Postmodern Approaches to Counseling: Solution-Focused, Motivational Interviewing, and Narrative Therapy
Introduction to Social Constructionism and Modernism
Postmodern Worldview: Truth and reality are understood as points of view bounded by history and context rather than objective, immutable facts.
Modernist Beliefs: Modernists believe in the ability to describe objective reality accurately and assume it can be observed and known through the scientific method. They believe reality exists independent of observation. In therapy, modernists assume clients seek help when they deviate too far from an objective "norm" (e.g., being "abnormally" depressed).
Postmodernist Beliefs (Social Constructionism): Postmodernists do not believe realities exist independent of observation or language. Social constructionism values the client’s reality without disputing its accuracy or rationality.
The Role of Language in Social Constructionism: Knowledge about reality is socially constructed through language used in stories. Meanings are as diverse as the people telling the stories. Language and cultural conditions create concepts like "depression"; without these definitions, the concept would mean nothing.
Therapeutic Stance: The therapist disavows the role of expert and prefers a collaborative or consultative stance. Clients are viewed as experts on their own lives.
Historical Paradigm Shift: The creation of the "self," which dominated modernist psychology (Freud, Adler, Jung), is being replaced by the concept of "socially storied lives."
Therapeutic Goal: Deconstructing the power of cultural narratives and co-constructing new lives of meaning.
The Collaborative Language Systems Approach
Definition: Developed by Harlene Anderson and Harold Goolishian (1992). Therapy is viewed as a conversational system that is "problem-organizing" and "problem-dissolving."
Not-Knowing Position: Therapists enter conversations with curiosity and intense interest in discovery rather than as experts. They do not assume they understand the client’s experience too quickly.
Client as Expert: The client informs the therapist of the significant narratives of their life.
The Process: Similar to the Socratic method, the therapist asks questions informed by the client's previous answers. The goal is the facilitate the telling and retelling of stories until new meanings and narrative possibilities emerge.
Solution-Focused Brief Therapy (SFBT): Foundations and Key Concepts
Contemporary Founders: - Insoo Kim Berg (1934–2007): Korean-born pioneer of SFBT; cofounded the Brief Family Therapy Center in Milwaukee in 1978. Published 10 books, including Family Based Services (1994). - Steve de Shazer (1940–2005): Director of research at the Brief Family Therapy Center. Wrote Keys to Solutions in Brief Therapy (1985) and Words Were Originally Magic (1994).
Core Definition: A future-focused, goal-oriented approach that emphasizes strengths and resiliencies by focusing on exceptions to problems.
Influence of Milton Erickson: Erickson believed individuals were "stuck" rather than "sick." He emphasized that small changes result in larger changes and that solutions can be found quickly by building on client strengths.
Positive Orientation: Grounded in the optimistic assumption that people are healthy and competent. SFBT parallels positive psychology by concentrating on what is right and working rather than deficits.
Focus on Solutions: SFBT eschews the past in favor of the present and future. It is not necessary to know the cause of a problem to solve it. Discussion of problems is limited only to validating the client’s experience.
Basic Assumptions (Walter & Peller): - Individuals have the capability to behave effectively, even if temporarily blocked by negative cognitions. - A positive focus on solutions and the future allows therapy to be brief. - There are exceptions to every problem; talking about these exceptions gives clues to solutions. - No problem is constant; change is inevitable. - Small changes pave the way for larger changes. - Clients want to change and can be trusted in their intentions.
Characteristics of Brief Therapy
Duration: Typically averages 3 to 8 sessions; the most common length is a single session.
Key Tasks: - Rapid working alliance establishment. - Clear specification of achievable treatment goals. - Clear division of responsibilities with active client participation. - Here-and-now orientation. - Time sensitivity; ending therapy as soon as possible.
The Solution-Focused Therapeutic Process
Five Basic Steps (De Jong & Berg): 1. Clients describe the problem; therapist asks: "How can I be useful to you?" 2. Develop well-formed goals and preferred futures: "What will be different when your problems are solved?" 3. Explore exceptions: Ask about times when the problem was absent or less severe. 4. Summary feedback: Offer encouragement and suggest tasks for the interval between sessions. 5. Progress evaluation: Evaluate progress using rating scales.
Goal Criteria (Murphy): - Start-based: Stated as the presence of something the client wants. - Specific: Concrete, observable, and behavioral. - Social: How others would notice the change.
Therapist Roles: - Not-knowing position: The client is the expert on what they want changed. - The therapist points the client in the direction of change without dictating the change.
Types of Relationships in SFBT (de Shazer): - Customer: Client and therapist jointly identify a problem and solution; client realizes personal effort is required. - Complainant: Client describes a problem but believes the solution is dependent on someone else's actions. - Visitor: Client is in therapy because someone else thinks they have a problem; they may not agree a problem exists.
SFBT Techniques and Procedures
Pretherapy Change: Asking: "What changes have you noticed since you called to make this appointment?"
Exception Questions: Directed at past experiences where the problem could have occurred but did not (e.g., "Tell me about times when things were going your way").
The Miracle Question: "If a miracle happened and the problem was solved overnight, how would you know, and what would be different?" This shifts focus from the past to a satisfying future.
Multicultural Variants of Miracle Question: Asking when a client felt empowered or what would be different if the world no longer marginalized them.
Scaling Questions: Using a scale of 0 to 10 to measure change in non-observable experiences like moods or communication. (e.g., "On a scale of 0 to 10, how would you rate your anxiety right now?").
Formula First Session Task (FFST): Homework for the first interval: "Observe what happens in your life/family that you want to continue to happen."
Therapist Feedback Structure: - Compliments: Affirmations of client strengths. - Bridge: Rationale for suggested tasks. - Suggesting a Task: Encouraging observational or behavioral homework.
Motivational Interviewing (MI)
Founders: William R. Miller and Stephen Rollnick.
Definition: A humanistic, client-centered, psychosocial, and modestly directive approach. It was initially designed for problem drinking but applied to substance abuse, anxiety, and chronic disease.
Goal: To reduce client ambivalence about change and increase intrinsic motivation.
Comparison to Person-Centered Therapy: Both emphasize accurate empathy, unconditional positive regard, and authenticity. However, MI is deliberately directive to stay within the client's frame of reference regarding change.
Five Basic Principles of MI: 1. Express Empathy: Understand the client's perspective without judgment. 2. Develop Discrepancy: Explore the clash between current behaviors and deeply held values. 3. Roll with Resistance (Discord): View reluctance as a normal part of the process; avoid arguing. 4. Support Self-Efficacy: Encourage clients to use their own resources to achieve success. 5. Implement Change Plans: Transition to strengthening commitment when the client shows readiness.
Characteristics of Action Plans (Marshall & Nielsen): - Specific, rewarding, observable, and measurable. - Clear, concrete, achievable goals. - Client is responsible for the plan. - Client assumes ownership and commitment.
The Five Stages of Change: 1. Precontemplation: No intention of changing behavior. 2. Contemplation: Aware of a problem, considering change, but not committed to action. 3. Preparation: Intending to take action immediately; small behavioral changes present. 4. Action: Overt behavioral modification and commitment. 5. Maintenance: Working to consolidate gains and prevent relapse.
Narrative Therapy: Key Concepts and Philosophy
Founders: Michael White (1949–2008) and David Epston (b. 1944).
Core Theme: "The person is not the problem; the problem is the problem" (White). Problems are manufactured in social, cultural, and political contexts.
Normalize Judgment: Narrative therapy critiques discourse that locates people on a "normal curve" (intelligence, mental health measures).
Double Listening: Listening both to the problem-saturated story and to the evidence of the client’s competence (counter story).
Deconstruction: Disassembling taken-for-granted assumptions about reality to open alternative possibilities.
Narrative Therapeutic Process: 1. Name the problem: Collaborate on a mutually acceptable name. 2. Personify and externalize: Attribute oppressive intentions to the problem. 3. Investigate influence: How has the problem disrupted or discouraged the client? 4. Search for unique outcomes: Find moments when the problem did not dominate. 5. Reauthoring: Build a new story based on historical evidence of competence and values. 6. Auditioning: Find an audience (social environment) to support the new story.
Narrative Therapy Techniques
Externalizing Conversations: Separating the person from the label (e.g., "anger recruited you" vs. "you are an angry person"). This mapping traces the influence of the problem on the person and the influence of the person on the problem.
Searching for Unique Outcomes: Highlighting "sparkling moments" where the client resisted the problem.
Circulation Questions: Asking who else should know about the client's progress to update their view of the person.
Documenting Evidence (Therapeutic Letter Writing): Writing letters to clients that reinforce the counter story. Some therapists suggest one well-written letter is worth five regular sessions.
Outsider Witnessing (Groups): Bringing in people to bear witness to the changes a client is making. Witnesses are asked what values they heard and how the storyteller's narrative reflected on their own lives.
Multicultural Perspectives and Social Justice
Philosophy: Highly congruent with multiculturalism because it rejects the idea of a single "truth."
Strengths: - Focus on how realities are constructed out of cultural discourse. - Relevance of sociopolitical contexts (gender, ethnicity, race, sexual orientation). - Encourages exploration of how social practices affect individuals.
Shortcomings: - The "not-knowing" stance may cause discomfort for clients from cultures that view the therapist as a directive expert. Therapists must emphasize they have expertise in the process, even if the client is the expert on their life.
Application Examples and Case Studies
Case of Sam (School Counseling - John Murphy): - Direction: Sam wanted to be "happier at school" rather than "in trouble." - Resource Building: Identified an exception where Sam arrived early to help a teacher rearrange a classroom. - Progress: Sam used 0-10 scales to move from a lower number to a 6.
Case of Stan (Integrative Postmodern Approach): - Externalizing: Named the problem "Disabling Depression." - Mapping: Traced what depression had cost him and conclusions it talked him into. - Unique Outcomes: Highlighted his courage in college and progress in curbing alcohol abuse.
Case of Gwen (SFBT and Narrative): - SFBT: Used the 0-10 pressure scale (Gwen was at an 8) and the Miracle/Magic Wand question. - Narrative: Gwen used journal writing to name her younger self and externalize "loneliness."
Domestic Violence Offenders (SFBT Group Application): - Research by Lee, Sebold, and Uken (2003) showed a recidivism rate of 16.7% and 92.9% completion rate using SFBT, compared to 40–60% recidivism and <50% completion in traditional programs.