Lecture 10_2201_LHP.pdf

PSYU2201 Counselling Approaches and Principles WEEK 10 LECTURE Acknowledgement of Country Macquarie University acknowledges the traditional custodians of the Macquarie University land, the Wallumedegal clan of the Darug nation, whose cultures and customs have nurtured, and continue to nurture, thi...

PSYU2201 Counselling Approaches and Principles WEEK 10 LECTURE Acknowledgement of Country Macquarie University acknowledges the traditional custodians of the Macquarie University land, the Wallumedegal clan of the Darug nation, whose cultures and customs have nurtured, and continue to nurture, this land, since the Dreamtime. I’d like to pay my respects to Elders past, present and future, and particularly to any Indigenous students in this unit. 1v Objectives In today’s lecture we will: • be introduced to solution focused brief therapy (SFBT) • unpack the SFBT Model • critique the SFBT Model 2 Change is Hard 3 So there are different stages of readiness! • • • Ambivalence is feeling two ways about behaviour change (wanting and not wanting change both at the same time), which is a normal part of any growth process (Gonçalves et al., 2018). Ambivalence is uncomfortable and can lead to 'procrastination' (sometimes seen as ‘resistance’ by therapists but in SFBT the term resistance is NOT used). SFBT is a conversation about change, it is collaborative and looks to evoke (call forth) the person's own commitment and motivation to engage in change their behaviours and cognitions. 4 Solution Focused Brief Therapy • A skilled therapist tunes into both the ambivalence and a client's readiness to change by using various techniques and strategies that are responsive to the client's point of motivation level, their readiness to change, their resources, and willingness (Shennan, 2019). • The role of autonomy (vs. authority) is central, whereby the true power for change stems from the client. ― Ultimately, the client is empowered by the idea that change occurs from them and that change can occur in multiple ways. • The client, therefore, takes the lead in developing their menu of options, in trying new things to make desired changes (Krause et al., 2018). 5 Solution Focused Brief Therapy SFBT therapists argue that in many cases: 1. The problem has little to do with the solution, and 2. The solution is more than the mere absence of the problem. • Focus on solutions not problems. • Focus on the here and now. • Highlights elements of the solution already present in client’s life. • Emphasis on articulating the desired life versus understanding the development of problems. • Brief: often around six sessions. 6 Four SFBT Core Principles 1. Building rapport through empathy so that client can safely identify, exam, and resolve ambivalence about changing behaviours. 2. Rolling with “resistance” (AKA 'dancing' with the client) i.e., avoid eliciting “resistance” by not confronting client's ambivalence about change. This occurs when therapists assist clients to explore their concerns, the pro's and the con's, inviting clients to examine new points of view, in a gentle manner. 7 Four SFBT Core Principles 3. Developing discrepancy i.e., change occurs when the therapist works to develop where the client is and where they want to be. • This occurs by helping clients to examine such discrepancies between current circumstances/values and future goals. • Process is gradual to help clients to become aware of how current behaviours may lead them away from, instead of towards, their goals. • Value cards (on iLearn) are a useful tool for developing discrepancy. Ask what the person’s guiding values are. What do they want in life? Ask how the continuation of target behaviour fits in with the person’s goals or values. Does it help realize an important goal or value, interfere with it, or is it irrelevant? 8 Four SFBT Core Principles 4. Supporting self-efficacy i.e., increasing an individual's belief in their capacity to execute behaviours necessary to produce specific performance attainments (Bandura, 1997) 9 Supporting Self-Efficacy • • • • • • • Clients have many existing strengths and resources. They are competent and resilient. Any environment/situation is full of resources. Assume a willingness and capacity to change. Collaborative relationship, rather than authoritative. Meet the client at their model of the world. Foster power and agency, rather than a dependency and a victim mindset. • Starts with the end in mind – what is the desired change? • Focuses on how rather than why. • Looks at what is working and how this can be strengthened. 10 In Brief 1. 2. 3. 4. 5. 6. If it ain’t broke – don’t fix it! Small changes can lead to bigger changes. If it’s working – keep at it! If it’s not working – stop! Keep it as simple as possible. Make the smallest change possible. 11 Objectives In today’s lecture we will: • be introduced to solution focused brief therapy (SFBT) • unpack the SFBT Model • critique the SFBT Model 12 Solution-Focused Process Model (Grant, 2022) 1. Change Talk 3. Strategy Talk 2. Solution Talk 13 Use those OARS! Open-ended questions, Affirmations, Reflection, and Summaries (OARS) • Open-ended questions invite elaboration and thinking more deeply about an issue. • Affirmations are statements that recognise client strengths. ― Assist in building rapport and in helping the client see themselves in a different, more positive light. ― Must be congruent and genuine. ― Can help clients feel that change is possible even when previous efforts have been unsuccessful. 14 Use those OARS! Open-ended questions, Affirmations, Reflection, and Summaries (OARS): • Reflection (listening and feeling) helps the client come to feel that the counsellor understands the issues from their perspective. ― Here, the therapist guides the client towards resolving ambivalence by considering the negative aspects of the status quo and the positives of making change. • Summaries communicate interest, understanding and call attention to important elements of the discussion. 15 Start with “Change Talk” Change Talk includes statements by the client that reveal consideration of, motivation for, or commitment to change. • Research indicates a clear correlation between client statements about change and outcomes (client-reported levels of success in changing a behaviour) (Kim et al., 2018; Zhang et al., 2018). • The more someone talks about change, the more likely they are to change. • Different types of change talk can be described using the mnemonic DARN-CAT… 16 Start with “Change Talk” Preparatory Change Talk Desire (I want to change) Ability (I can change) Reason (It’s important to change) Need (I should change) Implementing Change Talk Commitment (I will make changes) Activation (I am ready, prepared, willing to change) Taking Steps (I am taking specific actions to change) 17 Change Talk Questions • The “coping” question: intended to help clients recognise their own resilience and identify some of the ways in which they already cope with their problems effectively. • “How do you manage, in the face of such difficulty, to fulfill your daily obligations?” (Antin, 2018). ― When is the problem not here? What’s happening then? ― What’s working? ― When was a time when you succeeded even a bit? ― When are things better? ― When have you been able to exert some control? ― How did you do that? ― How does that make a difference? 18 Scaling • Ask: “On a scale from 0 to 10, how important is it to you to change [the specific target behaviour] where 0 is not at all important, and a 10 is extremely important? Follow up: “And why are you at ___and not _____ [a lower number than stated]?” “What might happen that could move you from ___ to [a higher number]?” Alternatively, you could also ask “How confident are that you could make the change if you decided to do it?” 19 Then Move to “Solution Talk” • • • • Bridges gap between change and strategies. Works on creating new goals and preferred outcomes. Requires collaborative relationship. Questions include: ― What will be the first sign to you that things are getting better? ― How do you want things to be? ― When things are going right, what will be happening? ― What will you be doing differently? ― What will others notice about you? ― Let’s imagine that the difficulty is solved. What will be happening and how will you know? 20 The Miracle Question (De Shazer et al., 2021) • Future oriented, identify existing solutions, clarify goals, give clues to strategies. • “Let’s imagine that after you leave here, you go home, you do whatever you would normally do tonight, you go to bed, you go to sleep…. And when you are asleep a miracle happens… and your problems are solved…. But because you are asleep, you didn’t know the miracle had happened… so tomorrow morning, how will you know the miracle has happened? …. What will be different that will tell you that this miracle has occurred? What will you be doing differently?” 21 Then Move to “Strategy Talk” • • • • • • Co-active planning and implementation of action plan. Utilise client’s existing abilities. Develop solutions – start with small changes. Stay with the solution focused orientation. Clarify goals – “Will this move you towards your goal?” Take-home message and tasks – summarise progress in session, ask “How do you feel?”, and homework tasks. • See “Do One Thing Different” exercise on iLearn, intended to help the client to learn how to break their problem patterns and build strategies for change. 22 Objectives In today’s lecture we will: • be introduced to solution focused brief therapy (SFBT) • unpack the SFBT Model • critique the SFBT Model 23 Strengths of SFBT • While it is not suitable to use as a treatment for major psychiatric conditions such as psychosis or schizophrenia, it could be used in combination with a more suitable psychiatric treatment, to help alleviate stress and bring awareness on the person's strengths and internal resources. • Research has shown that after a one-year follow up, SFBT was effective in reducing depression, anxiety, and mood related disorders in adults (Maljanen et al., 2012). ― A study on substance abuse in adults showed SFBT to be just as effective as other forms of talking therapy (problem-focused therapies) in treating addiction and decreasing addiction severity and trauma symptoms (Kim et al., 2018). • SFBT is most effective on child behavioural problems when it was used as an early intervention, before behavioural issues become very severe (Bond et al., 2013). 24 Limitations of SFBT • Contraindications for SFBT include when: ― it is impossible to establish a dialogue with the client ― the therapist is not prepared or unable to let go of their expertise i.e., clients may to focus on problems that the therapist believes are secondary problems (e.g., the client may focus on a current relationship problem rather than the underlying self-esteem problem, which is causing the relationship woes). SFBT dictates that the client is the expert, and the therapist must take what the client says at face value • If the client wants to discuss factors outside of their immediate ability to effect change, SFBT may be frustrating in its assumption that clients are always able to fix or address their problems. 25 Objectives In today’s lecture we will: • be introduced to solution focused brief therapy (SFBT) • unpack the SFBT Model • critique the SFBT Model 26 References Antin, L. (2018). Solution-focused brief therapy (SFBT). Good Therapy. Retrieved from https://www.goodtherapy.org/learn-about-therapy/types/solution-focused-therapy Bond, C., Woods, K., Humphrey, N., Symes, W., & Green, L. (2013). Practitioner review: The effectiveness of solution focused brief therapy with children and families: A systematic and critical evaluation of the literature from 1990– 2010. Journal of Child Psychology and Psychiatry, 54(7), 707-723. De Shazer, S., Dolan, Y., Korman, H., Trepper, T., McCollum, E., & Berg, I. K. (2021). More than miracles: The state of the art of solution-focused brief therapy. Routledge. Grant, A. M. (2022). Steps to solutions: A process for putting solution‐focused coaching principles into practice. Coaching Practiced, 299-310. Gonçalves, M. M., Ribeiro, A. P., Rosa, C., Silva, J. R., Braga, C., Magalhães, C., & Oliveira, J. T. (2018). Innovation and ambivalence: A narrative-dialogical perspective on therapeutic change. In Handbook of Dialogical Self Theory and Psychotherapy (pp. 120-134). Routledge. Krause, D. J., Green, S. A., Koury, S. P., & Hales, T. W. (2018). Solution-focused trauma-informed care (SF-TIC): an integration of models. Journal of Public Child Welfare, 12(2), 117-135. Kim, J. S., Brook, J., & Akin, B. A. (2018). Solution-focused brief therapy with substance-using individuals: A randomized controlled trial study. Research on Social Work Practice, 28(4), 452-462. Maljanen, T., Paltta, P., Härkänen, T., Virtala, E., Lindfors, O., Laaksonen, M. A., Knekt, P., & Helsinki Psychotherapy Study Group. (2012). The cost-effectiveness of short-term psychodynamic psychotherapy and solution-focused therapy in the treatment of depressive and anxiety disorder during a one-year follow-up. Journal of Mental Health Policy and Economics. 15(1), 13–23. Shennan, G. (2019). Solution-focused practice: Effective communication to facilitate change. Bloomsbury Publishing. Zhang, A., Franklin, C., Currin-McCulloch, J., Park, S., & Kim, J. (2018). The effectiveness of strength-based, solutionfocused brief therapy in medical settings: a systematic review and meta-analysis of randomized controlled trials. Journal of Behavioral Medicine, 41(2), 139-151. 28