N321 Lecture 6a (Patterson Fall 2024) PDF

N321: THERAPEUTIC INTERVENTIONS FOR INDIVIDUALS AND GROUPS Michelle Patterson (She/Her) RN, BSN, MN Lecturer, College of Nursing, Usask October 2024  Postmodern Approaches Solutions Focused Brief Therapy Motivational Interviewi...

N321: THERAPEUTIC INTERVENTIONS FOR INDIVIDUALS AND GROUPS Michelle Patterson (She/Her) RN, BSN, MN Lecturer, College of Nursing, Usask October 2024  Postmodern Approaches Solutions Focused Brief Therapy Motivational Interviewing Narrative Therapy TODAY Collaborative Language Systems Approach Postmodern Approaches in Groups  MODERNIST VS POSTMODERNIST Modernist Objective reality can be accurately described and observed. Objective reality can be systematically known through scientific methodology. Reality exists independent of any attempt to observe it. Clients seeks therapy when faced with a problem that is caused by deviating from the norm. Postmodernist Social constructionism: values the client’s reality without questioning its accuracy. Clients are experts of their lives. There is not one right or wrong way to live life.  HISTORY OF SOCIAL CONSTRUCTIONISM Focus on diversity, multiple frameworks, and integration. Seeks to provide a wider range of perspective in counselling practice. Change begins by deconstructing the power of cultural narratives, specifically the dominant cultural positions that exist in society.  Solutions-focused brief therapy POSTMODE Motivational Interviewing RN THERAPIES Narrative therapy Collaborative language systems approach  Initially developed by Steve de Shazer and Insoo Kim Berg in the 1980s. Future focused goal-oriented therapy SOLUTION- approach to brief intervention. Focusses on strength and resilience of FOCUSED people by focusing on exceptions to BRIEF the problem and their conceptualized THERAPY solutions. Emphasis is on constructing solutions rather than problem solving. Therapists assist clients in finding exceptions to their problems.  POSITIVE ORIENTATION Based on the assumption that people are healthy and competent and have the ability to construct solutions that can enhance their lives. We already can resolve the challenges life brings us, but at times we lose our sense of direction or our awareness of our competencies. The therapist’s role is to help clients recognize the competencies they already possess and apply them to solutions Therapists can be instrumental in assisting clients in making a shift from a fixed problem state to a world with new possibilities. One of the goals is to shift clients’ perceptions by reframing problem- saturated stories through the counselor’s skillful use of language SFBT BASIC PHILOSOPHY Change is constant and inevitable. Client want change. Clients are the experts & define goals. Future orientation – history is not essential. Emphasis is on what’s possible & changeable - do something differently. Short term and only small amount of change needed.  SFBT BASIC PHILOSOPHY Problems are maintained by: Doing More of the Same Expecting no change Solution Focused If it ain’t broke – don’t fix it. Once you know what works, do it more. If it doesn’t work, do something different. Change-Talk Solution talk, not problem talk Acknowledge distress  SFBT BASIC ASSUMPTIONS Clients have resources and strengths to resolve complaints. Since change is constant, the therapist’s job is to identify and amplify change. A small change in one part is all that is needed and can affect change in another. There is no one right way to view things and different views may be valid. Focus on what is possible and changeable. THERAPEUTIC PROCESS  5 STEP PROCESS 3. The therapist asks 2. The therapist works clients about those 1. Clients are given the with clients in times when their opportunity to describe developing well-formed problems were not their problems and the goals. Asks the question, present or less severe – therapist asks, “How can “what will be different in what did they do to I be useful to you?” your life when your make these events problems are solved?” happen? 4. At the end of each solution-building 5. The therapist and conversation, the clients evaluate the therapist offers clients progress being made. summary feedback, Clients are asked what encouragement, and needs to be done before suggests what clients they see their problem might do before the next being solved and what session to further solve their next step will be. their problem.  THERAPEUTIC GOALS Collaborative process Therapist strives to create a climate that will facilitate change and encourage clients to think in terms of a range of possibilities. Concentrate on small, realistic, achievable changes that can lead to positive outcomes. Three criteria for goals: 1. Start-based  stated in positive terms as the start or presence of something the client wants 2. Specific  Concrete, observable, measurable, detailed, behavioural description 3. Social  Description of what significant others would notice, how they might respond, how the responses might affect the  THERAPIST’S ROLE***** Not-knowing position Therapist retain their expert knowledge BUT enter the conversation with the client with curiosity and interest in discovery. Enter client’s world as fully as possible. No preconceived idea about what direction the conversation will take. Clients are experts. Strive to create a climate of mutual respect, dialogue, and affirmation. Help client imagine how they would like life to be different and what it would take to make this transformation happen.  CLIENT-THERAPIST RELATIONSHIP Three kinds of relationships that may develop between therapist and their clients: Complainant Customer-type relationship: relationship: Visitors: A client describes a Client and therapist Clients come to problem, but is not jointly identify a therapy because able or willing to problem and a someone else thinks take an active role in solution to work they have a problem constructing a toward solution  Skillful questions allow people to utilize their resources. Aim is not to gather information. Ask questions as part of conversation. THERAPEUTIC Not asked as a set list of questions. TECHNIQUES Be respectfully curious. QUESTION Asking “how questions” that imply change can be S useful. Effective questions focus attention on solutions. Questions can get clients to notice when things were better. Useful questions assist people in paying attention to what they are doing and can open possibilities for them to do something different.  SFBT TECHNIQUES Pre-Therapy Exception Coping Reframing Change Questions Questions What have Direct Ask about Involves you done clients to how clients building a since you times in manage to different made the their lives keep going frame of appointme when the when reference nt that has problem facing around the made a did not adversity. problem to difference exist. make it in your Reminds more problem? clients that solvable. problems are not “all- powerful!”  SFBT TECHNIQUES Formula First Therapist Scaling Questions Terminating Session Talk Feedback On a scale of A form of A summary From first zero to 10, where homework a provided to the session, therapist zero is the worst therapist might client, including is mindful of case and 10 give clients to strengths noted, working towards represents the complete signs of hope, termination. problem being between their commentary on Therapists assist solved, where first and second what the client is clients in are you with session. doing well to identifying things respect to Offers hope that work towards they can do to ______? change is goals. continue the On a scale of 0 to inevitable. Includes 3 changes they 10, how (offering hope) components  have already committed are Compliments, made. you to finding a Bridges, Discuss solution to your Suggesting perceived problems? tasks. hurdles or barriers in the  SFBT TECHNIQUES MIRACLE QUETIONS Miracle Question Follow-Up Can be asked in a variety of How will you know the miracle has ways… happened? Imagine waking up tomorrow What will others (parents, partner, morning. By some miracle children, work colleagues, etc.) notice overnight, life has turned out about you that makes them aware just as you have always wished. things are different or better? What does this look like? What would their reaction be? What What would your life be like if would they do? your (name problem or What would you do next? challenge) disappeared? What would we see (feelings, thoughts, How would you feel if you no and behavior) if we compared a before longer had any problems? and after picture? For someone that is grieving - Have you ever seen elements of this How will you know that better happen before? days are ahead?  Co founded by William R. Millar and Stephen Rollnick. Humanistic, client-centered, psychosocial, modestly directive. MOTIVATIONAL Evidenced-based. Brief and applicable across a variety of INTERVIEWING problem areas, Assists clients in committing to therapeutic process. Stressed client self-responsibility. Shares common characteristics of PCT and SFBT. MI BASIC PHILOSOPHY MI SPIRIT Clients possess abilities, strengths, resources, and competencies. Therapist works to evoke inner resources of clients. Bedrock attitude of therapist  like PCT Unlike PCT, MI is deliberatively directive while staying within the client’s frame of reference. Goal is to reduce client ambivalence to change and increase client motivation.  1. Therapists strive to see the world from the clients perspective. 2. Designed to evoke and explore discrepancies and ambivalence. MI BASIC PRINCIPLE 3. Reluctance is viewed as an expected part of the process. S 4. Therapists support client self-efficacy. 5. Once client’s are ready for change, therapists focus on strengthening commitment and implementing a change plan.  Precontemplation Stage  no intention of changing behavior anytime soon. Contemplation Stage Awareness of problem, consideration of change, no plans STAGES or commitment. Preparation Stage Individuals plan to take OF action immediately and small changes are noted. CHANGE Action Stage Steps are taken to modify behavior and solve problems. Maintenance Stage  Work is done to consolidate gains and prevent relapse.  MI TECHNIQUES Share many commonalities with SFBT. Nonpathological, health-promoting emphasis. Reframing resistance Every client wants something and is working towards it. Avoid labelling client at resistant. Resistance helps counsellor to adapt their approach to best support the client. Use of client’s strengths and resources. Skills improve with deliberate practice.  Founded by Michael White and David Epston. NARRATIVE Strengths-based approach. THERAPY Emphasizes collaboration between client and therapist. Goal is to help clients see themselves as empowered.  BASIC PHILOSOPHY Focus on respectfully listening to client’s stories. Searching for times in client’s life that they were resourceful. Avoids labelling and diagnosing. Dominant stories  events that clients have internalized. Therapist seek to assist clients to separate themselves from these stories to allow space for new stories.  KEY CONCEPTS Stories Problems are manufactured in social, cultural, and political contexts. Our stories shape our reality. Listening Therapist listens without judgement or blame. Affirms and values client experience. Normalizing Judgement  judging someone on what is deemed the “normal curve” (ex. of intelligence, mental health, normal behavior). Therapists listen to the problems of clients but don’t allow themselves to get stuck. Therapist avoid Totalizing language  reducing the complexity of the individual by assigning an all-embracing, single description to the person. Double listening  Separating the person from the problem while listening to the story. = THERAPEUTIC PROCESS  THERAPEUTIC GOALS Collaborate with client to name the problem. Personify the problem and attribute oppressive tactics to it. Investigate how the problem has disrupted, dominated, or discouraged the client. Inquire into alternative meanings for events to see the story differently. Discover moments of strength and resilience. Speculate on what a new future could look like. Help the client live the counter story outside of therapy.  Active facilitators Demonstrate care, interest, respect, openess, empathy, fascination THERAPIS TS ROLE Apply the “not-knowing” position Help clients create a preferred story line Avoids language of diagnosis, intervention, assessment  THERAPEUTIC TECHNIQUES Questions Not-Knowing position. Always asked from a position of respect, curiosity, openness. Externalization and Deconstruction The person is not the Problem – The Problem is the Problem. Deconstruct Problematic stories – Disassemble assumptions. Searching for Unique Outcomes Moments of choice or success regarding the problem. Alternative Stories and Reauthoring Inviting clients to author alternative stories. Turning Point between the problem-saturated story and the preferred alternative. Documenting the Evidence Gaining an audience (ex. Writing letters)  Not-Knowing Position COLLABORATI Intent is not to challenge or VE confront the client narrative, LANGUAGE but to assist in telling and re- SYSTEMS telling. APPROACH Conversation evolves into a dialogue of new meaning  new narrative  new possibilities.  POST- MODERN APPROACHES IN GROUP THERAPY 33  Group leader sets a solution-focused tone from the beginning. SOLUTION Focus on members seeing themselves as less problem-saturated. - FOCUSED Create opportunities for members to see themselves as resourceful. BRIEF THERAPY Work with members to develop well-formed goals. IN GROUPS Facilitator helps members to recognize personal resiliency and competency. Incorporates SFBT techniques in group session. 34  Group leader emphasizes how cultural, political, and social elements are often neglected in understanding how problems NARRATI arise in the first place. Group leader understands group member VE problems as being a product of social THERAPY forces that arise outside the person. IN Create a context where group members join forces to fight against externalized GROUPS societal forces of harm. Members are an active audience to witness story changes. 35  TAKE IT TO LAB: POST MODERN THERAPIES Double Miracle Externalizing Questioning Listening Question A way of Involves Asking specific How would the speaking that listening to the questions to client’s life be separates the problem story map the different if they problem from while also influence of the woke up the person. listening for the problem in the tomorrow and Addresses what counter story. client’s life. all their clients Contrast the problems were uncritically problem story gone? accept about and the Follow up themselves and Counter story questions. examines this. and keeps the contrast alive to allow the client to choose which story the want to invest in. REFERENCE COREY G. (2024). CHAPTER 10: POST MODERN APPROACHES. IN G. MAINA (EDS.), N321: THERAPEUTIC INTERVENTIONS FOR INDIVIDUALS AND GROUPS (PP. 302-355). CENGAGE LEARNING INC. BREAK TIME?