Transcript Solution Focused Brief Therapy

Brief Therapy
Professor Craig A. Jackson
Head of Division of Psychology
[email protected]
Solution Focused Brief Therapy
Social Constructionist
Focus on what clients want to achieve
Doesn't focus on problems
Doesn't focus on past
Solution Focused Brief Therapy
Solution Focused Brief Therapy
1980s USA
Steve de Shazer & Insoo Kim Berg
"Solution Behaviour" not "Problem Behaviour"
Initial Session
Find out what client wants from sessions
"Best hopes of our work together?"
Find out small details of life if problems solved
Miracle question
What do they already do that is successful
"Tell me about when the problem is not there"
What might change by asking a small step towards hopes
"What would others notice about you?"
How Brief a Therapy?
Aim for 5 sessions
45 mins each session
Rarely beyond 8 sessions
Sometimes 1 session enough
Any improvements after 3 sessions?
Increase gap between sessions as time goes on
Solution Focused Brief Therapy
Principle 1
Nobody's perfect all the time - even in their problems
What can these "exceptions" tell us
Things people ordinarily do can contribute to solution
Solution Focused Brief Therapy
Principle 2
Knowing where you wish to be makes getting there easier
Problems cloud our view of future
Lose sight of what we want apart from ending problem
Clearer it becomes, greater chance of making solution
Solution Focused Brief Therapy
Ask questions about. . .
Client's story
Client's strengths
Client's resources
Client's exceptions
Relationships
Self-esteem issues
Solution Focused Brief Therapy
Uses "Respectful Curiosity"
Requires client to see their preferred future
Begin steps to change
Small increments
Solution Focused Brief Therapy
Sees change as a constant & natural entity
Help people identify things they wish to change
Help people attend to what is currently happening
D
Help people attend to what they want to continue
happening
Create a concrete version of their preferred future
Plan for Sessions
A Preferred Future
Therapist identifies times in current life that
are close to the preferred future.
Focus on what is different on such occasions
Bring small successes to client's awareness
Help client repeat successful things
Enabling the Preferred Future
Focus on. . .
a) Support to explore preferred future
b) Explore (when, where, with whom, how) bits of it
already happen
Practical
No "theory" beyond social constructivism
Intuitive - stick to the above principles
Resources & Tools
Miracle Question
Scaling
Exception-seeking questions
Coping questions
Problem-free talk
Miracle Question
How the future may be
Helps establish goals
Ask slowly
Pay attention to NVCs
Give time to answer
Ignore "Don't knows"
Scaling Question
Identify differences for client
Usually range 0 - 10
Helps client identify resources
Helps identify referred future
"How would you improve things by 1 point?"
"Where on the scale would you be if...?"
Coping Question
Identify clent resources they dont even acknowledge
Can be used even in most pessimistic situations
Genuine curiosity helps
Genuine admiration for client helps
Helps identify referred future
Ensure client doesn't feel you're contradicting them
"Despite all the problems you still work. How you do it?"
Problem-free Talk
Identify client resources helping them relax or be effective
Talk about mundane life or irrelevant experiences
All probes - leisure, friends, relaxing, conflct resolution
Can use strengths and resources to move forward
Ordinary achievements & Everyday responsibilities
"you describe you're successful a work dealing with
conflicts. Could the skills be used at home with your
child?"
Playful ideas: Time Machine
“If you had a time machine which time would you go to?”
Rich / creative question which can yield possibilities:
More info about the client’s interests and enthusiasm
Resource identification – “When I won an art prize"
Regret – “when I said yes to my future husband".
Risk of being hi-jacked into problem saturated stories.
A time when a trauma could have been prevented – this gives an
opportunity to use The Rewind Technique
A future time: may be used to identify goals – another form of the
miracle question.
Playful ideas: Imaginary Machine
“If you had a machine to do anything”
A woman conjured up a “chill machine” which was
installed in her basement. You stepped through it and it
had green lights with a relaxing humming nose. After
filling out the description she decided that her son and
husband would also benefit.
A teenage boy had a sort of "anger radar" in his pocket
which beeped, so that only he could hear it. It gave him
an early warning signal so that he could dig himself out
of a difficult situation and do his deep breathing
Playful ideas:
Super sleuth
Imagine you are a Solution Detective – you could invoke your
favourite sleuth to find a solution to your problem
Do something different for 5 minutes a day
Doesn’t matter what it is (as long as legal and safe) – it is the
regularity of the practice:
Give someone a pleasant surprise
Practice random acts of kindness
The compliments box
A special box is set up in the home and members encouraged
to post complimentary comments about each other.
Internal Resources
Help clients attend to their resources, skills and abilities
Helps make a narrative of cent as a competent individual
Empowers client in identifying their own strengths
Skills
Strengths
Qualities
Beliefs
Tenacity
Capacity
External Resources
Supportive relationships
Friends
Partners
Faith
Workplace
Unions
Social services
Compliments
End sessions with compliment of client abilities
Focus on positive points
Set tasks using those abilities
Ordinary achievements & responsibilities
Agoraphobia case
Mrs Brown
Agoraphobic and was seen at home.
It is unusual for agoraphobic patients not to go out at all
(children have to be taken to school, dogs walked, shopping
done) but it seemed that Mrs Brown's case was so severe she
had not stepped out of her front door for several months.
It turned out that Mrs Brown could not even bring her milk in
off the step because being near the front door could set off a
panic attack. The therapist had noticed that the stairs came
down right beside the front door and after listening very
seriously to Mrs Brown's worries, asked about the courage
that it must take her to come down stairs each day.
Agoraphobia case
Mrs Brown
Agoraphobic and was seen at home.
The more her daily courage was explored and
acknowledged the stronger became her voice. She then
began to remember other acts of courage, like saying to
herself the day before ‘Don't be silly’ and bringing in the milk
or some months earlier when she had made herself attend
her aunt's funeral because her aunt had loved her. As she
became aware of this hidden but persistent courage, Mrs
Brown began to put it to greater use and over the following
weeks, with two more clinic sessions to support her, she
made her way back into the outside world.
Self-change Model
Pre-contemplation:
The client does not recognize that they have a difficulty and
will blame others: “it’s your problem not mine.”
People may be in this stage because they lack awareness
or they may have tried to change a number of times and
become demoralized about their ability to change.
Both groups tend to avoid reading, talking or thinking about
their problems. They may characterized as resistant or
unmotivated or as not ready for any intervention.
Self-change Model
Contemplation:
The client starts to recognize that they have a problem and
is the stage in which people are intending to change in the
near future.
They are more aware of the pros of changing but are also
acutely aware of the cons.
This balance between the costs and benefits of changing
can produce profound ambivalence that can keep people
stuck in this stage for long periods of time.
Self-change Model
Preparation:
The stage in which people are intending to take action
soon.
They may have made that initial phone call to therapist and
have turned up for the first session.
These individuals have a plan of action, such as consulting
a counsellor, talking to their doctor, buying a self-help book
or relying on a self-change approach.
Self-change Model
Action:
Clients have committed to a course of action and have
taken steps to change their behaviour, modifying thoughts
and feelings. They may now have a sense of timescale,
how long the change process may last.
Maintenance:
Clients are working at keeping the changes going; it is
important not to allow relapse to take place.
Relapse:
Possible and may be of different degrees of severity. Ideally
people can move back into the action phase as soon as
possible.
Brief Solution Focused Therapy MCQ
1. Solution-focused brief therapy is based on:
A.clear diagnostic formulation
B.appreciating the client's resources
C.detailed description of the client's problem
D.the scientific study of personality
E.the use of language as a creative process.
Brief Solution Focused Therapy MCQ
2. Solution-focused techniques involve:
A.the ‘miracle’ question
B.paradoxical injunctions
C.complimenting the client
D.careful administration of medication
E.the patient's acceptance of the problem.
Brief Solution Focused Therapy MCQ
3. Solution-focused techniques have been effective in
treating:
A.drug and alcohol misuse
B.agoraphobia
C.adolescent behavioural problems
D.eating disorders
E.chicken pox
Brief Solution Focused Therapy MCQ
4. Solution-focused authors include:
A.de Shazer
B.Lethem
C.Rollnick
D.O'Hanlon
E.White
Brief Solution Focused Therapy MCQ
5. Scaling questions explore:
A.the patient's achievements
B.the patient's description of the symptoms
C.medication requirements
D.possible areas for progress
E.goals of therapy.
Useful References
Berg, I. K. (1991) Family Preservation: A Brief Therapy Workbook. London:
BT Press.
Berg, I.K. & Miller, S. (1992) Working with the Problem Drinker: A Solution
Focused Approach. New York: Norton.
de Shazer, S. (1985) Keys to Solution in Brief Therapy. New York: Norton.
George, E., Iveson, C. & Ratner, H. (1999) Problem to Solution: Brief
Therapy with Individuals and Families. London: BT Press.
Hawkes, D., Marsh, T. & Wilgosh, R. (1998) Solution-Focused Therapy: A
Handbook for Health Care Professionals. Oxford: Butterworth–Heinemann.
Hoyt, M. F. (1984) Single session solutions. In Constructive Therapies (ed.
M. F. Hoyt). New York: Guilford.
Useful References
Jacob, F. (2001) Solution-Focused Recovery from Eating Distress. London:
BT Press.
Lethem, J. (1994) Moved to Tears, Moved to Action: Brief Therapy with
Women and Children.London: BT Press.
MacDonald, A. J. (1994) Brief therapy in adult psychiatry. Journal of Family
Therapy, 16, 415–426.
O'Connell, B. (1998) Solution-Focused Therapy.London: Sage.
Rhodes, J. & Ajmal, Y. (1995) Solution-Focused Thinking in
Schools. London: BT Press.
Sharry, J. (2001) Solution Focused Groupwork. London: Sage.
Talmon, M. (1993) Single Session Solutions. New York: Addison-Werlely.