A brief and hopefully motivational presentation on brief (solution focused) therapy

Dr. Bill McHenry, Associate Professor, Counseling and Psychology, Texas A&M University-Texarkana

SFBT - General Guiding Principles

• • • • • The client’s frame is the correct one The solution to the problem is within the client’s world The person is not the problem Awareness on the part of the client is NOT necessary for problem resolution Clients are NOT resistant to therapy

More Principles

• • • • • Change is constant (our job is to identify and amplify change) You do not need to know a lot about the complaint to help resolve it There is no “one issue” causing the problem Rapid and immediate long term change can occur Focus on possibilities and the future

Techniques

• • • Focus on exceptions – When was the problem smaller – What helped you in the past – What have other done to overcome this type of problem Change or solution-oriented talk – When the problem goes away… – When therapy works, what will let you know you don’t need it anymore?

Strength building – This is a somewhat special view of people • Rather than focus on what is wrong – notice and identify what is right

Miracles

• Especially in SFBT, the use of discussion about a “miracle” is useful – “Imagine you went to bed tonight and in the middle of the night, unbeknownst to you, the problem went away…what would you notice first? • Follow up questions: – – – Who would be most surprised?

What would others notice about you?

How would you behave/act differently?

The Terrible Question

• “Ok, this is going to be a terrible question. But, tell me what could make the problem come back?

– Usually used once a client has achieved their goal. Intended to promote further growth through strengthening the client’s resolve while also surfacing any possible plans or pathways to relapse/problem reformation

Scales

• Brief therapists use the client as the primary assessment tool. They rely on the movement along various scales to provide feedback to both the client and counselor – Scale things like: • Happiness • Sadness • Problem resolution – NOTE: always go back and reassess using the same scale. Often times it is useful to do this in the same session and talk about what (if anything) has changed…even fractionally.

Motivational Interviewing

• • • • Using the already existing desire of the client to change Addresses and focuses on the ambivalence the client may have regarding change Collaborative process of helping the client realize HIS or HER own desires to change Started by Miller, 1983, in his work with problem drinkers

Guiding thoughts in MI

• • • • • Empathy is paramount Rapport and relationship with the client should be developed and nurtured Support the client’s self-sufficiency Roll with resistance, do not confront Highlight discrepancies between where the client is and where they want to be

Case Example

• You are facilitating a group for parents who have lost a teenager. There are three couples in your group who all had a son die in the last year or so. It is a very emotional and personal group. In the middle of the third session, one of the mothers, who has appeared to have poor hygiene, significant emotion at times, and seldom makes good eye contact, says the following, “If it weren’t for my other kids, I would kill myself today. They are the only things that keep my going.” The group members do not know how to respond to this statement as it was a sudden and not well anchored comment to what the group had been discussing. Her husband sits in silence as he looks to you for help as well.