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Expressive Therapies Capstone Theses Graduate School of Arts and Social Sciences(GSASS)

Spring 5-18-2019

Solution Focused Brief Expressive Arts TherapyDavid ShermanLesley University, davidsherman82@gmail.com

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Recommended CitationSherman, David, "Solution Focused Brief Expressive Arts Therapy" (2019). Expressive Therapies Capstone Theses. 214.https://digitalcommons.lesley.edu/expressive_theses/214

SolutionFocusedBriefExpressiveArtTherapy

CapstoneThesis

LesleyUniversity

May18,2019

DavidSherman

Specialization:ExpressiveArtsTherapy

ThesisInstructor:ElizabethKellogg,PHD

SolutionFocusedBriefExpressiveArtTherapy

Abstract

Thisgraduatecapstonethesispaperandprojectproposesanewtherapeutic

interventioncalledSolution-FocusedBriefExpressiveArtsTherapy

(SFBExAT).Thisinterventionandapproachisbasedonthesynthesizedtheories,

techniques,andprinciplesofExpressiveArtsTherapy(ExAT)andSolution-

FocusedBriefTherapy(SFBT).Areviewofrelevantliteratureonthecombined

useofSFBT,ExATandexpressivetherapies,aswellasonthefoundational

literatureoftheindividualtheoriesestablishesconceptualgroundsfora

SFBExATmodel.ASFBExATinterventionisdevelopedandexplained.The

interventionwasultimatelyappliedinahospitaloutpatientsettingwithateenage

client.Theprocess,resultsandimplicationsoftheinterventionareexplored.The

paperandprojectultimatelyoffersSFBExAT’spotentialforfurtherresearchand

usebymentalhealthprofessionals.

Introduction

ExpressiveArtTherapy(ExAT)andSolutionFocusedBriefTherapy

(SFBT)aretwomoderntherapeuticmodals.Thiscapstonethesisexploredthe

waysExATandSFBTmaybeintegrated.TheaspirationisthatSFBT’s

treatmentmodelandconceptswillbeexpandedbeyondtalktherapyinthehope

thatclientsmaydance,draw,act,playandembodytheirsolutions,whileframing

ExATconceptsandpracticeswithinSFBT’sformalizedtreatment.SFBExAT

willexpandonthelanguageandexperienceofSFBTwhilefocusingand

groundingExAT’screativeexpression.

Thesolution-focusedbrieftherapytreatmentmodelisanevidence-based,

client-centeredtherapymodel(Gingerich&Peterson,2012).Solution-focused

brieftherapycliniciansaspirenottonarrateorsolvetheirclient’shistoryand

problemsbuttolistenandselectfromtheclient’sownexpressedthoughtsto

assisttheclientinbuildingtheirownsolutiontotheirownperceivedproblem

(Froerer&Connie,2016).

Expressiveartstherapyusescreativeexpressionasameansandanendfor

therapeutictreatment.Expression,creativityandart-makingareuniversal

languagesandExATandexpressivetherapieshavebeenclinicallyutilizedwith

diversepopulations(Knill,2005;Matto,Cocoran,&Fassler,2003;Moosa,

Koorankot,&K,2017;Tyson&Baffour,2004;Ylonen&Cantell,2009).

Expressiveartstherapyisapsychotherapeuticapproachuntoitselfandcanalso

beutilizedharmoniouslywithotherclinicalapproachesandtheories(Tyson&

Baffour,2004).ByintegratingExATwithotherevidence-basedmodalities,the

techniquesofexpressivetherapiescanbemoresharplyfocusedinamodern

clinicalcontext.

ThisthesisexpandsthedevelopmentofSolutionFocusedBriefExpressive

Therapy(SFBExAT)bycomparingrelevantliteratureoneachapproachand

examininginstanceswherethetwomodalitieswereintegratedtodevelopanew

effectivetreatmentmethod.

PersonalIntroduction

Ihavehadtwointernshipsduringmygraduatestudiesinmentalhealth

counselingandExAT.Inmyfirstinternship,Iworkedinaresidentialfacilityfor

youngmenagingoutofthefostercaresystem.Manyoftheresidentswere

teenagemalerefugeeswhowerequiteresistanttoformaltherapy.Furthermore,

thelanguageandculturalbarriersmeanttraditionaltalktherapywasadifficult

task.InterningatthissitewastheinitialinspirationforexploringSFBT.Moosa,

Koorankot,andK(2017)aswellasYlonenandCantell(2009),showedeffective

useofSFBT,specificallyintegratedwithexpressivetherapypractices,when

workingwithrefugeeclients.Expressiveartstherapy,initsgentleapproachand

useofuniversalartisticlanguage,hadalreadyshownpromisewhenworking

withtheseyoungmen.SFBT’seffectivenesswithmandatedclients(DeJong&

Berg,2001),aswellasitsabilitytoworkwithmultipleculturalperspectivesina

lessthanidealtherapeuticenvironment(Moosa,Koorankot,&K,2017),drew

metoSFBT.

TheinspirationtodevelopSFBExATwasfurtherinspiredbythe

environmentandthepatientsatmycurrentinternshippositionasanoutpatient

expressiveartstherapistinthebehavioralhealthservicesdepartmentata

children’shospital.Asanoutpatienttherapistinametropolitancity,Iworkwith

patientsfrommultipleculturalandsocio-economicbackgrounds.Therealitiesof

life(transportationdifficulties,monetaryissues,unstablefamilystructures,

weather,etc.)meanpatientsoftenstruggletoattendtheirappointments.

Insurancecompaniesalsolimitthenumberoftherapysessionsallocatedfor

patients.Thesefactorsallspeaktothebenefitsofbrieftherapeuticapproaches.

Byintegratingmyexpressivetherapiestrainingwiththeevidence-based

theoryofSFBT,IhopetocontinuealigningmyExATorientationwithinthe

moreacceptedorunderstoodtherapeuticpractices.Manyoftheproposed

benefitsofExATaredifficulttomeasure(Donohue,2011).Agoalofthisproject

wasthatbyjointlyapplyingExATandSFBTthemoreephemeralyetstill

effectiveaspectsofExATwouldbegroundedbytheverytangibleworkof

SFBT.

LiteratureReview

Inthisliteraturereview,thecoreprinciples,practices,techniques,and

approachesofSBFTandExATwerepresentedandcompared.Modernresearch

inthecombineduseofexpressivetherapieswithSFBTwerediscussedand

synthesized.Thestudiescitedaredynamicintheiruseofdifferentart

modalitiesandtheapproachtocombiningtheseartmodalitieswithSFBT

techniquesandpractices.Theliteraturereviewultimatelyshowedthepotential

forthecontinuedresearchanduseofSFBTwithExATaswellasthe

developmentoftheSFBExATinterventionandmodel.

IntroductiontoSolution-FocusedBriefTherapy

Solution-focusedbrieftherapy(SFBT)isamoderntherapeuticmodel

currentlyemployedbymentalhealthprofessionalsaroundtheworld.Solution-

focusedbrieftherapywasintroducedduringthe1970sinWisconsinbyde

Shazer,Bergandcolleagueswhileworkinginfamilytherapy(Berg&DeJong,

1996).Theteamcreatedaclient-centeredtherapeuticapproachthatfocusedon

solutionsinabrieftimeframe(Trepper,McCollum,DeJong,Korman,Gingerich

&Franklin,2012).Unliketraditionalpsychoanalyticmodels,SFBTdoesnotrely

onthetherapisttoderiveanswersorsolutionsbyexploringthepsychological

rootsofproblems.InthepracticeofSBFT,clientsdevelopsolutionsbychanging

theirperceptionofandinteractionwiththeirgoal(Berg&DeJong,1996).SFBT

focusesonsolutionsthroughtheidentificationofclients’strengthsinordertoset

goals.Thisstrength-basedmodelmotivatessmallchangesinabrieftimeframe,

withthehopethatthesesmallchangesinspireand/orbegetlargerchangethat

continueinthelongerrun.Basictenetsofthemodelincludeabeliefinall

clients’desiretochange,theirintrinsicindividualstrengthsanduniquepersonal

solutions(Schmit,Schmit,&Lenz,2016).

WhileSFBT’snameseemstosayitall,howSFBTisimplementedis

dependentonindividualclinicians.Intheirmeta-analysisonSFBT,Schmit,

SchmitandLenz(2016)assessedthefidelityoftheuseofSFBTinqualitative

studiesbyidentifiedspecificSFBTtechniques.Thetechniquesincluded:(1)

settinggoals,(2)themiraclequestion,(3)scalingquestions,(4)finding

exceptions,(5)therelationshipquestion,(6)consultingbreak,(7)compliments,

(8)homework,and(9)focusonwhatisbetter(Schmit,Schmit,&Lenz,2016).

NoneofthestudiesanalyzedbySchmit,SchmitandLenz(2016)employedall

ninetechniques.

IntheirDelphiStudy,FroererandConnie(2016)identifytheconceptof

solutionbuilding,nottheaforementionedSFBTtechniques,asthekeytenentof

SFBT.Solutionbuilding,accordingtoDeJongandBerg(2001),isa

collaborationbetweenclinicianandclienttoresolveproblemsbyempowering

theclient’sstrengthsandresources.Afterinterviewingwhotheydeemedas

relevantSFBTclinicians,FroererandConnie(2016)definedsolutionbuildingas

“acollaborativelanguageprocessbetweentheclient(s)andthetherapistthat

developsadetaileddescriptionoftheclient(s)preferredfuture/goalsand

identifiesexceptionsandpastexceptions”(p.25).Thestudysuggeststhatthe

cornerstoneofSFBTisacollaborativelanguagebetweenclientandclinician,

wheretheclinicianadeptlyparticipatesinathree-partpracticeoflistening,

selecting,andbuilding(Froerer&Connie,2016).SFBTclinicianslistentothe

clients’specificlanguagewhendiscussingpastsuccessesandpreferredfutures.

Theyselecttheclients’statedwordsandgoalstoaskthoughtfulquestions,

identifyexceptionsandoffercompliments.Theclinicianhelpsclientsbuild

solutionsbymakingapparentthedetailsoftheclient’sexpressedfuturegoals,

currentstrengthsandpastexceptions(Froerer&Connie,2016).BergandDe

Jong(1996)deemthisselectingandamplifyingofaclient’sexpressedthoughts

as“deconstructedexposure.”Whileaportionofavailableresearchdefines

SFBTmainlybyspecifictechniques(Gingerich&Peterson,2012;Kim,2008;

Matto,Cocoran,&Fassler,2003;Moosa,Koorankot,&K,2017;Schmit,

Schmit,&Lenz,2016),othersputmoreemphasisontheskillandintentofthe

practitioner(Berg&DeJong,1996;DeJong&Berg,2001;Froerer&Connie,

2016;Tyson&Baffour,2004;Ylonen&Cantell,2009).Ultimately,SFBTisa

solution-orientedlanguageandperspectivethatusesspecifictechniqueswithin

thatperspectivetoelicitchange(Trepper,etal.,2012).

Solution-FocusedBriefTherapyTechniques

Thisemphasisontheclinician/clientcollaborativeconversationisnotto

belittletheuniquetechniquesintrinsictoSFBT.Thesetechniquescanbeapplied

differentlybutalwayswiththeintentionofassistingtheclienttobuildsolutions

(DeJong&Berg,2001).ASFBTapproachtogoalsettingisstrength-based,

client-centered,concreteandaccessible.Cliniciansassisttheclienttoidentifya

goalthattheydeemworthyandphrasetheirgoalinsolution-focusedlanguage,

e.g.,“Iwill”not“Iwillnot”(Nims,2007).Theclinicianassistsclientto

identifyagoalthatisrealisticinsizeandscope.

WhilesolutionbuildingisthefoundationalgoalofSFBT,theuseofthe

miraclequestionisthekeystoneofthepractice(DeJong&Berg,2001;

Gingerich&Peterson,2012).Themiraclequestionhelpsclientsexperiencetheir

goalbydirectingthemtoimaginethatwhiletheywereasleepamiracleoccurred

wheretheirsolutionhassuddenlybecomereality.Byexploringthispossible

future,theclientbetterdefinestheirgoalandexperiencesa“virtualrehearsal”of

theirsolution(Trepper,etal.,2012).Clientsmayusethistimetoexplorehow

theirdailylives,interpersonalconnectionsandsenseofselfwouldimproveif

theirgoalisachieved.

Theexceptionquestionassistclientstofindatimewhentheydidnot

experiencetheirobstacle,anexceptiontotheirusualexperience.Byidentifying

atimewhentheclienthasexperiencedtheirsolution,theclientrealizesthattheir

solutionispossible(Trepper,etal.,2012).Additionally,identifyinganexception

isanopportunitytoexplorewhatelements(people,environments,etc.)theclient

wouldneedtoreachtheirgoal(Trepper,etal.,2012).Lastly,byacknowledging

thattheyhave,ifonlyforamoment,experiencedtheirsolution,clientscan

identifythepersonaltraitsandstrengthstheycanusetoreachtheirgoalmore

sustainably(Nims,2007).

Thistechniqueofcomplimentsseemssimpleenough;clinicianscontinue

topraiseandcomplimenttheirclientswheneverpossibleandforanysmallstep

theyhavetakentowardstheirgoal(Trepper,etal.,2012).Thistechniqueisan

exampleoftheoverallpositivisticperspectiveanSFBTpractitionerexpresses.

SFBThomeworkisanopportunityforclientstoexperimentwithfinding

andexperiencingexceptionsandsolutionsintheirdailylives(Trepper,etal.,

2012).Homeworkexperimentsmayincludemakingtheclient’sgoalmore

concreteorpretendingyourmiraclehashappenedandseeingwhonotices(De

Jong&Berg,2001).

IntroductiontoExpressiveArtsTherapy

ExATbeganforminginthe1960s.EarlytheoristssuchasSeanMcNiff

andPaoloKnillfoundconnectionsbetweenculturalhealingmethodsand

creativeexpression,whichtheyappliedtopsychotherapy(Donohue,2011).

Knill(2005)foundhealingvalueinthemovementbetweenartforms.Another

ExATpioneer,NathalieRogers(1993)integratedherfather’sclient-centered

therapeutictheoryintoherExATtheoryoftransferringbetweenart

forms/modalities,whichshenamedtheCreativeConnection.MitchellKossak

(2015)proposedthattheimprovisationalelementsofart-makingcreates

therapeutichealing.Morerecently,CarmenRichardson(2016)hasdevelopedan

ExATtreatmentmodelforworkwithadolescentsurvivorsoftrauma.

Richardson’sworkinspiredthisthesisinitsevolvingofExATintomoredefined

clinicalformulations.AsNathalieRogers(1993)stated,“Partofthe

psychotherapeuticprocessistoawakenthecreativelife-forceenergy.Thus,

creativityandtherapyoverlap”(p.1).

Whiletherearemanytheories,principlesandpracticesofExATthatdiffer

frompractitionertopractitioner,atitscoreExATisthepracticeofintegrating

imagery,storytelling,dance,music,drama,poetry,movement,andvisualarts,to

nurturegrowth,developmentandhealing(Rogers,1993;Richardson,2016).

WhatdifferentiatesExATfromindividualexpressivetherapymodalities(i.e.art

therapy,musictherapy,dramatherapy,dance-movementtherapy,etc.)isnotonly

ExAT’suseofmultipletraditionalartmodalities(painting,dancing,acting,etc.)

butabeliefthatallplay,creation,andexpressioncanbetherapeuticpractice

(Rogers,1993).McNiff(2009)spoketotheintrinsicsimilaritiesandoverlapping

conceptsbetweenvariousartforms,suchasmovement,narrative,metaphor,

embodiment,play,spontaneityandself-realization.Additionally,expressivearts

therapistsfindtherapeutichealinginthetransferbetweenartisticmodalities:

movingfrompaintingintodancing,drummingtopoetry(Donohue,2011;Knill,

2005,Kossak,2015;Rogers,1993;Richardson,2016).Thismovementbetween

modalitiesisknownasintermodaltransfer(Donohue,2011).Bymovingthrough

artmodalities,aclientcanaccessaflowofartmakingthatcontinually

stimulatesthesensesandawakescreativity(Knill,2005).Theintermodal

approachpushesclientstomovearoundtheExpressiveTherapiesContinuum,a

hierarchicaltheoryofexpressivetherapieswheredifferentareasofthebrainand

levelsofcreativityarestimulatedbydifferentartisticexperiences(Hinz,2009).

ExATintermodalapproachutilizesmultipleformsofverbal,non-verbaland

bodilyexpression,whichinvolvesbothofthebrain’shemispheresaswellas

corticalandsubcorticalprocessing(Cozolino,2002).ExATrecognizesthepower

ofeachartisticmodalityandthemovementbetweenmodalitiestoinspire

healing,creativityandchange(Donohue,2011).

Solution-FocusedBriefTherapiesandTheExpressiveTherapies

TherearenotableexamplesoftheuseofSFBTwithotherspecific

modalitiesofexpressivetherapies.ByexaminingtheuseofSFBTwiththese

moresingularlydimensionalmodalities,onecanexplorethepotentialfor

integratingSFBTwithintermodalExATtechniques,interventionsandtheory.

ThissectionreviewstheuseofExATpracticeswithinaSFBTcontext.

Intheir2009casestudy,YlonenandCantellcreatedamodelintegrating

SFBTwithDanceMovementTherapy(DMT).Workingwithrefugeeminors,

YlonenandCantell(2009)usedthenarrativeaspectsofDMTtoencourageself-

esteem,goal-settingandsolution-building.Theseresearchersfoundthattheir

clientswereabletobuildsolutionsthroughnarrativedance.Intheirpractice,

YlonenandCantell(2009)didnotintroducetheSFBTtechniquesexplicitly,but

didintegrateSFBTinterviewingtechniquesintoDMTdirectives,maintaining

theirworkasSFBT-informedpracticedandcallingformoredevelopmentofthe

combinationofSFBTandDMTtheoryandpractice.

Intheirworkwithadolescentsinaninpatientfacility,Tyson&Baffour,

(2004)foundsuccessintegratingMusicTherapyprinciplesandpracticeswitha

SFBTapproach,whilealsoemployingvisualartsandcreativewriting.Tyson

andBaffour(2004)directedtheirpatientstofindinspirationandtorecognize

theirstrengthswithindifferentartmodalities,thentoapplythesestrengthsin

buildingsolutionstotheirpresentingconcerns.Theirclientsrespondedtothis

methodthroughanobservableincreaseinengagementandhopefulness.

Matto,Corcoran,andFassler(2003)builtaneffectivecohesionbetween

ArtTherapyandSFBT.Theystated,“arttherapyworkstowardcollaboration

betweenpractitionerandclient.Indirectedartexperiences,thepractitionersides

withtheclientbysolicitingvisualrepresentationoftheclient’sreality”(p.266).

Thesamestudyfoundsignificantsimilaritiesbetweenthemannerinwhichan

arttherapistcollaborativelyprocessesartworkwithaclientandthesolution-

buildinginterviewtechniquesofSFBT.Accordingtothestudy,inart

Therapy/SFBT,thecliniciancollaborateswiththeclientbyofferingsolution

focusedartprompts.Aftertheartworkiscompleted,theclinicianusesaclient-

centeredlanguageinassistingtheclienttoelicitpersonalmetaphorsand

narrativesfromtheirartworks.Matto,CorcoranandFassler(2003)appliedthe

SFBTconversationalmodelwithArtTherapy,andadditionallyapplied

therapeuticart-makingtoSFBTtechniquessuchasscalingandthemiracle

question.

Moosa,Koorankot,andK(2017)combinedSFBTandArtTherapyin

theirworkwithrefugeechildren.Theirstudyusedvisualartstoovercome

differencesincultureandlanguagetohelptheirclientsexperiencetheirmiracle

questionthroughdrawingandpainting.Whiletheirprocessdidnotseemas

comprehensiveasMatto,CorcoranandFassler’s(2003),theyderivedan

effectivemethodwhenusingartmakinginthecontextofthemiraclequestion.

Currentresearchoffersconceptsandmethodsforusingexpressive

therapieswithintheSFBTmodel.Theuseofnarrativedancing/dramacanlead

clientstodiscovernewpossibilities(Ylonen&Cantell,2009).Visually

representingthemiraclequestionoffersclientsawaytoexplore,expressand

processtheirmiracle(Moosa,Koorankot,&K,2017)Inordertoidentify

problems,clientscanactorvisualizetheproblem:“ifyourproblemwasan

animal”forexample(Matto,Cocoran,&Fassler,2003).Usingvisualarts,

clientsdrawtheirproblem,identifythestrengthstheyexhibitintheirdrawing,

andreframetheminanewway(Matto,Cocoran,&Fassler,2003).

Implementingmusictherapyinterventions,clientscanwriteamotivationalsong

orchooseapersonalthemesongandwriteastorytogowiththesong.(Tyson&

Baffour,2004).Thesestudiesshowgreatpotentialforcombiningtechniquesand

theoriesofSFBTandotherexpressivetherapies.

ExploringSolution-FocusedBriefExpressiveArtsTherapy

Byreviewingrelevantliterature,thecombinationofSFBTandexpressive

therapiesseemtoexpandandelucidateonthetheoriesoftherespective

approaches.Thesereviewedstudiesshownotonlyaharmonybetweenthe

theoriesbutalsopotentialforSFBExATasanewandrelevantmodel.

Solution-buildingisafoundationforSFBT(Froerer&Connie,2016).To

buildasolutionis,inessence,aformofcreativeaspiration:anexpressionofa

newnarrative.Thisconcepthasbeeneffectivelyandnaturallyadaptedwith

expressivetherapyinterventions(Matto,Cocoran,&Fassler,2003;Moosa,

Koorankot,&K,2017;Tyson&Baffour,2004;Ylonen&Cantell,2009).

SFBTandexpressivetherapies,includingarttherapyanddance/movement

therapy,havebeenutilizedwhenworkingwithrefugeeyouth(Moosa,

Koorankot,&K,2017;Ylonen&Cantell,2009).Bothstudiesfoundpotentialin

integratingExATandSFBTinthatartisticexpressionwasausefultoolfor

transcendinglanguageandculture,andthatfocusingonsolutionswaspragmatic

andconciseinunstabletherapeuticsettings.Bothstudiesreportedthatthrough

expressivetherapies,clientswereabletocreate,innovate,express,andembody

theirsolutionsbeyondthescopeofsolelytalking.Indescribingthecompatibility

ofarttherapyandSFBT,Matto,CorcoranandFassler(2003)explained,“Art

therapyisawaytooperationalizespecificSFTtechniques,allowingformulti-

sensoryengagementthatincludesvisualandmotormodalities”(p.265).This

multi-sensoryengagementisonlyintensifiedwhencomparingSBFTtothe

multi-artmodalitymethodofExAT.FroererandConnie(2016)spoketothe

importanceoflanguageinSFBT,referringtotheprocessofsolutionbuildingas

“acollaborativelanguageprocessbetweenclient(s)andthetherapistthat

developsadetaileddescriptionoftheclient(s)’preferredfuture/goalsand

identifiesexceptionsandpastsuccesses…”(p.32).Goaldevelopmentand

solution-buildingcanmovebeyondcollaborativespokenlanguagetoa

collaborativeartisticexpression.

Whenoneviewscreativeexpressionasalanguage,thepotentialof

SFBExATbecomesclearer.Theartisticexpressionisaformofcommunication

thatcancommunicatefeelingsoftenhiddenbyverballanguage(McNiff,2009).

Theresearchshowsthattheuseofexpressiveartstherapiesworksharmoniously

with,whilealsoexpandingupon,thelanguageandtechniquesofSFBT.

RelevanceofSFBExATExplored

InthedevelopmentofanSFBExATintervention,itisimportantthatthe

interventioniseffectiveandrealisticforclientsandpatientsinamodern

therapeuticenvironment.AreviewoftheconceptsthatmakeSFBExATrelevant

forclientsandclinicianswillfollow.

BenefitsandNecessitiesofBrevity

TheHelsinkiPsychotherapyStudyfoundthatthosepracticingSFBT

averaged10sessions,asopposedtolong-termpsychodynamictherapy,which

averaged232sessionsorshort-termpsychodynamictherapywithanaverageof

18.5sessions(Gingerich&Peterson,2012).ClientswhoreceivedaSFBT

approachreportedanincreasedsenseofsuccesswithinfewersessionsina

shortertimeframethanwithotherpsychodynamicapproaches(Gingerich&

Peterson,2012).FocusingonExATthroughanSFBTlensmayincreasethe

potentialforutilizingexpressivetherapieswithinthestructureofinstitutional

treatmentplans,aswellasindifferingtherapeuticenvironments.

SFBExATandAdolescence

ExATandotherexpressivetherapymodalitieshavegreatpotentialwhen

workingwithadolescentpopulations(Richardson,2016).ExATiseffectivewith

teenagersasitoffersanon-verbalmeansforexpressionandagentlerwayto

approachdifficultsubjects,whilealsoaccessingtheirinnatecreativity(Moosa,

Koorankot,&K,2017;Richardson,2016;Riley,1999;Tyson&Baffour,2004).

Twoprominentmeta-analysesofSFBT,bothcitingaboutadozenstudiesof

SFBTwithteens,founddatasupportingitseffectivenesswithteenagers(Kim,

2008;Schmit,Schmit,&Lenz,2016).DeJongandBerg(1998)reportedthat

89%ofteenagersmadeprogresstowardstheirgoalswithSFBTintervention.

Promisingstudiesontheintegrationofsolution-focusedtherapiesandexpressive

therapieswithadolescentpopulationsisavailable(Matto,Cocoran,&Fassler,

2003;Moosa,Koorankot,&K,2017;Richardson,2016;Tyson&Baffour,

2004).Arttherapist,Riley(1999),proposedthatexpressive,solution-focused,

andbrieftherapiesareallbeneficialforteenagepopulationswhenadministered

singularlyorinconjunction.

Inmyexperiencethatteenagersmayberesistanttoexpressivetherapy.

Adolescentsmaybemandated,orfeelasthoughtheyaremandated,toattend

therapy.SFBTisaneffectivemodelforengaginginvoluntaryclientsasit

focusesontheclient’sownunderstandingandstrengths(DeJong&Berg,2001).

Asaclient-centeredapproachthatfocusesonclients’innatewisdomand

creativity,SFBExAThasthepotentialtoworkwithteenagersbygivingthemthe

controlsandartsuppliestocreatetheirownsolutions.Manyadolescentclients

areresistanttotherapyduetotheirpreconceptionthattherapywilllast

indefinitely(Riley,1999).Solution-focusedbrieftherapeuticapproachesnot

onlyencouragesteenstoparticipateintherapybutalsosuggeststhat,nomatter

theseemingimmensityoftheirproblem,asolutionispossible(Riley,1999).A

moreskepticalopiniononSFBT’seffectivenesswithteenagersmaybethatteens

aredrawntotheinstantgratificationSFBToffersoverthemoreincremental

changespossibleinlonger-termtherapies(Schmit,Schmit,&Lenz,2016).

SFBTInterviewingandClient-CenteredApproach

InpracticingSFBTandExAT,thereisnotonlyemphasisonspecific

directivesbutalsoontheapproach,perspective,andintentionoftheclinician

(Rogers,1993;Trepper,etal.,2012).ExATisuniqueinallowingforclientsto

expressthemselveswhileusingtheircreationsasameansforself-exploration.

JustastheSFBTtherapistassumesthatclientsaretheexpertontheirownreality

andsolutions,ExATtherapistsbelievethattheclientisthesoleproprietorof

theirartworks’meaningandpurpose(McNiff,2009).ExATandotherexpressive

therapiesutilizeinquisitivepracticestosolicitaclient’sownexplorationand

understandingoftheirart(Matto,Cocoran,&Fassler,2003).Justastraditional

SFBTpractitionersuselanguage-basedinterviewingtoaffirmandamplify

clients’goals,successes,strengths,andresources,thoseutilizingSFBExATcan

utilizeart-makingtoaccomplishthesesameobjectives.SFBTinterviewing

aspirestoassistclientsinrevealingtheirproblemsoverdeconstructedexposure

(Berg&DeJong,1996).Thisdeconstructedexposureismadeapparentthrough

thedetails,metaphors,experiences,andcreationofartisticexpression.Moora,

Koorankot,andK(2017)achievedthesameaffirmationandamplification

throughvisualart.Beyondsimplyusingartstoevadelanguageandcultural

barriers,theirusesofdrawingandpaintingallowedclientstosurpasslanguage

tofindnewresourcesforbuildingsolutions.Art-makingfurtherspersonal

investmentintheirprocessofchange(Matto,Cocoran,&Fassler,2003).

Makingarthelpstheclientexternalizetheirproblem,seeingitoutsideofand

apartfromthemselves.ThesestudiesshowtheeffectiveuseofSFBTlanguage

inanon-verbalcontext.

Method

Idevelopedandimplementedaninterventionwiththehopesof

discoveringhowSFBExATmaybeimplementedinclinicalpractice.The

methodisbasedinSFBTandExATtheoriesaswellasresearchthatintegrated

bothapproaches.Ihopedtoexamineitsusewithaparticularclientwhilealso

exploringthemethod’suniversalapplicability.Theprojectwasimplemented

withoneclientoverthreesessionsinanout-patientbehavioralhealthdepartment

ofachildren’shospital.

Goals

Mygoalwastheapplicationofdifferingartformsasameanstoexpress

andprocessthedifferentstepsoraspectsofSFBTtreatmentandinterviewing.

Myhopeistousearttovisualizeproblems.Dance/movementwouldhelpclient

embodytheirmiracle.Actingwouldservetopracticeandremembertheirpast

successes.Musicwouldexpresstheclient’sfeelings.Throughmulti-modaland

intermodalwork,theclientwillbeabletoexpressthemselvesinmultiple

dimensionsofexpressionandexperiencetheirsolutionthroughmultiplesenses.

WiththisSFBExATmethod,theclientcanhavecreativetoolsforsolution-

buildingandartisticevidenceoftheirabilitytochange.Oneobjectiveofthe

projectwasitseffectiveimplementationwiththeclient,meaningtheclientwill

participateintheintervention.Anotherobjectivewastolayafoundationforthe

furtherdevelopmentofSFBExAT.Ultimately,thehopewasfortheclientto

begintoexpresstheirsolutions.

Subject

ThisSFBExATinterventionwasimplementedwithoneteenageclient

diagnosedwithanxiousanddepressivesymptoms.Iconsultedwithmy

supervisorandprofessorstoensurethisinterventionwasinlinewiththeclient’s

treatmentplanandgoals.Theclienthadbeenseeingmeinanoutpatientsetting

forsometimeandwehadestablishedanotableleveloftherapeuticrapport.In

thenameoftransparency,theclientwasinformedabouttheinterventionandits

relationshiptomygraduatestudies.Includingthisclientasthesubjectofmy

projectwastheoreticallysoundasSFBTandExATarerelevanttotreatingthe

client’sdiagnosisandcurrentdevelopmentalstage(Berg&DeJong,1996;

Kim,2008;Gingerich&Peterson,2012).

Theclientwasa17year-oldfemalewithadiagnosisofmajordepressive

disorderandgeneralizedanxietydisorder.Asa17yearold,theclientwas

concernedabouthersymptom’seffectsonheracademicgoals,whichinclude

applyingforcolleges.Ibelievetheprojectwasbeneficialfortheclientasit

focusedhertherapybyestablishingcleargoalswhileempoweringandengaging

theclientinthetherapeuticprocess.

Process

ForthisprocesssectionIhavewrittenmyproposedinterventionina

directivestyle.Thischoiceisinthehopethatothercliniciansmayunderstand

andreplicatetheinterventionintheirownpractice.Thissectionmaybeviewed

asstep-by-stepdirectionsforimplementingthisSFBExATintervention.An

explanationandprocessingoftheactualexecutionoftheinterventionis

exploredintheresultssection.

Theproposedmethodwasbrokenintothreesectionsiscarriedoutover

threesessions.Iultimatelydecidedonusingthreesessionforanumberof

reasons:(1)Ididnotwanttorushthesessions,givingpatientstimetoworkon

theirartisticexpressions,(2)Iwantedtoleavetimeinthesessionsforpatientsto

beabletocheckinwiththetherapistandbeableprocessorreportanypressing

informationoutsideoftheSFBExATintervention,(3)Ihopedtoleavetimein

sessiontocompletetwosectionsifforanyunforeseenreasonitwasnecessary.

AsIdevelopedtheproject,threedistinctsectionsbecameapparent.

SectionOne:GoalSettingandStrengthBuilding

Thefirstsectionoftheinterventionworksintwodistinctparts.Thefirst

partintendsfortheclienttowarmupartisticallywhilealsoclarifyingtheirgoals.

Inthisvisualartintervention,theclientclearlyexpressasenseofself,agoaland

anobstacle.ThispartoftheprocesstakesonthegoalsettingtechniquesofSFBT

throughanExATexperience(Berg&DeJong,1996).Inexpressingasenseof

self,agoalandanobstacle,theclientcanreachnewmeanings,metaphors,ideas,

andclarity(Matto,Cocoran,&Fassler,2003).

GoalSetting

Alargepieceofpaperorcanvasandartmaterialsforpaintingordrawing

aresupplied.Theclientisdirectedtodelineatethreeverticalsectionsonthe

paper.Onthesectiontotheleft,theclientdepictsthemselvesinanywaythey

areinspired.Questionstheclinicianmayaskwhiletheclientcreatesshouldbe

strength-basedandcouldinclude:“Whoistheyouthatdeserveslove?”or“Who

areyouatyourbest?”.Iftheclientisunabletoconnectwiththesequestionsdue

toresistanceoranegativesenseofself,theclinicianmightask,“Whoisthe

personyouwanttobe?Whoisthepersonthatgotoutofbedandmadeitto

therapytoday?”Oncethisdepictionofselfiscompleted,clientisdirectedtothe

sectionontherightofthepaper.Heretheyareinstructedtodepicttheirgoal.

Whiletheclientshouldbetheonetocreatetheirowngoal,thecliniciancanhelp

thembuildtheirgoalthroughthoughtfulquestionssuchas:“Whatdoyouhope

toaccomplishintherapy?”or“Wheredoyouhopetobeinthreemonths?”Once

thegoalisvisualized,theclientisaskedtotakeamomenttoreflectbefore

movingtothethirdstepoftheintervention.Thislaststepoccursinthemiddle

portionofthecanvas.Theclientisdirectedtoexpresstheobstaclekeepingthem

fromtheirgoal.Thecliniciancancollaborativelybuildwiththeclientbyasking

questionssuchas“Whatistheobstacleyoucanchange?”or“Whatisthe

obstacleinsideofyou?”Theclinicianthenallowstheclienttimetoreflecton

theircompletedpiece.Byworkingnon-chronologicallyonthepaper,theclientis

hopefullystruckbythefinalartproduct,clearmetaphoroftheobstacleblocking

theirselffromtheirgoal.Theopportunitytoaddorchangeanypartofthe

finishedartpiecetheyfeelinspiredtochange.Ifanegativereactionoccurs,the

clientshouldbedirectedtoaddasourceofstrengthtoaccompanytheir

depictionofself.Thissourceofstrengthmaybeaperson,apersonaltalentor

symbol.Lastly,theclinicianaskstheclienttowriteaword,soundornamefor

eachsectionoftheirart.

StrengthBuilding

Forthesecondsectionofthisfirstsession,theself/obstacle/goalartworkis

placedsomewhereawayfromtheworkspace.Theclientisgivenapieceofpaper

forwritingandawritinginstrument.Theclinicianinstructstheclienttothinkof

personalstrengthsand/oratimetheywereproudofthemselves.Theclientis

thentoldthattheywill,forashorttime,becomeanewcharacter;anewspaper

journalistwiththeassignmenttowriteanarticleontheclient.Thisarticlewill

focusonaspecifictimetheclientfeltaccomplishedorontheclient’sgeneral

strengths.Iftheclientexpressesresistance,itmaybeexplainedthatthisonly

needstobeashortparagraph.Whentheclientfinishes,theyaredirectedto

circlethethreemostpositiveorstrength-basedwordsinthearticle.Theclientis

thenaskedtomemorizethesewords.

Next,theclientisinformedthattheyarenolongerthejournalistwitha

writingassignment;theyarenowafamousactoratanimportantaudition.The

cliniciandesignatesanareathatinvokesthefeelingofastage.Theclienttakes

thestage.Theclinician,takingontheroleofthedirector,explainsthatthelines

ofthisauditionarethethreepositivewordstheyhavememorized.Theclient

performstheirthreewordsthreetimesandeachtimetheywillbeperformingin

adrasticallydifferentmoviegenre.Theclinicianmaypromptthisexperiential

withthedirectionsto“Sayyourlinesasanactionherohangingoffthesideofa

helicopteroverabuildingwheretheyjustsavedtheday,”and/or“Repeatthe

linesasadramaticactorinascenewherethetruthisrevealedtotheworldon

everyTVscreenontheplanet,”and/or“Now,sayyourlinesasasoapoperastar

revealingasecrettotheirromanticinterest.”Theclientcouldaddanygenre

scenariostheydesire.Theclinicianisencouragedtoapplaudtheperformance.

Finally,theclientisgivenalargesheetofpaperorposterboardandaskedto

writetheirthreewordsasbigpossibleonthepaper.Thepaperissavedforfuture

sessions.Thisconcludesthefirstsession.

SecondSession:MiracleQuestion

Thesecondsessionfocusesonthemiraclequestion.Thesessioninvolves

mindfulness,visualartsandembodiedmovement.Beforethesession,the

self/obstacle/goalartworkandtheposterwithstrengthwordsintheroom.The

clientisgivenpaperoracanvasandart-makingtoolsandwillbeinvitedtosit

comfortablyanddirectedtoeithercloseorlowertheireyes.Whentheclientis

comfortable,thelightsintheroomwillbedimmedtoinvokearelaxedstate,

whilerelaxingmusicorsoundscanbeplayedsoftly.Theclinicianwillbegina

storyoftheovernightmiracle.

Imagineyouaresleepingonanaveragenight.Yousleeppeacefully.(Here

theclinicianmayallowtimefortheclienttofallintomindfulrelaxation).While

youareoffdreaming,unknowntoyou,amiracleoccurs.(Heretheclinicianwill

useawindchime,singingbowlorotherwhimsicalinstrumenttoinvokeasense

ofthemiraclehappening.Yourobstaclehasmiraculouslyandsuddenly

disappeared!(theclinicianwillturnonthelights.)Itistimetowakeuptolive,

whatyouthink,isanaverageday.Butyouwillsoonfindoutyourmiraclehas

happened!

Theclientshouldhavetheireyesopenandawarenessofbeingbackinto

theroom.Theclientisinstructedtovisuallydepicttheirmiracleday,expressing

themselvesonthecanvascontinuouslyandallowingtheircreativitytoflow

uninterrupted.Whiletheclientcreates,theclinicianofferssolution-building

questions,suchas:“Howdoyoudiscoveryourmiraclehasoccurred?Whendo

youfigureitout?Whileyouwerebrushingyourteeth?Onthewaytothebus?”

Theclientisadvisedtoanswerthesequestionsonthepaper,notverballytothe

clinician.Timewillbeleftbetweenquestionsfortheclienttocreatetheir

answers.Theclinicianbeginsofferingmoredirectivequestions,“Whoelsesees

thatyourmiraclehastakenplace?Isityourmother,yourfriend?Howdothey

know?”Aftersometime,theclinicianinquiresonhowthedaydiffersfroman

averagedaynowthattheobstacleisgone.Theclinicianaskswhatfeelings

mightariseintheclientastheygothroughtheirdaywithouttheirobstacle.The

clientisguidedtothinkaboutwheretheywouldbe,whowouldbethereand

howwhatwouldtheybedoingaweek,amonthorevenayearafterliving

withouttheirobstacle;wouldtheyaccomplishtheirgoal?

Whentheclientfeelsasenseofcompletionoftheirartwork,theyare

directedtostandandenteranopenareaofthetherapyspace.Theclinician

requeststhattheclientwalkaroundthespaceandactoutdailytasksinthe

mannerofanaveragedaywiththefocusonpostureandbodily-engagement.For

example,theclientmaywalktothebusstopwiththeirshouldersslumpedand

theirfeetshuffling.Theclientwillthenbedirectedtomoveandgoabouttheir

dayinamannertheyimaginetheymightiftheirmiraclehadoccurred.The

clientisinquiredonhowtheirbodyfeelsaftertheyhaveexperiencedtheir

miracle.Theclinicianmayinvokescenariosfortheclienttoenact,suchashow

theclientgreetsafriendorwalkshomefromschool.Thecliniciancan

encouragetheclientbyreflectingthechangestheyseeintheclient’smovements

frombaselinetomiracle.Toconcludethesession,theclienttakestimetoname

theircompletedartworkandwriteitsomewhereonthecanvas.

ThirdSession:Exception

Thethirdsessionisorientedaroundtheexceptionquestion,wherethe

clientidentifiesatime,evenifonlyabriefmoment,whentheirobstaclewas

gone(Berg&DeJong,1996).Moosa,Koorankot,andK(2017)deemedthe

exceptionthesmallmiracle;Ienjoycallingitthecuternameofmini-miracle.

Again,liketheprevioussession,theartofthepastisarrangedorpresented

fortheclientwhentheyarrive.Theclientreviews,eitheraloneorwiththe

clinician,theirself/obstacle/goal,strengthwords,andmiraclequestionartworks.

Paper/canvas/artmaterialsaremadeavailablefortheclient.Theclinicianshould

admittoclientthatovernightmiraclesmaynotbereal,however,mini-miracles

dooccur.Theclienttakesamomenttothinkofatime,nomatterhowshort,

whentheyexperiencedamini-miracle,atimewheretheirobstaclewasgoneand

theirmiraclewasoccurring,orwhentheymettheirgoal.Theclientvisually

representthismini-miraclemoment.Theclinicianmayofferpromptssuchas

“Howdidyoufeelwhilethismini-miraclewasoccurring?Whatwasdifferent

aboutthatday?”Whentheclientfeelsasenseofcompletion,theyareaskedto

searchtheirartforpeople,thingsoranyotherelementthathelpedthem

experiencetheirminimiracle.Theyaredirectedtolookforanythingintheart

thatmayhavepreventedtheirexperienceofthemini-miraclefrompersisting.

Theclientisthenbeencouragedtoerase,paintoverorchangethesehindrances,

aswellasaddanyelementsthatwouldhelptheirmini-miraclelastevenalittle

bitlonger.Finally,theywillnametheirmini-miracleartwork.

Musicalinstrumentsarethenofferedtotheclient.Thisinstrumentmaybe

rhythmicormelodic.Theyareaskedtoimprovisemusicthatisinspiredbytheir

self/obstacle/goalartpiece.Oncetheyareready,theclinicianguidesthemto

findasong,pattern,melody,themeormotifthatencapsulatestheir

improvisation.Afterwards,theclientisnextguidedtoimprovisemusicbasedon

theirmiracle,bigandmini.Again,theclientcreatesasong,pattern,melody,

themeormotifbasedontheirmiracleimprovisation.Finally,theclientisasked

toplaytheirself/obstacle/goalsong,thentoswitchtotheirmiraclesong.Client

switchesbetweenthesesongsafewtimes,ultimatelyfinishingwiththemiracle

song.Clinicianoffersanexplanationofthismusicalmetaphor:

Wesometimesexperienceourobstacleandwesometimesexperienceour

miracle.Justbecauseourobstacleappearsdoesnotmeanwearestuck.

Becausewehaveexperiencedamini-miracleandwecanexperienceit

again.Nomiracleshappenovernight,butwecanuseourstrengthsand

resourcestomakemini-miracleshappenmoreoftenandforlonger

durations

Nowtheclinicianmayreflectbacktoclientthestrengthstheyidentified

andthehardworktheyputintotheselastsessions.Attheconclusionofsession,

clientmaytaketheirartworkshome.Clientisgivenanexperimenttotryoutside

ofsession.Clientisaskedtopickameaningfulpersonintheirlivesand,inthis

specialperson’spresence,actasthoughtheirmiraclehasactuallyoccurred.The

clientisdirectedtocontinuetoactthiswayuntiltheirpersonnoticesthechange.

Thisthree-sessionSFBTtreatmentinterventionintegratestheSFBT

techniquesofgoal-setting,complementing,miraclequestion,andexception

questionwiththeExATtechniquesofintermodalcreativeexpression,intermodal

transfer,andembodiment.Theinterventiondirectstheclienttobuild-solutions

throughcreativeexpression.

Results

Inthissection,theactualimplementationoftheSFBExATintervention

withtheclientwillbeexplained.Theclientparticipatedintheentiretyofthe

intervention.Thefollowingdescribesthesesessions.

FirstSession

Onarrivalatthefirstsession,clientoneimmediatelyexpressedthatshe

wasreadyfortheproject.Theclientisinclinedtowardsvisualartsandquickly

engagedintheself/obstacle/goalexperiential.Iofferedguidedquestionsand

thoughtsasclientdrew.AsIhadexpected,shewantedextratimetocomplete

theself-portionoftheartwork.Iexplainedthatthisprocesswasmeanttobe

spontaneousandthattheclientwouldbeabletoelaborateartisticallyontheir

pieceatanothertime.Theclientinterpretedthedirectiveata

perceptual/affectivelevel,expressingtheself/goal/objectfigurativelyand

graphically(Hinz,2009).Forexample,theselfwasahumanfigurewiththe

characteristicfeaturesoftheclient.Thefinalproductlookedsimilartoacomic

strip.Whentheclientlookedatthefinalproductsheexpressedsurpriseatthe

clearpictureshehadproducedofherselfbeingobstructedfromhergoalbya

clearobstacle.Theclientwasgivensomeadditionaltimetoaddorchangethe

imageinanywaysshefeltnecessary.

Theclientusedmostofthetimeallottedtowriteherarticle.When

identifyingandcirclingherstrength-basedwordsclientaskedifshecouldcircle

asmanywordsasshewantedbutultimatelychoseonlythree.

Fortherecitingofthestrength-basedwords,theclientwasreluctantto

standandentertheareadeemedthestage.Iencouragedclienttoengageby

explainingthatshecouldparticipatehowevershefeltcomfortableaslongasshe

participated.Shewarmedtotheactivityandultimatelyofferedherown

additionalmoviescenariostoplayout.TheclientandIbothfinishedthissection

ofthesessionwithlargesmiles.

Whenwritingherthreewords,theclientpickedpersonallymeaningful

colorstowriteeachwordandfilledtheentirelargepage.Iofferedcompliments

ontheclient’sparticipation,openness,aswellasreaffirmingthestrengthsthe

clientself-identified.Clientwasofferedthehomeworktosaythesewordsto

herselfifherobstaclebecamepresentduringtheweek.

SessionTwo

Thissessionoccurredoneweekaftertheinitialsession.Clientspokeona

specificissuethatwasonhermindbeforeengagingintheactivity.Theclient

displayedengagementduringtheintroductiontothemiraclequestion.Oncethe

lightswereonandtheartinterventionwasintroducedsheinitiallybegan

drawinginasmallsectionofthepaper,butastimewentontheartbecamevery

elaborate.Clientagainappearedtoworkattheperceptual/affectivelevel,

drawingsceneswithstickfigures(Hinz,2009).Aftertheclientreportedshefelt

finishedwithherart,shewasgivenquestionstoaskherselfaboutherartwork.

Sheexpressedsomeconcernwhensherealizedclinicianwouldnotprocessthe

finishedproductwithher.Itwasexplainedthattheartcouldbeprocessedat

anothertimeandtheclientwasencouragedtotrustherownunderstanding.The

clientreportedthatshefelthighlyinspiredbythisaspectoftheprocess.

Duringthemovementportionofthissession,theclientactedoutmorning

ritualroutineswithadramaticslumpingoftheshoulders.Whenshewasaskedto

transfertomoving/actingoutthedayafterhermiracle,shenoticeably

straightenedherposture.Theclientwasallowedtoactouthermiraclewithout

muchclinicaldirection;however,afteronlyafewminutessheexpresseda

feelingofdisengagement.Ibegantonarratetheclient’sday,“Howwouldyou

walktoschoolwithyoursolutionachieved?Whatwouldyoudodifferentlyon

theway?”Ialsoplayedcharactersinformedbyclient’sinstruction,suchasthe

teacherwhoishappythatclientcompletedherhomeworkorherbrotherwhois

surprisedsheisnotsleepingintheafternoon.Neartheactivity’send,theclient

reporteddifficultyinactingoutthemiracle.Theclientwasaskedtosimply

moveinawaythatexpressedherfeelingsaboutthemiracle.Sherespondedwith

increasedengagementtothismoreexpressivetakeontheintervention.

Theclientleftsessionwiththehomeworktotrytoactasthoughher

miraclehadoccurredandseeifanyofherfamilymemberswouldnotice.

Session3

Thethirdsessiontookplacetwoweeksafterthesecondsessiondueto

clientillness.Afteraquickcheck-in,theclientwasreintroducedtotheartshe

createdandthestrengthwordsshewroteintheprevioussessions.

Toexpressherexceptionvisually,theclientagainchosecolorpenciledand

createdafigurativedrawing.Theclientwasthenofferedarangeofmusical

instrumentsanddecidedonaxylophone.Whenclientwasinvitedtomakea

songaboutatypicalday,sheexpressedconfusion.Theinstructionswere

elaboratedthatthissongwouldbeimprovisationalandopentoher

interpretation.Clientengagedinfreestyleplayingand,aftersomeminutes,was

abletocondensehersongintoasimplemotif.Themotifwasasingle

reoccurringnotewithanoffbeatrhythm.Clientwasgiventimetoreflectonhow

shefeltduringherbigandmini-miraclesbeforeperformingthemiraclesong.

Herplayingutilizedmorenotesandhadaspritelyrhythm.Whenclientwas

askedtofocusthissongintoamotifshecreatedamelodywithaverysillyfeel,

whichmadeherlaugh.Despiteherhumoroustakeonthemiraclesong,theeffect

wasevidentwhenclientalternatedbetweentheeverydaysongandthemiracle

song.Onceclientstoppedplaying,thepossiblemetaphorsofthisexperience

werediscussed.Clientclearlyexplainedhowshefeltthatevenifsheishavinga

toughdayitcanchangeforthebetter.

Tofinishthesession,Iofferedtheclientpraiseforherengagementand

reiteratedhowshehadembodiedherstrengthwordsthroughoutthelastthree

sessions.Possibilitiesforhomework/experimentswerediscussedanditwas

decidedthattheclientwouldremembertocomplimentherselfanytimeshefelt

hermiracleoccurringevenifshecouldnotsustainitindefinitely.Shedecidedto

leaveherartwiththecliniciantobeprocessedinafourthsession.

Discussion

Thisthree-partSFBTwassuccessfulonafewlevels.Ononelevel,the

clientwasengagedinartmakinganditsinherenttherapeutichealing(McNiff,

2009).Onanotherlevel,theclientidentifiedgoals,personalstrengthsandbegan

buildingsolutions(Berg&DeJong,1996).Theclientengagedinintermodal

expression,whereshecouldintegratehersolutionsthroughdifferentsensesand

experiences(Knill,2005).ThroughtheintegrationofSFBTandExATintoa

SFBExATmodel,theclientultimatelywasabletovisualize,embody,and

expresshergoals,strengthsandsolutions.

Materials

Inkeepingwiththeclient-centerednatureofSFBT,theclientwasallowed

tochooseherart-makingmaterials.Coloredpencilsweretheonlymaterialclient

chosetoworkwithoverthethreeweeks.Thischoiceofmaterialislinkedto

howclientinterpretedtheartisticdirectives,whichshedidinafigurative,

graphicandnarrativemanner.Whilethischoicewaslefttotheclientand

appearstohavebeenbeneficialforher,Iquestionhowthisinterventionmay

havebeendifferentifclientwasonlygivenpastelsortoldtofingerpaint.Would

themiracleartworkhavebeenmoremetaphoricalorkinesthetic(Hinz,2009)?

Thebenefitofthiscouldhavebeentoopentheclienttodifferentthinkingand

experiences(Knill,2005).However,byallowingtheclienttochooseherown

materialsandmeansforexpression,theclienthasbeengiventhecontrolover

herownsolutions.

Processing

Inmypastexperienceswiththisclient,shehasbeenveryreluctantto

processherartinameaningfulwaywithme.Idecidednottoprocesstheart

duringthesethreesessionstoallowtheclienttodecidewhatherartmeanstoher

withoutthepressureofanoutsidewitness.Notemphasizingprocessingthe

artworkfreestheclientfromtheconcernaboutthefinishedproductandallows

themthefreedomtoexperiencereflectionandexpressioninthemoment

(Kossak,2015).Ibelievethischoicewaseffective.Theclientwasabletocreate

artfreefromanyrealitybutherown,whilebeingempoweredtolistentoher

ownprocess.

Bynotmakingtheprocessingofartmandatory,theclientfeltthedesireto

talkaboutherartemanatefromherself.Inafollow-upsession,wedidreturnto

theartworksforprocessingfromtheclient.

Strength-Building

Whenworkingwithteens,TysonandBaffour(2004)putparticular

attentiononbuildingself-esteemintheirpatientsasakeyaspectoftheir

expressiveSFBTtreatment.Byputtingfocusdirectlyontheclient’spersonal

strengthsthroughexpressivetherapiestechniques,theclientwasgivenacreative

waytoidentifyandcelebrateherownsourcesofstrength.Theselectionofthree

wordsofferedanindirectwayfortheclienttocomplimentherselfandcreatea

personal-strengthmantraofsorts.Fortheclient,positiveself-talkisdifficult.

Usingartasameansforstrength-buildingcircumventedherresistances.

VisualArts

Theuseofvisualartgavetheclienttheopportunitytoexpressherfeelings

andseeherthoughts.Theartpiecesallowtheclienttoexternalize,visualizeand

expressthepossibilitiesandeffectsoftheirmiracle(Moosa,Koorankot,&K,

2017).Byexpressingthismini-miracleexperiencevisually,theclientcan

processtheeventwhileaddingresourcesandchanginglimitations(Matto,

Cocoran,&Fassler,2003).Thevisualartexpressioncanbenarrative,

metaphorical,literalorexpressivewhilestillservingtheclientintheirsolution-

building(Matto,Cocoran,&Fassler,2003).Thelevelofartisticskillisnot

important,astheartonlyhastohavemeaningfortheclient.

Movement

Theuseofmovementwasdifficultfortheclienttoaccess.Theclientwas

initiallyresistanttothemovementportionofthemiraclequestionintervention

butwithtimeandproperclinicaldirectivesclientultimatelyengaged.The

movementmixedexpressiveandnarrativeelements,whichtookthemiracleoff

thepageandcreatedabodilyexperience.Theuseofmovementcanofferthe

clientasomaticunderstandingofthemiracleapartfromthevisualoneshe

experiencedwithdrawing(Ylonen&Cantell,2009).Throughmovement,the

clientsawhowherbodychangedquitedrasticallybetweenherbaseline

experienceandwhensheexperiencedhermiracle.

Drama

WhileYlonenandCantell(2009)takeaDMTapproachtoSFBT,the

narrativeelementsoftheirworkandmyownexperiencesasanexpressive

therapistgaveampleinspirationtointegratedramatherapyintotheintervention.

Byactingoutthemiracledayorauditioningwiththestrengthwords,theclient

wasallowedtoexplorehersolutionfromadifferentperspectivefromtalkingor

drawing.Aclearexampleofthiswaswhentheclientactedoutascenewithher

brotherduringhermiracle.Theclienthadnototherwisethoughtabouthow

happyherbrotherwouldbetoseeherachievehergoal.Whilethenarrative

aspectofthemiraclemovementwasnotinitiallyused,thisclinicianintegratedit

tomeettheclient’sneeds.Itbecameapparentinthisexchangethat,clinicians

whowanttopracticeSFBExATneedtobeskilledinthepracticeofExAT,as

wellintheSFBTapproach.

IntermodalTransfer

Whiletheclientfellintoacomfortablepatternwhenengaginginvisualart

withcoloredpencil,byusingintermodaltransferandmultipleartmodalities,the

clientismadetomovebetweendifferentstatesofbeingandlevelsofexpression

(Knill,2005).Thisintermodalexperienceallowstheclienttoexperienceher

solutionthroughdifferenthemispheresofthebrainandmultiplesensesofthe

body(Hinz,2009).Iftheinterventionshadbeensolelyvisualartsbased,the

client’smulti-sensoryengagementintheprocesswouldhavebeenlimited.The

projectutilizedandtransferredbetweenvisualarts,freewriting,poetry,drama,

movement,andmusic.Theclientemployedimagination,narrative,performance,

improvisationandembodiment(Donohue,2011;Knill,2005;Kossak,2015;

McNiff,2009).Theuseofmultipleartforms,somefamiliartotheclientand

somenot,offerednewavenuesforexpressionandsolution-building.Overall,the

clienthasexperiencedthetherapeuticbenefitsofmulti-modalexpressionand

intermodaltransferinvokingdifferentlevelsofexperienceontheCreative

ContinuumandExpressiveTherapiesContinuum(Hinz,2009;Knill,2005;

Roger,1993).

TimeFrame

Thethree-sessionplanforthisprojectworkedoutverywellinregardto

fittinginnecessarytimeforclienttoengageinthemultipleactivities.Theclient

askedforafourthsession,andIagreethatafourthsessionwouldhavegreat

benefit.Inthefollow-upsession,clientexpressedthefeltbenefitsofpresenting

andprocessingherart,hergoals,andhersolutions.Duringthisfollowup,

cliniciancontinuedtotakeaSFBExATapproach,bylistening,selectingand

buildingfromclient’sperspective(Trepper,etal.,2012).

Implications

ItseemsapparentthatSFBExATcouldtakeonmanyformsdependingon

thestrengthsoftheclinicianortheneedsoftheclient.Tousemoreorless

drama,dance,visualart,free-writing,orintegratenewideasseemsbeneficial.

AsTrepper,etal.(2012)state,aprincipleofSFBTis“Ifsomethingisworking,

domoreofit”(p.33).Inthesamespirit,cliniciansskilledinSFBExATshould

understandthattheprocessisonethatcanbeadaptedandchangedaslongasthe

intentionistobenefittheclient.

Limitations

WhilethecreatorsandexpertsinSFBThaveresearchedandtheorizedthe

practiceintheattempttocreateatruepracticeofSFBT,theyacknowledgedthat

anaspectofpersonaltherapeuticstyleorinterpretationisanimplicitpartof

therapy(Berg&DeJong,1996;DeJong&Berg,2001;Gingerich&Peterson,

2012;Trepper,etal.,2012).TheSFBExATprojectIproposedandimplemented

isclearlydistinctfromapureSFBTapproach.Forexample,myprojectdidnot

includescalingtomonitorclient’ssenseofsolutioncompletion.Ihopeothers’

andmyfutureresearchwillfindnewandexcitingwaystoimplementSFBExAT

techniques.

TheExATinterventionsusedinthisprojectmaynotbetheperfectorsole

fitforeachcorrespondingSFBTtechnique.Forexample,theimprovisational

miraclesonginterventioncouldbereplacedwithapoeticwritingintervention.I

wouldproposethatfutureclinicianschangetheExATinterventionsand

modalitiesastheyseefitfortheirclientsortheirownprofessionalstrengths.

Conclusion

SFBExATproposesanewtherapeuticmodelthroughtheconjoining

ofthemultisensoryexpressionofExATwiththegoal-orientedapproachof

SFBT.TheSFBExATprojectshowedpotentialbenefitsforeachtherapeutic

modalbyfocusingExATprinciplesandpracticeswhileexpandingthecreative

languageofSFBTtheoriesandtechniques.Relevantliteraturehasstudiedthe

benefitsofaSFBTapproachwithexpressivetherapies.

ThethreesessionlonginterventionwassectionedaccordingtoSFBT

techniques.Thesetechniquesincludedstrengthbuilding,goalsetting,the

miraclequestion,exceptionsandhomework.EachSFBTtechniquewas

actualizedthroughthecreativeexpressionofExATpractices.TheuseofExAT

intermodalinterventionswasmeanttoengagetheclientviscerallyintheSFBT

solution-buildingprocessthroughplay,artisticexpression,embodiment,

improvisation,andmovement.ExATmodalitiesutilizedintheprojectwere

visualart,writing,drama,dance/movement,andmusic,aswellas,intermodal

transfer.SFBTinterviewingapproachandtechniqueswereintegratedintothe

ExATinterventionstocreatesolution-focusedandgoalorienteddirectives.

WhiletherearemanyinterpretationsofSFBTandExAT,thisSFBExATproject

stayedtruetoessentialprinciplesandpracticesofeachtherapeuticmodalwhile

expandingonthesetechniquesandtheories.Thispaperandprojectwill

hopefullypushfurtherunderstandingandadvancementofSFBExAT.SFBExAT

isamodern,relevant,pragmaticandaccessiblemodalwithimplicationsfor

varioussettingsandpopulations.Thispaperandprojectoffergroundsforfurther

studyanduseofSFBExAT.

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