Day2JohnMurphyBarryDuncan

www.heartandsoulofchange.com June 18, 2010 Unleashing the Giant To Become Better at Serving Kids and Families John J. Murphy, Ph.D. www.drjohnmurphy.com Barry Duncan, Psy.D. www.heartandsoulofchange.com Psy.D. Getting the Ball Rolling Think About a Time… 1

www.heartandsoulofchange.com June 18, 2010 Client/Extratherapeutic Factors (87%) Feedback Effects 15-31% Alliance Effects Treatment Effects 38-54% 13% Model/Technique 8% Model/Technique Delivered: Therapist Effects Expectancy/Allegiance 46-69% Rationale/Ritual (General Effects) Duncan, B. (2010). On becoming a better therapist. 30-?% Washington DC: American Psychological Association Translating Research into Practice •How do traditional theories and models marginalize the role of clients? •How can research showing the impact of the client be used?; How can the client be recast in heroic roles? 2

www.heartandsoulofchange.com June 18, 2010 Unleashing the Giant? “People are generally trash.” —Sigmund Freud, father of psychiatry OUCH! 3

www.heartandsoulofchange.com June 18, 2010 The Killer D’s of Client Diminishment Dysfunction Disorder Disability Disease Deficit Damaged Not Reliable or Valid None ever related to outcome Identities •The Sick Child •The Victim Child •The Bad Child 4

www.heartandsoulofchange.com June 18, 2010 The Sick Child Disorder/Disease/Disability • Depression • ADHD • Early onset bipolar* • Under- Under-diagnosed • Under- Under-treated Invites treatment, medication, hospitalization, evaluation, watchfulness, monitoring, assessment, restriction, correction. The Victim Child Damage/Deficit/Disability • Trauma • Chronic • Impairment • Symptomatic • Lifelong Invites: Rescue, Treatment, Vigilance Treatment, 5

www.heartandsoulofchange.com June 18, 2010 The Bad Child Dysfunction/Delinquent • Conduct Disorder • Antisocial • Aggressive • Dangerous Invites punishment, seclusion, medication, control, diminishment, evaluation, retraining, correction Sexual Abuse: The Research • Two thirds of sexually abused children improve • Most children who present as asymptomatic remain symptom free (70%) • Asymptomatic children may be a resilient group that just copes well. Others may not display symptoms because the event was not experienced as traumatic, although exploitative and illegal. 6

www.heartandsoulofchange.com June 18, 2010 Sexual Abuse: Implications for Treatment • Sexually abused children improve over time with or without tx, but tx more effective than the passage of time. • Standards for practice are not different from other types of cases; Working with caretakers appears to be essential. • Given the diversity of child sexual abuse, no single tx is effective for all. . . Tx plans need to be individualized. “Children are like rivers: You can’t step in the same river twice.” •Children change with changes in context •Children change as they develop •Children’s identities are impressionable and mutable 7

www.heartandsoulofchange.com June 18, 2010 What Do You See? You’re RIGHT! Seeing is Believing OR Believing is Seeing? Some Stories Are More Useful Than Others The Kinder Gentler “D’s” • Dilemma • Distress • Difficulty • Discouragement • Discomfort While children certainly can and do experience pain and sadness, these experiences can be validated and described in ways that foster hope and activate strengths. 8

www.heartandsoulofchange.com June 18, 2010 Casting the Client in Heroic Roles • No formula here…more of an attitude requiring a balance between listening empathically with mindfulness toward resources that you know are there. • Identify not what clients need, but what they already have in their world that can be put to use in reaching their goals Telling Heroic Stories • What are the obvious and hidden strengths, resources, resiliencies, and competences contained in the client’s story? • What are the competing stories—the stories of clarity, coping, endurance, and desire that exist simultaneously with the confusion, pain, suffering, and desperation? • What is already there to be recruited for change? • What is already “right” and “working”? The Heroic Client 9

www.heartandsoulofchange.com June 18, 2010 Therapeutic Lessons from IQ Zoo B.B. Duck: The Thrill is (not) Gone A-Rod the Chicken Elton Rabbit Romeo & Juliet (The Real Story) Pigs…Portraits of Precision Building on Natural Resources Help kids and families recognize and apply their resources. • Special interests and talents • Resilience and coping • Heroes and influential people • Hunches about the problem/solution • Exceptions and small victories 10

www.heartandsoulofchange.com June 18, 2010 Finding the Heroic Child What are you good at? When I am at my very best, I am_____________. So you must be the kind of kid whose good at . . . How did you learn how to do that? Or were you just born that way? Who else knows you’re good at this? Who notices how good you are at . . .? What do they say to you about being good at . . . Who would not be surprised to see you stand up to . . . ? Finding the Heroic Child (cont) Bringing New Identity to the Problem: What would happen if you used your [strength, smarts, etc.] to defeat . . .? I bet this [problem] would be no match for a kid like you! Consolidating the New Identity: How are you going to stay on top of . . .? Create a What will you do if the problem comes back? How could your [parents, friends] help if the “change problem comes back? audience;” What else will you be able to do, now that you know you can defeat this problem? Celebrate! 11

www.heartandsoulofchange.com June 18, 2010 Involving the Heroic Family • Listen for strength and resiliency in the stories of parents, siblings, and caretakers • Listen for family members’ ideas members’ of change • Include family members in discussions of change • Give family members a role to play in helping change happen • Believe in the child’s family as a child’ source of love and support Real- Real-World Examples of Resources and Heroism in Kids and Families 12

www.heartandsoulofchange.com June 18, 2010 Andrew—the Disordered Child • Story of “ADHD” • Story of “Bed Wetter” • Story of “Classroom Disruption” Andrew—the Heroic Child • Story of a boy who knows his games, and his monsters. • Story of a responsible boy with knowledge of animals. • Story of a smart boy ready to take charge and depend on himself. 13

www.heartandsoulofchange.com June 18, 2010 Reggie—the Disordered Child • Story of a “Little Criminal” • Story of “Can’t Help Himself” • Story of “Attention Seeking” Reggie—the Heroic Child • Story of a “Confused and Remorseful” child • Story of a “Committed and Courageous” child who likes wrestling • Story of “Standing Up to Bruiser” vs. being bullied 14

www.heartandsoulofchange.com June 18, 2010 Stephen—“Killer D” Stories • Story of “criminal record” • Story of “gang involvement” • Story of “poor adaptability” Stephen—Heroic Stories • Story of a young man with vast experience. • Story of resilience. • Story of lessons learned from a lifetime of experiences. 15

www.heartandsoulofchange.com June 18, 2010 Allison and Family—Resilient with a Capital R • Caring Single Mother 2 jobs, therapy • Push On Little Soldier “We do what we must” • Friday Night Pizza • “They Forget About Saturdays” Resilience and Resources Revisited • Think of a time in your life that was very difficult, but you managed to get through it. • What personal resources did you draw on to get through this difficulty? • What family, spiritual, friend, or community support did you draw on to get through? • What does this story tell you about who you are and what you can do? • Who else knows this story about you? • What do you think they say this story says about who you are and what you are capable of? • Who wouldn’t be surprised that you stood up to this problem and prevailed? What made them so sure? 16

www.heartandsoulofchange.com June 18, 2010 Recruiting Personal Heroes and Influential People • Who do you respect most? • Who are your heroes? • What would they do if they were in your shoes? • What would they advise you to do? Recruiting Clients’ Ideas About Solutions • What do you think might help? • What have you thought about doing but haven’t yet tried? • What advice would you give someone else struggling with this problem? 17

www.heartandsoulofchange.com June 18, 2010 Becoming Change Focused • Listen for a change! Ask about and be curious about change: How did you do that? Where did that idea come from? • Validate the clients contribution to change. How is (drug/tx program) helping access strengths and resources that have always been there but were just beyond your grasp? The Exception is the Solution • Farmer sees approaching tidal wave… • The solution has no relationship to the problem 18

www.heartandsoulofchange.com June 18, 2010 Solution-Building Exceptions Problem names imply permanence. In reality, the severity, duration, and frequency of problems are in constant flux. These instances of freedom from the problem, even momentarily, are called exceptions. An exception is a specific circumstance in which the problem does not occur, or occurs less often or intensely. When is the problem not quite so bad or absent altogether? Even in seemingly dismal situations, exceptions exist. Exercise • Therapist/client/observer • Better if participants share real (but not too personal) struggles • Role-playing clients is second best, but okay 19

www.heartandsoulofchange.com June 18, 2010 Listening for a Change: What’s Right With You? • How do you cope with the problem? When do you cope a little better? • When are things just a bit better? • Tell me about times that you are able to overcome the temptation to engage in the problem? • Tell me about a time when the problem isn’t occurring and how you are able to make it that way. • Who or what is helpful or going well in your life? • What do you seek out for even a small measure of comfort? • What things are happening that you would like to see continue? Listening for a Problem: What’s Wrong With You? • Tell me about the problem. • How long has it been going on? • When did it start? • How often does it occur? • How does it make you feel? • Who all is involved in the problem? • Describe a recent example of the problem in detail. 20

www.heartandsoulofchange.com June 18, 2010 Listening for a Change The “Three E Interview” for Building on Exceptions • Elicit • Elaborate • Expand (solution building or reversing figure and ground) Relationship Factors The Alliance: • Relational Bond • Agreement on goals 38- 38-54% • Agreement on tasks Seven Times the Impact of Model/Technique…Accounts for Most of Therapist Variance Duncan, B., Miller, S., & Sparks, J. (2004). The Heroic Client. San Francisco: Jossey-Bass 21

www.heartandsoulofchange.com June 18, 2010 Quick Exercise: Relationship Factors What Works With and For You? The Therapeutic Alliance The Alliance Goals, Means or Meaning Methods: or Theory of Purpose Change Client’s View of the Relationship 22

www.heartandsoulofchange.com June 18, 2010 Relationship Factors in Child and Family Work • The relationship is related to outcome across diverse types of youth treatment • Tx characteristics (family, indv, behavioral, non- behavioral, etc.) do not moderate associations between the relationship and outcome. • The alliance predicts premature dropout in youth and family therapy--dropout rates over 40% Sparks J., & Duncan, B. (2010). Couple and family Therapy and the common factors. In B. Duncan et al (eds). The Heart and Soul of Change (2nd ed). Washington, DC: APA Relationship Factors in Child and Family Work (cont.) • Child-therapist and parent- therapist alliance related to changes in the child. • Parent-therapist alliance related to improvement in parenting skills and interactions at home • Child and parent evals of the alliance predict outcome better than therapist’s 23

www.heartandsoulofchange.com June 18, 2010 Remember… Working with kids and families means honoring multiple views. When they go home, everyone needs to feel you’re “on their side.” Translating Research into Practice •How have traditional theories and models minimized the role of the alliance and client engagement? •How can research showing the importance of the therapeutic alliance and client engagement be used? 24

www.heartandsoulofchange.com June 18, 2010 Attitude is Important Alliance is Central Filter • Is what I am doing and saying now building or risking the alliance? • Doesn’t mean you can’t challenge but rather that you have to earn the right and, consider the alliance consequences 25

www.heartandsoulofchange.com June 18, 2010 Alliance As An Overarching Framework: The Alliance Filter • Transcends any beh & is a property of all—from tech. to scheduling an appt • Engage in purposive work • Requires utmost attention & best clinical skills: proactive, conscience, hard work • Have to earn it each & every time; alliance is our craft; practice elevates to art Obtaining Recognizing Accommodating feedback and strengths and ideas, goals, adjusting resources preferences, services language Listening Alliance Giving Builders credit Validating concerns and Complimenting Asking perceptions 26

www.heartandsoulofchange.com June 18, 2010 How to Improve Outcome: Reliance on the Alliance Concern: Referred for oppositional behavior and bullying; Principal said he may not talk or cooperate Exception: Teacher said Ronald did “ a little better” during the past week Ronald: Consulting the Client: Ronald was asked for his advice to other students A Client Example “Police guards on both sides” (CBT Fantasy) “Take my own advice” (Responsibility Fantasy) The Client’s Theory of Change Pre- Pre-existing beliefs about the problem and change Duncan, B., Solovey, A., & Rusk, G. (1992). Changing the Rules. New York: Guilford. 27

www.heartandsoulofchange.com June 18, 2010 How to Improve Outcome Reliance on the Alliance Alliance Rebecca: Goals, Meaning or Means or Methods A Client Example Purpose Theory of Change Client’s View of the Therapeutic Relationship Wrapping Up, Looking Ahead •Client Knows Best OR Solutions You’ll Never Find in ESTs or Textbooks •Reliance on the Alliance OR It Takes Two to Tango 28

www.heartandsoulofchange.com June 18, 2010 “Chance favors the prepared mind.” Louis Pasteur December 7, 1854 Listen for a Change! Monitor Outcomes •Don’t leave change to chance •Make sure kids’ and families’ voices are included •What tomorrow with John and Jackie is all about 29

www.heartandsoulofchange.com June 18, 2010 Accommodate the Client Monitor Alliance • Don’t leave the alliance to chance • Make sure kids and families have a voice • What tomorrow with John and Jackie is all about 30

www.heartandsoulofchange.com June 18, 2010 Thank You! Unleashing the Giant To Become Better at Serving Kids and Families John J. Murphy, Ph.D. www.drjohnmurphy.com Barry Duncan, Psy.D. www.heartandsoulofchange.com Psy.D. 31

Day2JohnMurphyBarryDuncan

by Barry Duncan on Jun 05, 2010

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