This week we are learning about Solution-Focused Treatment. Please review the four Step by Step video clips paying careful attention to the clinician's use of solution-focused techniques. What do you notice that feels different than a general counseling approach or than CBT or psychodynamic therapy. Please identify an example where you see the clinician using the "Exploring for Exceptions" skill. How does this assist with Solution Building?
This approach feels more different in that, especially with the female clinician, there appears to be a lot more closed ended questions which is certainly the opposite to a lot of the other therapeutic interventions we have been discussing as of late. Although the session continues to focus around the wants and desires of the client, the clinician appears to be challenging the client a lot of times and the sessions, to me, don’t feel as relaxed and “safe.” I feel as though some of the clients appear defensive (ie: the husband during the couples therapy session) and that some of the questions are either difficult for the clients to definitively answer, or, these are questions they have not given much thought to in the past. I think that all therapies should have goals and solutions that both the therapist and client work together in developing, however, I find this approach a little invasive and almost forceful. I understand the idea is to focus on what steps can be made now to make positive changes but I also feel like sometimes clients just need to vent and have someone listen to their needs, providing empathy and validation rather than always asking questions (for example when the clinician asks the DWI client how he could help in the session. For me, changing a client is not going to happen in just one session and the client appeared to be very put on the spot looking for an answer).
ReplyDeleteYou mentioned that you thought the approach felt there were a lot more closed ended questions- I also noticed that there was such a difference in the close ended questions with sessions with male clinicians and female. I thought the male clinician was much more direct and less open than the female clinicians. I am used to working with so many females in this field and I really am noticing the difference in the way males ask questions and just the deeper tons in their voice and overall more direct questioning. I think this is interesting to think about-
DeleteRebecca, I agree SFT approaches the client in a much different way than we are used to, but I do like the idea that the client is in control of the outcome and the therapist is there just to guide the process. I agree for those of us who are used to using MI or other practices of open ended questions this practice will take work!
DeleteAnnie & Rebecca,
DeleteI have been doing intake assessments and I have noticed the difference in tones when I ask questions. I also notice then men have been more open, more relaxed, whereas most of the women will provide me with the information that I need, but not want to go into detail. Although if they have medical issues onto of psychiatric, then woman will spend a lot of time talking to me, as if I have some pull on getting them medications or a quicker way to see a medical doctor.
I was not focused on the closed ended versus open ended, but after you brought it up, I agree that there were close ended, but I felt in the first video there were a lot of open-ended. I am not sure if that was part of getting them to talk or not. I agree I did not feel a relaxed atmosphere as I did with other videos we watched with various other techniques demonstrated.
Christine Mc.
Hi Rebecca,
DeleteI agree with your observations in regards to the amount of closed ended questions. I also noticed that rather than incorporating summaries, reflections or room for client input, the clinician seems to fill every space with questions. I also agree that the tone and overall feeling of the conversation did not create a sense of safety, but rather an integration where I too, noticed clients seemed defensive. Great observations.
Christine George
From what I understand Solution-Focused Treatment is a very straight forward treatment which focuses on strengths, resources and solutions. I think the "scale" and "miracle question" is partly what sets this treatment aside from others which we have learned so far. From the examples that we saw there were many times when the clinician used the "exploring for exceptions" skill. In the case of the young woman who kept having fights with her husband, Kim Berg was able to help her draw upon the time when she decided to not fight and take a walk- I noticed her point out this exception by saying things like "wow- how did you do that" "wow that must of taken a lot of strength" In response to Berg highlighting the time when she didn't fight, the patient gained confidence and that was clear in her overall attitude and tone of voice. I also saw in one of the clips the male clinician talking to a client who was in counseling for domestic violence. In this case the man was referred by his parole officer and although he was resistant at first, we heard the clinician asking him a lot about the times when he didn't use violence when he was fighting with his girlfriend. I thought the exception piece was interesting to watch although at times it felt like the clinician was "tricking" the patient or leading them to believe they were doing better than they may have actually been doing. Personally I loved the miracle question- because it felt in a way a lot like a fun question. I was able to ask myself the miracle question and I think when I reflected on what my life would be like if I woke up tomorrow and what my change would look like. I could imagine this being a great question for a social worker to ask in terms of helping a client set a goal and really understanding what they want and why. Overall I really have been enjoying the attention to positive thinking which I have seen in both CBT, MI and now Solution Based Treatment. I would be interested to apply some of the techniques from these different treatment plans when working with a client.
ReplyDelete(Hope everyone has a Happy Thanksgiving!!)
Hi Annie,
DeleteI agree that SFT seems like a pretty straightforward treatment which draws on the client's strengths to help them achieve their goals. I can definitely see why Lee said it's one of the most "social worky" techniques out there. (Not that she phrased it that way.) I was thinking about what you said about how the therapist was "tricking" the client into thinking they were doing better than they actually were. I think that might be a matter of perspective. We've read a lot in our schoolwork about the power of positive thinking creating greater possibilities for change for clients. Many people who want to make changes in their lives get stuck in a rut of "I can't do this"...which, in turn, makes that prophecy true. By emphasizing the good aspects of what the client is doing (and yes, even by exaggerating them), I think the clinician is maximizing the client's potential for change by changing the way they see themselves. It may not be an actual reflection of how the client is doing...but by minimizing the negative, the "trick" can lead to the therapist's vision becoming a reality. You're right that that's maybe not completely honest. But is it wrong? Hm. I don't know. I tend to think not.
Hi Annie and Alice,
DeleteWhen I watched the clip about the guy with Domestic Violence I had to get in touch with my countertransference....
Anyway, I though the clinician in using the Exploring Exceptions wants the client to remember that he sis not always use violence, as sometimes people get stuck thinking they can never change. I think it is important for people to connect the way they were before with the way they may want to be in the future, i.e. without violence.
And, I did have a great Thanksgiving!
Hi Annie,
DeleteI also appreciate the positive nature of SFT and other approaches we have studied. I think the positive nature of the work can go a long ways for clients, but also those who serve them. I wonder what the burnout rate would be for those social workers using approaches that are less solution and goal focused, like the psychodynamic approach.
Christine George
Hi Annie,
DeleteI forgot to mention in my earlier post that I appreciate your comments about the "miracle question". This was not a therapeutic element that I liked or think I will use in the future, however, I did appreciate hearing from you and your interest in this tool.
Christine George
This technique felt very different to me, compared to the other techniques we've been learning I noticed the focus is very tight. For instance, I noticed several times when the therapist running the session would react differently to the client's expressions than I have become accustomed to. When the clients said things that, using other techniques, would lead to a more in-depth analysis of their beliefs, the therapist instead seemed to gloss over those statements in favor of focusing on the positive and on reasons for changing. In this way, s/he was able to keep the focus tightly on the subject matter (the solution) that s/he wanted to talk about.
ReplyDeleteAn example of this would be the client mandated to be there for his drinking. Upon asking him what his girlfriend would think of his being there, he says something along the lines of, "She's happy I'm here. SHE thinks I have a problem". (With arms crossed and a quasi-hostile expression.) Clearly, he thought no such thing (and he says as much later). But instead of asking him to expand on this clear nonverbal cue, the therapist continued asking questions from the girlfriend's POV to keep the talk focused on potential deal solutions. This struck me as a very different way to handle the situation than either CBT or MI's techniques. CBT would, I think, be more about exploring the thoughts behind his defensiveness, while with MI, that would have been an opportunity to identify ambivalence. And yet it seemed highly effective. I am very interested in this technique.
As for Exploring for Exceptions, in Clip #2, the male therapist is talking to the young black client who is talking about stopping his drug use. The client mentions in passing that "I have to stop...actually, I have stopped." The therapist jumps on that and asks him to talk about the reasons he was able to stop, which got the client talking about his fear of the consequences (going to jail) helping him get up the impetus to stop.
Hi Alice -
DeleteI think you bring up a great point in stating that the clinician appeared very solution focused and seemed to skim over some of the information presented by the client. I felt as though some of the responses could have used a more in depth discussion and perhaps even the client was slightly throwing out bits of information and the clinician was not biting or exploring those issues further which may have lead to the disclosure of some important information.
Rebecca
Alice,
DeleteI have some clients who like to get a reaction out of staff and will do or say certain negative things. So I will sometimes gloss over things myself and try to keep the ones who do this in a positive space as they will get depressed if they continue to "awfulize", as we call it. That is why I created the 2 positives for every negative. So every time they say something negative I have them follow it up with two positives. It has worked for a few. I have a new client who is testing the watering with me today, screamed at the top of her lungs in the elevator and stomped her feet because I would not drive her to Shaw's. I monitored her taking her PRN for anxiety, talked to her calmly, made sure she had food as she complained of a sick stomach. Provided education, that sometimes as medical symptoms increase, so do psychiatric. I told her to relax and allow her PRN to work, then made a follow up appointment before leaving, without her. I will not drive someone in their 50's to Shaw's after having a temper tantrum. This is an example of testing new staff, just a heads up for anyone who enters mental health, do not feed into negative behavior, stay calm, keep the client calm and just make sure their needs are met. We are not on DBT this week, but this client would benefit , as CBT and Solutions Focused Therapy as short term treatment.
Christine Mc.
Hi Alice,
DeleteThank you for your comment about the therapist glossing over key information. I also observed this. I believe the therapist ignoring body language and possible feeling conversation made the conversation feel forced, rigid and one sided. It could just be specific to these videos, but I felt that the therapists were dragging the clients along with their questions (they asked way too many questions) and it did not have the collaborative, natural feel that other approaches seem to have.
Christine George
Hi Christine M.,
DeleteI agree that there is a time and a place to ignore information that a client is sharing. I often will say to clients that if they are not interested in discussing a solution i.e. using DBT skills that can be used to make the situation better, then I am not going to engage in the conversation. Like you mentioned, these are usually people wanting to dwell in the negative. Now that I am writing this post, I think of a lot of people in my personal life where I do this as well. :) However, I did not feel that the clinicians in these videos were doing this. I did not find any of the clients to be catastrophizing or dwelling in the negative. I almost found the therapist to be dismissive of the information clients were sharing. However, it is important to remember, these are just glimpses of these conversations and do not really give justice to the rapport that I assume has developed over time.
Christine George
Solution Focused therapy focuses on what clients want to achieve, rather than on the problem(s) that made them seek help. The approach does not focus on the past, but instead focuses on the present and future. The counselor asks the client to envision their preferred future/goal(s) and then, working with the counselor, the client starts to work toward achieve this future/goal(s).
ReplyDeleteSolution Focused therapy focuses on the client finding/discovering their own strengths and solutions. It also takes an optimistic approach to the success of clients, leaving the clients success in their own hands, not relying on the therapist to give the client all the answers or solutions.
A great example of Exploring for Exceptions would be the married couple whose husband went to jail. In the past before 1990 when there was “less tension, a relaxed atmosphere and bills were paid.” In the past he believed spending time with his family was important. To make changes he would need to make them a priority again. Knowing what the couple wants will help them to create their own solution. Him eating breakfast with the children, interacting with the family in a positive way. His wife would feel the change and make her own changes in the way she interacts with her husband.
The goal of psychodynamic therapy is to focus on how the client’s history (problems) effects their current behaviors, just as CBT is used to show clients how their thoughts and feelings effect their behavior again a problem focused treatment.
Jen,
DeleteThe couple was a great example of Exploring for Exceptions. Each partner had their own goals and their own changes that they had to make in order for the marriage to work.
Christine Mc.
Hi Jennifer,
DeleteThank you for your comments on SFT and how problem solving and finding solutions is left in the client's hands, rather than the therapist's. This caused me to sit and think about clients that this approach would be beneficial for. I would imagine that SFT would be helpful for individuals who do not have a lot of time (i.e. only 6 mandated sessions) for therapy, rather than spending years using the psychodynamic approach. By focusing on only one to two issues, I believe the approach is extremely specific and can be helpful to individuals dealing with one issue. This can be different from other approaches, as psychodynamic and CBT can discuss many different issues at once.
Christine George
Christine, I would agree this would be a great tool when working with short term clients. This would be a great technique to use with clients who are grieving a loss or struggling with situational problems that may be causing increased stress or depression.
DeleteHi Jennifer,
DeleteI think you are right to point out that SFT is focused on the future. I commented in my post about how it seemed to me that the therapists would sometimes gloss over the problem talk the clients brought up. I wonder if a reason for that could be to try to keep the focus on the next steps, as opposed to the causes of the problem. ...To sort of keep the conversation positive and future focused.
I also agree with you that the therapists were adept at drawing out the clients' strengths, and then using them to come up with the solutions. I guess that's exactly what SFT is all about, right?
You got it, Alice. SFT is very present and future-oriented, so does not delve into the past at all. Or very little. Sometimes it might feel a bit dismissive, but it is important to think of these models within the context of your own personality ( use of self!) and relationship with the client. The SFT clinician will build this relationship through a focus on present and recent past - not distant past. If your assessment is that the client needs to explore distant past family dynamics or perhaps a trauma history - then you might refer them to a different therapist or do a different "piece of work" at a different time.
DeleteI noticed a deliberate focus on the positive aspects, the strengths, the possibilities and just as strong of a focus away from any problem talk. There were a few exceptions, but for the most part, as in the case of the married couple, when the wife started talking about how hard it has been for her and all the trouble she has had to put up with, the therapist gave a cursory glance- not even a nod. This was a great demonstration of keeping the focus on solutions and moving in the only direction that will aid and accomplish the desired change. I also noticed the skilled guidance of each therapist in asking questions, even if the question was a dead end, coming up with another that would work. The clinicians were clearly guiding the ship, but the work was being done by the clients: they were in charge of the direction and speed at which the ship was going to move. One example of the Exploring for Exceptions was asking the gentleman with the deinking problem "What was different on the days you didn't drink?" The benefit of the exploring for exceptions is it connects the future hope and goal with actual lived experienced from the client's past. So the client has something to remember and something to look forward to within him or herself. It makes the solution concrete and attainable, because it has already been done.
ReplyDeleteI particularly liked the work being done with Terrence: it was so concrete, gentle, and encouraging. The focus on the positive was optimistic without being out of reach.
Hi Gail,
DeleteThank you for your last sentence in your post. I felt differently when reviewing SFT and I felt that techniques used in this approach such as the miracle question did make success feel out of reach. When watching the videos, it seemed that the miracle question did not flow with other tools such as the evaluating the evidence technique.
Christine George
Gail, I think the struggle I had with these techniques are that we have been really focused on asking open ended questions. I agree the therapist kept the conversations solution focused for the most part, even with the married couple. while I understand the technique and approach, I think in the beginning of my work with clients it would be hard to use this technique and retrain my brain, not to always use MI and other forms of open ended questions and affirmations with clients.
DeleteHi Gail -
DeleteI also noticed a lot of positive talk, especially in identifying the ways the couple appreciated eachother and how the relationship felt when they were first married. While I think it is great that they are able to pick out the good things and the things they envision, I feel that there lacks understanding of what brought them into treatment and how to not re-engage in these problematic behaviors in the future. This particular session felt a little more different as the husband appeared to be taking some responsibility for his past behaviors (ie: not being home in time after work to spend time with his family). I still struggle with this technique because I feel like the ability to move towards the future must encompass some sort of ability to heal from the past. Good observations.
Rebecca
Hello Everyone,
ReplyDeleteI apologize that my post is delayed-self care, family, food and traveling trumped homework this week. :)
While reviewing this week's material, it is clear that Solution Focused Therapy is very specific, i.e. goals and does not follow other therapeutic approaches in exploring feelings or past events. This approach feels like a one lane road.
I have an appreciation for the overall goal of solution focused therapy. During video 1, the clinicians described a client's future as being created and negotiated, thus goals are person centered and generated by the client. I believe this overall concept is similar to CBT, DBT and MI. It has been my experience, both professionally and personally, that this is the best approach when working with individuals-especially in the realm of substance abuse or behavioral issues. A comment was also made about this approach generating and establishing respect, while supports of NASW Code of Ethics and helps to build a therapeutic rapport.
One element that feels different from the other approaches we have reviewed is the lack of agenda. While this can be good, I did see some examples in the videos where it felt that the same types of questions were being asked over and over again and the conversation did not have any "meat".
In video 1, a clinician asked the client if therapy was worthwhile to him and how they could make the most of these sessions. I found that these questions and this overall approach really spent a lot of time engaging in treatment and therapy sessions by asking direct questions like "who's idea it was to seek treatment" and asking if therapy was as bad as the person expected. This can be good in helping to create a space that is client centered and focused on assisting the person.
I am still iffy about the use of the miracle question. I don't think this is something I would use in therapy. However, I believe I ask similar questions in regards to how life would look and feel without certain behaviors. Maybe the title of it being a "Miracle" is what turns me off from this technique, I feel it is important to help clients to see solutions as attainable rather than needing a "miracle" to achieve change. I also think the clinician comment about "it being a silly question" is somewhat off putting and dismissive.
Overall, after watching these videos and listening to the lectures, I felt that this approach was scattered and did not have a lot of direction. I felt that while in the earlier videos goals were discussed (ex. client quitting drugs or alcohol first), it did not have a natural flow as other approaches seem to have. When comparing it to the other approaches we have learned I found myself underwhelmed, even though I did write down a few specific questions that I thought were helpful, but could be applied to any therapeutic approach.
Christine
Christine, I would agree that several of the video clips appear to lack an agenda, but the idea of the client setting the agenda is really the goal. I also struggled with the idea that the therapist didn't ask many questions one would think should be asked, but when I really think about this approach and technique it makes sense. It also made a lot of sense to me that this is not an approach that I am comfortable using right now and will take additional practice to be able to use effectively. It was clear that the therapies in the videos are well trained to use SFT!
DeleteHi Christine,
DeleteI agree hearing "this may sound like a silly question" could be off-putting...it was to me. However, I just wouldn't use that phrase. I have been thinking about the Miracle question and the reason I like it and why I think it works is because everyone knows what a miracle is...and may openly or secretly wish for one in their lives. So it is relatable, Secondly, it gives the client a chance to hope, to dream, to imagine. Imagination can be really under-used; yet if a person can envision a new life, they have cognitively already set the mind in motion to work, even subconsciously, towards that which is desired. In order for a client to see a solution as attainable he or she may need to envision it first, as they may be at such a low point they cannot even think, hope or desire a way out, unless asked to by something like this exercise, where the sky is the limit, but is woven into a real plan.
Hope everyone had a great holiday!
ReplyDeleteSolution focused treatment is solution building and goal-oriented, rather than problem solving. It focuses on modern resources and future things that clients hope for, rather than past causes and present issues or problems. Solution focused treatment aims at the desired outcome of therapy as a solution, rather than focusing on the symptoms or problems that brought someone into therapy. CBT on the other hand, is based on the scientifically supported assumption that most emotional and behavioral reactions are learned. Therefore, the goal of CBT therapy is to help clients unlearn their unwanted reactions and to learn a new way of reacting.
I enjoyed watching the Solution focus Solutions Step by Step Clips. Right from the beginning I was impressed in the style of the therapists and they treated the clients the same in their approach, whether they were court ordered for treatment or came in voluntarily. I could relate with the therapist who was working with the client who was working with the client who was court ordered to be there. In my current internship, I have a lot of clients who are court ordered to be there due to legal charges, as they have done illegal things under the influence or to obtain money for drugs. I like how the therapist said “Well let’s say you did get something out of this hour, what do you think that would be”? It gets the client to think in future tense, rather than past tense and being angry for the reasons of why he was sent for treatment. It is that anger which will get in the way of successful treatment. I was happy that the client responded, “Well I am here, I might as well try to get something out of it”. The therapist continued on in order to help the client generate their own ideas, by saying, “You got me curious, what could that be”? The client was able to identify being in the wrong place at the wrong time.
Christine McGovern
P.S.Sorry for the late post this week, I had internet problems and I took the last two days off for family time and self-care for once in a very long time…well needed. I had to drive to my office to go online, but I will be taking home my Wi-Fi card, as I had lent it out to a co-worker who left it for me today.
Hi Christine M.,
DeleteI also liked the question regarding what someone may get out of the hour session. I also liked similar questions that were posed regarding things that may need to change to make the sessions more beneficial. I wrote many of these down to use in the future when a patient and I run into roadblocks or the patient is resistant to meeting with me, but required to do so.
Christine George
Wow! What a rich conversation here about SFT - what you liked, may not have liked so much, and more! Please take some time to read the entire post as I found it so filled with important information as you all tried to integrate what you learned this week with what you have learned other weeks and in other experiences. As we mentioned in class - in reality, you may use some of all models or adjust as needed depending on your clients. I find that I always use the Miracle question - whether I label it as such or not - as an effective way to help clients to articulate their wishes for the future. I especially like to do this in working with couples. I find it moves them quickly from focusing on all the "he said, she said" or "he did, she did" negativity of problem-focused discussion to a problem-solving focus on their future. Then you add in some exploring for exceptions and you are working well towards solutions.
ReplyDeleteYou have all offered a great deal here as you articulated the benefits of certain aspects of SFT or revealed what you did not feel comfortable with. This is all part of learning about how to work effectively with clients. Excellent work!
My apologies for yet again coming late, too late, to this week's discussion. My reality is that I haven't yet acclimated to my new work/internship schedule. The coursework student in me sorely misses the eight hours that I now give to the new internship.
ReplyDeleteThe video clips illustrating Solution-focused therapy are great. The minimalist in me appreciates the restraint these pros exercise. Restraint that is designed to keep this a client generated solution.