements that theory or practice wisdom suggests will add value to one other in achieving specific functions or therapeutic purposes.
Scholarly analysis of the variety of ways in which practice elements could be configured within modules is just beginning to emerge (Mitchell, 2012). Two examples might serve to illustrate.
One type of module can comprise elements that are drawn from the same therapeutic approach and are already well established as sequential steps. Examples of this include ‘Cognitive restructuring’ and ‘Problem solving skills training’ with all elements drawn from Cognitive Behaviour Therapy.
A second type of module could comprise elements drawn from a wide variety of different therapeutic models. Examples of this include ‘Engagement’ and ‘Building a more positive self-concept’ with elements drawn from at least four different models. In this case the practice elements all contribute to the same therapeutic intention, but they do so in subtly different ways. Different elements within such a module could be used with different clients depending on their preferred communication style, and at different times depending on the specific engagement and relationship challenges that emerge over time.