COUN A221F Lecture 10 Solution Focused Brief Therapy PDF

LECTURE 10: SOLUTIONFOCUSED BRIEF THERAPY COUN A221F Theories and Practice in Counselling and Mental Health Hong Kong Metropolitan University INTRODUCTION ▪ Solution-Focused Brief Therapy (SFBT), also called Solution- Focused Therapy, Solution-Building Practice therapy was developed by Steve de S...

LECTURE 10: SOLUTIONFOCUSED BRIEF THERAPY COUN A221F Theories and Practice in Counselling and Mental Health Hong Kong Metropolitan University INTRODUCTION ▪ Solution-Focused Brief Therapy (SFBT), also called Solution- Focused Therapy, Solution-Building Practice therapy was developed by Steve de Shazer (1940-2005), and Insoo Kim Berg (1934-2007) and their colleagues beginning in the late 1970’s in Milwaukee, Wisconsin. ▪ A treatment manual on SFBT was first developed in 2008, and updated in 2013 (Bavelas et al., 2013) by the Solutionfocused Brief Therapy Association (SFBTA). IF KEEP FOCUSING ON THE PROBLEM. . . ▪ Digging a hole! ▪ The more you talk about the problem, the hole gets bigger. BASIC PHILOSOPHY OF SFBT ▪ Therapy grounded on a positive orientation (people are healthy and competent). ▪ Therapeutic focus on client’s desired future not past. ▪ View people are healthy, competent, and resourceful, and can construct solutions to enhance their lives. ▪ Therapy is concerned with looking for what is working. ▪ Therapists assist clients in finding exceptions to their problems. BASIC PHILOSOPHY OF SFBT ▪ Small increments of change lead to large increments of improvement. ▪ The counsellor's skills invite the client to build their own solution not diagnosis and treat problems. ▪ Focuses on client’s unique pathway through life, cultural context, and his/her personal understanding of the current situation. CO-CONSTRUCTION ▪ It is a collaborative process in communication where speaker and listener purposefully use of the client’s language to negotiate meanings, and this jointly produced information in turn acts to shift meanings and social interactions (Bavelas et al., 2013, p. 5). ▪ Clients are specifically asked to co-construct a vision of a preferred future and draw on their past successes, strengths, and resources to make that vision a part of their everyday lives. RATIONALE OF SFBT ▪ Non-pathological ▪ Non-judgmental stance regard on client’s problem. ▪ No reality is better than other, they are just different. ▪ Solution focus and future oriented ▪ Early training of “problem focused model” focus on analysis the problems and focus on symptoms. ▪ SFT focus on client strengths and help to identify their preferred goals. RATIONALE OF SFBT ▪ Exceptions and client strengths ▪ Help client recognize lives not only fill with problems. ▪ SFT is aim to looking for times when the problem has not saturated the client life. ▪ Readiness, not resistance ▪ There's no resistance client , they ‘re not yet found an available mechanism to change. THREE KINDS OF RELATIONSHIPS IN SFBT (GAN, 2020) ▪ Customer-type relationship: client and therapist jointly identify a problem and a solution to work toward. Realize personal effort is required. ▪ The client is open to new ideas, suggestions, reframes, and encouragement. THREE KINDS OF RELATIONSHIPS IN SFBT (GAN, 2020) ▪ Complainant relationship: a client who describes a problem but is not able or willing to take an active role in constructing a solution. Expect another person to change. ▪ They are very good at describing the problem, their frustrations with the problem, and unsuccessful attempts to solve the problem. ▪ At this stage, they want help from the “expert” to “fix” the problem. THREE KINDS OF RELATIONSHIPS IN SFBT (GAN, 2020) ▪ The best thing to do when a person is complaining is to listen and sympathize. ▪ This is not the time to do solution-building until the person is ready to engage in change behavior. ▪ Empathic responses such as “A lot of family members would have given up by now, but here you are, still looking for answers.What has helped you cope so far?” THREE KINDS OF RELATIONSHIPS IN SFBT (GAN, 2020) ▪ Visitors: clients who come to therapy because someone else thinks they have a problem. Disagree they have a problem. ▪ People who are visiting are checking out. ▪ Can we be trusted? Is it worth my time to come and meet with us? ▪ For example, an individual who is referred by a rehabilitation provider, an adolescent who is brought to therapy by parents, or a spouse who attends therapy at the partner’s insistence. THREE KINDS OF RELATIONSHIPS IN SFBT (GAN, 2020) ▪ The therapist can start off from a position of curiosity and not knowing. ▪ “Whose idea was it that you come here today?”“ ▪ “What’s your understanding of why you’re here?” ▪ If the individual is reticent and prefers not to talk, allow the individual to sit back and listen. ▪ Empathize with them about having to attend the session against their wishes. ▪ Acknowledge their ambivalence about therapy and reframe their response. ▪ Thank them for coming and staying in the session. GOLDEN RULE OF SFT GOLDEN RULE OF SFT COMPARISON OF COUNSELING APPROACHES PROBLEM FOCUSED VS SOLUTION FOCUSED QUESTIONING PROBLEM TALK VS SOLUTION TALK THERAPEUTIC GOALS ▪ Believe clients can define their goals and the resources required to solve their problems. ▪ Focus on small, realistic, and achievable changes. ▪ Small change leads to big change ▪ Remain goal-directed and future-oriented. ▪ E.g., what has changed since last session? ▪ Talk about solutions instead of talking about problems. THERAPIST’S FUNCTION AND ROLE ▪ No knowing position: clients as experts about their own lives. ▪ Create a collaborative relationship. ▪ Create a climate of mutual respect in which clients are free to create and explore solutions. ▪ Help clients to explore what they would like things to be different, how to make a difference, and what signs to indicate the changes are happening. THERAPIST’S FUNCTION AND ROLE ▪ Solution-focused brief therapy is designed to be brief, so therapist must shift the focus as soon as possible from talking about problems to exploring solutions. ▪ Help clients to use their strengths and resources to construct solutions. PHASE OF THERAPY Stage 0 Pre-session change Stage 1 Forming a collaborative relationship Stage 2 Describing the problem Stage 3 Establishing preferred goals Stage 4 Problem solution focus Stage 5 Reaching preferred goals Stage 6 Ending Therapy Fact Belief • What do you want to solve? • How long have you been in the relationship? • What do you think of the current situation? • How much energy do you have for a solution on a 1-10 scale? Possibility • If you were the boss, how would you deal with the problem? • What ways did you use to cope with the problems in past? • What are the options for action here? Challenge • What will you do if he does not communicate with you? • What is the benefits if cooperation is successful? Action • • • • When will you do?/ What’s the first time? Whom you need to work with? How long will you do? What early signs are there that things might be getting better? 01 02 03 04 05 Preferred goals questions Coping questions Exceptionseeking questions Miracle question Scaling questions USE OF QUESTIONS IN SFBT 1. PREFERRED GOALS QUESTIONS ▪ Focus on how the client’s life will look when goals are reached and how long the client believe will take. ▪ Not problem-focused but on the client’s hoped for the future. ▪ If the client has difficulty producing goals in the session, the therapist can ask: ▪ “What would need to happen today to make this a really useful session?” ▪ “What needs to be different in your life for you to be able to say that it was a good idea you came in and talked with me?” PREFERRED GOALS QUESTIONS ▪ How will you know that coming here has been worthwhile for you? ▪ What are your best hopes for this sessions? ▪ How will you know when things are getting better? ▪ How long do you think it will take before things get better? ▪ How will you know when things are getting better? ▪ Between now and the next time, think of something that you want to continue happening, or see more of. 2. COPING QUESTIONS (IF IT WORKS, DO MORE OF IT) ▪ Ask client the time they are/ were able to cope with the problem effectively. ▪ “What was the way you found to help manage or alleviate your depression?” ▪ “How have you kept this from getting to be a bigger problem?” ▪ “Your depression seems to have impacted your eating , how is that you are able to eat sometimes?” ▪ “This sounds so hard for you. How have you coped so far? What are you doing to help you get through each day?” ▪ “Sounds like you had a rough week. How did you manage to get through that week?” COPING QUESTIONS (IF IT WORKS, DO MORE OF IT) Only after a client has been validated and the client’s pain has been acknowledged that the therapist can move on to explore what the client is doing to mobilize his or her strengths in order to get through this difficult time. (De Jong & Berg, 2013) 3. EXCEPTION-SEEKING QUESTIONS (AMPLIFYING) ▪ Direct clients to the time in their lives when the problem did not exist, especially those exceptions related to what the client wants to be different and encouraging the client to do more of what he/she did to make the exceptions happen (Trepper et al., 2012). ▪ There are also times when the problem recurs with less intensity, frequency, or regularity. ▪ “I bet there have been times in your life when you have not felt depressed, can you describe them for me?” ▪ “What was going on in your life when you did not feel depressed?” EXCEPTION-SEEKING QUESTIONS (AMPLIFYING) ▪ The client uncovers the strengths they bring with them from current or past experiences. ▪ The conversations orient towards their already proven ability to master challenges which may then be applied to help solve the client’s current situation rather than teaching the client new skills. ▪ “How did you do it?” ▪ “What did you do to win over anger?” ▪ “Who else noticed you keeping your cool?” ▪ “What difference did/will that make in your life?” 4. MIRACLE QUESTIONS ▪ Fantasy about the solution. ▪ Miracle is a means to a goal. ▪ Be cautious of using it in sensitive situations– when the client has a terminal illness or has suffered a recent bereavement. ▪ The miracle questions will be unattainable, e.g., a bereaved person wants the return of person who has died. MIRACLE QUESTIONS “Let me ask you a strange question. Suppose that while you are sleeping tonight, a miracle happens. The miracle is that the problem which brought you to therapy is solved. You are asleep so you don’t know that the miracle has happened. When you wake up tomorrow morning, what will be different that will tell you that a miracle has happened and the problem which brought you here is solved?” (Bavelas et al., 2013, p. 13) 5. SCALING QUESTIONS ▪ Scaling helps to generate hope by rating the range of problem experiences in comparison to dichotomous all or none thinking (Trepper et al., 2012). ▪ Ask client subjectively rate themselves on experience, feeling behavior from past, present and future, from 0 to 10. ▪ “With 0 equal to the worst and 10 would be the best situation, where on you today?” ▪ “Your rate is 6 in last session and now is 7 , what is that 1 meaning and how?” SCALING QUESTIONS ▪ Help client to see the progress and instill hope for positive change. ▪ “Suppose you moved to a ‘4’ over the next week, what would be different? What would you be doing that you’re not doing now?” ▪ “What are some steps you can take to move to a 4?” ▪ “How confident are you that you could raise the number to a 4?” MORE QUESTIONING TECHNIQUES Questions for clarification • What makes you say that? • How does this relate to our discussion? Questions that probe assumption • What could we assume instead? • How can you verify or disapprove that assumption? Questions that probe reasons and evidence • What would be an example? • What do you think causes to happen? Questions about viewpoints and perspectives • What would be an alternative? • What is another way to look at it? • What are the strengths and weakness of? MORE QUESTIONING TECHNIQUES Questions that consequences probe implications and • What are the consequences of that assumption? • What are you implying? • How does it affect? Questions about question • What was the point of this question? • What does…mean? • How does…apply to…? OTHER TECHNIQUES ▪ Amplification the success ▪ Discussion on the solution ▪ Complimenting on client effort ▪ Direct (e.g., “That was impressive how you handled that situation.”) ▪ Indirect (e.g., “How did you figure out how to solve that problem?”). ▪ Reframing ▪ For example, “I don’t want to be depressed anymore.” change to “I want to wake up and begin to feel good again.” and then setting goals as “doing things with my family ▪ again, having coffee with a friend, going to a movie”. The value of SFBT includes its future focus, the collaborative stance, and the focus on strengths. CONTRIBUTION OF SFBT Fits in nicely with managed care and the pressure to provide effective counseling in a briefer time frame. Emphasizes the positive attributes in clients. It can be used effectively with a variety of clients and issues. CONTRIBUTION OF SFBT ▪ Researchers have noted that specific questioning techniques (e.g., miracle questions, scaling, etc.) are an important means of facilitating changes with clients (Beyebach, 2014), and increasing positive expectancies, and positive emotion, such as hope and optimism, may be associated with positive outcomes within SFBT (Kim & Franklin, 2015). ▪ SFBT applies co-construction of meaning is a specific method that is used for building solutions with clients (De Jong & Berg, 2013; Korman et al., 2013; Jordan et al., 2013). CONTRIBUTION OF SFBT ▪ Solution-focused questions have been found to produce a significantly greater increase in self-efficacy, goal approach, and action steps than problem-focused questions, and a significantly greater decrease in negative affect (Franklin, Zhang, Froerer, & Johnson, 2017). LIMITATION OF SFBT ▪ Critics say it is too simplistic and does not have enough empirical research to support it. ▪ It may be maltreatment with dependent clients. ▪ It may not adequately address clients with serious mental issues. ▪ It may not develop the counsellor-client relationship in enough depth to be therapeutic. ▪ Therapists may employ techniques in a mechanistic fashion. IN-CLASS EXERCISE (1) ▪ In solution-focused therapy, asking "When did the problem NOT occur?", is referred to as: ▪ complimenting ▪ an exception-seeking question ▪ the miracle question ▪ scaling IN-CLASS EXERCISE (2) ▪ One who practices SFBT posits the view that: ▪ there is some inherent mechanism in each one of us (cognitive schemas) that functions to create one’s reality ▪ reality is always be questioned ▪ we all have a tendency towards actualization ▪ one’s personality structure form the id, ego, and superego IN-CLASS EXERCISE (3) ▪ A client is ready to work on defining his or her preferred goals and on problem solving. This client would be viewed as a: ▪ customer ▪ changer ▪ visitor ▪ complainant REFERENCES ▪ Archer, J., & McCarthy, C. J. (2007). Theories of Counseling and Psychotherapy: Contemporary Applications. Upper Saddle River, NJ: Merrill Prentice Hall. ▪ Bavelas, J., De Jong, P., Franklin, C., Froerer, A., Gingerick, W., & Kim, J. (2013). Solution focused therapy treatment manual for working with individuals (2nd version). Solution Focused Brief Therapy Association, Retrieved December 9, 2015, from http://www.sfbta.org/PDFs/researchDownloads/fileDownloader.asp?fname=SFBT_Revised_Treatment_ Manual_2013.pdf ▪ Beyebach, M. (2014). Change factors in solution-focused brief therapy: A review of the Salamanca studies. Journal of Systemic Therapies, 33(1), 62–77. ▪ Corey , G (2008). Theory and Practice of Counseling and Psychotherapy, Thomson Learning. ▪ De Jong, P., & Berg, I. K. (2013). Interviewing for solutions (4th ed.). Belmont, CA: Thomson Brooks/Cole. ▪ Franklin, C., Zhang, A., Froerer, A., & Johnson, S. (2017). Solution-Focused Brief Therapy: A systematic review and meta-summary of process research. Journal of Marital and Family Therapy, 43(1), 16-30. ▪ Gan, C. (2020). Solution-focused brief therapy (SFBT) with individuals with brain injury and their families. Neuro-Rehabilitation, 46, 143–155. ▪ Gingerich,W. J., Kim, J. S., &MacDonald, A. J. (2012). Solution-focused brief therapy outcome research. In C. Franklin, T. Trepper, W, Gingerich & E McCollum (Eds.). Solution-Focused brief therapy: A handbook of evidence-based practice (pp. 95–111). New York: Oxford University Press. REFERENCES ▪ Hanks, R., Rapport, L., Waldron-Perrine, B. & Millis, S. (2014). Role of character strengths in outcome after mild complicated to severe traumatic brain injury: A positive psychology study. Archives of Physical Medicine and Rehabilitation, 95, 2096-102. ▪ Jordan, S. S., Froerer, A. S., & Bavelas, J. B. (2013). Microanalysis of positive and negative content in solutionfocused brief therapy and cognitive behavioral therapy expert sessions. Journal of Systemic Therapies,32(3), 46– 59. ▪ Kim, J. S., & Franklin, C. (2015). Understanding emotional change in solution-focused brief therapy: facilitating positive emotions.Best Practices in Mental Health,11(1), 25–41. ▪ Korman, H., Bavelas, J. B., & De Jong, P. (2013). Microanalysis of formulations in solution-focused brief therapy, cognitive behavioral therapy, and motivational interviewing. Journal of Systemic Therapies,32(3), 31–45. ▪ Mcleod, J. (2003) An Introduction to Counselling.(3rd ed.). Open University Press. ▪ Raymond, J. C., & Danny,W. (2005). Current Psychotherapies.(7th ed.).Thomson Brooks / Cole. ▪ Trepper, T. S., McCollum, E., De Jong, P., Korman, H., Gingerich, W.,&Franklin, C. (2012). Solutionfocused brief therapy treatment manual. In C. Franklin, T. Trepper, W, Gingerich & E. McCollum (Eds.). Solution-Focused brief therapy: A handbook of evidence-based practice (pp. 20–38). New York: Oxford University Press.