chapter 13 post modern approaches

Modern approaches (CBT, Behavioral, DBT)

Therapies that rely on observable behavior, assume an objective reality, use the scientific method, and aim to return clients to "normal"

Postmodern approaches

View reality as constructed by history and context, value the client's personal reality, and emphasize language and social constructionism

Solution-Focused Brief Therapy (SFBT)

A postmodern, goal-focused therapy that emphasizes future solutions, strengths, and short-term change

Primary assumption of SFBT

People get stuck in past problems

Positive orientation (SFBT)

Belief that clients are healthy and competent and can build on strengths and past successes

Preferred future

A clear, positive description of what the client wants instead of focusing on the problem

Start-based goal

Goal framed around the presence or start of something the client wants

Specific goal

A goal that is measurable, attainable, and clearly defined

Social goal (SFBT)

A goal framed so others would notice a change after the client achieves it

Client as expert

SFBT stance that the client knows what works in their life and has insight into possible solutions

Exception question

A question that asks when the problem was absent or less severe to identify coping behaviors

Miracle question

Imagine the problem is gone overnight — what would be different and what would you do?

Scaling question

Client rates progress/importance/confidence on a numerical scale (eg 0–10)

Pre-therapy change

Noting positive changes that happened after scheduling the first appointment

Formula first session task

Homework between session 1 and 2: observe what happens that you want to continue

Therapist feedback (SFBT)

5–10 minute written summary at end of session: affirmation + bridge to a suggested task

Customer (SFBT relationship type)

Client and therapist collaborate to identify problems and solutions

Complainant (SFBT relationship type)

Client reports a problem but does not see themselves as agent of change

Visitor (SFBT relationship type)

Client attends but does not see themselves as having a problem

Termination in SFBT

Wrap up when clear goals are achieved

Motivational Interviewing (MI)

A client-centered, directive method to enhance intrinsic motivation by resolving ambivalence

Ambivalence

Conflicting thoughts about staying the same versus making a change

Spirit of MI: Collaboration

Therapist supports rather than persuades

Spirit of MI: Evocation

Therapist draws out the client's own motivations for change

Spirit of MI: Autonomy

Client is responsible for and has control over change

MI principle: Express empathy

Use genuine acceptance and reflective listening to understand the client

MI principle: Develop discrepancy

Help the client see the gap between current behavior and larger values/goals

MI principle: Roll with resistance

Avoid arguing

MI principle: Support self-efficacy

Increase the client's belief they can make the change

Open-ended questions (MI)

Questions that invite narrative and exploration (what/how), not yes/no answers

Affirmations (MI)

Genuine appreciation of the client's strengths or efforts, focused on behavior not evaluation

Reflections (MI)

Reflective listening statements that paraphrase or extend client meaning

Simple reflection

Paraphrase what the client said to show understanding

Complex reflection

Interpretation or extension that connects client statements to values or meaning

Summaries (MI)

Longer reflections that gather key points and highlight change talk

Change talk

Client statements favoring change (desire, ability, reasons, need, commitment, activation, steps)

Rulers (importance/confidence)

Scaling questions that assess importance/confidence and prompt follow-up (eg why a 6 not a 3)

Contributions of postmodern approaches

Quick progress, non-pathologizing stance, focus on strengths, effective across many problems

Limitations of SFBT/postmodern

Requires skill, risk of mechanical technique use, may weaken therapeutic alliance if misapplied