Theory and Practice of Counseling and Psychotherapy

Theory and Practice of Counseling and Psychotherapy MacDonald Postmodern Approach (solution-focused brief therapy and narrative therapy)

Questions… • If persons see therapists, in general, what is/are the expectation(s) from their therapist? • If persons sees therapists for their problem, what is/are the final goals after completing the therapy sessions?

View of Human Nature • Assume that realities are socially constructed. There is no absolute reality. • View people are healthy, competent, resourceful, and have the ability to construct solutions and alternative stories to enhance their lives. • Help clients recognize their competencies and build on their potential, strengths, and resources.

Key Concepts of Solution-Focused Brief Therapy • Therapy grounded on a positiveorientation --- people are healthy and competent • Downplay “past”, while highlight “present and future” • View people are healthy, competent, and resourceful, and have the ability to construct solutions to enhance their lives • Therapy is concerned with looking for what is working • Therapists assist clients in finding exceptions to their problems • The therapy process is to focus on creating solutions rather than talking about the problems

Basic Assumptions of Solution-Focused Therapy • 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 • Believe clients have the ability to define their goals and the resources required to solve their problems • Focus on small, realistic, and achievable changes • Small change leads to big change • Remain goal-directed and future-oriented • E.g., what has changed since last session? • Talk about solutions instead of talking about problems

Therapist’s function and Role • No knowing position: clients as experts about their own lives. • Create a collaborative relationships • Create a climate of mutual respect in which clients are free to create and explore solutions • 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 • The therapeutic relationship is an important factor for change to occur. • 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 • Help clients to use their strengths and resources to construct solutions

Three Kinds of Relationships in Solution-Focused Therapy • Customer-type relationship: client and therapist jointly identify a problem and a solution to work toward. Realize personal efforts is required. • 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. • 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 • Pre-therapy change: What have you done since you made the appointment that has made a difference in your problem? • Exception questions: Direct clients to times in their lives when the problem did not exist.

Techniques Used in Solution-Focused Brief Therapy • Miracle question: If a miracle happened and the problem you have was solved overnight, what would be different in your life? • 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 • Formula first session task: ask clients to observe about what happens in your life (relationship, family…) that you want to continue to happen • 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 • 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. • How do you apply solution-focused brief therapy to help Mary to solve her problem?

Case discussion • 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. • How do you use solution-focused brief therapy to help Tome to solve his problem?

Questions? Reactions? • 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 • 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 • Collaborate with the client in identifying (naming) the problem • Separate the personfrom 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 • 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 • To become active facilitators • To demonstrate care, interest, respectful curiosity, openness, empathy, contact, and fascination • To adopt a not-knowing position that allows being guided by the client’s story • To help clients construct a preferred alternative story • To separate the problemfrom the people (instead of person own the problem) • To create a collaborative relationship --- with the client being the senior partner

Therapeutic Relationship • 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 • No recipe, no set agenda, and no formula • This approach is grounded in a philosophical framework • Questions—and more questions: • 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 • Externalization & Deconstruction • 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 co-created

Therapeutic Techniques • Search for unique outcomes • Successful stories regarding the problem • Creating Alternative Stories • 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 • Documenting the evidence • 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 • Contributions • Fit with diverse worldview • Clients provide their own interpretations of life events • Limitations • Diverse clients may expect therapist as a expert instead of “client-as-expert”

Summary and Evaluation • 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 • Limitations • 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

Theory and Practice of Counseling and Psychotherapy