Transcript Theory and Practice of Counseling and Psychotherapy

Theory and Practice of
Counseling and Psychotherapy
Psych422
Chapter13: Postmodern Approach
(solution-focused brief therapy and narrative
therapy)
Questions…
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If persons see therapists, in general,
what is/are the expectation(s) from their
therapist?
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If persons sees therapists for their
problem, what is/are the final goals
after completing the therapy sessions?
View of Human Nature
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Assume that realities are socially constructed.
There is no absolute reality.
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View people are healthy, competent, resourceful,
and have the ability to construct solutions and
alternative stories to enhance their lives.
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Help clients recognize their competencies and
build on their potential, strengths, and resources.
Key Concepts of
Solution-Focused Brief Therapy
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Therapy grounded on a positive orientation --- people are
healthy and competent
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Downplay “past”, while highlight “present and future”
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View people are healthy, competent, and resourceful, and
have the ability to construct solutions to enhance their lives
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Therapy is concerned with looking for what is working
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Therapists assist clients in finding exceptions to their
problems
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The therapy process is to focus on creating solutions rather
than talking about the problems
Basic Assumptions of
Solution-Focused Therapy
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People can create their own solutions
Small changes lead to large changes
The client is the expert on his or her own life
The best therapy involves a collaborative
partnership
A therapist’s not knowing afford the client an
opportunity to construct a solution
Therapeutic Goals
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Believe clients have the ability to define their goals and
the resources required to solve their problems
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Focus on small, realistic, and achievable changes
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Remain goal-directed and future-oriented
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Small change leads to big change
E.g., what has changed since last session?
Talk about solutions instead of talking about problems
Therapist’s function and Role
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No knowing position: clients as experts about their own
lives.
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Create a collaborative relationships
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Create a climate of mutual respect in which clients are
free to create and explore solutions
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Help clients to explore what they would like things to
be different, how to make a difference, and what signs
to indicate the changes are happening.
Relationship Between Therapist and Client
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The therapeutic relationship is an important factor for
change to occur.
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Solution-focused brief therapy is designed to be brief, so
therapist must shift the focus as soon as possible from
talking about problems to exploring solutions
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Help clients to use their strengths and resources to
construct solutions
Three Kinds of Relationships in
Solution-Focused Therapy
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Customer-type relationship: client and therapist
jointly identify a problem and a solution to work
toward. Realize personal efforts is required.
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Complainant relationship: a client who describes
a problem, but is not able or willing to take an
active role in constructing a solution. Expect
other person to change.
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Visitors: clients who come to therapy because
someone else thinks they have a problem.
Disagree they have a problem.
Techniques Used in
Solution-Focused Brief Therapy
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Pre-therapy change: What have you done
since you made the appointment that has
made a difference in your problem?
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Exception questions: Direct clients to times
in their lives when the problem did not exist.
Techniques Used in
Solution-Focused Brief Therapy
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Miracle question: If a miracle happened and
the problem you have was solved overnight,
what would be different in your life?
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Scaling questions: On a scale of zero to 10,
where zero is the worst you have been and
10 represents the problem being solved, how
would you rate your anxiety right now?
Techniques Used in
Solution-Focused Brief Therapy
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Formula first session task: ask clients to
observe about what happens in your life
(relationship, family…) that you want to
continue to happen
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Therapist feedback to clients: therapists
provide summary feedback for clients--compliment what clients have done toward
effective solutions, provide rationale for the
suggestions, and suggest a homework
assignment
Case discussion
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Mary feels that she must win everyone’s
approval. She has become a “super nice
guy” who goes out of her way to please
everyone. Rarely does she assert herself,
for fear that she might displease someone
who then would not like her.
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How do you apply solution-focused brief
therapy to help Mary to solve her problem?
Case discussion
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Tom, a college sophomore, want to
overcomes his shyness around women. He
doe not date and even des his best to keep
away from women because he is afraid
they will reject him. But he want to solve
his problem.
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How do you use solution-focused brief
therapy to help Tome to solve his problem?
Questions? Reactions?
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What are your reactions?
What did a therapist (Dr. O’Hanlon)
do?
What can you as a therapist continue
to do by using solution-focused brief
therapy?
Key Concepts of Narrative Therapy
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Listen to clients with an open mind
Encourage clients to share their stories
Listen to a problem-saturated story of a
client without getting stuck
Therapists demonstrate respectful curiosity
and persistence
The person is not the problem, but the
problem is the problem
The Therapeutic Process in
Narrative Therapy
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Collaborate with the client in identifying
(naming) the problem
Separate the person from his or her problem
Investigate how the problem has been disrupting
or dominating the person
Search for exceptions to the problem
Ask clients to speculate about what kind of future
they could expect from the competent person that
is emerging
Create an audience to support the new story
Therapeutic Goals
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Therapists invite clients to describe
their experience in new language and
facilitate the discovery or creation of
new options that are unique to them
Narrative Therapist’s function and role
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To become active facilitators
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To demonstrate care, interest, respectful curiosity,
openness, empathy, contact, and fascination
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To adopt a not-knowing position that allows being guided
by the client’s story
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To help clients construct a preferred alternative story
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To separate the problem from the people (instead of
person own the problem)
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To create a collaborative relationship --- with the client
being the senior partner
Therapeutic Relationship
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Emphasize the quality of therapeutic
relationship, in particular therapists’ attitudes
Client-as-expert, clients are the primary
interpreters of their own experiences
Therapists seek to understand client's lived
experience and avoid effort to predict, interpret,
and pathologies.
Therapeutic Techniques
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No recipe, no set agenda, and no formula
This approach is grounded in a philosophical
framework
Questions—and more questions:
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Questions are used as a way to generate experience
rather than to gather information
Asking questions can lead to separating “person”
from “problem”, identifying preferred directions,
and creating alternative stories to support these
directions.
Therapeutic Techniques
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Externalization & Deconstruction
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Externalization is a process of separating the
person from identifying with the problem
Externalizing conversations can lead clients
in recognizing times when they have dealt
successfully with the problem
Problem-saturated stories are deconstructed
(taken apart) before new stories are cocreated
Therapeutic Techniques
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Search for unique outcomes
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Successful stories regarding the problem
Creating Alternative Stories
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The assumption is that people can continually
and actively re-author their lives
Invite clients to author alternative stories
through “unique outcomes”
An appreciative audience helps new stories to
take root
Therapeutic Techniques
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Documenting the evidence
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Therapists write and send a letter to clients
between sessions regarding their strengths
and accomplishments, alternative story, and
unique outcomes or exceptions to the
problems.
From a multicultural perspective
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Contributions
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Fit with diverse worldview
Clients provide their own interpretations of
life events
Limitations
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Diverse clients may expect therapist as a
expert instead of “client-as-expert”
Summary and Evaluation
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Contributions
 Client-as-expert (not knowing position)
 View people are competent and able to create
solutions and alternative stories
 Do not support the DSM-IV-TR labeling
system
 A brief approach, is good for managed care.
 In general, studies provided preliminary
support for the efficacy of solution-focused
brief therapy
Summary and Evaluation
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Limitations
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No set of formulas or recipes to follow
Inexperienced therapist may view SFBT as
techniques. However, the attitude of the therapist is
critical to the success of outcomes.
Therapists need to be able to make quick
assessments, assist clients in setting up the goals, and
effectively use appropriate interventions