Transcript Strength-Based Approaches - MI-PTE

Strength-Based Approaches
Mark M. Lowis, LMSW
MML Consulting, LLC
Transition?
From What?
 Institutional Memory
 Goal is to Maintain Stability
in within the System
 What the Agency Offers
 Prescribing/telling
 Compliance Based
 Monitoring compliance
 Deficit Based
To What?
 Targeted Treatment
 Goal is to Exit the System
through Amelioration
 Individualized Issues
 Assistive Interventions
 Collaborative
 Guiding Incremental change
 Recovery based
Institutional Memory
• Historical Approach to Treatment in which the
need is to protect the public by:
• Identify Persons with Mental Illness based upon
dangerous, aberrant or abhorrent behavior
• Remove from Mainstream
• Place in institution
• Stabilize Symptoms
• Maintained forever (for their own good)
– State Facility
– Forensic Center
– Jail
Old Muscle
MECHANIC
PHYSICIAN
PROBATION OFFICER
Diagnose
Fix
Diagnose
Prescribe
Prescribe Behavior
Monitoring Compliance
Dosing with Reality (warn)
Violate
PARENT
COMMANDER
JAILER
Prescribe Behavior
Confront Resistance
Entice/Warn/Emotional
blackmail
Consequences to motivate
Change
Give Orders
Confinement
Monitor Compliance
Dominate
COACH
THERAPIST
POLICE OFFICER
Directs
Rates performance
Bench
Identify Dysfunction
Advise
Confront Resistance
Violation
Citation
Detain/Arrest
New Muscle
MECHANIC
PHYSICIAN
PROBATION OFFICER
Quality
Warrantee
Support
Customer Service
Respects Autonomy
Empathic
Explains
Reassure
Emphasize Choice and control
Monitor Orders of Probation
Focus on Offender’s reason
for change
Assists in finding ways to be
successful
PARENT
COMMANDER
JAILER
Clarify Expectations
Teach Skills
Coach Performance
Emphasize Choice and Control
Support Change Motivation
Train
Motivate
Focus on Skills
Promote
Observe
Respond
COACH
THERAPIST
POLICE OFFICER
Train
Motivate
Focus on Strengths
Assist in increasing strengths
Assist in attaining goals
Respect Autonomy
Emphasize choice and control
Empathy
Assist
Focus on strengths
Protect
Deter
Deficit-Based Approaches
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Prescriptive
Treatment is “taking over” or “rescuing”
Interprets Client behaviors as pejorative
Approach shifts from client to practitioner
Labels and sub-labels are used to describe clients
Client’s ways are backward, unsophisticated, incorrect
Interventions are seen as necessary for client’s own Good
Effort to address practitioner emotional states over client
needs
• Confronting is seen as an intervention based on authority of
the practitioner over the client
Deficit-Based (Institutional Memory)
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Prescribed Goals and Objectives
Encounters are cumulative and general
Time frames are subjective
Consumer must accept expert advise
Consumer must match expectations of system
Confront Resistance
– Guardianship
– Consequences
– More Restrictive
– Seclusion and Restraint
– Behavior Management Committee
Absent From Deficit-Based
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Autonomy = Self Governance
Right of Choice and Control
Lifestyle Choices
Medication Choices
Relationships
Hygiene
Income
Activities
I See You As A Person Who…
Strength Based
The individual has the right to
dignity and respect from the
practitioner(s) and every person
whom they encounter at the
agency
(Mutuality)
Strength Based
Its not looking for their strengths.
Its knowing that they are there
•Honors autonomy
•Emphasizes choice and control
•What assistance are they seeking
•What do they already understand
•How do they see us working with them
Strength-Based Approaches
• Strong Emphasis on Joining and Engaging (Alliance)
• Treatment focuses on Amelioration of issues targeted
by the individual
• Behaviors are understood from the Client’s perspective
• Approach shifts from practitioner to the client’s goal
• Focus shifts from “should(s)” to client’s motivation
• Focus is on what the client is able to do
• Interventions are collaborative and assistive strategies
meant to aid in achieving goals and objectives
• The client and practitioner are “Mutually” involved
Strength-Based
• Bio-Psycho-Social
A. Fred enjoys reading, music and watching sports on
TV
B. Fred has been able to maintain himself with few
resources despite his paranoia
C. Fred has a driver’s license
D. Fred values his independence and wants to manage
his own medication
E. Fred is open and verbal
F. Fred needs to have more activities outside his home
I See You As A Person Who…
Strength-Based Techniques
• Reframing
– The other way
– An other way
– Deeper Recognition
• Understanding Resistance
– What makes sense?
– How do we work on that?
– Flexible learning/Socratic
Making Sense Out of Resistance
Strength-Based Methods
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Motivational Interviewing
Solution Focused
Cognitive Behavioral Therapy
Gentle Teaching
Positive Psychology
Targeted Case Management
Multi-Systemic
Family Psycho-Education
Etc.
Video
• Describe Jim Clinically
• Describe Jim as a Person
Case Work
• Lets develop a case
• Write a Strength-Based Goal with Good
agreement and interventions that are assistive
and collaborative
• Interview this person
Thank You