Strengths Based Case Conceptualization - PowerPoint Presentation

Slide1

Strengths Based Case Conceptualization

Michele Aluoch, LPCC

c.2017Slide2

Facts About Solution Focused Therapy

Average length of sessions= 5-8 sessions for SFT

Average length of sessions for SFBT is 1-3 sessions

Max benefits of treatment are usually achieved win 6-8 sessions for 75% or more of patients.

Graduate students in research studies endorsed and had the most successes with solution-focused approaches compared to other treatment approaches: saw real transformation and maintained changes in clients, ease of useSlide3

Facts About Solution Focused Therapy

With 80% of patients in a 2005 study having 4 sessions or fewer still 77% maintained symptom reduction at 9 month follow up (

Rothwell

, N., 2005)Slide4

Why Do People Have Problems?

They do things that don’t work.

They don’t have an expectation of change

Lack of insight/awareness

Not doing the right thing enough

Unwillingness to do something differentSlide5

What Keeps People Stuck

Don’t listen to anybody.

Listen to everybody.

Endlessly analyze and never change anything.

Blame others.

Blame yourself.

Keep doing what does not work.Slide6

What Keeps People Stuck

Keep focusing on the same things when that does not help.

Keep thinking the same thoughts that doesn’t help.

Keep putting yourself in unhelpful environments.

Keep relating to unhelpful people.Slide7

Basic Tenants of the Solution-Focused Approach

What works in spite of what doesn’t work

Looking for exceptions

Planning experiments and tests

There is some good even in bad or unpleasant circumstances.

Nothing stays awful forever.

If you have done something that works one time before you can do it again- twice, ten times, etc.

If you have done something for a small length of time you can do it a little longer until it becomes a new habit.Slide8

Basic Tenants of the Solution-Focused Approach

Clients want things to be different to where they are not so problem bound.

Clients would not come to us if they did not believe things could be better.

Clients are capable of self evaluating.

Clients are the experts on their own lives.

Treatment does not need to be scripted to be successful and effective.Slide9

What Works in Spite Of What Doesn’t Work

Focus on client strengths

A success driven model

Solution building

Focus on the desired outcome

Uses success language: How have your managed?...

All clients have resource already.Slide10

What Works in Spite Of What Doesn’t Work

1) A 22 year married couple states that their marriage is on the rocks again. When asked about their relationship history they state that they connected right away when they met and moved in a few days later. Since then they both describe the relationships as “always intense-sometimes in a good way, sometimes not.” Currently husband had been having another affair (1 of many throughout the years) and is living with this other woman because of frustrations in the marriage. The wife expresses anger but also admits throughout the last 22 years to having other men on the side. They both admit that “no matter what we’ve done through the years we always come back to each other.”Slide11

What Works in Spite Of What Doesn’t Work

2) A mother comes in stating that her daughter is nothing but strong willed, defiant, and opinionated. She wants her to be more happy and cooperative. She wants her daughter to have treatment for behavior issues.

3) A husband says his wife’s Bipolar “just plain gets to him.” He comments, “can’t she just be more self controlled and stop the mood swings?” He admits that on the other hand he would not want to lose her passion and enthusiasm as this is one of the things that drew him to her.Slide12

What Works in Spite Of What Doesn’t Work

4) A family comes in stating that “no one ever agrees on anything.” The presenting problem is that the house has become increasingly chaotic all the time. The whole family agrees that things are out of hand with how they relate to each other. You ask if there was a time when things were different. They state “before we moved here. Life was consistent

and predictable

.

We had the schools, friends, and jobs we had for over 10 years. This place is a world of difference and the only people we know are each other.”Slide13

What Works in Spite Of What Doesn’t Work

5) A young adult is in trouble and is being referred by his company for counseling. The referral states that they are concerned that he is defensive, always gives input even when not asked, likes to do things his own way.” The client states that he “sees himself as made for so much more than just this current job.”Slide14

What Works in Spite Of What Doesn’t Work

6) A young married coupe comes in after he had an affair with the neighbor lady. They are young and only married 5 years. Both state that “they have generally been happy” until recently. They met in a small town up north and their families knew each other from childhood. Both consider themselves to have strong values until this recent affair so they are shocked. They were actively involved in community events and church groups in the small town but haven’t really connected with people in the city since moving here. They have not found a church home in the last year so they are staying away from services. They used toSlide15

What Works in Spite Of What Doesn’t Work

be involved in small town

pot lucks and get

togethers

. They state that they were never partiers but they only way to get to know people in the current neighborhood is to “drink and watch sports at the block parties.” Both believe they let each other down by drinking and being around people with different values

t

han they normally would. Both are desperate for friends and felt their compromising led them to drinking, the parties, and the husband’s affair. Both desire marriage reconciliation,

maintanence

of values, and communication with the old town 2 hours away in which they used to live.Slide16

What Works in Spite Of What Doesn’t Work

7) A teenager has a disability. She always dreamed of being the athlete she was passionate about until her recent injury which put here in a wheelchair, She swam, ran, and played many seasonal sports until the day she was injured. Docs told her that she probably will not regain full use of her limbs except with exceptional therapy and practice. She feels out of place, battles depression and feels as if no peers really understand her. In one week she is to start mentoring

jr.

high girls in an after school program promoting self esteem called “You Can Do It.” She started writing a book about hopes and dreams but is unsure if she will finish it because she feels depressed, unattractive, and like her life is over since the mobility problems.Slide17

What Works in Spite Of What Doesn’t Work

8) A man has tried to interview for job after job at his company only to find out each time he is turned down, he thinks deep down, “it’s all about who you know and who you are willing to play up to.” A colleague recently told him of a job he thinks this man is perfect for at a well know agency around town. The first reaction of the client is, “I should not even think about it because they probably have their cliques too” but the friend continues sharing how smart, creative, and relevant he believes the guy is for the job. With apprehension and doubt the gentleman schedules an interview not sure this job will come through either.Slide18

What Works in Spite Of What Doesn’t Work

9) Grief seems to be unending for a young man in his early thirties. Matt buried 2 young children. Then one month ago his wife had a miscarriage. Matt’s best friend was shot and later died in the military. His mother recently let him know that she has terminal cancer. People say that Matt “is a strong person” but he admits to feeling weak. He is uncertain he can handle more bad news. He attends a grief support group in the community. Fellow members say that he has encouraged them. He agrees that in many situations he has been the “go to” person in life but is unsure he can do this anymore or take on one more thing. He believes he is at the end of his strength. Slide19

What Works in Spite Of What Doesn’t Work

10) Allison was molested throughout childhood by her foster parents. Kids bullied her in school, Now here house was recently broken into, Her car also broke down and she has no money to pay for repairs. She feels like “bad things keep happening to her.” She is having flashbacks , sleep problems, and anxiety, and wondering if the problems will ever end. She says she has always been the victim in life and can’t handle it any more. She does consult with an older woman friend for emotional support and also periodically goes to “Victims of Crime” meetings in the community. She mentors other young women who have blamed themselves for being raped.Slide20

Things Will Change

Planning for change vs. avoiding change

Inevitable and constant

Planting as seed in the client’s mind that things always eventually turn around

Therapist amplify changeSlide21

Looking For Exceptions

Even in the stressor or presenting problem when does it not occur?

Are there parts of the situation or reactions which are useful?

No problem happens all the time.

Solutions are there already but just aren’t implemented enough.

1) When you do not have the problem?

2) When the situation is “less bad?”Slide22

Looking For Exceptions

Insert VideoSlide23

Planning Experiments and Tests

Insert VideoSlide24

Planning Experiments and Tests

We can plan for alternatives to the presenting problem.

Therapist makes a suggestion of something to try.

Assignments outside the sessions used as adjuncts to the session.Slide25

There is some good even in what seems bad.

There are no problems...

O

nly

opportunities.

There are no failures.. Only

learnings.

There are thousands of

solutions

.

There are no uncooperative people but only people with

unique ways of cooperating

.Slide26

NO Real ResistanceSlide27

There is some good even in what seems bad.

Insert video.Slide28

Nothing stays awful forever.

Give me the courage to change

the things I can change

, the serenity to accept the things I cannot change and the wisdom to

know the difference

.

Situation What I Can’t Change What I Can ChangeSlide29

Moving Away From “Why?”Slide30

Developing New Solution StatesSlide31

Nothing stays awful forever.

Insert video.Slide32

You can do the right thing more/longer until it is a habit.

Insert video.Slide33

MECSTAT

Miracle Questions

Exception Questions

Coping Questions

Scaling Questions

Time Out

Accolades

TaskSlide34

Miracle Questions

A virtual reversal of the problem

Rehearsing the preferred future

If a miracle happened tonight what would be different?

What if your problems were solved just like that?

What was the most recent thing that was just like this miracle?

0-10 miracle- don’t need to solve everything

Small miracles

Assumption: something happened and the problem is gone.

Co-constructing a new narrative with the therapist.Slide35

Miracle Questions

Negotiated between the client and therapist

Deliberate

wordsmithing

What speakers talk into being

A bringing forth of possibilities

Framing as a fresh startSlide36

Exercise: Miracle Questions

Anger management

Unfaithfulness

Behavior Problems

Slacking/low motivation

Work run ins with the supervisorSlide37

Exception Questions

When was the problem less severe?

What was happening?

When doesn’t the problem happen?

What would it take to recreate this?

What would you have to do to create more of this?

Idea of camera check or video showing somethingSlide38

Exercise: Exception Questions

How would you handle these?

Drinking

: “I’ve been drinking as long as I can remember.”

Anxiety

: “I feel nervous and my heart races all the time.”

Relationships

: “I am afraid my friend will leave me.”

Marriage

: “We never have any trust.”

Job

: “My boss is out to notice everything I do wrong. He is waiting to fire me.”

Negative Expectation

: “Life never goes my way. Nothing works out for me.”Slide39

Coping Questions

How did you manage?

What resources do you have?

How could you do that again?

What gets you through day to day?

What is your greatest support?

How did you get through that (in the past)?Slide40

Accomplishment Questions

How did you do that?

How did you manage?

Helping to get the client to realize that someone thing positive happened as a result of their actions.Slide41

Scaling Questions

Determining where a goal is at on the scale now.

Moving increments of one point.

Scaling: preparedness for change, readiness for new things, importance of a particular goal or desired outcome

Things get better, stay the same or get worse- how to frame for the clientSlide42

Examples: Scaling Questions

Different dimensions of a young ladies life (Spiritual, intellectual, personal, etc.- what would these look like and in relationship to each other.

Example: Framing if things got better

Example: Framing if things stayed the sameSlide43

Goal Questions

How will we know when therapy was successful?

How will we know when therapy should end?

Looking at what elements are necessary for problem resolution.Slide44

Typical SFT Questions

What are your hopes from our work together?

How will you/other know that having been here was useful for you?

What would be the signs that you are better?

Supposing a miracle happened: what would be different?

What would one step in the right direction look like?Slide45

Compliments or Praise

How did you do that?

Most people ____ yet you managed ____. How did you decide _______ instead?

To help give clients credit for their accomplishments, good intentions or functioning.Slide46

Time Out

Avoiding toxic behavior

Indirectly increasing the positiveSlide47

Solution Focused Therapeutic Conversations

Problem focus

Solution Focused

How long have you been What would it be like if you

depressed? were not depressed?

What happens when you are

anxious?

When your relationship problems

are worse between you and your

parents how do you act?

Tell me about the nights when you

cry yourself to sleep.

Everywhere you go there seems

to be pain and grief.Slide48

Accolades

Compliments are important to producing change in client.

Must be verbalized.

Looking for consistent positive feedback “in spite of”Slide49

Examples: Accolades

Insecure/no boundaries: Never could speak out assertively and finely stated feelings

Not a risk taker and finely tried out for team, new job, etc.Slide50

Task

Concrete way of keeping what is productive or on the path to the goal going

Homework is not best when created by the therapist.

E

mphasis on the client doing his/her work

First Session: between now and next time, we would like you to observe so you can describe to us what you would like to continue happening in your life.Slide51

Task

Specific observations:

O

bserve times between now and next time when you and ____ could have done (neg. behavior) and didn’t. Observe times where (pos. behavior) occurred.

I am betting you won’t notice how things are.Slide52

Do one thing differently.

Change on part of a problem: the timing, your body patterns, what you say, where you act, the order you do things in, the speed at which you do things, etc. (e.g. Bill’s anger)

Think of something someone else does that works.

Focus on what you could concretely do instead of what you feel.

Change what you are focusing on.Slide53

Do one thing differently.

Imagine not having the problem.

Create a solution focused narrative. What were you doing, focusing on?

Focus outside yourself on God, faith.

Act rather than analyzing the problem more. Use solution focused words to affirm behaviors you want (e.g. “I like it when….)Slide54

Exercise: Do Something Differently

What way can the person change his or her actions?

Bob is frustrated with his classmates. When he gets answers wrong some classmates laugh at him and talk about how stupid he is. He gives them dirty looks back, screams, “Stop it! Stop it!” and cries. He does not even want to go to school anymore at this point .Slide55

Exercise: Do Something Differently

Mary hates going out in public because she feels on the spot. She scopes out and notices all the people she sees looking at her. Her heart races then and she has often run out of social situations because of it. She leaves groceries behind, misses numerous appointments, and sees her family and friends less often. She is becoming more home bound and states, “this is the only place I am safe from people’s opinions.”Slide56

Exercise: Do Something Differently

Andrew tries to ask a girl he likes for a date. It takes him a lot of courage but when he asks her she turns him down. He determines not to talk to people again or take risks. He sits in the corner of the lunchroom, refuses to talk to people and ignores others’ attempts at conversation with him stating that “he knows they will turn out bad too so why even try.”Slide57

Exercise: Do Something Differently

Think of something else someone else does.

Todd gets angry when things don’t go his way. He threatens people to make them do what he wants but now he is finding out that many people are fed up and just avoid him anymore.

Ann always sits in the corner of the room in college. He

p

refers to not be noticed. When the professor asks her something directly she

wispers

and talks very quietly often hiding her face or looking down or away from others.Slide58

Exercise: Do Something Differently

Dave determines that the only way out of his trouble is suicide. More and more stresses pile up at every turn. He thinks that just when he wants to deal with one thing another comes. Since his life is full of surprises and is much harder than anyone else’s life he should just end it all. That is the only way he believes he can have less stress in life.Slide59

Exercise: Do Something Differently

Focus on what you will concretely do instead of what you feel.

“All eyes are on me,” says anxious Patty. “I know I should not try new things because people will tell how bad I am. I feel sure that they an all tell how inexperienced I am and awful that I should not be even trying out for the play.”Slide60

Exercise: Do something Differently

Diane states , “I feel very self conscious. I do not like the way I am. Wish I looked differently, had better clothes, and didn’t seem so awkward to others. I always feel on the spot.”

Jim feels doubtful about interviewing for another job because when he interviews things usually do not come through. It is not just jobs though but many businesses he’s tried and relationships he sought out have had their rough spots. Why try again? He reasons. It feels like I’m up against a brick wall.Slide61

Exercise: Do something Differently

Change what you are focusing on.

Lucy looks out at the crowds of people and scans their faces before her speech. She studies the faces closely and notices how many people appear to not be exited about being there. She is sure they will not be receptive to what she has to say.Slide62

Exercise: Do something Differently

Daniel suffers from chronic pain. He states that his back , spine and knees constantly give him trouble. He is always aware of how his body is “falling apart” and that he is not as young and vibrant as he used to be.

Amber looks out her window daily to see reminders of living in a poverty stricken, unsafe neighborhood because this is all she can afford now. She frequently thinks about how she will never have anything better.Slide63

Exercise: Do something Differently

Imagine not having the problem.

Amy has become increasingly depressed to where she does not want to get out of bed, bathe or attend to tasks of daily living. She no longer visits neighbors. She eats less because even making food takes too much energy. She stays in bed at least 12-16

h

ours per day to forget about life.Slide64

Exercise: Do Something Differently

Ramon is fearful about is job because the company is unstable. Every day he waits to hear whether he is the next one gone as the company is downsizing. He believes it is just a matter of time before he is gone too.

Caroline is

d

oubtful whether or not she will make any real, long lasting friends since she has not connected with anyone since moving from another town 3 months ago. She feels out of place and is not sure that she will ever have anything in common with the people from the big city.Slide65

Changing Narratives

What happens when others do not view the person as mentally ill, crazy, incompetent, depressed etc.

Are there other people who managed through similar situations?

Restorative narratives

Normalizing things people faceSlide66

Changing Narratives

Using the narrative to provide insight into self, beliefs, values, goals

Identify choices.

Considering various endings to the story.Slide67

Changing Narratives

Change these problem focused narratives to solution focused narratives.

Bad things keep happening to me. Everywhere I turn there is another issue to deal with. I slipped on the ice one month ago and twisted my ankle. Now I got in a car accident. I lost my job one week ago too. All there is to do is sit at home and wait for the next bad thing around the bend. Life doesn’t seem to work well for me.Slide68

Changing Narratives

Once I was a young vibrant leader of the team. I was so fit and able to do it all. But after my work accident I can never hope to be the athlete I once was. The physical therapy is challenging and reminds me of how disabled I am. Going around my buddies and seeing them throw the football in Jim’s yard while I sit at the sidelines is degrading. I’ll only ever be the great athlete of the past. I’m just a typical slowed down 50 year old like others who never were great athletes. What was all my physical hard work even for!Slide69

Changing Narratives

The flashbacks and nightmares will never stop. I lived through a horror movie. My childhood was one abuse by mom’s different boyfriends after another. I see people so happy and trusting in relationships but I know that can never be me. People only hurt, betray, and cut down others. There is nowhere to really feel safe. If you weren’t safe in your own home how can you be safe anywhere?Slide70

Focus on God or faith.

You realize that stopping the alcohol abuse and addiction is beyond you. Many generations of your family have had alcohol problems. You can never take just one drink because it always ends up in binging, fights, and blackouts.Slide71

Focus on God or faith.

Your

moodswings

make it hard to handle interpersonal situations. It is challenging to be flexible. Things get to you easily. You are helpless to change unless you look outside yourself.

So many times you have said, “I feel awful. All can see is anxiety and depression. Life is paralyzing and immobilizing. When I look at myself I am miserable.”Slide72

Focus on God or faith.

Too many stressors seem to be happening at once. It seems like it has been a long time since something went well for you the way you think it does for others. Two years ago there was someone thing you worked hard at and waited on and had faith for. Then one of your dreams came true.Slide73

Highlight what works well in words.

Use language to highlight what you like: “I like it when.”

In talks with my spouse I often do not feel like he listens well. It seems like we talk two different languages. But every now and then it seems like he will understand what I am saying. He will pause, stop what he is doing and look at me and really hear me out.Slide74

Highlight what works well in words.

Many times my teenage children seem to have minds of their own. They don’t seem to care about my rules at all. They tell me they just want to do their own things But the other day I had the surprise of my life because they cleaned their rooms and talked very respectfully to me and said, “Happy birthday, mom. We love you.”

The team at work I lead seems to be very inconsistent with their productivity Some days it seems like they are slow and take all the time in the world to even get started. But when the nice weather started they worked harder and faster and got nearly double the productivity so they could go home earlier. It helped the company. Too bad they don’t have this work ethic on a regular basis.Slide75

The Language of Change

Method/Technique: Therapeutic

D

ialogue

Questioning

Staging conversations:

1. Client concerns

2. Important topics

3. Exceptions and strengths

4. Resources available

5. Scaling to increase motivation for change

6. Scaling to reach the preferred futureSlide76

The Language of Change

Refer to the problem in past language: “was”, “were”, “have been” versus “is” or “are”

Create expectancy- “when” versus “if”

Avoid yes and no questions. Invoke narrative.

Assume problem free times.

Use fast forward questions: who will notice improvements? What will they say? How will they respond? What will you be doing?Slide77

The Language of Change

Small changes are emphasized

One ball or one layer at a time

Shift from impossible and what’s out of or hands to what we can doSlide78

The ACCEPT Framework

A

cknowledge, validate, and value.- attending to client’s perceptions, normalizing experience

C

larifying concerns- discovering what would be a successful outcome for the client

C

hanging or challenging what is being attended to and how it is done

E

valuating progress- are the beliefs and actions helpful?Slide79

The ACCEPT Framework

P

lanning next steps- Set up experiments. What is progress? Try more of what works, less of what doesn’t work. Modify as needed in small steps.

T

erminating treatment- Once client is implementing viable solutions and has understanding of the possibility, solution focused applications allow them to take responsibility for applying the framework in other areas of their lifeSlide80

Link Past, Present, Future

Past- strengths, abilities

Present- clients goals, desired outcomes

Future- PossibilitiesSlide81

Client Centered

Therapist as facilitator

Clients set the goals

Clients shape how goals are defined

Clients shape what defines when goals are reached (scaling)

Clients shape the success of counseling by their narrative

About clients working through

THE CLIENT IS THE EXPERT !!!Slide82

Client Centered

Clients should always be consulted regarding goals, directions, and interventions of therapy.

Diagnosis, treatment, and notes are made available readily to the client as a partner in determining the course of therapy.

Simple, non clinical language is used.

The client’s language

i

s used.

Clients are not passive people coming to an expert but rather are active contributors in their own planning and treatment. Slide83

Key Ingredients

Cooperative Therapeutic Alliance

Warmth

Positive Regard seeing the good in people

Flexible to new ideas

Listen for solutions in problem languageSlide84

PROCESS VARIABLES

Still critical foundations for success

Empathy

Non possessive warmth

Genuineness

Whose are these? (Counselor Versus Client

?)

Hypothesis #1

: Good counselors enhance treatment when they have high levels of these variables.

Hypothesis #2

: Clients determine the levels of variables. Good clients elicit high variables but poor clients elicit low variables

.

NON-POSESSIVE WARMTH- mutual function

EMPATHY/GENUINENESS- under control of the therapistSlide85

The Person-Centered Approach

(Original Outlook): Rogers- 1957

1. Two people in psychological contact

2. The client feels vulnerable or anxious about something

3. The therapist is congruent and integrated

4. The therapist has unconditional positive regard for the client.

5. The therapist shows an empathic understanding of the client’s frame of reference.

6. The values listed above are communicated directly to the client.Slide86

Defining Empathy

(

Peterson, 2007;

Miville

, M.L.,

Carlozzi

, A.F.,

Gushue

, G.V.,

Schara

, S.L., Ueda, M., 2006;

Vanearschot

, G., 2007)

1)

A mode of experiencing the client

2) An ability to communicate this understanding back to the client

3) Both affective and cognitive componentsSlide87

Three Types of Empathy (Clark, A.J., 2010)

1.

Subjective

- momentary experiencing in session what it may be like to be the client

2.

Interpersonal empathy

-Interpretation of the client’s internal frame of reference

3.

Objective empathy

- the factual components of behaviorSlide88

Solution Focused Assessment

Relabel

what clients put in the past so as not to hinder forward movement on goals:

“I’m so depressed all the time.”

“You have been depressed.”

Decrease the generalizability of the problem.

“I don’t recall when I’m not miserable. Everywhere life is awful.”

“You have felt depressed much of the time lately.”Slide89

Solution Focused Assessment

Introduce a possibility mindset.

“I will never meet friends. They will abandon and betray me too. How can I ever trust anyone?”

“You would like to consider getting into a safe healthy new relationship.”Slide90

The Questions of Solution Focused Assessment

How will we know when it’s time to leave therapy? When can we say that therapy is successful?

What kind of changes would you make?”

When were you pleased about how things were going? What was happening?

What approach worked best for you?”

“What was your favorite _____ ?”Slide91

The Questions of Solution Focused Assessment

How will we know therapy has been successful?

Who decided that this treatment was good for you?

What shows that this is the best way for you to solve things?

What will others see when you are better?

How would you deal with ____ if things were better?”Slide92

The Questions of Solution Focused Assessment

What meds, therapies, decisions, actions, etc. worked best for you?

What has been most valuable to you?

What would a future free of this problem look like?

What is going well? How could we use that to our advantage?Slide93

Listening To The Client

Honor the clients story.

Be willing to do nothing.

Sit with the client.

Resist the urge to fix.

Give credit for small efforts.Slide94

Key Ingredients

Solution Focus

There is something you do well. You just don’t know it.

Recollecting what works.

Creating insight and understanding of what is useful and advantageous for this client, this situation, this setting, etc.Slide95

Key Ingredients

Answers are within the clients

.

Clients generally know what to do . They just don’t do it enough.

Clients have strengths in the midst of perceived weaknesses.

Breaking down the problem past is not useful to recovery and goal attainment.

Diagnosis should not be the emphasis.Slide96

Key Ingredients

Measurable Behavioral Goals

How can I be useful to you?

What would others notice if therapy worked fro you?

How would we know therapy did what it was supposed to do?

What needs to be different for your life to be as you’d like it?

Multiple simultaneous goals

Describe production action rather than absence of action

Realistic and achievableSlide97

Key Ingredients

All behaviors have contexts.Slide98

Key Ingredients

Measurable Behavioral Goals

Actions are changeable.

Actions do not need to be changed all at once.

Small steps can caused positive chain reactions in other areas.

Emphasize why the problem is not worse.

Talk a lot about what happens when things work.Slide99

Key Ingredients

Client Evaluation (Through Scaling)

Putting a 1-10 number on motivation, preparedness, importance of goal, progressSlide100

Areas That Can Be Changed

Location

Timing

F

requency

Interactions

Antecedents

Duration

Nonverbals

Sequences of actions

Attention

ReactionsSlide101

Facilitating Solutions

Previous solutions

Exceptions

Competencies

Goals, hopes

PossibilitiesSlide102

Action Plans

SMART

S

mall

M

easurable

A

chievable

R

ealistic

T

imelineSlide103

Exercise: Concrete, Behavioral Solution-Focused Goals

Stated Goal

New Concrete, Behavioral Goal

To feel less depressed

To be more confident and assertive

To not be so fearful in new situations

To have a better relationship with my child

To improve

the quality of my marriage

To be more motivated in school

To take care of myself

betterSlide104

The Language of Solution

1.

exceptions to the rule

(

e.g

when you weren’t hopeless or acted in spite of panic)

2.

the end game

- thinking about what life will be like when the problem has ended

3.

highlighting choice

- there are always a variety of reactions

4.

find contexts of competence

(if you face this.. how to handle)

5.

worst case comparison

-

why not worse?

6.

tapping into altruistic experience

- how you learned and applied something to help others with similar issuesSlide105

Types of Scaling

Willing to change scaling

Confidence in change scaling

Relationship scaling

Behavioral outcomes scalingSlide106

Key Ingredients

An active approach by setting up situations outside therapy

What do you like about yourself?

What are 2 things to try?

What are some things that happened right?

What would hope look like?Slide107

Examples of Thoughts Provoking Considerations For Clients

Who I can trust?

Who I can share my story with?

Who helps me be less depressed, anxious, etc.?

Who can get me the resources or support I am looking for?

Who will leave me alone unless I need them?

Who/what promotes hope?

What helps me regain control in my life?Slide108

Key Ingredients

Compliments

Validating is a key element.

Building therapeutic alliance

Building client competency

In midst of genuine supportive relationship

Affirmation needs to be verbal in the therapeutic process.

Affirmation needs to be specific and behavioral.Slide109

Key Ingredients

Do something different

.

Don’t continue what does not work.

This may include switching therapist and techniques

Change goals.

Change anything!!! Disrupting the system often creates positiveSlide110

Termination in Solution Focused Counseling

How will we know we have reached goals?

How do we know when to stop meeting like this?Slide111

Solution Focused Groups

Change is constant.

Change is inevitable.

The group dynamics embody the changes of the individuals in timeSlide112

Comparison of Traditional and Solution-Focused Therapies

Traditional Counseling

Solution Focused Counseling

Impairments, deficits

Competence, abilities,

possibilities

Pathology

Health

Resistance, defenses, hidden agendas

Good intentions, cooperation

Cure

Consultation, small changes

Therapist as expert

Therapy is collaborative, shared experience, client

is expertSlide113

Comparison of Traditional and Solution-Focused Therapies

Traditional Counseling

Solution Focused Counseling

Working through, insight

Goals, behaviors, results

Past

Present, future

Expression

of emotion

Validation of experience

Diagnosis

Change orientation

Problem identity, character, personality

Productive action, processSlide114

Couples SFT

Talk about what works.

Avoid blame.

Use I messages to summarize and empathize with each other.

Use action requests.

Affirm helpful behaviors.

Change only your part.

If things aren’t working change it. Don’t repeat the same things which don’t work. Slide115

Drug and Alcohol Treatment

De- emphasize labels of alcoholic and addict

Focus on personal choices.

Look at interpersonal dynamics which contribute to denial and resistance.

Acknowledge client concerns.

Encourage alternative behaviors.

Disease concept is not helpful- maintains problem focus, not truth.Slide116

Chronically Mentally Ill Patients

Don’t get hung up on diagnosis.

Relate to the client.

Help them deal with misperceptions by others and self critical attitudes.

Be flexible to learn from the client.

Just because something seems chronic does not mean it cannot change (e. 50-60% of schizophrenics significantly improve as they get older and learn to manage symptoms better)

Support client goals

Reward small incremental goals rather than cures.Slide117

Career Counseling With SBTBurwell, R., & Chen, C.P. , 2006

Strong collaborative working alliance

Therapist is curious and unknowing, being taught by client

Looking at accessible resources rather than analyzing problems

Developing viable vision and alternatives which promote hope

Finding alternative solutions with the last option being changing work environmentSlide118

Career Counseling With SBT

Burwell, R., & Chen, C.P. , 2006

Don’t fix what is going well.

Change what is not working.

When is the problem not co-

occuring

?

Goal oriented: multiple solutions, collaborative constructing of problems and solutions

Scaling- what would be the next step

Normalizing problems

Restructuring problems in context

Affirming efforts in spite of problemsSlide119

Career Counseling With SBT

When the problem was not there or was less of an issue what behavior choices were going on?

Imagining self five years for now without the problem. What needs to happen?Slide120

Educational Settings and SFTSimm,J

.,& Ingram, R., 2008

Do problem solving with students using students own ideas

Educational staff using solution focused approaches in meetings

Using solution focused approaches for behavior plans and IEPs

Using solution focused approaches in peer supportsSlide121

Educational Settings and SFTSimm,J

.,& Ingram, R., 2008

Concentrating on solutions

Felt like a relief

More do-able

More successful because based on students or staff’s own ideas

Empowering

Not trying to impose something from without

Not an assumption of teachers or administration being the experts

Within 20 minutes or less saw results from difficult students

Efficient problem solvingSlide122

Reducing Truancy Through SFTEnea

, V., &

Dafinoiu

, I, 2009

61% compared to 0% on control group

Behavioral programs imposed from without generally did not work

Motivational interviewing and SFT did well with truant kids

Stimulated intrinsic motivation

Focus on pros and cons of truancy, development of trust, building strengths and resources, brainstorming and reframing, negotiating change Slide123

Reducing Truancy Through SFTEnea

, V., &

Dafinoiu

, I, 2009

Imaging truancy not being a big issue

Reflecting on times when this happened

Affirming efforts and successes at getting up, getting to school on time, etc.

Scaling

Supports need to lessen truancy

Options to typical truancy behaviors- eating out, walks, meeting up with friends, smoking/drugs, etc.Slide124

Domestic Violence Therapy Using SFT

Milner, J., & Singleton, T., 2008

No single factor predicts re-offense

Hearing client’s unique stories

Client responsibility for development of new behaviors

Consideration of exceptions to the problems that got them in trouble

Framing in terms of choices and options

Learning to monitor risk and use scaling Slide125

Sexual Abuse Survivors and SFTKress, V.E., & Hoffman, R.M., 2008

Shift from self as blame to alternative possibilities

Therapeutic stories

Letter writing to those who have gone through similar things- providing wisdom and support

New symbols and representations of overcoming

Management of strong feelings

Increased self confidenceSlide126

Sexual Abuse Survivors and SFTKress, V.E., & Hoffman, R.M., 2008

Improved self esteem

Decreased isolation

Better interpersonal connectedness

Awareness of strengths they did perceive before

Increased future orientation

Examples: The Girl Who Didn’t Treat Herself Well, The CaterpillarSlide127

The Girl Who Didn’t Treat Herself Well

Once upon a time there was a very kind and caring girl who was kind to everyone she met. She was kind to her friends, her teacher, and her neighbors. Because she was so kind, friendly, and agreeable, pretty much everyone liked her.

However the girl who was so nice to others was not so nice to herself. She did many things to herself that were not so nice. She would smoke, she did not sleep well, have fun doing things she enjoyed, didn’t keep safe, didn’t have a sense of humor and have fun, didn’t think about the future, ate unhealthy foods and never exercised. Because neglect can make a heart sad, her heart became very sad. “You are nice to everyone but me, cried the girl’s heart. But she continued to ignore it because she thought that everyone else was more important than she was, and she believed it was selfish to take care of her own heart.Slide128

The Girl Who Didn’t Treat Herself Well

So her heart continued to cry

.

The tears got so hard that they clogged up her heart. When this happened, the girl felt pains in her chest and all over her body. “You have been ignoring me as I’ve cried for you to be nice to me, so I am going to give you a pain that you won’t be able to ignore---- you need to pay proper attention to me---help me!” Her heart was right about that! The pain felt so bad that she decided to go to the hospital. The doctors took pictures of her heart and found that the tears had become so hard that they clogged up her arteries leading to her heart.Slide129

The Girl Who Didn’t Treat Herself Well

“We’ve got to fix your heart,” the doctors told her. “We are going to take you to surgery to repair the damage.” So that is just what they did.

As she recovered for her surgery the doctors came to talk to the girl. “We have heard that you are nice to everyone but we have discovered that you are not nice to yourself. From now on, you must be nice to yourself. You have to eat healthy foods and get enough sleep, think positively, plan your future, exercise, talk to your friends, be with safe people, and not smoke or do drugs. If you can learn to love your body and be nice to yourself in these ways, the pain in your heart will go away. Then your heart can be filled with love for yourself as well as for others- and you will be way happier!”Slide130

The Girl Who Didn’t Treat Herself Well

Because the girl was smart and because her heart had taught her a valuable lesson, she found ways to be nice to herself. She learned to think positive plan her future, sleep well, eat right and exercise, and do lots of really caring and safe things. She learned that the more safe and healthy things she did for herself the better she felt. She was soon able to be as good to herself as she was to others. And from that time on, her heart began to smile. The girl learned that having a heart filled with love means not only loving others but also loving yourself.Slide131

The Caterpillar

Once upon a time there was a caterpillar named Anna. Anna thought, “I am not colorful like birds. I do not flutter, fly, or pollinate flowers like butterflies. I don’t make beautiful noises like crickets. I’m really different.”

As the caterpillar grew, she noticed that children were even afraid of her. Some children would occasionally say ”

ewwwww

” or “yuck” when they saw her. Even when they didn’t say anything mean, she thought that they were thinking they did not like her. She wondered why she couldn’t be like the others- the birds, or the crickets, or even the soft and fuzzy squirrels. She thought those other creatures must be so much happier than she. All she knew was that she felt ugly.Slide132

The Caterpillar

Mostly though, she just didn’t think anyone noticed her or cared about her. With all these sad thoughts, it’s no wonder Anna felt bad and sad. “Why did this happen to me?” she would cry… why can’t I be a beautiful bird? No one else knows how it feels to be me…why? Why? Why? My destiny is to be ugly and to repulse others.”

She was afraid to tell others how hurt and sad she felt. One she tried to

t

ell someone how she felt, and they ignored her; and this hurt even worse. She thought, that’s it. I can’t trust people and I can’t trust what I think and feel either. I am just an ugly caterpillar.” So Anna went on… fighting with herself and fighting against the world and how she thought everyone saw her.Slide133

The Caterpillar

She met several other caterpillars- they all quickly became friends. Anna somehow mustered up the courage to tell the other caterpillars how she felt. They chuckled to themselves and told her that she was beautiful inside and someday she would realize this beauty. “Deep inside,” they said, “you are a beautiful butterfly! She thought…”yeah right… I’m beautiful? Come on. They’re just saying that. I’m not beautiful on the inside or on the outside!”

The caterpillars told her that in order to become a butterfly she’d need to look inside for the beauty and the strength….that they could talk with her and support her but she had to believe in herself and have faith., and only then she could do what was necessary to change into a beautiful butterfly.Slide134

The Caterpillar

Anna thought this was a hopeless and very silly thing to do. She thought this was fine for her friends but that she was different. She was more ugly and way worse off than them. “Even though my friends are caterpillars, “she said, “I’m different and

m

ore hopeless than them.”

So she sat…and

sat,,,and

sat…and watched her friends turn into butterflies and fly away. One day she became sick and tired of sitting. That’s it, she said. I’m going to really try to believe I’m beautiful. I’m going to think positive thoughts and I’m going to feel better…even if a little part of me is afraid to do that. I’m going to really look inside myself for my beauty. I’m not going to fight myself any more.Slide135

The Caterpillar

And then… she put her energy into trying to find the beauty, and thinking positively and trying to be happy. It was so hard though; she had to be very patient and that was really frustrating!

But she tried and tried and tried and tried to see her beauty.

As she tried she noticed and began to develop a warm, safe cocoon around her little caterpillar body. It just sprang up! It felt a little scary and weird but a little nice also! She wanted to fight it but she didn’t fight it…she embraced it. But eventually the cocoon started to feel very comfortable and safe.

And then one day she emerged from her cocoon a beautiful butterfly!Slide136

The Caterpillar

“You were always beautiful,” said one of the caterpillars. “You had to put your energy into believing and look what you’ve become.” As the butterfly thought about what had happened she realized that her beauty was buried inside her just waiting to be unleashed and that others could see it in there but she couldn’t.Slide137

Couples Therapy and SFT

Couples can build on successes in spite of perceived problems

New healthy observable, measurable, achievable goals can be worked on in small steps

We can find exceptions to the problem.

Couples can actively seek and look for change.

Learning to discover a window on your spouse’s world.Slide138

Couples Therapy and SFT

Teach couples how to use solution focused language with each another:

“What was useful about this?”

“What tells you we are at a ____ (#)?

What would people notice first if we changed that way?

How does that help you?

What would be useful right now?Slide139

Solution Focused Groups

4-6 sessions

Time limited

Very focused and goal directed action

Transition away from problem language to strengths based language

Building on the multitude of examples in group

Help overcome

stuckness

Empower group members

Help people learn new skills and redefine problemsSlide140

Solution Focused Groups

Improved overall well being

New options and opportunities

Address universal goal of a happier lifeSlide141

Spiritualty Based Clients

Revisit spiritual moments and times.

Recreate helpful spiritual experiences.

Increase the frequency of what worked. Bring those past experiences into the present.Slide142

Solution Focused SupervisionMcCurdy, K., 2006

Collaboration between supervisor and supervisees

Process variables highlighted

Allows for imperfections in counselors

Concentrating on what the supervisee is doing rather than what he or she is not doing

Emphasizing on present performance rather than past failuresSlide143

Solution Focused SupervisionMcCurdy, K., 2006

Rewarding effort rather than outcome

Mistakes seen as learning experiences

Allowing supervisees to role model and teach others

Referring clients to supervisees

Inquiring about the supervisees perspective- “What do you think is the most important part of this counseling or supervision relationship?”

Acting as if improvements happened

Use of scaling (1-10)

Noting exceptions to

stuckness

with clientsSlide144

Bibliography

Burwell, R., & Chen, C.P. (

J

une 2006). Applying the principles and techniques of solution-focused therapy to career counselling.

Counselling Psychology Quarterly, 19(2)

, 189-203.

Enea

, V., &

Dafinoiu

, I. (September 2009). Motivational solution focused intervention for reducing school truancy among adolescents.

Journal of Cognitive and Behavioral Psychotherapies, 9(2),

185-198.

Kress, V.E., & Hoffman, R.M. (2008). Empowering

adolesent

survivors or sexual abuse: application of a solution-focused Erickson counseling group.

Journal of Humanistic counseling, Education, and deelpoment,47,

172-186.

McCurdy, K.G. (Summer 2006). Adlerian supervision: A new perspective with a solution focus.

The Journal of Individual Psychology, 62(2)

, 141-153.

Miller, J.H. (September 2010). Does teaching a solution-focused model of counselling work? A follow up of graduates.

Counseling and Psychotherapy Research, 10(3)

, 173-182.

Milner, J., & Singleton, T. (2008). Domestic violence: Solution-focused

practice with men and women who are violent.

Journal of Family Therapy, 30, 29-53

.Slide145

Bibliography

Peacock, F. (2000). Water the flowers, not the weeds. Montreal: Open Heart Publishing.

Simm

, J., & Kendal, R. (March 2008). Collaborative action research to develop the use of solution-focused approaches.

Educational Psychology in Practice, 24(1),

43-53.

Strong

, T., & Pyle, N.R. (2009). Constructing a conversational “miracle”: Examining the “miracle question” as it is used in therapeutic dialogue.

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Turneil

, A. (

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