Solution-Focused Brief Therapy PDF

Modernism is Stories solution-focused brief therapy characterized by a belief in objective truth and rationality, while Postmodernis and narrative therapy m emphasizes The key theme of focusing on the client's unique Rememb...

Modernism is Stories solution-focused brief therapy characterized by a belief in objective truth and rationality, while Postmodernis and narrative therapy m emphasizes The key theme of focusing on the client's unique Remember there is no subjectivity, narrative and context is about understanding that each real problem. The client individual has their own story shaped by personal complexity, has a story that said experiences, cultural background, and social and the interactions. This approach values the client’s there is a problem! And multiplicity of perspective and recognizes that their reality is if you change the story, truths. constructed through their lived experiences. problem disappears!!  if we can isolate the source of the problem We can then control it and make sure it doesn't happen, or at least we can moderate it, manage it and try to improve a person's Modernism life. As long as we can find the source of the problem. We can try to design measures, protocols, exercises, activities that will address this problem and try to solve it. So this is very mechanistic. It's like dealing with a machine Truth of things can be discovered through objective measurement (like you are a machine, and if I can analyze the body as a machine, I know where the problem is, and I give you medication to heal the problem. So it's all based on the belief that we can control reality.) Once laws discovered, humanity can control the environment Cybernetic machine (therapist as technical expert who can diagnose problems) Structural and strategic – search out flaws and glitches to be repaired Facts that do not fit theories are ignored  this is NOT a deterministic approach (e.g., there's actually no clear objective reality. People make meaning in their lives. They psychodynamic approach) do not simply respond mechanistically. Postmodernism People give meaning to events based on our own filters, based on the stories we tell ourselves. So now we're getting closer to narrative. There is no reality, only points of view Concerned with how people make meaning in their lives Glasserfeld’s “ Radical Constructivism” : “we can never know the real world, because we can only know the internal images of it” – mental construction of the observer Meaning is the primary target We're not so much interested in the objective reality we're interested in how the client is telling a story to themselves, and our focus is on how we can change that story similar to Cbt. Where we want to change the beliefs but a little bit more complex than just addressing beliefs. We're looking at a whole story, different characters.  Key Concepts of Social Constructionism Postmodernists assume there are multiple truths A problem exists when people agree there is a problem Reality is subjective and is based on the use of language One situation is experienced differently by each individual Postmodern counselors strive for a collaborative and consultative stance Clients are the experts of their own lives  Social Constructionism Therapy Goals Generate new meaning in the lives of clients Co-develop, with clients, solutions that are unique to the situation Help people develop alternative ways of being, acting, knowing, and living Help clients identify perceptions and “stories” that can help them lead more satisfying lives.  View of Human Nature (1) Assume that realities are socially constructed. There is no absolute reality. View people as healthy, competent, resourceful, and having the ability to construct solutions and alternative stories to enhance their lives. Help clients recognize their competencies and build on their potential, strengths, and resources.  Solution-Focused Brief Therapy (1) If a person’s reality is merely a social construct - a product of language – then the goal of therapy is simply to change the way he or she uses “language”. Once described differently, the problem disappears, since it only existed in the way the person talked about it. - “Language is reality”  Key Concepts of Solution-Focused Brief Therapy (1) Therapy grounded on a positive orientation --- people are healthy and competent. Downplay “past”, while highlight “present and future”. View people as healthy, competent, and resourceful, and having the ability to construct solutions to enhance their lives. Therapy is concerned with looking for what is working. Therapists assist clients in finding exceptions to their problems. The therapy process is to focus on creating solutions rather than talking about the problems.  O’Hanlon (1994 and 1999, in Corey, 2009) “Grow the solution-life enhancing part of people’s lives rather than focus on the pathology-problem parts and amazing changes can happen pretty rapidly”. “…encourages people to move out of analyzing the nature of the problem and how it arose and instead to begin to find solutions and take action to solve it.” Ex: … tell me about when it was going better for you…what was it like then?  Basic Assumptions of Solution-Focused Therapy (1) People can create their own solutions. Small changes lead to large changes. Domino effect. The client is the expert on his or her own life. The best therapy involves a collaborative partnership. A therapist’s not knowing can afford the client an opportunity to construct a solution. Within 3-4 sessions. As this is solution focus. Usually doesn’t require very long period of counselling. Central SF philosophy (1) If it works, don’t fix it If it worked once, do it again If it doesn't work, do something different ( Berg and Miller, 1992) Solution focus may not work with every client. Some people will be very resistant, particularly those that are very identified with their stories, and they don't want to change their stories. That's what we call resistance to change. They just want an audience to sympathize with their problem, and then they feel less alone. They want someone to say your parents were really bad parents, weren't they? A lot of clients are looking for allies to strengthen their stories. and so these clients will not enjoy solution focused. They will not get on board.  Therapeutic process 1. Clients talk about problem and Counselor asks: “how can I be useful to you?” (positive expression, how do you want to positively use the time we have together.) 2. Set clear goals and ask: “What will be different in your life when the problem is solved?” 3. Clients explore exceptions to the problem, what they did to bring these about 4. Counselor gives feedback, encouragement and suggestions before next session 5. Rating scales are used to measure progress  Therapeutic Goals (2) Believe clients have the ability to 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? Goals can include changing how the client views a situation, changing what a client does in a situation, or identifying clients strengths and resources Talk about solutions instead of talking about problems.  Therapist’s function and Role (2) Not knowing position: clients as experts about their own lives. Therapist empathically tries to understand the clients world with curiosity and interest. Create a collaborative relationships Create a climate of mutual respect in which clients are free to create and explore solutions. Help clients to explore how they would like things to be different, how to make a difference, and what signs to indicate the changes are happening.  Relationship Between Therapist and Client (2) The therapeutic relationship is an important factor for change to occur. 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.  The Fit with Clients (2) De Shazer (1988) identified three types of clients, each linked to the level of client motivation. (Visitors / Complainant / Customers) Visitors - reason to be in here is simply someone told them to come or someone brought them Any intervention is likely to be rejected Counselor’s error is not recognizing these people as visitors sets up a classic “resistant relationship”  Complainants (2) Therapeutic conversation begins with a complaint Client has developed some expectation of solution as a result of the interview; expect change but generally in others rather than themselves. Task – observation tasks so that clients become more aware of themselves and able to describe what they want. Example: “between now and next time we meet, I would like you to notice things that are happening in your life that you want to continue”. (again, focusing on what’s working!) So complainants, you might have them do something like observation, so that clients become more aware of themselves, and they're able to describe what they want. So instead of focusing only on the outside, they need to become more aware between now and next time. I would like you to notice things that are happening in your life that you want to continue again. I'm focusing on what's working. So instead of focusing on, go back.  Customer (2) When, during the course of the session, the complainant clearly indicates that he or she is not only willing but wants to do something about the complaint and is willing to make efforts. Counselor can give behavioral tasks with a high degree of confidence that customer will do. Task – action task with the expectation that they will be completed.  Techniques Used in Solution-Focused Brief Therapy (3) Establishing a collaborative relationship: This is the foundation for all else Pre-therapy change: What have you done since you made the appointment that has made a difference in your problem? Exception questions: Direct clients to times in their lives when the problem did not exist. (“change-talk”)  Techniques Used in Solution-Focused Brief Therapy (3) Miracle question: If a miracle happened and the problem you have was solved overnight, what would be different in your life? (helps to start viewing and doing things differently and the perceived problem can also change) Scaling questions: On a scale of zero to 10, where zero is the worst you have been and 10 represents the problem being solved, how would you rate your anxiety right now? “Why 7 and not 6 or 5?”  Techniques Used in Solution-Focused Brief Therapy (3) Formula first session task (FFST): ask clients to observe about what happens in their life (relationship, family…) that they want to continue to happen. Usually between 1st and 2nd sessions. Gives hope that change will happen. Therapist feedback to clients: therapists provide summary feedback for clients (may take a break to formulate) --- compliment what clients have done toward effective solutions, a bridge between compliments and suggestions that provides rationale for the suggestions, and suggest a homework assignment. Tasks: Observational tasks: self-monitoring Behavioral tasks: take action that may lead to constructing solutions.  Techniques Used in Solution-Focused Brief Therapy (3) Terminating: When the problem is solved, what will you be doing differently? What will you be doing differently when you have achieved your goals? Scaling questions can help clients monitor their movement towards their goals. Counselors can help identify what clients need to continue doing after counseling and also identify potential barriers in the future. Narrative Therapy: Involves storytelling, exploring themes, and co-creating a new narrative with the therapist. The therapist plays a collaborative role in helping the client re-author their story. Narrative Therapy (1) We tell ourselves stories that shape our lives and reality (if you tell yourself you are weak, you will interpret differences as luck) Narrative therapy becomes a process of helping people reexamine the stories they live by Goal is to expose these internalized narratives so they can be replaced with more empowering stories  Key Concepts of Narrative Therapy (1) People do not change because they're using their old narrative. So the narrative approach will allow us to deconstruct a person's story, and then we need to look for new possibilities and that will change the story that people tell themselves. And if you change the story, what changes the way you perceive reality changes and then you start to experience a new reality. Listen to clients with an open mind. Encourage clients to share their stories. Listen to a problem-saturated story of a client without getting stuck. Stay alert for evidence of client’s competence. Therapists demonstrate respectful curiosity and persistence. The person is not the problem, the problem is the problem!  The Therapeutic Process in Narrative Therapy (2) Collaborate with the client in identifying (naming) the problem. Separate the person from his or her problem. Investigate how the problem has been disrupting or dominating the person (Mapping the effects) Invite clients to see story from different angle (alternative meanings for events). Search for exceptions to the problem. Ask clients to speculate about what kind of future they could expect from the competent person that is emerging (similar to SFPT). Create an audience to support the new story.  The Therapeutic Process in Narrative Therapy (2) The process can be summarized as: Moving problem stories toward externalized descriptions of problems Mapping the effects of a problem on the individual Listening to signs of strength and competence in the client’s problem-saturated stories Building a new story of competence and documenting these achievements. moving problem stories toward externalized descriptions of problems mapping the effects of a problem on the individual. how does the problem affect you? What do you do when the problem is present when the anger appears? What do you do in response to it? So it's sort of mapping how this element that enters the story affects your behavior affects your mood, affects your relationship, affects your work, environment.etc, etc, etc. So all of that is called mapping the effects of a problem and it helps to externalize and differentiate the client from the problem.  Therapeutic Goals (2) Therapists invite clients to describe their experience in new language and facilitate the discovery or creation of new options that are unique to them.  Therapist’s function and role (2) Active facilitators. Demonstrate care, interest, respectful curiosity, openness, empathy, contact, and fascination. Adopt a not-knowing position that allows being guided by the client’s story. (participant-observer and process- facilitator) Help clients construct a preferred alternative story through the use of questions. Separate the problem from the people (instead of person and problem being fused). Create a collaborative relationship --- with the client being the senior partner. Believe in the client’s abilities, talents and positive intentions. Therapeutic Relationship (2) Emphasize the quality of therapeutic relationship, in particular therapists’ attitudes Client-as-expert, clients are the primary interpreters of their own experiences Therapists seek to understand client's lived experience and avoid effort to predict, interpret, and pathologies. The also look for the “counter story” which leads to a different future for the clients.  Therapeutic Techniques (3) No recipe, no set agenda, and no formula. This approach is grounded in a philosophical framework. Questions—and more questions: Questions are used as a way to generate experience and to empower clients rather than to gather information. Asking questions can lead to separating “person” from “problem”, identifying preferred directions, and creating alternative stories to support these directions. Questions are always asked from a position of respect, curiosity, and openness (never judgement) Therapists ask questions from a not-knowing stance  talking about the problem, externalizing, mapping it, how does in effect, your life? And then slowly looking for exceptional outcomes. And then we start integrate that into how the person can move forward by deconstructing, so externalizing, separating from Therapeutic Techniques (3) the problem. Externalization & Deconstruction Living life means relating to problems, not being fused with them Externalization is a process of separating the person from identifying with the problem. Externalizing conversations can lead clients in recognizing times when they have dealt successfully with the problem. (how does the anger trick you into believing in it? What does the anger want to achieve?) Problem-saturated stories are deconstructed (taken apart) before new stories are co-created. And then you have externalizing conversations like we just saw. How does the anger trick you into believing it? How does Fatty affect you when it comes? What does anger want to achieve when it knocks on your door. Right? It wants justice, for example. Okay, so anger is wanting to achieve justice. And so you'll start to map out the effects of these characters on the person's experience. and then slowly, these stories get deconstructed right through a process of mapping when it's present, when it's not present. When you start to have a dialogue, this is the deconstructing when it's there, when it's not there. How do I behave differently? How do other people behave differently. So it's it's deconstructing the whole experience of  Therapeutic Techniques (3) Search for unique outcomes Successful stories regarding the problem. (Do you remember not having this problem? What was that like for you? What would it be like for you? How would you act differently?) Creating Alternative Stories The assumption is that people can continually and actively re-author their lives. Invite clients to author alternative stories through “unique outcomes”. (“given what you’ve learned about yourself, what is the next step you might take?”) An appreciative audience helps new stories to take root.  Therapeutic Techniques (3) Documenting the evidence Applying the learning that happens in sessions to the outside world. Therapists can write and send a letter to clients between sessions regarding the influence the problem is having on their life, their strengths and accomplishments, questions the therapist has thought of that relate to the alternate story that is emerging, and unique outcomes or exceptions to the problems.  Summary and Evaluation (4) Contributions Client-as-expert (not knowing position). Views people as competent and able to create solutions and alternative stories. Does not support the DSM-IV-TR labeling system. A brief approach (about 5 sessions), is good for managed care. In general, studies provided preliminary support for the efficacy of solution-focused brief therapy.  Summary and Evaluation (4) Limitations No set of formulas or recipes to follow. Inexperienced therapist may view SFBT as techniques. However, the attitude of the therapist is critical to the success of outcomes. Therapists need to be able to make quick assessments, assist clients in setting up the goals, and effectively use appropriate interventions.