solution-focused counseling: advanced techniques and applications (handout)

Solution-Focused

Counseling: Advanced Techniques

and Applications

Education Session

American Counseling Association

Jeffrey T. Guterman, Ph.D.

Clayton V. Martin, M.S.

Saturday, March 14, 2015

10:30 a.m. – 12:00 p.m.

American Counseling Association

2015 Annual Conference

Orlando, Florida

Hyatt Regency, Ballroom M

Copyright © 2015 by Jeffrey T. Guterman and Clayton V. Martin

The PowerPoint for this Education Session is available at http://JeffreyGuterman.com

http://jeffreyguterman.com/

Solution-Focused Counseling 2

Contents

About the Presenters ............................................................................................................... 3

Selected Publications by the Presenters .................................................................................. 4

Education Session Description ............................................................................................... 5

Education Session Objectives ................................................................................................. 5

Formula First Session Task ..................................................................................................... 5

Principles of Solution-Focused Counseling ............................................................................ 5

Implications of a Postmodern Position ................................................................................... 6

Problem and Exception ........................................................................................................... 6

Theory of Change ................................................................................................................... 6

Common Change Factors ........................................................................................................ 7

Stages of Solution-Focused Counseling ................................................................................. 7

Coconstructing Problems and Goals ....................................................................................... 8

S.M.A.R.T. GOALS ............................................................................................................... 8

Identifying Exceptions ............................................................................................................ 8

Questions for Amplifying Exceptions .................................................................................... 9

Solution-Focused Tasks .......................................................................................................... 9

Solution Identification Form ................................................................................................. 10

Scaling Form ......................................................................................................................... 11

Solution-Focused Checklist .................................................................................................. 12

Outcome Rating Scale (ORS) ............................................................................................... 13

Session Rating Scale (SRS) .................................................................................................. 14

Child Outcome Rating Scale (CORS) ................................................................................... 15

Child Session Rating Scale (CSRS) ...................................................................................... 16

Young Child Outcome Rating Scale (YCORS) .................................................................... 17

Young Child Session Rating Scale (YCSRS) ....................................................................... 18

Suggestions and Considerations for Using Rating Scales and Client Feedback .................. 19

References and Suggested Readings ..................................................................................... 20

Suggested Internet Resources ............................................................................................... 22


About the Presenters

Jeffrey T. Guterman, Ph.D. is a mental health counselor in Fort Lauderdale, Florida. He is

author of over 125 publications. The first edition of his book Mastering the Art of Solution-

Focused Counseling was published by the American Counseling Association (ACA) in 2006,

it was translated in Korean in 2007, and an updated and expanded second edition was

published by ACA in 2013. He has presented numerous workshops on solution-focused

counseling.

Contact Information

Email: [email protected]

Phone: 305-725-4583

Web: http://JeffreyGuterman.com

Twitter: http://twitter.com/JeffreyGuterman

Clayton V. Martin, M.S. is a counselor in Atlanta, Georgia. He has presented workshops on

the topics of strength-based approaches to counseling and LGBTQ advocacy issues in

counseling. He has written articles for counseling journals on solution-focused approaches to

counseling and philosophical issues in counseling. He has extensive clinical experience in

solution-focused counseling with children, adolescents, and young adults in various clinical

settings.

Contact Information

Email: [email protected]

Phone: 404-449-3028

–

Jeffrey T. Guterman, Ph.D. and Clayton V. Martin, M.S. are available to provide training and

workshops for your organization on various topics. Program topics and formats will be

tailored to meet the needs of your organization.


http://twitter.com/JeffreyGuterman


Selected Publications by the Presenters

de Castro, S., & Guterman, J.T. (2008). Solution-focused therapy for families coping with

suicide. Journal of Marital and Family Therapy, 34, 93-106.

Guterman, J. T. (1994). A social constructionist position for mental health counseling.

Journal of Mental Health Counseling, 16, 226-244.

Guterman, J.T. (1996a). Doing mental health counseling: A social constructionist re-vision.


Guterman, J.T. (1996b). Farewell to families: Language systems in the postmodern era. The

Family Journal: Counseling and Therapy for Couples and Families, 4, 139-142.

Guterman, J.T. (1996c). Reconstructing social constructionism: A reply to Albert Ellis.


Guterman, J.T. (1996d). Tales of mental health counseling. Journal of Mental Health

Counseling, 18, 300-306.

Guterman, J.T. (1998). Identifying pretreatment change before the first session. Journal of

Mental Health Counseling, 20, 370-374.

Guterman, J.T. (2013). Mastering the art of solution-focused counseling (2nd

ed.).

Alexandria, VA: American Counseling Association.

Guterman, J.T., & Leite, N. (2006). Solution-focused counseling for clients with religious

and spiritual concerns. Counseling and Values, 51, 39-52.

Guterman, J. T., Martin, C.V., & Kopp, D.M. (2012). Science and humanities: A necessary

unity for the counseling profession. Journal of Humanistic Counseling, 51, 145-154.

Guterman, J.T., & Martin, C.V. (in press). Using puppets with aggressive children to

externalize the problem in narrative therapy. In (A.A. Drewes & C. Schaefer, Eds.),

School age play therapy. Washington, DC: American Psychological Association.

Guterman, J.T., Mecias, A., Ainbinder, D.L. (2005). Solution-focused treatment of migraine

headache. The Family Journal: Counseling and Therapy for Couples and Families,

13, 195-198.

Guterman, J.T., & Schildbach, J. (2014, June). The stigma of mental illness and the noble

savage. Counseling Today, pp. 60-63.

Martin, C.V., Guterman, J.T., & Kopp, D.M. (2012). Extending the dialogue about science

and humanities: A reply to Hansen. Journal of Humanistic Counseling, 51, 161-163.

Martin, C.V., Guterman, J. T., & & Shatz, K. (2012). Solution-focused counseling for eating

disorders. VISTAS, 1-11.


Education Session Description

Solution-focused counseling is a comprehensive model that emphasizes clients' strengths,

resources. This session provides an opportunity to learn advanced solution-focused

counseling techniques and clinical applications. Solution-focused counseling is a

comprehensive model that emphasizes clients' resources, strengths, and effective coping

skills to bring about positive change. If these resources—called exceptions—are identified

and amplified, then problem resolution can be brought about in an effective and efficient

manner. Case examples illustrate using solution-focused counseling for a variety of clinical

problems and populations.

Education Session Objectives

1. Identify and review the main principles of solution-focused counseling.

2. Identify and review the theory of problems and change in solution-focused counseling.

3. Identify and review the clinical stages in solution-focused counseling.

4. Identify and review advanced techniques used in solution-focused counseling.

5. Identify and review clinical applications of solution-focused counseling.

Formula First Session Task

Between now and next time we meet, I want you to observe so that you can tell me next time,

what happens in your life that you want to continue to have happen (cf. Molnar & de Shazer,

1987).

Principles of Solution-Focused Counseling

Solution-focus

Collaborative approach

Small changes can lead to big results

Emphasis on process

Strategic eclecticism

Brief by design, but not always

Responsiveness to diversity

Committed to outcome


Implications of a Postmodern Position

for Solution-Focused Counseling

Clinical reality as a social construction rather than an objective reflection of reality.

Counselors as participant-observers rather than independent of clients and problems.

A perspective that understands language as the distinction of treatment concern rather

than human systems as the locus of problems.

A collaborative approach and an emphasis on cooperating rather than a perspective

that views clients’ oppositions to change as resistance.

Problem and Exception

Problem:

o Problem: A subjective and/or intersubjective complaint

o Problem/Exception : The subjective or intersubjective complaint is subsumed

by the problem/exception formal theory which is used across cases to

conceptualize problems and change

Exception: “Times when the complaint/problem does not happen even though the

client has reason to expect it happen” (de Shazer, 1991, p. 83).

Theory of Change

Theory of Change: When the problem is the rule, then exceptions tend to remain hidden or

decrease. When exceptions are identified and amplified, the problem tends to decrease.

Exceptions can be amplified by encouraging clients to do more of the behaviors that have led

them to solve the problem in the past, or to observe times when they are dealing better with

the problem, or ascribe significant meaning to the exceptions.


Common Change Factors

Research in the area of common change factors (Lambert, 1992) clearly supports the theory of change

in solution-focused counseling (Guterman, 2013). Lambert identified four common change factors

that contribute most to improvement in counseling and psychotherapy. According to Lambert, each of

these common change factors accounts for the following percentages of improvement that occur in

counseling and psychotherapy:

1. Client factors (or self-help): 40%

2. Client-counselor relationship factors: 30%

3. Expectancy factors: 15%

4. Model factors: 15%

These findings support the theory of solution-focused counseling for two reasons. First, the finding

that client factors accounts for the most improvement in counseling (40%) affirms solution-focused

counseling’s theory of change. The primary function of a solution-focused counselor is to help clients

tap into their problem-solving resources and potentials. Although a wide variety of techniques are

used in the model (which accounts for 15% improvement based on the research), solution-focused

counseling is to be considered a process model because it attributes change mainly to what the client

does to solve problem rather than to the model. In effect, its focus on client factors is the model. The

second reason that research on common change factors supports solution-focused counseling is

because the model emphasizes the important role of the client-counselor relationship. The finding that

client-counselor factors account for 30% of improvement supports the unique emphasis that solution-

focused counseling places on developing a collaborative relationship between the client and

counselor.

Stages of Solution-Focused Counseling

Coconstructing problems and goals

Identifying and amplifying exceptions

Coconstructing tasks

Evaluating the effectiveness of tasks

Reevaluating problems and goals


Coconstructing Problems and Goals

1. Coconstruct solvable problems (e.g., ineffective coping skills, rather than merely

‘depression’).

2. Develop goals in positive language (an increase in something), rather than

negative language (a decrease in something).

3. Encourage clients to provide video description of the problem.

4. Coconstruct a problem and a goal that fits with the client's worldview.

S.M.A.R.T. Goals

Specific Goals

Measurable Goals

Achievable Goals

Relevant Goals

Time-based Goals

Identifying Exceptions

Presuppositional questions: Ask, “When has there been a time when _____ (the

problem) has not happened?” or “When has _____ (the goal) happened?” rather than,

“Has there been a time?

Identifying small exceptions

Identifying potential exceptions

o The miracle questions:

Suppose that one night there is a miracle and while you are sleeping the

problem . . . is solved: How would you know? What would be different?

(de Shazer, 1988, p. 5)


Questions for Amplifying Exceptions

How did you make it happen?

How is that different from how you have dealt with the problem in the past?

How did it make your day go differently?

Who else noticed?

What did you tell yourself to make it happen?

What does this say about you and your ability to deal with the depression?

What are the possibilities?

Solution-Focused Tasks

Task # 1

The client is told and asked, “Between now and the next time, I would like you to observe, so

that you can tell me next time, about those times when you are able to make it (the goal)

happen.”

Rationale: This task is given if the client is able to construct a problem and goal, and

identify and amplify exceptions.

Task # 2

The client is told and asked, “Between now and the next time, I would like you to pay

attention to and make note of what you do when you are able to effectively cope with or deal

with the problem.”

Rationale: This task is given if the client is able to construct a problem and goal and

identify exceptions, but is unable to amplify exceptions.

Task #3

The client is told and asked, “Between now and the next time, I would like you to observe, so

that you can tell me next time, what happens in your life (relationship, family, work

situation) that you want to continue to have happen.”

Rationale: This task is given if the client is able to construct a problem and goal, and

potential exceptions, but is unable to identify exceptions.

Task #4

The client is told and asked, “Try to avoid making any drastic changes. If anything, think

about what you will be doing differently when things are improved.”

Rationale: This task is given if the client is able to construct a problem, but is unable to

construct a goal.

Task #5

The client is told and asked, “The situation is very volatile. Between now and the next time,

attempt to think about why the situation is not worse.”

Rationale: This task is given if the client is in severe crisis.


Solution Identification Form

Name ________________________Age (Years):____ Sex: M / F

Session # ____ Date: ________________________

Who is filling out this form? Please check one: Self_______ Other_______

If other, what is your relationship to this person? ____________________________

Date and

Time

Describe the solution (What

happened)

Describe how you came up with the

solution (What you did to make the

solution happen)


Scaling Form


Session # ____ Date: ________________________



Please rate your progress on the problem and goal for each day on a scale from 0 to 10

with “10” being the least and “0” or “1” being the best. Also, describe what you did to

make the progress in relation to the problem and goal.

Date Rating Describe what you did


Solution-Focused Checklist

Did you carefully and patiently try to help the client identify exceptions?

o Small exceptions?

o Potential exceptions?

Did you try asking questions differently?

Did you persist in your efforts?

Did you negotiate small, simple, and relevant goals that the client knows how to

accomplish?

Did you try helping the client to amplify the exceptions?

Maybe the client identified a small or potential exception during the session but he or

she—and you!—considered it to be irrelevant or unremarkable.

Did you try a strategic approach to eclecticism?

Did you try doing something different?


Outcome Rating Scale (ORS)

This scale is for illustration purposes only. The actual scale, which includes 10-centimeter

lines for each item, may be downloaded from http://www.scottdmiller.com. Adapted from

Guterman (2013) and used with permission of Scott D. Miller (http://www.scottdmiller.com).


Session # ____ Date: ________________________



Looking back over the last week, including today, help us understand how you have been

feeling by rating how well you have been doing in the following areas of your life, where

marks to the left represent low levels and marks to the right indicate high levels. If you are

filling out this form for another person, please fill out according to how you think he or she

is doing.

ATTENTION CLINICIAN: TO INSURE SCORING ACCURACY PRINT OUT THE

MEASURE TO INSURE THE ITEM LINES ARE 10 CM IN LENGTH. ALTER THE

FORM UNTIL THE LINES PRINT THE CORRECT LENGTH. THEN ERASE THIS

MESSAGE.

Individually

(Personal well-being)

I----------------------------------------------------------------------I

Interpersonally

(Family, close relationships)

I----------------------------------------------------------------------I

Socially

(Work, school, friendships)

I----------------------------------------------------------------------I

Overall

(General sense of well-being)

I----------------------------------------------------------------------I

http://www.scottdmiller.com/



Session Rating Scale (SRS)

This scale is for illustration purposes only. The actual scale, which includes 10-centimeter

lines for each item, may be downloaded from http://www.scottdmiller.com. Adapted from

Guterman (2013) and used with permission of Scott D. Miller (http://www.scottdmiller.com).


Session # ____ Date: ________________________



Please rate today’s session by placing a mark on the line nearest to the description that best

fits your experience.

Relationship

I-------------------------------------------------------------------------I

Goals and Topics

I------------------------------------------------------------------------I

Approach or Method

I-------------------------------------------------------------------------I

Overall

I------------------------------------------------------------------------I

I felt heard,

understood, and

respected.

I did not feel

heard,

understood, and

respected.

We worked on

and talked

about what I

wanted to

work on and

talk about.

We did not

work on or

talk about

what I wanted

to work on and

talk about.

Overall,

today’s session

was right for

me.

There was

something

missing in the

session today.

The therapist’s

approach is a

good fit for

me.

The therapist’s

approach is

not a good fit

for me.




Child Outcome Rating Scale (CORS)

This scale is for illustration purposes only. The actual scale may be downloaded from

http://www.scottdmiller.com. Adapted from Guterman (2013) and used with permission of

Scott D. Miller (http://www.scottdmiller.com).

Name ________________________Age (Years):____

Sex: M / F_________

Session # ____ Date: ________________________

Who is filling out this form? Please check one: Child_______ Caretaker_______

If caretaker, what is your relationship to this child? ____________________________

How are you doing? How are things going in your life? Please make a mark on the scale to

let us know. The closer to the smiley face, the better things are. The closer to the frowny

face, things are not so good. If you are a caretaker filling out this form, please fill out

according to how you think the child is doing.

Me

(How am I doing?)

I------------------------------------------------------------------------------------I

Family

(How are things in my family?)

I------------------------------------------------------------------------------------I

School

(How am I doing at school?)

I------------------------------------------------------------------------------------I

Everything (How is everything going?)

I------------------------------------------------------------------------------------I




Child Session Rating Scale (CSRS)




Name ________________________Age (Years):____

Sex: M / F_________

Session # ____ Date: ________________________



How was our time together today? Please put a mark on the lines below to let us know how

you feel.

Listening

I-----------------------------------------------------------------------------------I

How Important

I-----------------------------------------------------------------------------------I

What We Did

I-----------------------------------------------------------------------------------I

Overall

I-----------------------------------------------------------------------------------I

The therapist

listened to me.

The

therapist did

not always

listen to me.

What we did

and talked

about were

important to

me.

What we did

and talked

about was not

really that

important to

me.

I hope we do

the same kind

of things next

time.

I wish we

could do

something

different.

I liked what

we did today.

I did not

like what

we did

today.




Young Child Outcome Rating Scale (YCORS)




Name ________________________Age (Years):____

Sex: M / F_________

Session # ____ Date: ________________________



Choose one of the faces that shows how things are going for you. Or, you can draw one

below that is just right for you.




Young Child Session Rating Scale (YCSRS)




Name ________________________Age (Years):____

Sex: M / F_________

Session # ____ Date: ________________________



Choose one of the faces that shows how things are going for you. Or, you can draw one

below that is just right for you.




Suggestions and Considerations for

Using Rating Scales and Client Feedback

1. Introduce the rating scales to clients by describing their purposes in clear and simple

language.

2. Openly discuss the ratings with clients, and be prepared to take the ratings seriously,

but not personally.

3. Adapt and revise counseling sessions based on the ratings and feedback received from

clients.

4. Adjustments based on rating scales and client feedback may reduce the likelihood of

drop outs and thereby improve treatment outcomes.

5. When clients have difficulty reading or are otherwise unable to understand the rating

scales, especially children, counselors should consider explaining the rating scales

clients.


References and Suggested Readings

Berg, I.K., & Miller, S.D. (1992). Working with the problem drinker: A solution-focused

approach. New York: Norton.

de Castro, S., & Guterman, J.T. (2008). Solution-focused therapy for families coping with

suicide. Journal of Marital and Family Therapy, 34, 93-106.

de Shazer, S. (1982). Patterns of brief family therapy. New York: Norton.

de Shazer, S. (1984). The death of resistance. Family Process, 23, 11-17.

de Shazer, S. (1985). Keys to solution in brief therapy. New York: Norton.

de Shazer, S. (1988). Clues: Investigating solutions in brief therapy. New York: Norton.

de Shazer, S. (1991). Putting difference to work. New York: Norton.

de Shazer, S. (1994). Words were originally magic. New York: Norton.

de Shazer, S. (1997). Commentary: Radical acceptance. Families, Systems, & Health, 15,

375-378.

de Shazer, S., Berg, I. K., Lipchik, E., Nunnally, E., Molnar E., Gingerich, K., & Weiner-

Davis, M. (1986). Brief therapy: Focused solution development. Family Process, 25,

207-222.

Duncan, B. (2014). On becoming a better therapist: Evidence based practice one client at a

time. (2nd

edition). Washington DC: American Psychological Association

Duncan, B.L., Miller, S., Huggins, A., & Sparks, J. (2003a). Young child outcome rating

scale. Chicago: Author.

Duncan, B.L., Miller, S., Huggins, A., & Sparks, J. (2003b). Young child session rating

scale. Chicago: Author.

Duncan. B.L., Miller, S.D., & Sparks, J. (2003). Child outcome rating scale. Chicago:

Author.

Duncan. B.L., Miller, S.D., & Sparks, J.A. (2004). The heroic client: A revolutionary way to

improve effectiveness through client-directed, outcome-informed therapy. San

Francisco: Jossey-Bass.

Duncan, B.L., Miller, S.D., Sparks, J.A., & Johnson, L.D. (2003). Child session rating scale.

Fort Lauderdale, FL: Author.

Franklin, C., Trepper, T.S., McCollum, E.E., & Gingerich, W.J. (2011). Solution-focused

brief therapy: A handbook of evidence-based practice. New York: Oxford University

Press.

Gergen, K.J. (2009). An invitation to social construction (2nd ed.). Thousand Oaks, CA:

Sage.

Guterman, J. T. (1994). A social constructionist position for mental health counseling.


Guterman, J.T. (1996). Doing mental health counseling: A social constructionist re-vision.


Guterman, J.T. (1998). Identifying pretreatment change before the first session. Journal of

Mental Health Counseling, 20, 370-374.

Guterman, J.T. (2013). Mastering the art of solution-focused counseling (2nd

edition)


Guterman, J.T., & Leite, N. (2006). Solution-focused counseling for clients with religious

and spiritual concerns. Counseling and Values, 51, 39-52.


Guterman, J.T., Mecias, A., Ainbinder, D.L. (2005). Solution-focused treatment of migraine

headache. The Family Journal: Counseling and Therapy for Couples and Families,

13, 195-198.

Held, B.S., (1992). The problem of strategy within the systemic therapies. Journal of Marital

and Family Therapy, 18, 25-35.

Johnson, L.D., Miller, S.D., & Duncan, B.L. (2000). Session rating scale 3.0. Chicago:

Author.

Lambert, M.J. (1992). Implications of outcome research for psychotherapy. In J.C. Norcross

M.R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 94-129). New

York: Basic Books.

Lambert, M.J., Whipple, J., Smart, D., Vermeersch, D., Nielsen, S., & Hawkins, E. (2001).

The effects of providing therapists with feedback on patient progress during

psychotherapy: Are outcomes enhanced? Psychotherapy Research, 11, 49-46.

Lipchik, E. (2002). Beyond technique in solution-focused therapy: Working with emotions

and the therapeutic relationship. New York: Guilford.

Martin, C.V., Guterman, J. T., & & Shatz, K. (2012). Solution-focused counseling for eating

disorders. VISTAS, 1-11.

Miller, S., & Duncan. B.L. (2000). Outcome rating scale. Chicago: Author.

Molnar A., & de Shazer, S. (1987). Solution-focused therapy: Toward the identification of

therapeutic tasks. Journal of Marital and Family Therapy, 13, 349-358.

Murphy, J.J. (2008). Solution-focused counseling in middle and high schools (2nd

ed.)


O'Hanlon, B., & Rowan, T. (2003). Solution oriented therapy for chronic and severe mental

illness. New York: Norton.

O'Hanlon, W. H., & Weiner-Davis, M. (1989). In search of solutions: A new direction in

psychotherapy. New York: Norton.

White. M., & Epston, D. (1990). Narrative means to therapeutic ends. New York: Norton.


Suggested Internet Resources

Jeffrey T. Guterman, Ph.D.

PowerPoint for this Institute is available at http://JeffreyGuterman.com

Twitter: http://twitter.com/JeffreyGuterman

Facebook: http://facebook.com/jeffreygutermanpage

International Center for Clinical Excellence (ICCE)

http://www.centerforclinicalexcellence.com

Scott D. Miller, Ph.D.

http://www.scottdmiller.com

Institute for Solution-Focused Therapy

http://www.solutionfocused.net

Solution-Focused Brief Therapy Association (SFBTA)

http://www.sfbta.org


http://twitter.com/JeffreyGuterman

http://facebook.com/jeffreygutermanpage

http://www.centerforclinicalexcellence.com/


http://www.solutionfocused.net/

http://www.sfbta.org/

solution-focused counseling: advanced techniques and applications (handout)

Education

solutionfocused counseling

solutionfocused tasks

solutionfocused checklist

principles of solution

stages of solution

education session description

education session objectives

session task