minnesota child welfare training system solution-focused brief therapy strategies &...
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Minnesota Child WelfareTraining System
Solution-Focused Brief Therapy
Strategies & Interventions
Bob Bertolino, Ph.D.Assistant Professor, Rehabilitation Counseling
Maryville University – St. Louis, MissouriSr. Clinical Advisor, Youth In Need, Inc. – St. Charles, Missouri
There is More to See
No More Boxes Recalibrating Compasses and Expanding Personal
Worldviews
“You must be the change you wish to see in the world”
– Mahatma Gandhi
Recalibrating Compasses1. What are the core beliefs you have about the
people with whom you work?2. How have you come to believe what you believe
and know what you know? What have been the most significant influences on your beliefs?
3. How have your beliefs and assumptions affected your work with clients? With colleagues? With the community?
4. Do you believe that change is possible even with the most “difficult” and “challenging” clients?
5. How do you believe that change occurs? What does change involve? What do you do to promote change?
6. Would you be in this field if you didn’t believe that the clients with whom you work could change?
H. O. P. E.
HHumanism
OOptimism
PPossibilities
EExpectancy
“Optimism is the faith that leads to achievement.
Nothing can be done without hope or confidence.”
- Helen Keller
Experience as a Catalyst:The Presence of H.O.P.E.
• What inspires or moves you?What inspires or moves you?• How does that increase your sense of How does that increase your sense of
hope?hope?• What does an increased sense of hope What does an increased sense of hope
allow you to do?allow you to do?• How can you promote hope with others?How can you promote hope with others?• How do you maintain your sense of hope How do you maintain your sense of hope
when you are struggling with clients?when you are struggling with clients?
What Does The Data (Research) Say?
What Does The Data Say?
• The most significant portion of change occurs earlier rather than later in services
• The client’s rating of the therapeutic relationship is the best and most consistent predictor of outcome
• One of the best predictors of negative outcome is lack of structure
• Most clients are making some form of progress
What Does the Data Say? (cont.)
“Real-Time” feedback increases factor of fit Long-term services without an improved
outcome combined with “more of the same” on the part of the worker equals an “impossible” case
Long-term services with high alliance scores and no improvement in outcomes can indicate dependence
• Practitioners whose clients do not seem to be making progress tend to do similar things:• More of the same, “Clients must get worse before they
get better,” More severe diagnosis, Return to their models
What Does the Data Say? (cont.)
• Non-model-specific factors account for 8-12x more than methods and models and up to 92% of the variance
• Although models (approaches) account for very little of the variance in outcome, the person of the practitioner can significantly affect change
• Among effective approaches it is the similarities not the differences that account for the significant portion of change (e.g., MST, FFT, BSFT, MI, CBT, etc.)
• Through different mechanisms of change, effective approaches are vehicles for activating and transporting common factors
Common Factorsin Change
40%
30%
15%
15%
Client Factors
Relationship Factors
Expectancy and Placebo
Model and Technique Factors
Hubble, M. A., Duncan, B. L., & Miller, S. D. (Eds.) (1999). The heart and soul of change: What works in therapy. Washington, D.C.: American Psychological Association.Lambert, M. J. (1992). Psychotherapy outcome research: Implications for integrative and eclectic therapists. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 94-129). New York: Basic Books.
Ingredients of Change
70%
8%
22%GeneralEffects
SpecificEffects
UnexplainedVariance
Wampold, B. E. (2008). The great psychotherapy debate: Models, methods, and findings (2nd ed.). New Jersey: Lawrence Erlbaum.
Strengths and Solution-Based (SSB) Principles
Martin Seligman“What we have learned is that pathologizing does
not move us closer to the prevention of serious disorders. The major strides in prevention have largely come from building a science focused on systematically promoting the competence of individuals…. Fifty years of working in a medical model on personal weakness and the damaged brain has left mental health professionals ill-equipped to do effective prevention. We need massive research on human strength and virtue. We need practitioners to recognize that much of the best work they do is amplifying the strengths rather than repairing their patient’s weakness.”
What is Strengths-Based?
A A strengths-basedstrengths-based perspective is not a theory, but perspective is not a theory, but an overarching philosophical position in an overarching philosophical position in which people are seen as having capabilities which people are seen as having capabilities and resources within themselves and their and resources within themselves and their social systems. When cultivated, activated, social systems. When cultivated, activated, and integrated with new experiences, and integrated with new experiences, understandings, ideas, and skills, these understandings, ideas, and skills, these strengths help such persons to reduce pain strengths help such persons to reduce pain and suffering, resolve concerns and conflicts, and suffering, resolve concerns and conflicts, and cope more effectively with life stressors. and cope more effectively with life stressors. This contributes to improved sense of well-This contributes to improved sense of well-being and quality of life, and higher levels of being and quality of life, and higher levels of relational and social functioning. Strengths-relational and social functioning. Strengths-based helpers promote change through based helpers promote change through respectful educational, therapeutic, and respectful educational, therapeutic, and operational processes and practices that operational processes and practices that encourage and empower others.encourage and empower others.
Principles of SSB
1. Client Contributions2. The Therapeutic Relationship
and Alliance3. Cultural Competence4. Change as a Process5. Expectancy and Hope6. Model and Factor of Fit
Active Client Engagement (A.C.E.)
Building Strengths and Solutions
Create a Context of Collaboration
Point• Start services by
offering options that are respectful of clients and their cultures and incorporate their preferences and perceptions
• Preparatory
How• Be prepared• Keys to Collaboration
Strengthen Through Presence
The Therapeutic Relationship in Context…
Even for those who are convinced that the therapeutic relationship is healing by and of itself, there are strategies that can foster its impact. In other words, since not all kinds of relationships are likely to bring about change, one needs to be aware of interventions (including modes of relating) that should be encouraged or avoided for the relationship to become a corrective experience. (Castonguay & Beutler, 2006, p. 353)
Castonguay, L. G., & Beutler, L. E. (2006). Common and unique principles of therapeutic change: What do we know and what do we need to know? In L. G. Castonguay & L. E. Beutler (Eds.), Principles of therapeutic change that work (pp. 353-369). New York: Oxford University Press.
Strengthen Through Presence
Point• Listen and Attend to Clients’
Stories and Strengths• Engagement
How• Acknowledge and validate• Separate experience from
action• Summarize, validate, and
soften• Avoid platitudes or trying
make things more “positive”• Be aware of stories of
impossibility• Consider the influence of
words• Use possibility-laced
language• Be a “life witness”
Strengths-BasedEngagementand Practice
Creating EffectiveHelping Relationships
Allyn & BaconFebruary, 2009
The Influence of Words
The Influence of Words
Sad. Helpless. Inconvenience. Defeat. Tired. Oppressed. Doubtful.
Uninterested.
Life is so hard. Nothing seems to go my way. There is no one to turn to. It feels
like I’ve been forgotten. Times are hard. Nothing seems to help. Things will not
get better. In fact, they will probably get worse. There is no hope.
The Influence of Words
Exciting. Fun. Laughter. Joy. Anticipation. Possibility. Aliveness.
Love. Peace.
When I think about the future I become energized. There is so much I can accomplish. Life is wonderful.
There are so many possibilities in the world.
Possibility-Laced Language
1. Reflect client statements in the past tense.
► From: “It’s always that way.”► To: “It’s been that way.”
2. Move from global (“everybody,” nobody,” “always,” “never”) to partial (“recently,” “somewhat more,” “a lot”).
► From: “He’s always in trouble.”► To: “He gets in trouble a lot.”
3. Move from truth/reality to perception (“It seems to you,” “You’ve gotten the idea”).
► From: “Things will never get better.”► To: “From where your standing it really seems
that it will never get better.”
Possibility-Laced Language
1. Assume the possibility of future change and/or solutions by using words such as “yet” and “so far.”
► From: “It’s always going to be this way.”► To: “So far you haven’t found any evidence that things will be
different than the way they are now.”
2. Recast the problem statement into a statement about a preferred future or goal.
► From: “I’ll never be able to have the life I really want.”► To: “So you’d like to be able to move toward the life you really
want.”
3. Presuppose that changes and progress toward goals will occur by using words such as “when” and “will.”
► From: “No one wants to be around me.”► To: “So when you begin to notice that there are people who
enjoy your company and want to be around you what will be different for you?”
Possibility-Laced Language
Give Permission “to,” “not to have to,” and both
From: “I shouldn’t be angry.” To: “It’s okay to be angry.” From: “People keep saying that it
really should make me angry.” To: “It’s okay to not be angry about it.” From: “Sometimes I’m angry and
sometimes I’m not. I must be crazy!” To: “It’s okay to be angry and you don’t
have to be angry and you’re not crazy.”
Possibility-Laced Language
Include any parts, objections, feelings, aspects of self, or clients’ concerns that might have been left out or seen as barriers to change/goals.
From: “Nothing will change until people get off my case.”
To: “Things can change while people are continuing to look after you.”
From: “I can’t concentrate when these kids are always screaming!”
To: “You can find a way to concentrate even though the kids may be loud.”
Utilization Take what clients bring to
services, no matter how small, strange, or negative the behavior or idea seems and use it as a resource to open up the possibilities for change.
From: “He’s always doodling and playing around.”
To: “So he’s a creative and playful kid.”
Being a Valuing orLife Witness
Learn Clients’ Orientations
Point• Gain an improved
understanding of clients’ perceptions, perspectives, and theories
• Words and Pictures
How• Ask questions as to
what clients attribute problems to and possible solutions
• Assess clients’ readiness for change (Stage of Change)
Address Case Management Matrix
Point• Explore services and
program parameters• Monitor relationship and
outcome • Interim Family Safety
Guidelines
How• Collaborate and
Negotiate• Concurrent planning• Track outcomes (impact)• Information-Gathering
(Assessment)• Use feedback processes
to client perceptions of the alliance
Information-Gathering (Assessment)
• Pre-session/Pre-Pre-session/Pre-meeting changemeeting change
• Primary Areas Primary Areas (Spokes of Life)(Spokes of Life)
• ExceptionsExceptions• Scaling QuestionsScaling Questions
• Rate Intensity and Rate Intensity and variationsvariations
• Effects of Problem Effects of Problem of Personof Person
• Effects of Person Effects of Person over Problemover Problem
8Other
7Work/
Employ-ment
6School/
Education
5Outside Helpers
4Commun
-ity
3Friends/Social
Relation-ships
2Family
1Client
Eliciting Client Feedback In Initial Sessions and Interactions…In Initial Sessions and Interactions…
Are there certain things that you want to be sure we talk Are there certain things that you want to be sure we talk about?about?
What is most important for me to know about you and/or What is most important for me to know about you and/or your situation/what you’ve been experiencing?your situation/what you’ve been experiencing?
What ideas do you have about how therapy/coming What ideas do you have about how therapy/coming here/coming to see me might be helpful to you?here/coming to see me might be helpful to you?
““Checking In” –As Sessions and Interactions Progress…Checking In” –As Sessions and Interactions Progress… Have we been talking about what you want to talk about?Have we been talking about what you want to talk about? Are we moving in a direction that seems right for you?Are we moving in a direction that seems right for you? Are there other things that we should be discussing instead?Are there other things that we should be discussing instead? What, if anything, should I do differently?What, if anything, should I do differently?
At the End of Sessions and Interactions… At the End of Sessions and Interactions… How did the session go for you?How did the session go for you? How was the pace of our conversation/interaction/session?How was the pace of our conversation/interaction/session? Did we work on what you wanted? Was there anything Did we work on what you wanted? Was there anything
missing?missing?
Accommodate Services to Clients’ and Others Goals
Point• Create focus and
direction• Gain clarity
regarding goals and indicators of change and progress
How• Action-talk• 3-Point Strategy
Goal-Setting
• Non-Action TalkNon-Action Talk• Cab driver talkCab driver talk
• Opinions, evaluations, assessments, Opinions, evaluations, assessments, judgmentsjudgments
• Politician talkPolitician talk• Vague, general, not specific as to person, Vague, general, not specific as to person,
place, time, thing, or actionplace, time, thing, or action• ““Someday” talkSomeday” talk
• Vague as to time or frequencyVague as to time or frequency
Goal-Setting (cont.)
• Action-Talk/VideotalkAction-Talk/Videotalk• Move from vague, non-sensory-based descriptions to
clear, observable, behaviors• Using Action-Talk to Clarify Meanings
• Action complaints – specifics about what one doesn’t like or one wants to have change
• Action requests – specifics about what one would like to have happen
• Action appreciation – specifics about what has liked about something and would like more of
• Specific to person, place, time, thing, action, or result• Who is to do what by when?• Who did what, when?
3-Point Strategy1. Problem Description: What
needs to change?• Scaling questions (with all 3 points)
2. Vision of the Future: How will we know that change has been achieved?
• Miracle question, crystal ball, time machine, etc.
• General future-oriented questions3. Movement: How will we know
that progress is being made?
Be Change-Oriented and Solution-FocusedPoints
• Consider strategies that offer the best possible “fit” for clients
• Methods should fit with and be sensitive of clients’ cultures, beliefs
• Focus on processes that enhance change
• Similar-But-Different Role Play
How• Reassess clients’
readiness for change• Collaborate on tasks/way
to achieve goals and improve outcomes
Reflecting Consultation Exercise
Evaluate PlanPoints
• Ensure expectations are clear
• Ensure plans are clear
• Final Family Safety Plan
How• Discuss benefits of
positive change• Discuss possible
consequences of lack of follow-through
• Encourage feedback
Monitor ProgressPoints
• Determine progress and gains
• Identify barriers to change
• Determine next steps• Follow-Up
How• Identify, amplify, and
extend change• Reassess goals• Determine outcomes• Explore transitions• Check in with self and
remain aware of pathways of impossibility
The Therapist’s Notebook for Strengths and Solution-Based
Therapies
Homework, Handouts,and Activities
Bob BertolinoMichael KienerRyan Patterson
RoutledgeSummer, 2009
““It’s not enough to be It’s not enough to be compassionate.compassionate.You must act.”You must act.”
– Tenzin Gyatso14th Dalai Lama,
1992
ThankYou
Bob Bertolino, Ph.D.TCCT, LLC – P.O. Box 1175 – St. Charles, Missouri 63302
+01.314.852.7274 – [email protected] – www.bobbertolino.com
Maryville University650 Maryville University
DriveSaint Louis, Missouri
63141 USA+01.314.529.9659 (Phone)
www.maryville.edu
Youth In Need, Inc.516 Jefferson
Saint Charles, Missouri 63301 USA
+01.636.946.0101 (Phone)+01.636.925.0125 (Fax)
www.youthinneed.org