Straight to the point

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Straight to the point

• Top 10 solutions for general practice
• Outi Seppälä Leif Lindberg
• EBTA 2009

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Introduction

• Outi Seppälä
• specialist in general practice since 1998
• solution focused psychotherapist since 2003,
  continuining education 2005-2007 in
  Lyhytterapiainstituutti Oy
• GP in Helsinki Health Care Centre since 1988
• Kallio Health Station
• outi.seppala_at_hel.fi

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Introduction

• Leif Lindberg
• GP since 1982
• solution focused psychotherapist studies
  2006-2009 in Lyhytterapiainstituutti
• private practitioner since 1983
• main interest in occupational health care

• head of Vantaa Medical Center
• 1leif2_at_gmail.com

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Our goals are

• to open up the fascinating solution focused world
  of general practice
• to help the multiprofessional cooperation
• to give you at least one new idea as a souvenir

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Why do GPs need psychotherapy skills?

• It has been estimated, that
• 20-25 of all people suffer from psychological
  problems needing treatment
• 30 of GP appointments happen at least partly
  for the patientspsychological problems
• the resources of psychiatric clinics and other
  specialised care can not satisfy the wide need
• a big part of the patients can not afford to buy
  professional psychotherapeutic services
• some psychotherapeutic supportive elements are
  included in a lot of the work in general
  practice, also in the treatment of somatic
  diseases

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The most common problems

• depressive and burn out symptoms
• anxiety symptoms
• sleeplessness
• alcohol and drug problems
• helping patients change behavior
• psychosomatic disorders

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Why is just solution focused therapy the best
model for general practice?

• flexibility
• the time used, the form and the frequency of the
  appointments are free
• the duration of the treatment is free
• does not tie the patient too much to the
  therapist
• seeks to find the patients own resources
• concentrates on the future
• seeks to find practical solutions
• has got a lot of similarities with the work of GPs

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Similarities of solution focused psychotherapy
and general practice

• equality each of us is/can become a GP patient
• the focus is on the patient
• trying to form a collaborative partnership
• reframing is a central tool
• avoiding unnecessary pathologisation
• the focus is on practical problems
• the focus is on the future
• the frequency and the duration of the treatment
  vary a lot
• a realistic attitude when planning the care and
  assessing the results taking into account all
  the influencing factors and resources in
  patiets lives

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The most central solution focused tools in
general practice

• Equality
• Reframing
• Positive feedback

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Examples from our own practices

• Please express your ideas how to solve these
  following case examples of common problems in
  general practice with a solution focused way?

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These were the tools used in the real cases

• externalisation
• positive feedback
• reframing
• choosing
• utilizing doctors wide range of possibilities
• giving a ritual task
• finding an answer to the right question
• utilizing the previous successes

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Case 1 Now and again pain in the knees

• a middle aged man comes to see his GP for pain in
  his knees.X-ray has shown some arthrosis, but not
  severe enough to demand any surgery
• the usual medications and physiotherapy have
  given him some relief, but not enough
• the GP needs desperately new ideas how to help
  his patient
• Please make an externalizing conversation with
  the patients knees in order to find the patients
  own resources in helping himself with the pain

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Case 2 Creating collaboration

• a chronically alcohol abusing drunken man came to
  see his GP
• he had badly neglected taken care of himself, and
  was now having a serious skin infection needing
  treatment with antibiotics
• Please give him now at once positive feedback
  creating collaboration so that maybe it is more
  likely that he really takes the antibiotics
  prescribed

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Case 3 A type II diabetic patient comes to a
control appointment

• her sugar balance is still bad
• she becomes sad, because she considers her
  efforts substancial
• she has abandoned her daily bun with coffee
• she has had a half an hour walk daily in whatever
  the weather may have been
• the traditional way taught to GPs is to ask
  whether her weight has reduced, and make a remark
  of her still remaining overweight and dietary
  mistakes
• Please reframe the situation with a solution
  focused way, which is probably making the patient
  feel better and motivating her better to change
  behavior than the traditional way described above.

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Case 4 A janitor afraid of doctors

• smoking 3 packages cigarettes per day
• having diabetes and superhigh cholesterol
• blood pressure measured high 210/115,waist 108 cm
• does not trust doctors, never seen one
• has minimal education and is retiring soon
• mission impossible?
• Please find a solution focused way to help the GP
  forward

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Case 5 A driver afraid of going home

• he has relieved his problem by working hundreds
  of hours extra every year
• he comes from a very religious family and was
  not allowed to play with other children because
  of their bad influence on him
• he relies on one religious older man, who said
  the fobia is caused by his lonely childhood
• he is 30 years now and has fallen in love with
  a woman sharing his religion he has decided he
  must work normal hours he must be able to go
  home
• Please suggest the GP some ways to help the
  patient

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Case 6 Solving a family hell

• the patient is a middle-aged woman having 3
  children
• her husband is a violent alcoholic abusing the
  family both psychologically and physically
• all attempts to help him have been in vain
• mission impossible?
• Please think about a possible way for the GP to
  try to help the wife while not being able to cure
  the husband.

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7 A man who lost his son in an accident

• he had an exceptionally good relationship with
  his son
• he is very skilful with his hands
• his GP thinks that he has not yet been able to
  process his grief
• also the patients relationship with his wife is
  problematic giving no comfort
• Please find a way to use his resources to help
  him to deal with his sorrow

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Case 8 A sad and sleepless adonis

• A young good looking and charmingly behaving
  young carpenter came to see his GP. He could not
  go to work, because he was so tired having been
  unable to sleep for two weeks after a break up
  with his girlfriend.
• He had a short talk with his GP, was out of work
  for three days, and was prescribed a little
  amount of sleeping pills. After two weeks he came
  to control appointment. He was sleeping well
  without taking medication, he was at work and had
  already found a new girl friend.
• Please think about what could have been the
  important question, for what he was seeking an
  answer from his GP?
• What kind of solution focused talk could have
  helped him recover so quickly?

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Case 9 An alcohol abusing woman

• A middle aged woman came to see her GP, because
  she was tired after abusing alcohol together with
  her husband for two months. Their money was gone
  and the relationships of the family members were
  in a mess.
• She had a conversation with her GP. She came to
  the next appointment with her husband, and
  afterwards they both continued living without
  alcohol.
• After 9 months they came again after having
  abused alcohol for a month. They were desperate.
  After a conversation they started again a life
  without alcohol and continued the same way at
  least 1,5 years.
• Please think about the best solution focused
  remarks(one for an appointment), which you could
  have said first in the beginning of the
  appointments.

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Case 10 Inducing marital happiness

• an elderly but very firm lady came to see her GP
• she was very dissatisfied with her husband for
  his hard of hearing he had a hearing aid, but it
  did not help enough
• she was angry and feeling sorry for herself
• Please form one solution focused remark reframing
  the situation in order to make her pleased and
  happy with her situation in life.

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Miracles do happen also in Finland!

• Comments?
• Questions?
• Thank You for Your attention!