Transcript Back to Basics

Back to Basics
Bill O’Hanlon
Finland
March 2007
Back to Basics
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SFT: A revolution in
psychotherapy
• It has changed the practice of therapy all over the
world
• Many books and articles have been written about
it
• Psychology (positive psychology), social work
(strength-based social work), and organizational
consulting (Appreciative Inquiry) have variations
of it in widespread use today
• Steve and Insoo traveled all over the world
planting the seeds of this approach and
introducing these ideas to thousands
Exercise
• In small groups, tell the other group
members when you first became aware
of SFT, what attracted you to the
approach and your favorite story or
memory about Insoo, Steve or SFT
Precursors and Background of
SFT
• Milton Erickson’s African Violet Queen
• Case treated by Erickson in the 1950s
• I heard it from Erickson in 1977
Precursors and Background of
SFT
• Don Norum - The Family Has The Solution
• A presentation given in Milwaukee in 1978,
attended by Steve deShazer, Insoo Kim Berg and
Eve Lipchik
• The premise was that families and family
members often have solutions, but they rarely
mention them because therapists don’t ask about
them
Precursors and Background of SFT
• Milton Erickson
• Resource-oriented therapist
• Believed that people have the answers to their problems
within themselves and in their social situations
• Everything, even symptoms, are potentially resources
• Find what the person does well, where their strengths are and use
them in service of change
• The use of language is important; be careful to assume and
evoke change
• Evoke rather than instruct or tell
• Pseudo-orientation in time (the crystal ball technique)
• People’s experience is changeable, sometimes very rapidly
• Utilize what people are already doing
• Small changes in patterns can effect change
• Each person is unique, so each therapy must be unique
Precursors and Background of
SFT
Steve’s influences
• The Social Construction of Reality
(Berger and Luckman)
• Fritz Heider’s Balance Theory
Precursors and Background of
SFT
• MRI Brief Interactional Therapy
• Designed to be deliberately brief
• Held that repetitive interactions created problems
or held problems in place
• The problem is the attempted solution
• Attempted to de-frame, reframe and change interactional
patterns around the problem
• Small changes can result in bigger changes
• Be careful of pushing for change as it may cause a
backlash
• MRI theorists initially resisted SFT
Precursors and Background of
SFT
• Systemic Therapies and the Milan Family
Therapists
• Began to study the therapist-client system
• The therapist became part of the problem or part
of the solution depending on what he/she evoked
• The use of “invariant prescription” began to show
that the solution/intervention was not necessarily
related to the problem
Precursors and Background of
SFT
• Thomas Szasz, Foucault, radical psychiatry
and critiques of psychotherapy, pathological
labeling/diagnosis
• Questioning both the legitimacy and helpfulness of
diagnosis and pathology
• Challenging the idea of “mental health” and
“mental illness”
Philosophy and Assumptions of SFT
• People have resources, skills, strengths, abilities,
competencies and solutions
• What gets focused on and talked about during therapy
increases in emphasis and prominence
• What caused the problem is not as relevant as what
helps make the situation better
• Focus more on actions, viewpoints and contexts than
on personality traits, feelings or intentions
• Clients are experts on their own lives and experiences
• Resistance is typically brought about by unhelpful
interactions between therapists and clients
• It is not always necessary to understand all about the
problem in order to begin to change it
Principles of SFT
• If it is working for the client(s) and doesn’t harm
anyone, there is no need to intervene or change it,
even if it doesn’t fit some theoretical model of “mental
health”
• If you find something that works, even a little,
encourage the client to do more of that
• Do not take up unhelpful or problematic conversations.
Listen politely and then refocus on what is working,
could work or what the client wants
• Ask about and listen for exceptions, solutions and
preferences
• Compliment people when possible and when
congruent and not patronizing; recognize their
progress, positive coping skills and their competence
• Therapy should be as brief as possible
Attitudes of SFT
• Curiosity
• Non-expert stance (clients are experts on their lives,
responses to our interventions, and experiences)
• Not interested in causes, labels, diagnoses or
exploring the past
• No normative model for “healthy” thinking or living
• Pragmatic
• Not much use of jargon; very plain speaking
First Wave
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Past-oriented
Past causes for problems; usually trauma
Pathology/deficit-oriented
Therapist as expert
Theory-driven
Examples: Psychoanalysis; psychodynamic;
hypnoanalysis; family-of-origin/multi-generational therapy;
most trauma therapies; genetic/neurological set
Second Wave
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Present-oriented
Current causes for problems
Problem-oriented
Therapist as expert
Theory-driven
Examples: Behavior therapy; cognitive therapy; family
systems; EMDR; TA; addictions therapies; DBT
Third Wave
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Present towards the future-oriented
Not oriented to causes
Solution-oriented; strengths-based
Client as expert
Collaborative
Agnostic as to causes and theories
Examples: Solution-focused; narrative; collaborative
language systems; solution-oriented; possibility therapy;
new neurological theories with plasticity
Common Factors research
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Therapy is successful about 68% of the time
When it is successful, research has indicated that there are four common factors
to its success
These are:
• Client factors: The person’s strengths, resources, social supports,
environments and the type (frequency, intensity, and duration) of the
complaints they have (40%)
• The therapeutic relationship: How engaged and connected is the client in
the therapy? A therapist who is perceived by the client as warm, empathic,
genuine, trustworthy, non-judgmental and respectful contributes to
developing a positive alliance. (30%)
• Expectancy, hope and placebo: The therapist’s optimism, confidence and
sense of hope make a difference. (15%)
• Theory/technique: What procedures and model the therapist is guided by
or uses. How much the therapist has allegiance to his/her model and
methods. (15%)
Lambert, M. J. (1992). Implications of outcome research for psychotherapy integration. In J.
C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 94129). New York: Basic Books.
The Use of Time in SFT
• The past is used to find exceptions to
the problem, strengths, competencies,
and positive coping skills, not to
discover the cause of the problem or
earlier traumas or troubles
The Use of Time in SFT
• The present is used to find complaints
and desires for change, exceptions to
the problem, strengths, competencies,
and positive coping skills, not to
discover what maintains the problem or
“resistance”
The Use of Time in SFT
• The future is used to investigate or
imagine what a time without the
problem or complaint would look like,
what the person prefers and the criteria
for stopping therapy successfully
Methods of SFT
• Skeleton key interventions
• Between now and the next session, notice what is
going right in your situation; we don’t want to get
rid of anything that is working
• Write about what you is bothering you for 15
minutes each night, always at the same time; then,
when you have fully expressed everything you
think needs to be expressed, read it over each
night until you really feel that it is complete and
you have gotten it all out, then burn the paper you
have written on
Methods of SFT
• The Miracle Question
• The key to its successful use is to get the person experientially
involved in the question
• Set the scene; wait until they are there in their experience and
imagination
• Give them the premise (a miracle occurs when you are asleep that
resolves the concern you brought to therapy/counseling)
• Then break it down into the near future and ask about personal feelings,
actions and perceptions as well as interpersonal feelings, actions and
perceptions
• It may be enough just to discuss the problem-free future; or you might
encourage the person to bring little bitd of that future into the present or
near future
• Variations: Magic wand; time machine; crystal ball; rainbow bridge; letter
from the future self
Exceptions and Solutions
• Investigate other times of successfully navigating or
resolving a similar problem
• Find times when the problem would have been
expected but didn’t occur
• Find someone in the person’s life who has solved a
similar problem well
• Discover times when the problem is not quite as
severe
• Find out what the person is doing when the problem
is not happening
Evoke competence
• Find out in what settings the person is competent and
skilled
• Find out who believes or believed in the person and
their goodness and abilities; perhaps ask on behalf of
that person what they would advise if they were
present
• What advice would the person give others who were
facing this or a similar problem?
• Suggest that the person transfer skills, knowledge
and abilities from a context of competence to the
problem area
Positive coping
• Find out how the person has been coping
positively with the problem
• Ask why the problem isn’t worse or does not
always occur
• Ask the person to give you advice or comfort
for others who might be going through the
same kind of problem or suffering
Noticing pre-interview change
• Find out about any positive change or
progress in the problem situation in recent
times
• Ask the person to give you their sense or idea
about why this change has happened and
what it might take to continue positive change
in the future
Give compliments, honor clients, notice and
highlight cooperation and motivation
• Notice and acknowledge any positive
development or positive risk-taking or efforts
clients show
• Compliment clients for coming to therapy and
cooperating with the process
Ascertaining customership, motivation
and engagement in the change process
• Is the person there for change? Were they
sent by someone else?
• Who is motivated to make change and what
change?
• Window shoppers - compliment and send them on
their way
• Complainants - Listen respectfully and
acknowledge; perhaps they will become motivated
customers
• Visitors - Find out what they want and give them
perceptual tasks only; sometimes they become
clients or customers
• Clients/Customers - They can be given action
tasks or perceptual tasks
Scaling
• Ask the client to rate on a scale of 1-10
(or 1-100) where they are now with their
concern, where they would like to be
and what enough progress would be to
stop wanting or needing therapy
• Ask them what it would take to increase
their rating by a small, achievable
amount
Positive prediction
• Ask the client to predict how many days
they will be at the higher number they
say they are capable of achieving in the
time between sessions
Other SFT methods
• Investigating or attributing personal
agency to change
• Wow, how did you do that?
• Perceptual tasks
• Action tasks
Exercise
• In small groups, discuss your best
success using SFT in your work, which
methods you would like to use more
and what difference working this way
has meant in your life and your work
The Language of SFT
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Scaling questions
Difference questions and observations
Accomplishment questions and observations
Goal or preferred outcome questions and checking
Preferred future questions
Compliments/praise/appreciation
Exception questions and observations
Description questions
Smaller steps questions and statements
Highlighting change questions and observations
Motivation/customership questions
Positive prediction questions
Positive expectancy questions or statements
Exercise
• In small groups, discuss which
questions and statements you have
found work best for you and the people
with whom you work
Research Support for SFT
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Brief therapy research
SFT research
Psychotherapy outcome research
Positive psychology findings
Brief Therapy Research
In well-designed psychotherapy studies,
distinguished by experienced therapists, clinically
representative clients and appropriate controls
and follow-up, brief therapy has been shown to
be as effective as longer courses of treatment.
[Koss and Butcher (1986) “Research on brief psychotherapy,”
(pp. 627-670) in Garfield and Bergin (Eds.) Handbook of
Psychotherapy and Behavior Change. NY: Wiley.]
Brief Therapy Research
The average duration of therapy is 5-8 sessions in both private
practice and community mental health centers, regardless of the
theoretical orientation or techniques used by the clinician.
Clients generally expect to stay in therapy about 6-10 sessions
and no longer than 3 months.
[Garfield (1978) “Research on client variables in psychotherapy,” in Garfield
and Bergin (Eds.) Handbook of Psychotherapy and Behavior Change. NY:
Wiley; Taube, Burnes & Keesler (1984) “Patients of psychiatrists &
psychologists in office-based practice: 1980,” American Psychologist, 39:
1435-1447; National Institute of Mental Health (1981) “Provisional data on
federally funded community mental health centers, 1978-79,” U.S. Gov.
Printing Office; Howard, Kopta, Krause, & Orlinsky (1986) “The dose-effect
relationship in psychotherapy.” American Psychologist, 41: 159-164.]
Brief Therapy Research
75% of those clients who benefit from therapy get that
benefit within the first 6 months in therapy. The major
positive impact in therapy happens in the first 6-8
sessions, followed by continuing but decreasing positive
impact for the next 10 sessions. No one form of
psychotherapy is demonstrable better than others for the
wide range of clients and problems. [Lambert, Shapiro
and Bergin, 1986, “The effectiveness of psychotherapy,”
in Garfield and Bergin (Eds.) Handbook of
Psychotherapy and Behavior Change. NY: Wiley. and
Smith, Glass, and Miller (1980) The Benefits of
Psychotherapy. Baltimore: Johns Hopkins University
Press]
Brief Therapy Research
Many studies have shown that even very brief course
(1 session or 6 sessions) can dramatically reduce the
use of both inpatient and outpatient (best estimates are
between 9 and 24% reduced general medical savings)
even up to five years after the brief therapy. Biodyne
Institute did a study involving people who visited a
doctor more than 20 times a year and gave them an
average of 7 therapy sessions. The therapy reduced
patients’ use of medical services by between 22% and
34%.
Brief Therapy Research
[Cummings, N.A. & Follette, W.T. (1968) “Psychiatric services and medical utilization in
a prepaid health plan setting, Part II,” Medical Care, 6:31-41; Cummings, N.A. &
Follette, W.T. (1976) “Psychotherapy and medical utilization: An eight-year follow-up,” In
H. Dorken (Ed.), Professional Psychology Today (pp. 176-197). San Francisco:
Jossey-Bass; Cummings, N.A. (1991) “Arguments for the financial efficacy of
psychological services in health care settings. In Sweet, J.J., Rozensky, R. G., & Tovian,
S.M. (Eds.) Handbook of clinical psychology in medical settings (pp. 113-126) NY:
Plenum Press; Cummings, N.A. (1994) “The successful application of medical offset in
program planning and clinical delivery,” Managed Care Quarterly, 2, 1-6; Goldberg, I.D.,
Krantz, G., & Locke, B.Z. (1970) “Effect of a short-term outpatient psychiatric therapy
benefit on the utilization of medical services in a prepaid group practice medical
program,” Medical Care, 8, 419-428; Jones, K.R. & Visci, T.R. (1979) “Impact of alcohol,
drug abuse and mental health treatment on medical care utilization: A review of the
literature,” Medical Care, 17(suppl.), 1-82; Munford, E., Schlesinger, H.J. & Glass, G.V.
(1978) “A critical review and indexed bibliographical of the literature up to 1978 on the
effects of psychotherapy on medical utilization,” NIMH: Report to NIMH under Contract
No. 278-77-0049-M.H.; Pallak, M.S., Cummings, N.A., Dorken, H. & Henke, C.J. (1993)
“Managed mental health, medicaid, and medical cost offset,” New Directions for Mental
Health Services, 59, (Fall), 27-40; Cummings, N.A. & VandenBos, G.R. (1981) “The
twenty-year Kaiser-Permanente experience with psychotherapy and medical utilization:
Implications for national health policy and National Health Insurance,” Health Policy
Quarterly, 1(2), 159-175.]
Brief Therapy Research
Emotionally disturbed children and their families
who received a brief assessment and a follow-up
interview showed more improvement (closer to
the goals set by the therapist at the initial
session) in a 4-year follow-up than those families
who had time-unlimited psychodynamic therapy
or time-limited (12-session) psychodynamic
therapy.
[Smyrnios and Kirkby (1993) “Long-term comparisons of
brief vs. unlimited psychodynamic treatments with
children and their parents,” Journal of Consulting and
Clinical Psychology, 61, pp. 1020-1027.]
Brief Therapy Research
Several studies have indicated that one session is the
most common length of treatment (30% in one study,
39% in another, and 56% in another) across the range of
clinicians, whether biologically-oriented psychiatrists,
psychoanalysts, or eclectically-oriented therapists.
Surprisingly, follow-up research indicates that a large
percentage (78% in one study) felt that they got what
they wanted and that their problem was better or much
better from that one session.
[Talmon (1990) Single Session Therapy. SF: Jossey-Bass and Pekarik &
Wierzbicki (1986) “The relationship between expected and actual
psychotherapy duration,” Psychotherapy, 23: 532-534.]
SFT Research
Research done through the Milwaukee Brief Family Therapy
Center on solution-focused therapy showed that 77% felt they had
met their treatment goal and 14% thought they had made
progress toward their treatment goal. In an18-month follow-up of
164 cases 51% reported their problem was still resolved and 34%
reported that the problem was not as bad as when they started
therapy (85% then thought they experienced long-term
improvements). All these clients, which presented with diverse
problems and from diverse ethnic populations and genders)
received less than 10 sessions of therapy (average of 3.0
sessions).
[Research done by Dave Kaiser and reported in Wylie, M.S. (1990) “Brief Therapy on
the Couch,” Family Therapy Networker, 14: 26-34, 66.]
SFT Research
Research done in Sweden found that 80% of the
clients completing solution-focused therapy
accomplished their stated treatment goals.
Average length of treatment was 5 sessions.
[Andreas, B. “A follow-up of patients in solution-focused brief
therapy,” Paper presented at the Institution for Applies
Psychology, University of Lund, Sweden.]
SFT Research
The more “solution-talk” (discussion of solutions
and goals by clients) in the initial session, the
more likely the client was to complete therapy (vs.
dropping out).
Shields, C.G., Sprenkle, D. H., & Constantine, J.A. (1991)
“Anatomy of an initial interview: The importance of joining and
structuring skills,” American Journal of Family Therapy, 19, pp. 318.
Positive Psychology Research
Optimism and Positive Psychology
• Psychotically optimistic dogs
Pessimistic vs. Optimistic
Explanatory Styles
Pessimistic
Optimistic
Bad stuff is permanent and
will persist, pervasive and
out of my control; Bad stuff
reflects my
resourcelessness and bad
qualities (“I’m such a
loser”)
Bad stuff is time and
context limited (“I am just
going through a rough
patch”; or “This job sucks”)
and under my influence; I
possess good and
resourceful qualities
Positive Psychology Research
One study found that even naturally pessimistic people who spent
one week doing exercises in which they identified and wrote
down times in the past in which they were at their best, their
personal strengths, expressing gratitude to someone you have
never properly thanked, and writing down three good things that
happened made them happier when their happiness levels were
measured 6 months later
Seligman, M., Stern, T., Park, N & Peterson, C. (2005) “Positive Psychology
progress: Empirical validation of interventions,” American Psychologist, 60: 410421.
Positive Psychology Research
Two studies show that focusing on or creating pleasant experiences enhances
our learning or performance abilities.
• Kids who were asked to spend 30 seconds remembering happy things did
better on learning tasks they were given just after remembering the happy
stuff.
• Internists who were given some candy (vs. reading humanistic statements
about medicine and a control group) did better at diagnosing a hard-todiagnose case of liver disease.
References:
Masters, J., Barden, R. and Ford, M. (1979) "Affective states, expressive behavior, and learning in children," Journal of Personality
and Social Psychology, 37:380-390.
Isen, A, Rosensweig, A. and Young, M. (1991) "The influence of positive affect on clinical problem solving," Medical Decision Making,
11:221-227.
Positive Psychology Research
People who are in a more positive mood
are better liked by others and more
open to new ideas and experiences
Frederickson, Barbara (1998) “What good
are positive emotions?” Review of
General Psychology, 2:300-319.
Positive Psychology Research
Several studies have shown that whatever the most recent or last part of
an experience is tends to color and strongly influence our overall
memory or sense of that experience. A particularly graphic example
involves people who were undergoing proctological exams. Patients
were divided into two groups: the first was given the standard
proctological exam; the second was given the exam but the scope was
left in but not moved for an extra minute at the end (sorry for the pun) of
the exam. Those patients who experienced the longer exam were more
willing to undergo the procedure again in the future. Ending on a good
note makes a difference in how the whole (sorry again) experience is
remembered.
Reference: Redelmeier, D., and Kahneman, D. (1996) "Patients' memories of painful medical
treatments: Real-time and retrospective evaluations of two minimally invasive procedures,"
Pain, 116:3-8.
Positive Psychology Research
Happily married couples say 5 positive
remarks for every negative remark, even when
having conflicts
Couples who are headed for divorce use less
than 1 (0.8) positive remarks for every negative
one
Source: Gottman, J., Gottman, J. And DeClaire, J.(2006). 10
Lessons to Transform Your Marriage. NY: Crown.
Positive Psychology Research
The Gratitude Exercise
At the end of each day, after dinner and before going to sleep,
write down three things that went well during the day. Do this
every night for a week. The three things you list can be
relatively small or large in importance. After each positive event
on your list, answer in your own words the question: “Why did
this good thing happen?” and “What did I have to do with this
good thing happening?”
This exercise was found to increase happiness and decrease
depression up to 6 months after the week [note: 60% of
participants carried on the habit]
Seligman, M.; Steen, T.A.; Park, N.; and Peterson, C. and (2005). “Positive psychology
progress: Empirical validation of interventions,” American Psychologist, 60:410-421.
Development and
Refinements of SFT
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Possibility therapy
Inclusive therapy
Solution-Oriented Hypnosis
Narrative therapy
Spirituality as a resource and source of
solutions
Acknowledgment and Possibility
Carl Rogers with a twist
• 3 methods
• Reflecting in the past tense
• Reflecting from total to partial
• Reflecting from truth/reality claims to
validating perceptions
Future Pull:
Orient to a Future with Possibilities
Elspeth McAdam
. . . A young girl I was working with had experienced abuse.
She walked into my office as a very large girl with shaved
hair, tattoos on her head, and I don't think she had
showered in a week. I had been asked to see her because
she was so angry. She clearly didn't want to come and see
an expletive expletive shrink. She was very angry at being
there. I just said to her, 'You've talked to everybody about
your past. Let's talk about your dreams for the future.' And
her whole face just lit up when she said her dream was to
become a princess. In my mind I could not think of two
more opposite visions–but I took her very seriously. I
asked her about what the concept of princess meant for
her.
Elspeth McAdam
She started talking about being a people's princess who would do things for
other people, who would be caring and generous and a beautiful ambassador.
She described a princess who was slender and well dressed. Over the next
few months, we started talking about what this princess would be doing. I
discovered that, while this girl was 14 and hadn't been attending school for a
long time, the princess was a social worker. I said, 'Okay it is now ten year's
time and you have trained as a social worker. What university did you go to?'
She mentioned one in the north of England. I asked, 'What did you read
[study] there?' She said, 'I don't know, psychology and sociology and a few
other things like that.' Then I said, 'Do you remember when you were 14?
You'd been out of school for two or three years. Do you remember how you
got back in school?'
Elspeth McAdam
She said, 'I had this psychiatrist who helped me.' I said, 'How did she help
you?' And she started talking about how we made a phone call to the
school. I said, "Who spoke? Did you or her?' She replied, 'The
psychiatrist spoke but she arranged a meeting for us to go to the
school.' I said, 'Do you remember how you shook hands with the head
teacher when you went in? Do you remember what you wore?' We
went into these minute details about what that particular meeting was
like–looking from the future back. And she was able to describe the
conversations we had had, how confident she had been, how well she
had spoken, and the subjects she had talked about. I didn't say any
more about it.
Elspeth McAdam
About a month after this conversation she
said to me, 'I think it's about time we went
to the school, don't you? Can you ring and
make an appointment?' I asked if she
needed to talk about it any more and she
said no, she knew how to behave. When we
went into the school she was just brilliant. I
first met that girl ten years ago. Now she is
a qualified social worker. She fulfilled her
dream–although she didn't go to the
university she mentioned.
Letter From The Future
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Write a letter from your future self to your current self from a place
you are happier and have resolved the issues that are concerning
you now
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From [five years/two months/ten years/one year] from now
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Describe where you are, what you are doing, what you have gone
through to get there, and so on
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Tell yourself the crucial things you realized or did to get there or
write about some crucial turning points that led to this future
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Give yourself some sage and compassionate advice from the future
Working backwards from the future
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When we are done with therapy and things are better, what will be happening in your
life?
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What could you do, think or focus on during the next while that would help you
move a little bit in that direction or would at least be compatible with it?
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If your problem disappeared, what would be different?
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In your relationships?
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In your daily life?
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In your thinking or focus of attention?
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In your actions?
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In any other areas?
Is there any part of that you could start to implement in the near future?
Future Pull
“The best thing about the future
is that comes only one day at a
time.” –Abraham Lincoln
Future Pull
"You have to go fetch the
future. It's not coming
towards you, it's running
away." –Zulu proverb
Future Pull Interventions
Problems into goals
• Rephrase from what is unwanted to what is
desired
• Redirect from the past to the future
• Mention the presence of something rather
than the absence of something
• Suggest small increments rather than big
leaps
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Future Pull Interventions
Expectancy talk
Yet, so far
Before
After
How quickly?
Overview of SFT model
• Change the doing
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Actions
Interactions
Language
Nonverbal behavior
• Change the viewing
• Meanings/interpretations
• Focus of attention
• Change the context
• Anything that surrounds the complaint
Inclusive Therapy
Undoing Injunctions
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Restraining: Can’t
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Compelling: Have to
Inclusion Level 1
Permission #1
• To
• You can
• It’s okay
• You’re okay if
Inclusion Level 1
• Permission #2
• Not to have to
• You don’t have to
• It’s okay if you don’t
• You’re okay if you don’t
Inclusion Level 2
Inclusion of seeming opposites
• You can and not
• Opposite polarities
• Previously incompatible
experiences/traits
Inclusion
“Do I contradict myself? Very
well, then I contradict myself.
I am large, I contain
multitudes.”
–Walt Whitman
Inclusion
“Consistency is the last
refuge of the
unimaginative.”
–Oscar Wilde
Inclusion
“The only completely
consistent people are the
dead.”
–Aldous Huxley
Inclusion
Ambivalent? Well, yes and no
Inclusion Level 3
Exceptions
• That’s the way it is, except
when it’s not
• Moments of exception
• Including the opposite
possibility
• Recognizing complexity
Inclusion/Exceptions
“Nothing is as
dangerous as an
idea when it is the
only one you have.”
– Emile Chartier
The Inclusive Self
Nature
Spirituality
Future selves
Exceptions
Resources
Alien voices
(society’s/others)
Alternative
Stories
Devalued aspects
(Disidentified Self)
Identified Self
(Identity Story)
Community
Previous
solutions
Polarities
(Non-identified self)
Solution-Oriented Hypnosis
• Evocation rather than revealing
traumatic roots of problems or reprogramming beliefs
• Better with automatic (non-deliberate)
problems (somatic/emotional issues)
• Permissive vs. authoritarian
Narrative Therapy
• Added the “being”/identity to the doing
and viewing
• Externalizing
• The search for valued/hero qualities
• Spreading a new story about the client
Externalizing
• Name/personify
• Investigate negative effect of
problem on people concerned
• Investigate exceptions to
problem’s dominance or intrusion
• Elicit/investigate valued/hero
qualities that allowed/created
exceptions
Strengthening the
Valued Identity Story
• Finding supportive historical
evidence
• Speculating on the future with
preferred/valued/hero story
dominant
• Spreading the story to others
Strengthening the
Valued Identity Story
Share the valued story with the
larger social context
• In person
• In imagination
Spirituality as a Resource
Definition of spirituality: Connecting to
something beyond the ego and small
self
Spirituality
Three Cs of spirituality:
• Connection
• Compassion
• Contribution
Seven Pathways to
Connection
•
•
•
•
•
•
•
Soul/heart/deep or core self
Body
Another
Others
Nature
Art
Bigger meaning or purpose (could involve
God, higher power, cosmic consciousness)
Connection to Nature
Children diagnosed with ADHD were more calm, more
focused and more able to follow directions after spending
time in a “green” setting like a park or backyard.
Frances E. Kuo and Andrea Faber Taylor, A Potential Natural Treatment for AttentionDeficit/Hyperactivity Disorder: Evidence From a National Study, American Journal of
Public Health, Sep. 2004; 94: 1580 - 1586
Connection to Nature
 Patients with rooms overlooking deciduous trees healed more quickly
and had less need for pain medication than patients who viewed a brick
wall.
 Dental patients who stared at a large mural of a natural scene had
lower blood pressure and less anxiety than those who didn’t.
 Inmates whose cell windows face the prison yard made 24% more sickcall visits than those whose cells looked outward on rolling farmland and
trees.
Frumkin, Howard, American Journal of Preventative Medicine, 20(3), 2001
Personal, Interpersonal and
Transpersonal Connections
Transpersonal
Great Spirit
Goddess
Interpersonal
Nature
God
Another
Soul
Personal
Body
Allah
Family
Community
Cosmic
Consciousness
Tao
Brahman
Higher power
Universe
Connective rituals
• A review of 50 years of research on family rituals showed that regular
routines had a positive effect on health and family relationships
• Of the 32 studies reviewed, one of the more common routines identified
was dinnertime, along with bedtime, chores, and everyday activities such
as talking on the phone or visiting with relatives. The most frequently
identified family rituals were birthdays, Christmas, family reunions,
Thanksgiving, Easter, Passover, funerals and Sunday activities including
the "Sunday dinner."
Fiese, Barbara H.; Tomcho, Thomas J.; Douglas, Michael; Josephs, Kimberly ;
Poltrock, Scott; and Baker, Tim. (2002)."A Review of 50 Years of Research on
Naturally Occurring Family Routines and Rituals: Cause for Celebration?," ;
Journal of Family Psychology, Vol. 16, No. 4.
Connective rituals
• Rituals involve repetitive activities that connect one to
oneself, others and/or to something beyond self and others
(God, higher power, bigger meaning and so on)
• Can be daily, weekly, monthly, yearly or seasonally repeated
• Religion has been shown to be correlated with positive
mental health (less depression, anxiety and major mental
illness) and more stable relationships (more marital stability
and lower divorce rates); Perhaps rituals built in to religious
traditions might explain some of this positive correlation
See: Koenig, Harold George; McCullough, Michael E.; Larson,
David B. (2001) Handbook of Religion and Health.
Oxford: Oxford University Press.
Compassion/Contribution/Service
Mitzvah therapy
•
•
The African Violet Queen
Sol Gordon’s Abuse Victim
Ghandi
The best way to find yourself
is to lose yourself in the
service of others.
The Talmud
The highest form of
wisdom is kindness.
Contribution
•
Is there anywhere your client could be of service or make a contribution that would
help them make amends or heal wounds?
•
Become aware of some social injustice or victim situation that moves or touches
you.
•
Every time you experience some recurrent problem, do one thing to contribute to the
relief of the victim’s suffering or to righting some social injustice. It may be writing a
letter, making a donation of money or time to some charitable group, praying, or
some other action you are moved to.
Directions and predictions for
the future of SFT
• More integration with the mainstream of
therapy
• More research support for SFT
• More refinement of the methods, with
same basic theory/assumptions
Exercise
• In small groups, discuss what has been
the most helpful part of this workshop
and how you think you might use it in
your work or your life
Permission to use
This Powerpoint presentation was
created by Bill O’Hanlon ©2007. You
have my permission to use it for noncommercial purposes (like sharing it
with your colleagues or studying it
yourself). If you want to use it in any
commercial (money-making) activities,
please contact me for permission and
discussion.
Bill O’Hanlon’s info
Websites:
http://www.billohanlon.com
http://www.getyourbookpublished.com
http://www.thewebwhisperers.com
http://www.getovertrauma.com
Bill's original music
Personal email:
[email protected]
Business email (for slides):
[email protected]
Contact information
Bill O’Hanlon, M.S., LMFT
Possibilities
223 N. Guadalupe #278
Santa Fe, NM 87501 USA
[email protected]
505.983.2843
Fax 505.983.2761
www.brieftherapy.com