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Sfbt us pt
 

Sfbt us pt

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    Sfbt us pt Sfbt us pt Presentation Transcript

    • Solution Focused Brief TherapySteve de Shazer& Insoo Kim BergOHanlon"Solution Behaviour" not "Problem
    • Social ConstructionistFocus on what clients want to achieveDoesnt focus on problemsDoesnt focus on past
    • How Brief a Therapy?Aim for 5 sessions45 mins each sessionRarely beyond 8 sessionsSometimes 1 session enoughAny improvements after 3 sessions?Increasegap between sessions as time goes on
    • Solution Focused Brief TherapyPrinciple 1Nobodys perfect all the time - even in theirproblemsWhat can these "exceptions" tell usThings people ordinarily do can contribute tosolution
    • Solution Focused Brief TherapyPrinciple 2Knowing where you wish to be makes getting thereeasierProblems cloud our view of futureLose sight of what we want apart from endingproblemClearer it becomes, greater chance of makingsolution
    • Basic Assumptions Clients have resources and strengths to resolve complaints Change is constant The therapist’s job is to identify and amplify change It is usually unnecessary to know much about the complaint in order to resolve it. It’s not necessary to know the cause or function of a complaint to resolve it.
    • Basic Assumptions continued A small change is all that is necessary.  A change in one part of the system can affect change in another. Clients define goals There is no one right way to view things.  Different views may be valid. Focus on what is possible and changeable, rather than what is impossible and intractable.
    • 3 types of Clients Visitors: no complaints, along for the ride; complimented and given no tasks Complainants: going along to placate and appease; complain, distant, observant, and expectant - given observational and thinking tasks Customers: Do Something – want to change; given behavioural tasks
    • Solution Focused Brief TherapyAsk questions about. . .Clients storyClients strengthsClients resourcesClients exceptionsRelationshipsSelf-esteem issues
    • Resources &ToolsMiracle QuestionScalingException-seeking questionsCoping questionsProblem-free talk
    • Typical First Session Opening: Social introductions, structure session Collect Complaints - Problem Rank Complaints  (What’s 1st, 2nd, 3rd) Discuss Exceptions
    • Typical First Session continued...Find out what client wants from sessions "Best hopes of our work together?"Find out small details of life if problemssolved Miracle question Miracle questionWhat do they already do that is successful "Tell me about when the problem is not there"What might change by taking a small steptowards hope "What would others notice about you?
    • Session Structure Miracle question process Exceptions / pre-session changes Identify Goals Scales: situation now, willingness, confidence Anything else/ Break Message
    • Subsequent Sessions Less Time on Complaint(s) More Time on Exceptions & Solutions  Opening: What’s different this week from last  Exceptions: elicit, recognise, discuss, amplify  Scaling: Accentuate any improvements Therapeutic Break – time for reflection & consider task for next week Compliments & Summary Tasks & Homework
    • Five Useful Questions The Miracle (Magic Wand) Question Has anything been better since the last appointment? What’s changed? What’s better? Can you think of a time in the past (month / year / ever) that you did not have this problem?  What would have to happen for that to occur more often? Scaling Questions 1 – 10 With all of that going on, how do you manage to cope?
    • Coping QuestionIdentify clent resources they dont even acknowledgeCan be used even in most pessimistic situationsGenuine curiosity helpsGenuine admiration for client helpsHelps identify referred futureEnsure client doesnt feel youre contradicting them"Despite all the problems you still work. How you do it?"
    • De Shazer’s MiracleSuppose that one night, while you are asleep, there is a miracle and the problem that brought you here is solved. However, because you are asleep you dont know that the miracle has already happened. When you wake up in the morning, what will be different that will tell you that the miracle has taken place? What else? (1988)
    • O’Hanlon’s Videotape Question Let’s say that a few weeks or months of time had elapsed, and your problem had been resolved. If you and I were to watch a videotape of your life in the future, what would you be doing on the tape that would show that things were better? (1987)
    • Scaling Scale of 1 – 10  1 is the worst it’s ever been  10 is after the miracle has happened Where are you now? Where do you need to be? What will help you move up one point? How can you keep yourself at that point?
    • Exception Questions Tell me about the times when (the complaint) does not occur, or occurs less than at other times. When does your partner listen to you? Tell me about the days when you wake up more full of life. When are the times you manage to get everything done at work?
    • Comparing PCT and SFBT1. PCT because historically it is a fundamental therapuetic approach has influencedmost approaches that have fol owed. Even CBT is now delivered from anempathetic relationship, albeit asymetric. SFBT is no different it draws on empathyand the relationship too.2. Most therapists now integrate different elements into their practice thereforecomparisons are based on unrealistic ideal types.
    • Similarities1. Both are client centred and value the client as the author of their own lives.2. Both emphasise client talk and see therapist utterances as having locutionary force e,g. metaphor paraphrasing and the miracle question, What and how something is said is important for both.3. Both are minimally directive especially compared to behavioural oriented therapies e.g. CBT and DBT.4. Both value the here and now in contast to psychoanalytic approaches.5. Both rely on tentative dialogue as opposed to direct challenge.6. Both focus on the clients frame of reference.
    • Differences1. In later Rogerian therapy there was/is an ultimate counselling/existential goal ie to become a fully self actualised being. SFBT is more concerned with short medium term goals focused on more effective adaption or coping.2. The above is based on philosophical differences related to the nature of reality. For SFBT it is socially constructed and relative. For Rogers scientific truth was possible and differences of world view were temporary not eternal.3. PCT therapists tend to reflect and paraphrase whereas SFBT therapists would use questioning more to draw out the clients thoughts and emphasise positives.
    • Differences4. SFBT will use reinforcing techniques for behaviours and attitudes it sees as positive (within the frame reference) e.g. the therapist compliments the alcoholic for drinking less.5. SFBT is short 5-8 45min sessions. In theory PCT can be for as long as the client wishes with the proviso that the therapist can end if they believe it unproductive.6. Possibly, PCT can “allow” acceptance of immutables such as death and inequality whereas SFBT is about amplifying hope in order to better cope.
    • Useful ReferencesBerg, I. K. (1991) Family Preservation: A Brief Therapy Workbook.London: BT Press.Berg, I.K. & Miller, S. (1992) Working with the Problem Drinker: A SolutionFocused Approach. New York: Norton.de Shazer, S. (1985) Keys to Solution in Brief Therapy. New York: Norton.George, E., Iveson, C. & Ratner, H. (1999) Problem to Solution: BriefTherapy with Individuals and Families. London: BT Press.Hawkes, D., Marsh, T. & Wilgosh, R. (1998) Solution-Focused Therapy: AHandbook for Health Care Professionals. Oxford: Butterworth–Heinemann.Hoyt, M. F. (1984) Single session solutions. In ConstructiveTherapies (ed. M. F. Hoyt). New York: Guilford.
    • Useful ReferencesJacob, F. (2001) Solution-Focused Recovery from Eating Distress. London:BT Press.Lethem, J. (1994) Moved to Tears, Moved to Action: Brief Therapy withWomen and Children.London: BT Press.MacDonald, A. J. (1994) Brief therapy in adult psychiatry. Journal of FamilyTherapy, 16, 415–426.OConnell, B. (1998) Solution-Focused Therapy.London: Sage.Rhodes, J. & Ajmal, Y. (1995) Solution-Focused Thinking inSchools. London: BT Press.Sharry, J. (2001) Solution Focused Groupwork. London: Sage.Talmon, M. (1993) Single Session Solutions. New York: Addison-Werlely.