Transcript Innovations, Best Practices & Policy Change

Minnesota Child Welfare
Training System
Solution-Focused
Brief Therapy
Treatment Strategies & Interventions
Bob Bertolino, Ph.D.
Assistant Professor, Rehabilitation Counseling
Maryville University – St. Louis, Missouri
Sr. Clinical Advisor, Youth In Need, Inc. – St. Charles, Missouri
There is More to See
Creating A Culture of
Care and Respect
Philosophy, Research, & Practice
Creating A Culture of Care
and Respect
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Philosophy
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Ideas/principles that inform change. Philosophy reflects
one’s core beliefs about the world and the human condition.
It precedes and informs theory.
Research
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Comes from different agendas. Although it is influenced by
economics, politics, society, etc., we owe it to our clients and
to ourselves to search for what each has to offer and how that
can influence ethical, effective, and respectful practice.
Practice
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Evolves from philosophy and research and should fit with
and be respectful of clients’ worldviews including their
cultural backgrounds, preferences, and expectations. Modes
of practice should also assist with helping clients to meet
their needs, achieve goals, and experience improved
outcomes.
No More Boxes
Recalibrating Compasses and
Expanding Personal Worldviews
“You must be the change you wish to
see in the world”
– Mahatma Gandhi
Recalibrating Compasses
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6.
What are the core beliefs you have about the people
with whom you work?
How have you come to believe what you believe and
know what you know? What have been the most
significant influences on your beliefs?
How have your beliefs and assumptions affected your
work with clients? With colleagues? With the
community?
Do you believe that change is possible even with the
most “difficult” and “challenging” clients?
How do you believe that change occurs? What does
change involve? What do you do to promote change?
Would you be in this field if you didn’t believe that
the clients with whom you work could change?
H. O. P. E.
H
Humanism
O
Optimism
P
Possibilities
E
Expectancy
“Optimism is the faith that leads to achievement.
Nothing can be done without hope or confidence.”
- Helen Keller
Experience as a Catalyst:
The Presence of H.O.P.E.
• What inspires or moves you?
• How does that increase your sense of hope?
• What does an increased sense of hope allow
you to do?
• How can you promote hope with others?
• How do you maintain your sense of hope
when you are struggling with clients?
What Does The Data
(Research) Say?
What Does The Data Say?
• The most significant portion of change occurs
earlier rather than later in services
• Dose-Response Effect
• The client’s rating of the therapeutic relationship
is the best and most consistent predictor of
outcome
• One of the best predictors of negative outcome
is lack of structure
• Most clients are making some form of progress
What Does the Data Say? (cont.)
“Real-Time” feedback increases factor of fit
 Long-term services without an improved outcome
combined with “more of the same” on the part of
the therapist equals an “impossible” case
 Long-term services with high alliance scores and no
improvement in outcomes can indicate dependence
• Practitioners whose clients do not seem to be
making progress tend to do similar things:
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• More of the same, “Clients must get worse before they get
better,” More severe diagnosis, Return to their models
What Does the Data Say? (cont.)
• Non-model-specific factors account for 8-12x more
than methods and models and up to 92% of the
variance
• Although models (approaches) account for very
little of the variance in outcome, the person of
the practitioner can significantly affect change
• Among effective approaches it is the similarities not
the differences that account for the significant
portion of change (e.g., MST, FFT, BSFT, MI, CBT,
etc.)
• Through different mechanisms of change, effective
approaches are vehicles for activating and
transporting common factors
Outcome
Management
(OM)
EmpiricallySupported
Relationships
(ESR)
Strengths and
SolutionBased
EmpiricallySupported/
EvidenceBased
(EST/EBP)
Common
Factors
(CF)
Common Fact or s
in Change
15%
40%
15%
30%
Client Factors
Relationship Factors
Expectancy and Placebo
Model and Technique Factors
Hubble, M. A., Duncan, B. L., & Miller, S. D. (Eds.) (1999). The heart and soul of change: What works in therapy. Washington, D.C.:
American Psychological Association.
Lambert, M. J. (1992). Psychotherapy outcome research: Implications for integrative and eclectic therapists. In J. C. Norcross & M. R.
Goldfried (Eds.), Handbook of psychotherapy integration (pp. 94-129). New York: Basic Books.
Ingredients of Change
22%
General
Effects
Specific
Effects
8%
70%
Unexplained
Variance
Wampold, B. E. (2008). The great psychotherapy debate: Models, methods, and
findings (2nd ed.). New Jersey: Lawrence Erlbaum.
Points of Convergence
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Culturally sensitive
Relationship-oriented
Client-informed
Collaborative
Change-oriented
Outcome-oriented
Strengths and solution-based
Martin Seligman
“What we have learned is that pathologizing does not move
us closer to the prevention of serious disorders. The major
strides in prevention have largely come from building a
science focused on systematically promoting the
competence of individuals…. Fifty years of working in a
medical model on personal weakness and the damaged
brain has left mental health professionals ill-equipped to do
effective prevention. We need massive research on human
strength and virtue. We need practitioners to recognize that
much of the best work they do is amplifying the strengths
rather than repairing their patient’s weakness.”
Principles of SSB Philosophy
1. Client Contributions
2. The Therapeutic Relationship and
Alliance
3. Cultural Competence
4. Change as a Process
5. Expectancy and Hope
6. Model and Factor of Fit
Active Client
Engagement (A.C.E.)
Principles in Motion
Create a Context of
Collaboration
Point
• Start services by offering
options that are respectful
of clients and their cultures
and incorporate their
preferences and perceptions
• Preparatory
How
• Be prepared
• Keys to Collaboration
Strengthen Through
Presence
The Therapeutic Relationship in
Context…
Even for those who are convinced that the
therapeutic relationship is healing by and of itself,
there are strategies that can foster its impact. In
other words, since not all kinds of relationships are
likely to bring about change, one needs to be aware
of interventions (including modes of relating) that
should be encouraged or avoided for the
relationship to become a corrective experience.
(Castonguay & Beutler, 2006, p. 353)
Castonguay, L. G., & Beutler, L. E. (2006). Common and unique principles of therapeutic change: What
do we know and what do we need to know? In L. G. Castonguay & L. E. Beutler (Eds.), Principles of
therapeutic change that work (pp. 353-369). New York: Oxford University Press.
Strengthen Through Presence
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Point
Listen and Attend to Clients’
Stories and Strengths
Engagement
How
Acknowledge and validate
Consider the influence of words
Use possibility-laced language
Separate experience from action
Summarize, validate, and soften
Avoid platitudes or trying make
things more “positive”
Be aware of stories of
impossibility
Be a “life witness”
Strengths-Based
Engagement
and Practice
Creating Effective
Helping Relationships
Allyn & Bacon
February, 2009
The Influence of Words
The Influence of Words
Sad. Helpless. Inconvenience. Defeat. Tired.
Oppressed. Doubtful. Uninterested.
Life is so hard. Nothing seems to go my way. There
is no one to turn to. It feels like I’ve been
forgotten. Times are hard. Nothing seems to
help. Things will not get better. In fact, they will
probably get worse. There is no hope.
The Influence of Words
Exciting. Fun. Laughter. Joy. Anticipation.
Possibility. Aliveness. Love. Peace.
When I think about the future I become
energized. There is so much I can
accomplish. Life is wonderful. There are so
many possibilities in the world.
Being a Valuing or
Life Witness
Learn Clients’ Orientations
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Point
Gain an improved
understanding of clients’
perceptions, perspectives,
and theories
Words and Pictures
How
• Ask questions as to what
clients attribute problems
to and possible solutions
• Assess clients’ readiness
for change (Stage of
Change)
Address Case Management
Matrix
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Point
Explore services and program
parameters
Monitor relationship and
outcome
Interim Family Safety
Guidelines
How
Provide information
Collaborate and negotiate
Concurrent planning
Introduce outcome measures
Use feedback processes to client
perceptions of the alliance
Eliciting Client Feedback
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In Initial Sessions and Interactions…
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Are there certain things that you want to be sure we talk about?
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What is most important for me to know about you and/or your
situation/what you’ve been experiencing?
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What ideas do you have about how therapy/coming here/coming to
see me might be helpful to you?
“Checking In” –As Sessions and Interactions Progress…
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Have we been talking about what you want to talk about?
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Are we moving in a direction that seems right for you?
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Are there other things that we should be discussing instead?
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What, if anything, should I do differently?
At the End of Sessions and Interactions…
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How did the session go for you?
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How was the pace of our conversation/interaction/session?
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Did we work on what you wanted? Was there anything missing?
Accommodate Services to
Clients’ and Others Goals
Point
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Create focus and direction
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Gain clarity regarding goals
and indicators of change and
progress
How
• Determine what needs to
change
• Determine how it will be
known that sufficient change
has been made and goals have
been met
• Determine what will indicate
that progress is being made
Be Change-Oriented and
Solution-Focused
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Points
Consider strategies that offer the
best possible “fit” for clients
Methods should fit with and be
sensitive of clients’ cultures,
beliefs
Focus on processes that
enhance change
Similar-But-Different Role Play
How
• Reassess clients’ readiness for
change
• Collaborate on tasks/way to
achieve goals and improve
outcomes
Evaluate Plan
Points
• Ensure expectations are
clear
• Ensure plans are clear
• Final Family Safety Plan
How
• Discuss benefits of
positive change
• Discuss possible
consequences of lack of
follow-through
• Encourage feedback
Monitor Progress
Points
• Determine progress and gains
• Identify barriers to change
• Determine next steps
• Follow-Up
How
• Identify, amplify, and extend
change
• Reassess goals
• Determine outcomes
• Explore transitions
• Check in with self and remain
aware of pathways of
impossibility
The Therapist’s Notebook
for Strengths and SolutionBased Therapies
Homework, Handouts,
and Activities
Bob Bertolino
Michael Kiener
Ryan Patterson
Routledge
Summer, 2009
“It’s not enough to be compassionate.
You must act.”
– Tenzin Gyatso
14th Dalai Lama, 1992
Thank
You
Bob Bertolino, Ph.D.
TCCT, LLC – P.O. Box 1175 – St. Charles, Missouri 63302
+01.314.852.7274 – [email protected] – www.bobbertolino.com
Maryville University
Youth In Need, Inc.
650 Maryville University Drive
Saint Louis, Missouri
63141 USA
+01.314.529.9659 (Phone)
+01.314.529.9139
[email protected]
www.maryville.edu
516 Jefferson
Saint Charles, Missouri
63301 USA
+01.636.946.0101 (Phone)
+01.636.925.0125 (Fax)
[email protected]
www.youthinneed.org