Presented at the first solution-focused world conference in 2008

1. Utilizing Solution-Focused Brief Therapy Practices with
Long-term Psychiatric Patients in an Out-patient Program
Jeffrey Cotton, MS, Ph D Candidate
Setting: Hollywood Pavilion Intensive Outpatient Program, Hollywood, Florida
Ph D Candidate: Nova Southeastern University, Ft Lauderdale, Florida
Website: Cotton5150.com
E-mail: Cotton5150@aol.com

2. So, suppose that while we are spending this time
together today, that we did something very useful and
some great moments happened in our room. And later
on, when you leave this workshop and you think back
about what stood out for you, what is it that you will be
thinking of and telling others that made this experience
worth your effort to come here?

3. “Sometimes simple is not so easy.”
Insoo Kim Berg

4. Overview
* Setting: Intensive Out-patient Hospital
* Diverse Population: age, race, gender, education &
socioeconomic status.
* Treatment Context: Group therapy, 3 hours a day, 4
days a week.
* Common Diagnoses: Schizophrenia, Schizo-affective, Bi-polar Disorder,
mixed, and Major-Depressive Disorder, recurrent, severe. Substance Abuse,
in remission.

5. “Assumptions about causality are often based on
preconceived ideas about the problem.”
Paul Watzlawick
So let us move beyond the label of diagnosis...

6. Group participants are NOT ALWAYS acting as if they are...
a) out of touch with “reality,”
b) depressed,
c) anxious,
d) hearing voices,
e) paranoid,
f) hallucinating,
g) cutting,
h) suicidal,
i) isolative,
j) uncooperative,
k) moody,
l) lacking isight,
m) lacking awareness,
n) resistant,
o) unable to cope,
p) lacking impulse control,
q) experiencing low self esteem,
r) hostile,
s) delusional,
t) unable to focus,
u) dissociating,
v) unable to solve problems,
w) having low self esteem,
x) lacking judgment,
y) stuck,
z) or anything else you can plug in here.
Psychiatric patients are more than their label...

7. Treatment Approach of Hope
Solution-Focused Brief Therapy Practices in
The Group Context:
Miracle
Scaling Exceptions
Question
Relationship Not Knowing
Amplifying
Questions Stance

8. Addressing...
Whatever the patient
brings up...
Grief/Loss
Trauma
Family Issues

9. The Working on What Works Group: Behavioral Health
Monday Tuesday Wednesday Thursday
Goals Problem Solving Social Skills Grief/Loss
Enhance Problem Enhance Coping Enhance Social Address Unresolved
Solving Skills Skills Competence. Grief and Loss.
Coping Skills Team Building Family Systems Mental Health Issues/
Addiction Issues
Enhance Functioning/ Enhance Social Skills Enhance Knowledge/
Social Skills Understanding of Enhance Knowledge of
Family Relational the Recovery Process.
Patterns
Self-Empowerment Stages of Change Stress Management Process
Enhance Motivation & Decrease Psychotic/ Enhance Mood Sta- Enhance Communica-
Commitment for Clinical Syndromes. bility tion Skills
Change

10. How SFBT Techniques are Applied to Long-Term
Populations
Goal Setting
SF Art Therapy
Directives/Letter Writing
Scaling Motivation as
“self-empowerment”
Working on What Works
Question Utilization...

11. SFBT Questions that work well in group.
So, what needs to happen today so you know coming to
group has been useful?
What is it that you will take away from group today?
Who will notice when...
What is working for you today?
So, how was that a different experience for you?

12. SFBT Questions that work well
(continued).
How was it that you decided to make that happen?
How did you manage to get through that difficult time?
Where are you at on the scale? What is working for you to
be at the number you scaled yourself? What needs to be
different so that you can go up just one small notch, 10%?
And of course the miracle question...

13. Long-term use of the Miracle
Question:
So, on the eve on your birthday when you go to
sleep...and when you wake up on the day of your
birthday what is the first thing you would notice that
would let you know this miracle happened?
Religious Holidays
Thanksgiving
Anniversaries
My personal favorite: The in-session Miracle Question

14. In-session Miracle Question
So, suppose that while we are talking during this
session that something odd happens outside of our
room. But because we are having group, we don’t
know that something happened. Then, we finish our
session, you open the door and walk out, and you
notice that everything is different with the problems that
brought you here today...what is the first thing you will
notice as you go through the rest of your day that will let
you know that a miracle occurred while we were in
group?

15. Goal Setting: The Monday Group
The big 3 questions [post-miracle question].
1). What is better since we met last week?
2). So what do you want to see different, between
today and next week, so you know that coming here
has been useful?
3). What do you want to see continue for you this
week?
Rules...

16. Goal Sheet & Rules
Patients are invited {not required} to add their goals to
the community goal sheet for the new week.
The first rule is: The goal must be very small {one tiny
step}.
The second rule is: The goal must be specific. {only as
specific as the patient wants it to be}
The third rule is: list one or more resources that will help
you reach your goal this week. {always optional}
Example...

17. Goals for the Week Goals for the Week
First Name Weekly Goal Resources First Name Weekly Goal Resources
Discourse....

18. Therapist: So with all the difficulties you have
experienced in your life, how do you manage to
get up and come here to group everyday?
Client X: Its because I’m educated...it filters out
the evil.”
Therapist: Wow, so how is your education useful
for you so that you can continue your hard work in
group?
Pay attention to the language of the group for new ideas...

19. Solution-Focused Art Therapy/Letter Writing
In session task: Draw a picture or write about...
anything you can do
well.
someone special or
important to you.
a day when everything
was OK in your life.
Describe what was
different on that day.
your miracle picture.
anything you want.

20. Scaling the “Group”
10: The best group in all of Broward County, Florida...
9
8
7
6
5
4
3
2
1: The worst group in Florida...

21. Scaling “Group Therapy Progress
This Week”
10: My Group Therapy Progress is Excellent this week.
9
8
7
6
5
4
3
2
1: My Group Therapy Progress is low this week.

22. Notice any blossoming changes that will
emerge:
Patients will learn SFBT
language and often
repeat it in very unique
ways.
Scaling will take on its
own meaning.
Utilizing relationship
questions in group
builds cohesiveness.
Utilizing consultants for the group...

23. Our Solution-Focused Family and Consultants...
The Schmo Family

24. The Schmo Family Comes
out...
when examples of relational patterns are needed.
when things get boring.
to help build creativity and engages patients’ strengths.
the family can be integrated into solution focused
questions to include: scaling, miracle pictures,
exceptions, etc.

25. The one SFBT question session
Write down one question on the board and have the entire
group write down the answer {5 min} before anyone shares:
• Write down one stress management technique that
you’ve used in the past but are not currently using.
• Write down one one stress management technique
that you are currently using.
• Write down one stress management technique that
you have never used before and you are open to
experimenting with this idea.
• Create you own useful question...

26. The Support Seat Technique {formally known as the HOT Seat}
(a). Begin group by placing a chair, one that can rotate, in the
middle of the group circle. Next, ask if anyone would like to
volunteer and go into the Support Seat. Everyone in the group
is invited to ask the person in the Support Seat a question,
give a compliment, or make a supportive statement.
(b). When finished, the person in the Support Seat is
instructed to invite any group member to take their place in
the support seat to continue with the group process.
Note: before the group is familiar with this technique, it can be useful for
the therapist to go into the support seat first and invite the group to ask
you any questions they want to ask.
Special Note: This is not intended to be used for confrontation but rather
for support, encouragement, and especially compliments.

27. Balancing:
Process and Content
Creativity with Therapy
The Past, Present, & Future
Solution Talk and Problem Talk
Common Ground and New Common Ground

28. What ideas do you have?
Feedback?

29. Thank You!