Theory and Practice of Counseling and Psychotherapy

1
Theory and Practice of Counseling and
Psychotherapy

• MacDonald
• Postmodern Approach
• (solution-focused brief therapy and narrative
  therapy)

2
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?

3
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.

4
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

5
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 therapists not knowing afford the client an
  opportunity to construct a solution

6
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

7
Therapists 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.

8
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

9
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.

10
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.

11
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?

12
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

13
Case discussion

• Mary feels that she must win everyones 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?

14
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?

15
Questions? Reactions?

• What are your reactions?
• What did a therapist (Dr. OHanlon) do?
• What can you as a therapist continue to do by
  using solution-focused brief therapy?

16
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

17
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

18
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

19
Narrative Therapists 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 clients 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

20
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.

21
Therapeutic Techniques

• No recipe, no set agenda, and no formula
• This approach is grounded in a philosophical
  framework
• Questionsand 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.

22
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

23
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

24
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.

25
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

26
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

27
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