Brief Solution-Focused Therapy

 

With emphasis on working in the school

 

 

Brief Therapy Tenets

 

The task of therapy is to coach the client

Client is the expert and knows the best way to solve the problem

Insight is not necessary for change

The unit (individual, couple, family) is not as important as the type of relationship you have with the client (visitor, customer, complainant)

The time orientation is present and future oriented

The focus is on the solution, not the problem or the past.

Rapport is assumed, not “worked on”, and happens because of the therapist’s respect for the client from the beginning.

 

Treatment Plan Definitions

 

Problems are failed attempts to solve difficulties

Goals are what you want to achieve

Techniques are what the therapist does to help move the client forward

Interventions are what the client does to progress forward – also called “tasks” or “homework” – they are what progresses the client between sessions

 

Where to Start

 

First session – hear the problem (let client tell their story)

If it is a long story then you may only get this far – not unusual in brief therapy

Find out “why now?”

 

Goal Setting

 

End of first session or beginning of second session: set goals for treatment

Rationale - How will you know when you get there if you don’t know where you are going?

If client “doesn’t know” what their goal for therapy is, ask the Miracle Question

 

Miracle Question

 

A form of goal development

Know when to ask the Miracle Question and when not to

Know when will it not work.

Say it in four parts 1. Suppose, a miracle happens…..   2.  …and the miracle is that all of your problems are solved….. 3. but the miracle happens at night while you are sleeping, so you don’t know that it has happened….   4. …what will you notice in the morning and as the day goes on that will tell you that the miracle has happened?

 

Miracle Questioning

 

Turn negatives into positives by using “instead” questions

Look for criteria for well-formedness and keep asking questions until the “goals” pass the test of well-formedness conditions

 

Miracle Question Alternatives

 

• Fortune telling

• “Magic”

• Video camera question

• Act like Detective Columbo

• Use the client as expert in help you with other clients who are similar

 

Assess client involvement

 

            Visitor? Sent by someone else

            Complainer?  Believes others are the problem

            Customer?     They want to change

 

Having one customer in the family is all it takes to solve a problem

 

Between session work

Tasks from the very beginning, help clients to work on problem (solution) between sessions ---

Progresses treatment more quickly

Teaches them to depend on their own efforts instead of waiting for the therapist to do the work for them

Do not give Visitors tasks

 

Formula First Session Tasks – “Between now and the next session, notice what is happening (in your family, at home, at school) that you would like to stay the same.”

 

Prediction Task – “Predict whether or not the next day will be an “up” day, and in the middle of the next day try to figure out why it is an “up” day.

 

Predict The Miracle Happened task – “Pick two days in the next week to pretend the miracle has happened, but don’t tell each other which days. When you come back next session, we’ll see if you can guess which days.”

 

 

 

Treatment Plan Development

  

As you ask expansion questions you will begin to define the techniques you will use to achieve client goals

 

            "What else”

"Who will notice first?"

"Who will notice next?"

"What will be different about you (you mother,father, teacher, friend)?"

"How will you know when your problem is solved?"

 

Techniques

 

1. Looking for exceptions. Start with what has already worked. Tell me about the times when bits and pieces of the miracle already happened. What was different about those times?
2. Unique Redescription questioning – How did you manage to make that change in the past? What does this tell you about yourself that is important to know?
3. For highly negative clients who can’t see any exceptions, use coping questions. What keeps the problem from getting worse? How did (do) you do that? How can you do it more often?
4. If negativity continues, move into the pessimistic questioning. What will you do if things continue to worsen? Who will suffer the most? What will you do then? Could you get a little bit of that to happen now?
5. Break down the goals into workable pieces.  – What would have to be the  first thing to happen in your miracle? FOR MANAGED CARE, MAKE IT MEASURABLE
6. Use Scaling Questions -  1-10 scale. Where are they now? What would have to happen for you to go up/down ½ point? Don’t ask for more than one point of movement. Only small change is necessary. Go above 10 or below 1 if it will help to get an answer.
7. Avoid power struggles by “going with the resistance”
8. To help a client gain distance, have them imagine themselves on a movie screen
9. Hot air balloons also help give distance
10. Use of medication in therapy – “Waterwings” – useful but not for everyone.
11. Find out what worked and prescribe more of it. Start subsequent sessions with “What is better since the last session?” Otherwise, find out why it is not worse.
12. Ask if any other family member needs to be present in the sessions.
13. As client progresses, increase the time between sessions. Try to give the client at least two weeks between 2^nd and third session. Ask client when THEY want to return.
14. Family Tune up. For clients who have had slips after past progress. “What will have to happen to get you back on track?”
15. Termination Questions – What would you have to do to go backwards? What will you have to do to prevent backsliding?

 

Interventions

 

• Do more of what is working
• Base it on the answers to your questions
• Let the client help look for clues
• Ask them to come up with their own tasks or..make the task “Do something different”

 

 

SCHOOL SETTING

 

Fostering Cooperation 

•  Relabel negative behaviors into positive ones

      Example: Parental anger could be a high level of concern and commitment to a

      resolution

• Self-disclosure
• Use of humor
• Normalizing
• Cultural sensitivity
• Compliments, cheerleading

 

Techniques Helpful in Working With Adolescents

 

1. Externalizing the problem is very useful – What do you do to keep “the anorexia” from overtaking you on those good days?
2. Future-oriented questioning. When Tim stops skipping school, who will be the most surprised? Begins to develop positive perspective of the future.
3. Paradoxical Prescriptions – Have them do more of the symptom. A form of “going with the resistance”.
4. Pattern Interruption tasks – Given after learning problem sequences. Possible changes include who’s involved, when it occurs, how often, where it occurs, and the sequence of events.
5. To get them unstuck from an unhelpful position, offer a worse alternative.
6. Reframing – Give an alternative, believable reason for the dysfunctional behavior.
7. Restraint from immediate change – Useful with clients who are rebelling against vague authority. Useful if clients feel hopeless about being able to change.
8. Conversational Questioning – “Not knowing” – Good for entrenched clients. “What did your previous therapists miss in working with you?” “What one question were you hoping I would ask?”
9. Learn from others’ mistakes – Find out what has already been tried. Why didn’t it work? What was helpful? Don’t do MORE of the SAME.
10. Act as intergenerational mediator. Have individual time with adolescent. Empower them to utilize their developmental skills, such as negotiation. Let parents know what are normal rules for adolescents.
11. Use a reflective team – This can be the client’s peer, not just other professionals.

 

Interventions Helpful in Working With Adolescents

 

1. Letter writing. Utilize the parents in joining with the teachers. Have them write letters to teacher telling them client is to notice five things they like about the teacher this week.
2. Have a “Mailbox” on the bedroom door for “difficult to speak” feelings.
3. Benevolent Sabotage – Parents pretend they are weak and “not themselves” today. Good for highly rebellious teenagers.
4. Create a tickler file – Write down solutions to problems. Good for therapists too.
5. Symbolic externalization ritual – Pick a symbol which represents the problem behavior. Talk to the symbol.
6. Ordeals – Offer a ritual more difficult to do than the positive behavior hoped for.
7. Structured fighting tasks.
8. Splitting the team

 

Techniques Helpful in Working With Young Children

 

1. Have toys available
2. The magic of individual time – The child and the parent expect individual time. Parents assume there is something that happens when they are not present that will make things better. Use time to further join with the child.
3. Storytelling – Make it a metaphor similar to client’s problem. Offer a solution in story.
4. Turn an emotional wound into a “badge of courage” – keeps client from being labeled as dysfunctional or impaired. Accesses their internal resources.
5. Coin-Flip Task – parents take turns being in charge of the discipline.
6. Secret Surprise – Child does two things this week to surprise parents. Parents guess what they are.
7. End-of-therapy ritual – encourages clients to continue future focus on continued success.

 

 

Do’s and Dont's

 

DO         Have fun, be creative, be playful, add in yourself, improvise, use

               humor, award successes, especially with kids, collaborate with

               other professionals,  expect clients to have strengths

               and resources to change.

 

DON’T   make the counseling interview an interrogation.

 

DON’T   Label. Labeling leads to doing “more of the same” in treatment

                and provides excuses.

 

AVOID   being drawn into client’s expectation of talking about the past

                looking for insight, blaming others etc.

 

DO         Refine client’s stated goals according to well-formed conditions.

 

 

 

SAMPLE TREATMENT PLAN

 

Presenting Problem: Depression and School conduct problems

 

Goal: 1. Cessation of Depression 

               2. Appropriate Behavior in school

 

Objectives for Goal 1:

 

A.  Client and parents will report client’s depression at no higher than a three on a 1 – 10 scale for 5 days per week for two consecutive weeks using the Scaling Technique

 

B. Client will be actively engaged in past or new      activities, such as basketball or reading, AEB      participation in activities for three of five days a     week for three weeks.

 

 

 

Objectives for Goal 2:

 

A. Client will participate in class by turning in homework, raising hand for permission before speaking, and listening to teacher without putting head on desk, AEB doing the above at a level of at least 7 on a 1-10 scale reported by teacher daily for three consecutive weeks.

 

B.  Client will talk with therapist about what it would take to move one more number on the scale 2 x week for two times a week.

 

 

Techniques

 

1.      Looking for positive exception and prescribing more of what works.

2.    Future focus, Miracle Question, Complimenting, Coping Questions, Relationship Questions, Reframing, Assuming strength and competence.

3.   Arranging collaborative meetings including parents, teachers, and school guidance counselor at the beginning and at the end of treatment. The purpose of meeting would be to determine what each would like to see, what each have tried, what they believe to be successful, and to have a coordination in the plan of action.

4.      Family and individual counseling to determine if there are other family problems needing to be addressed, and how family can help in carrying out plan of action at home and at school. If further treatment of family is needed, treatment plan will be amended.

 

Interventions

 

1.     Client and family will determine weekly tasks, such as   “Do homework nightly” and how each will help client to carry out tasks.

2.      Teacher will sign off on homework nightly and write weekly notes home to parents about behaviors, emphasizing the positives.

3.      Parents will take six-week parenting class and apply what they learn with client.

4.      Client will notice five positives about his teacher per week, and discuss it with his parents and counselor.