Transcript Slide 1

Practical Applications of a Solution
Focused Approach to Counseling
and Intervention
Leslie Cooley & Michael Haas
Tell me, and I’ll forget
Show me, and I may not remember
Involve me, and I will understand
Native American Saying
A mind that is stretched by a new
experience can never go back to its
old dimensions
Oliver Wendell Holmes
Change is inevitable
Growth is an option
What do you think creates
change?
How have these ideas
influenced your choices in work
with clients?
Ask yourself….
• Can I tell if I am making a difference?
• Am I helping to create change?
• Is there anything I could do
differently to help create change?
If what you are doing isn’t
working…..
At least do something different
Lipstick Story
SFBT is a strength-based
perspective
Change is frequently connected
to success.
Success breeds success….
Building on Success
Notice what is strong in people
instead of what is wrong in
people
How many of you quit smoking at
some point in your life even if it was
a long time ago?
Or quit some other habit you
wanted to discard?
About quitting something…
• How did you do it?
• Compared to all the times in the past that
you thought of quitting and wanted to but
didn’t, how did you make it happen this
time?
• What helped you stick with it?
• What made the difference this time?
• What’s your theory about how you got this
change to occur?
In a strength-based approach,
questions are
• Curious… a posture of “not
knowing”
• Look for exceptions to the problem…
most problems don’t occur all the
time
• Respectful… must be genuine
• Complimenting… directly or
indirectly
• Future focused… connect to goals
From a problem-based approach,
questions sound quite different
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When did you first start smoking?
How long did you smoke?
How much?
How many times have you tried to
quit?
• What health problems has this
caused for you?
• How has this impacted your
relationships?
The assumptions are different
From a SFBT approach…
• Clients have resources & strengths
to solve problem, even if they are
unaware of these resources
• People have tried to solve their
problems, but the attempts have not
worked
• Expression of emotion does not
necessarily bring about change
More assumptions
• It is not always necessary to know
the true cause, history, or function of
a problem in order to resolve it
• Every problem pattern included
examples of exceptions… when the
problem is not happening… typically
not seen as significant by the client
What you focus on expands
SFBT
vs.
• Client as expert
• Focus on present
& future
• Client determines
goals
• Change connected
to success
Problem-focused
• Tx. Is expert
• Focus on past
• Tx. Often has
unspoken goals
• Change based on
insight
Insight
• In a problem-focused approach, the
assumption is that if the person
understood why they were stuck, that
person would be able to change their
behavior or thinking
• Story of the couple who were heavy
smokers
• Story of the man who refused to wear his
shirt to the dinner table
• Insight doesn’t guarantee that change will
occur
Certainty
vs.
• We know what is
best for our clients
• Clients can be
resistant
• Concerned with
“why” questions
• Client goals can be
secondary
Curiosity
• “Not Knowing”,
position of
curiosity
• May not be asking
the right questions
• Concerned with
“what” & “how” ?s
• Client goals are
critical
The Implications of
Common Factor Research
• After reviewing hundreds of outcome
studies involving a variety of clients
and problems, Lambert (1992, 1999)
concluded that positive outcomes in
psychotherapy result primarily from:
Common Factors
• What clients bring to treatment
• Practitioners’ respect for these
resources
• The quality of the relationship
Client Factors 40%
• Inner strengths, resources, and
innate capacities
• Ability to enlist support and help
from others
• Fortuitous events
Relationship Factors 30%
• Empathy, warmth, acceptance, and
encouragement of risk taking lead to
a cooperative working relationship
• Client perceptions of relationship are
the most consistent predictor of
improvement
Expectancy Factors 15%
• Expectation of help and improvement
• Faith and hope
• Emphasis on possibilities, personal
agency and an internal locus of
control
Model Factors 15%
• To be effective, techniques must
match the client’s view of what is
helpful and the client’s relationship
to the problem
Implications
• Focus on collaboration and assume
a stance of “not knowing”
• Assume the client is competent and
the “expert” in his or her own life.
Implications
• Convey an attitude of hope and
possibility without minimizing the
problem or pain
• Encourage client's to focus on the
present and future possibilities
rather than past problems
• De-emphasize diagnosis and labels
GOALS…..
Developing a future focus and
well formed goals
Goals
• “I skate to where the puck is going,
… not to where it’s been.”
Wayne Gretsky,
hockey champion
Goals:
The agenda for counseling
• Focus on what the changed state will be
like… the non-problem future
• Concrete, specific, action & positive
language
• Meaningful & important to the client
• Small and within easy reach, realistic
Goals:
The agenda for counseling
• Within the client’s control
• Viewed as the first step, rather than the
end pt.
• Perceived by clients as involving hard
work
Goal Questions
• How will you know when you won’t
need to come here anymore?
• How will you know when things are
better?
• When is a little of that already
happening?
Future certain language
• What WILL be different when this is
no longer a problem for you?
• Quite different from…
• What would be different if this were
no longer a problem for you?
Whose goals?
• “The problem is other people think
there’s a problem”
• Accepting the client’s position
• Goal=proving that I don’t have a
problem
• The sincerity question
Miracle Question
• Suppose a miracle happened and the
problem that brought you here today is
solved. What would be different about
your life?
• What part of that is already happening
even a little?
• Give the client time to ponder
• Expect “I don’t know”
• Ask clarifying follow-up questions
If you don’t know where you are
going, how will you know when
you get there?
Goal setting
• Imagine that a 16 yr. old girl has been
referred to you for “depression”.
Work in groups of 3 to develop some
questions that would be appropriate
to help develop a goal.
• See handout
Asking questions…From a “not
knowing” position
• Avoid embedded assumptions about how
someone should be living their life
• “How do you feel about being pregnant
again?”
• “Did you use birth control?”
• “Do you find you are making the same
mistakes in parenting as your mother?”
• “Would you be interested in hearing about
how adoption works?”
Create questions for this pregnant
client from a position of curiosity or
“not knowing”
Refer to the questions in the
handout if you find your self
stuck
Identifying the client’s relationship
to the problem
and establishing a collaborative
working relationship
Tools for Collaboration
• Adopt a stance of “not knowing” or
respectful curiosity
• Match your responses to the student’s
readiness for change
Not Knowing
• Listen! Even if you don’t agree
• Listen with the “empathy of natural
interruptions”
• Ask questions rather than tell students
what to do
• Assume the “Colombo” approach
• “And” rather than “but”
• “How come?” rather than “why?”
Empathy
• Remember, you are trying to
establish a collaborative
relationship not come to a perfect
understanding of a student’s
experience
Communicating Respect
• Ask permission to do what we are going
to do anyway
• Announcing the change of topic context marker
• Inform student about every step of what
is happening
Insoo Kim Berg BFTC Web Site
Stage Model of Change
• Pre-contemplation – No recognition of a
problem
• Contemplation – Thinking about change but
not sure it is worth the time and effort
• Preparation – Thinking about what change to
make
Stage Model of Change
• Action – Ready to take action and make
change
• Maintenance – Maintaining changes already
made, preventing relapse
• Termination – 100% confident that client will
not fall back into old behaviors
Visitor Relationship
No Problem – No Goal
• Precontemplaton stage of change
• Often “sent” or mandated to come to
counseling
• “What am I doing here!?”
Responding in a Visitor Relationship
• Listen and acknowledge the client’s point
of view
• Expresses sympathy for the client’s
situation
• Use relationship questions to address the
wishes and needs of referring party
Relationship Questions
• What do you think _____ wants to be
different as result of us talking
• Who do you need to convince that you
don’t need to be in counseling
anymore?
• What would convince them?
Responding in a Visitor Relationship
• Respectfully provide information about
nonnegotiable requirements
• Notice small exceptions
• Refrain from offering suggestions to “do”
anything
Responding to “I don’t know”
• “I realize I’m asking you some tough
questions, (pause) So, suppose you did
know, what you would you say?”
• Ask relationship questions
• Use multiple choice questions
Browser Relationship
Problem but No Role in Solution
• Identifiable problem but no role for the
client in building a solution
• Often in contemplation stage of change
• Someone else has the problem
• Client sees self as victim, powerless, an
“innocent by-stander” to problem
Responding in a Browser
Relationship
• Listen, acknowledge POV, express
sympathy for the client’s situation, and
use relationship questions
• Encourage reflection
• Notice small exceptions and refrain from
offering suggestions to “do” anything
Responding in a Browser
Relationship
• Provide accurate information
• Instill hope that change is possible
• Explore the pros and cons of change
without pressure
Customer Relationship
Problem and Goal
• Preparation or action stage of change
• Client and counselor can jointly identify
a problem and a goal
• Client sees him or herself as part of the
solution and is willing to do something
about the problem
Responding in a Customer
Relationship
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Counselor “sells”
Brainstorm, problem solve, plan
Help develop goals and a realistic plan
Assess strength of commitment to
change
• Action or “doing” tasks
Working with exceptions
and client resources
Looking for Exceptions
• Problem descriptions are seldom useful
for building solutions
• Exceptions= times when the problem
doesn’t occur, especially if expected
• Ask “Times when the problem is less
severe?”
• “Suppose I asked your partner if you had
any better days… what might he/she
say?”
• Ask for details: who, what, when, where
Exceptions to the problem
• Much easier to talk about the
problem… but knowing more about
the problem doesn’t necessarily
suggest what to do about it. (DSM
Dx. Doesn’t = intervention)
• Search the past and present for
solutions by focusing on times when
the problem wasn’t present, less
frequent, less intense
Focusing on Exceptions
• Shrinks problems… Ask about
details
• Demonstrate client abilities…How do
you suppose you did this?
• Point towards solutions… What
would it take to repeat this?
• Focus on what is possible… You
already know what to do
Case examples
• Dahlia’s victory over her anger and
fighting
• Kid with the temper who played
soccer
• Your life?
• Not as useful with young children
Scaling Questions
• 1-10 or get creative: faces, karate belts,
circles
• On a scale of 1-10 where 10 means how
you want things to be and 1 means the
worst things have been, where would you
say things are now?
• What’s the highest you have ever been?
• When was that? What were you doing
then?
• How did that make things different?
Advantages of scaling questions
• Makes things concrete
• Makes small successes noticeable
• Build into goals… what would it take
to move up one more number?
• Maintain gains… what will it take for
you to hold this position?
• See handout
Scaling exercise
• On a scale of 1-10, where are you in
your quest to be a competent
therapist?
• What tells you that you are at a ___?
• What will it take for you to move up
10%?
• What is something specific you can
do to make that happen?
• What will be different for you when
you are at a ___?
Tasks and homework
What kind of relationship
do you have with the
client?
Types of Tasks
• View or think something different
– Observe, think, reflect, consider
– Insight, explanations, theories,
interpretations
• Do something different
– Direct suggestions, homework
– Act, do, behave
Tasks and Relationships
Visitor Relationship
Compliment only
Browser
Relationship
Observational task
Customer
Relationship
Action task
Introducing Your Ideas
Into a Conversation
• Offer suggestions or advise by invitation
only
• Present suggestions or interpretations
in a “non-expert” manner
– I wonder if…
– Sometimes…
– A lot of people in your situation might….
Observational Tasks
• Observe for exceptions
– “Pay attention to those times that are better
so that next time we meet you can tell me
about them”
– “Pay attention to those times when things
are better and notice if you are doing
anything different to make that easier”
– “Pay attention to those times when you
overcome the urge to…”
Observational Tasks
• Reflect on problem
– “Pay attention to what will be different if this
problem is solved or not solved”
– “Pay attention to what is happening in your
life that tells you this problem can be solved”
Observational Tasks
• Reflect on consequences, for
yourself or other people
– “What would your mom say if you were able
to …..?”
– What would you able to do differently if….?”
– What would it say about you if you were
able to …?”
Action Tasks
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Public expression of intent to change
Gathering information
Dramatic Relief – Talking, writing, art
Countering or “do this instead”
Action Tasks
• Changing the environmental or
antecedent conditions
• Make internal and external rewards
readily but contingently available
• Enlistment of help from others – Ask
relationship questions, exploring social
resources
• Helping others
Techniques for speeding up change
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Validate client’s concerns
Interrupt respectfully
Assume clients can change
Build on small changes
Go lightly with archeological digs
Begin each session focusing on what
has worked