Psychotherapeutic Methods Flashcards

Psychotherapeutic Methods: Brief Solution Focused Therapy

• Brief Solution Focused Therapy (BSFT) was developed in the late 70's and 80's by Steve de Shazer & his associates.
• It was originally inspired by MRI and now has a higher profile.
• BSFT identifies exceptions to the problem to develop new solutions, and therapists give compliments and praise.

Basic Theoretical Assumptions

• Clients have resources and strengths to resolve problems.
• Change is constant.
• The therapist's job is to identify and amplify change.
• It is usually unnecessary to know a great deal about the complaint in order to resolve it.
• It is not necessary to know the cause or function of a complaint to resolve it.
• A small change is all that is necessary; a change in one part of the system can affect another part of the system.
• Clients define the goals.
• Rapid change or resolution of the problem is possible.
• There is no one right way to view things; different views may be just as valid and may fit the facts just as well.
• Focus on what is possible and changeable, rather than what is impossible and intractable (O’Hanon & Weiner-David, 1989).

Stages of Therapy

Problem-free Talk: Building Rapport

• Before starting to talk about what brought you here, I would like to get to know you a little..
• This is helpful as the client is perceived as a person with a problem and not just a problem.

Statement of the Problem

• The therapist asks about the problem and its effect on the family.
• Questions like: What brought you in? What would be helpful for me to know about how the problem has affected you in your life are asked.

Exploration of Solution Patterns (Exceptions)

• The therapist searches for exceptions in the present and past.
• Examples:
  • What is different about the days when you two are getting along? What are you doing differently? What do you notice that is different from each other?
  • Tell me about a problem or two that you handled well in the past?
  • How did you manage to do that?
  • I’m really surprised that things are not much worse. How have you kept going? How have you coped? What has helped you cope?

Establishing Goals for Therapy

• Use of the miracle question:
  • Suppose that one night there is a miracle and while you are sleeping the problem that you brought in to therapy is solved: How would you know? What would be different?
  • What will you notice different the next morning that will tell you that there has been a miracle?
  • Who will be the first person to notice that you have changed, that the miracle has changed? What will this person notice about you?

Guidelines for Well-formed Goals

• Important
• Small
• Concrete and specific
• The start of something
• Positive
• Realistic, achievable
• Something that the client expects to be doing
• Involving “hard work” on the part of the client and his family

Scaling Questions as an Intervention

• The aim of these questions is to see where the client is currently in regard to finding solutions.
• They are used to help define potential solutions: small steps or changes that indicate the problem is on the way of being solved
• Example:
  • If zero means that you are basically going to be like this for the rest of your life and ten means that there is a good chance that you will have this problem beaten at some point in the future, where would you place yourself in the scale today?
  • What would it take for you to move up half a point or even one point on the scale?
• The questions also help to maintain and amplify change when the client sets goals to reach a certain point on the scale.

First Session Formula Task

• An end-of-session assignment designed to help the clients focus on the future and to create an expectation for change.
• It helps the client notice the positive aspects of his or her life.
• For example: ‘between now and next time we meet, I want you to observe, so that you can describe to me next time, something that happens in your family that you want to continue to happen’

Key Points of BSFT

• It is a Strengths-based model of therapy that shifts the focus from problems to solutions, with little focus on why problems occurred and more focus on how the client has avoided similar problems in the past.
• In solution-focused therapy, the goal is defined by the client, not the therapist. The therapist only aids the client in helping to visualize or describe the goal.
• Resistance is attributed to the therapist not having found what works for the client, because fundamentally solution-focused therapists believe that clients want to change.

Narrative School of Family Therapy

How the Story Began

• Narrative therapy emerged as a school of family therapy in the late 80s/early 90’s.
• It is a post-modern, social constructionist therapeutic approach influenced by ideas from Foucault, Derrida, Bateson, and Geertz.
• Michael White and David Epston are credited with developing the therapy as we know it today.
• It is a collaborative approach between client and therapist, focused on life stories and the empowerment of the disempowered.

Assumptions of Narrative Therapists

• The problem is the problem; the person is not the problem.
• Problems are never present 100% of the time.
• Our understanding of life experiences changes across time.
• Problems are constructed within cultural contexts.
• There is no one objective truth; there are only multiple truths.
• People are experts in their own lives and have skills/beliefs/values and abilities to help them with problems.
• The therapist should take a non-expert position.
• The use of therapeutic documentation and ritual is a valuable resource to sustain change. (Morgan, 2000)

Narrative Therapy Terms

• Alternative story – narrative therapy is about searching for stories that do not support the dominant story and indicate new possibilities for future life.
• Deconstruction – the aim of therapy is to deconstruct by interpreting the beliefs, ideas, and experiences of the person and others that underpin the story of the problem.
• Dominant story – it is usually made up of fixed beliefs about the persons that affect their past, present, and future understanding of themselves, e.g. ‘I am the pretty sister not the brainy one’; ‘I am lazy’
• Mapping the influence of the problem: uncovering how the problem has influenced every aspect of life. From the way the person thinks and feels about himself and others and how they behave.
• Problem-saturated story – a dominant story that organizes a person/family preventing it from changing or finding alternative stories.
• Unique outcomes – Occasions when the problem had not been present, which are contradictory to the experience of the problem.

Stance

• Genuine curiosity.
• It is an optimistic stance which will actively contribute to shaping the therapeutic conversation.

Techniques

• Search for unique outcomes (or exceptions to the problems)
  • How did you get yourself to take this step?
  • What do these discoveries tell you about what you want from life?
  • Who wouldn’t have been surprised?

Externalizing the problem

• Externalization is the objectification of the problem in order to separate it from the person.
• Through externalizing conversations, questions are asked to develop this externalization and establish its personality and relative influence on the person.
• This allows for a refocus away from the person, with the possibility of actions against the problem that were previously impossible.
• Once the family establishes a distance between the person and the problem, then they can also change their attributions of the person.

The Problem of Sneaky Poo (Example)

• A child presented with encopresis, and the therapists decided to turn the problem into a Sneaky Poo situation.
• The task is to explore the influence the problem has on the life of a child:
  • Th: How much control do you think Sneaky Poo wants over your life?
  • Cl: It wants complete control . . . it wants to do what it wants. How does it do that?
  • Th: What tricks does it have?
  • Cl: It tricks me to come out really quick, and it hurts my stomach and tries to get out … it goes all bubbling and crackling in my stomach.
  • Th: What is Sneaky Poo trying to stop you from doing?
  • Cl: It stops me from having fun, from watching TV … from playing. l have to lie down when I’m feeling sick. Mum has to rub down my stomach . . . it ruins my life and l know it will never go away
  • Who is winning you or Sneaky Poo?

Quotes on Externalization

• ‘By engaging in therapeutic externalizing conversations it is possible to re-author one’s life, to challenge the dominant knowledge and social practices that are demeaning of us, and to develop a preferred alternative narrative’ (McMahon, 2008, p.351)

Other Narrative Techniques

• Outsider-Witnesses group – A staged ritual when two or more people, known or unknown to the person (who may have life experience relevant to the person’s situation), are invited to listen to and give reflections to the person as they talk about their story and their preferred future.
• Narrating therapeutic stories
• Asking questions on the strengths of the different family members
  • Eg If you were to find yourself in a desert island; what are the strengths that Peter has and that you would be relying on?

Transforming the Story

• From shame to courage
• Writing new chapters
• How do you see yourself in a year’s time?
• Recruiting an audience

Key Points

• The core narrative belief is that our realities are organized and maintained by the stories we and other people tell about us.
• Narrative therapists hold a series of assumptions that guide their work, and these assumptions are connected to a number of techniques or interventions that the therapist uses with the person that consults with them.
• The narrative therapists seek to uncover the skills of the person who has the problem to enable them to manage change in a different way.
• These techniques have been integrated into the work of non-narrative therapists and other helping professionals.