Theory and Practice of Counseling and Psychotherapy

Psych422

Chapter13: Postmodern Approach

(solution-focused brief therapy and narrative therapy)

Questions… If persons see therapists, in general,

what is/are the expectation(s) from their therapist?

If persons sees therapists for their problem, what is/are the final goals after completing the therapy sessions?

View of Human Nature Assume that realities are socially constructed.

There is no absolute reality.

View people are healthy, competent, resourceful, and have the ability to construct solutions and alternative stories to enhance their lives.

Help clients recognize their competencies and build on their potential, strengths, and resources.

Key Concepts of Solution-Focused Brief Therapy

Therapy grounded on a positive orientation --- people are healthy and competent

Downplay “past”, while highlight “present and future” View people are healthy, competent, and resourceful, and have

the ability to construct solutions to enhance their lives Therapy is concerned with looking for what is working Therapists assist clients in finding exceptions to their problems The therapy process is to focus on creating solutions rather than

talking about the problems

Basic Assumptions of Solution-Focused Therapy

People can create their own solutions Small changes lead to large changes The client is the expert on his or her own life The best therapy involves a collaborative

partnership A therapist’s not knowing afford the client an

opportunity to construct a solution

Therapeutic Goals Believe clients have the ability to define their goals and

the resources required to solve their problems

Focus on small, realistic, and achievable changes Small change leads to big change

Remain goal-directed and future-oriented E.g., what has changed since last session?

Talk about solutions instead of talking about problems

Therapist’s function and Role No knowing position: clients as experts about their own

lives.

Create a collaborative relationships

Create a climate of mutual respect in which clients are free to create and explore solutions

Help clients to explore what they would like things to be different, how to make a difference, and what signs to indicate the changes are happening.

Relationship Between Therapist and Client The therapeutic relationship is an important factor for

change to occur.

Solution-focused brief therapy is designed to be brief, so therapist must shift the focus as soon as possible from talking about problems to exploring solutions

Help clients to use their strengths and resources to construct solutions

Three Kinds of Relationships in Solution-Focused Therapy

Customer-type relationship: client and therapist jointly identify a problem and a solution to work toward. Realize personal efforts is required.

Complainant relationship: a client who describes a problem, but is not able or willing to take an active role in constructing a solution. Expect other person to change.

Visitors: clients who come to therapy because someone else thinks they have a problem. Disagree they have a problem.

Techniques Used in Solution-Focused Brief Therapy Pre-therapy change: What have you done

since you made the appointment that has made a difference in your problem?

Exception questions: Direct clients to times in their lives when the problem did not exist.

Techniques Used in Solution-Focused Brief Therapy

Miracle question: If a miracle happened and the problem you have was solved overnight, what would be different in your life?

Scaling questions: On a scale of zero to 10, where zero is the worst you have been and 10 represents the problem being solved, how would you rate your anxiety right now?

Techniques Used in Solution-Focused Brief Therapy Formula first session task: ask clients to observe

about what happens in your life (relationship, family…) that you want to continue to happen

Therapist feedback to clients: therapists provide summary feedback for clients--- compliment what clients have done toward effective solutions, provide rationale for the suggestions, and suggest a homework assignment

Case discussion Mary feels that she must win everyone’s

approval. She has become a “super nice guy” who goes out of her way to please everyone. Rarely does she assert herself, for fear that she might displease someone who then would not like her. How do you apply solution-focused brief

therapy to help Mary to solve her problem?

Case discussion Tom, a college sophomore, want to

overcomes his shyness around women. He doe not date and even des his best to keep away from women because he is afraid they will reject him. But he want to solve his problem. How do you use solution-focused brief

therapy to help Tome to solve his problem?

Questions? Reactions? What are your reactions? What did a therapist (Dr. O’Hanlon)

do? What can you as a therapist continue

to do by using solution-focused brief therapy?

Key Concepts of Narrative Therapy Listen to clients with an open mind Encourage clients to share their stories Listen to a problem-saturated story of a

client without getting stuck Therapists demonstrate respectful curiosity

and persistence The person is not the problem, but the

problem is the problem

The Therapeutic Process in Narrative Therapy

Collaborate with the client in identifying (naming) the problem

Separate the person from his or her problem Investigate how the problem has been disrupting or

dominating the person Search for exceptions to the problem Ask clients to speculate about what kind of future

they could expect from the competent person that is emerging

Create an audience to support the new story

Therapeutic Goals

Therapists invite clients to describe their experience in new language and facilitate the discovery or creation of new options that are unique to them

Narrative Therapist’s function and role To become active facilitators

To demonstrate care, interest, respectful curiosity, openness, empathy, contact, and fascination

To adopt a not-knowing position that allows being guided by the client’s story

To help clients construct a preferred alternative story

To separate the problem from the people (instead of person own the problem)

To create a collaborative relationship --- with the client being the senior partner

Therapeutic Relationship Emphasize the quality of therapeutic

relationship, in particular therapists’ attitudes Client-as-expert, clients are the primary

interpreters of their own experiences Therapists seek to understand client's lived

experience and avoid effort to predict, interpret, and pathologies.

Therapeutic Techniques No recipe, no set agenda, and no formula This approach is grounded in a philosophical

framework Questions—and more questions:

Questions are used as a way to generate experience rather than to gather information

Asking questions can lead to separating “person” from “problem”, identifying preferred directions, and creating alternative stories to support these directions.

Therapeutic Techniques Externalization & Deconstruction

Externalization is a process of separating the person from identifying with the problem

Externalizing conversations can lead clients in recognizing times when they have dealt successfully with the problem

Problem-saturated stories are deconstructed (taken apart) before new stories are co-created

Therapeutic Techniques Search for unique outcomes

Successful stories regarding the problem Creating Alternative Stories

The assumption is that people can continually and actively re-author their lives

Invite clients to author alternative stories through “unique outcomes”

An appreciative audience helps new stories to take root

Therapeutic Techniques Documenting the evidence

Therapists write and send a letter to clients between sessions regarding their strengths and accomplishments, alternative story, and unique outcomes or exceptions to the problems.

From a multicultural perspective Contributions

Fit with diverse worldview Clients provide their own interpretations of

life events Limitations

Diverse clients may expect therapist as a expert instead of “client-as-expert”

Summary and Evaluation Contributions

Client-as-expert (not knowing position) View people are competent and able to create

solutions and alternative stories Do not support the DSM-IV-TR labeling system A brief approach, is good for managed care. In general, studies provided preliminary support

for the efficacy of solution-focused brief therapy

Summary and Evaluation Limitations

No set of formulas or recipes to follow Inexperienced therapist may view SFBT as

techniques. However, the attitude of the therapist is critical to the success of outcomes.

Therapists need to be able to make quick assessments, assist clients in setting up the goals, and effectively use appropriate interventions