Minnesota Child Welfare Training System Solution-Focused Brief Therapy Treatment Strategies

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Minnesota Child WelfareTraining System
Solution-Focused Brief TherapyTreatment
Strategies Interventions Bob Bertolino,
Ph.D.Assistant Professor, Rehabilitation
CounselingMaryville University St. Louis,
MissouriSr. Clinical Advisor, Youth In Need,
Inc. St. Charles, Missouri
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There is More to See
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Creating A Culture of Care and Respect
Philosophy, Research, Practice
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Creating A Culture of Care and Respect

• Philosophy
• Ideas/principles that inform change. Philosophy
  reflects ones core beliefs about the world and
  the human condition. It precedes and informs
  theory.
• Research
• Comes from different agendas. Although it is
  influenced by economics, politics, society, etc.,
  we owe it to our clients and to ourselves to
  search for what each has to offer and how that
  can influence ethical, effective, and respectful
  practice.
• Practice
• Evolves from philosophy and research and should
  fit with and be respectful of clients worldviews
  including their cultural backgrounds,
  preferences, and expectations. Modes of practice
  should also assist with helping clients to meet
  their needs, achieve goals, and experience
  improved outcomes.

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No More Boxes Recalibrating Compasses and
Expanding Personal Worldviews
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You must be the change you wish to see in the
world Mahatma Gandhi
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Recalibrating Compasses

1. What are the core beliefs you have about the
   people with whom you work?
2. How have you come to believe what you believe and
   know what you know? What have been the most
   significant influences on your beliefs?
3. How have your beliefs and assumptions affected
   your work with clients? With colleagues? With
   the community?
4. Do you believe that change is possible even with
   the most difficult and challenging clients?
5. How do you believe that change occurs? What does
   change involve? What do you do to promote change?
6. Would you be in this field if you didnt believe
   that the clients with whom you work could change?

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H. O. P. E.
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HHumanismOOptimismPPossibilitiesEExpectancy

• Optimism is the faith that leads to achievement.
• Nothing can be done without hope or confidence.
• - Helen Keller

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Experience as a CatalystThe Presence of H.O.P.E.

• What inspires or moves you?
• How does that increase your sense of hope?
• What does an increased sense of hope allow you to
  do?
• How can you promote hope with others?
• How do you maintain your sense of hope when you
  are struggling with clients?

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What Does The Data (Research) Say?
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What Does The Data Say?

• The most significant portion of change occurs
  earlier rather than later in services
• Dose-Response Effect
• The clients rating of the therapeutic
  relationship is the best and most consistent
  predictor of outcome
• One of the best predictors of negative outcome is
  lack of structure
• Most clients are making some form of progress

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What Does the Data Say? (cont.)

• Real-Time feedback increases factor of fit
• Long-term services without an improved outcome
  combined with more of the same on the part of
  the therapist equals an impossible case
• Long-term services with high alliance scores and
  no improvement in outcomes can indicate
  dependence
• Practitioners whose clients do not seem to be
  making progress tend to do similar things
• More of the same, Clients must get worse before
  they get better, More severe diagnosis, Return
  to their models

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What Does the Data Say? (cont.)

• Non-model-specific factors account for 8-12x more
  than methods and models and up to 92 of the
  variance
• Although models (approaches) account for very
  little of the variance in outcome, the person of
  the practitioner can significantly affect change
• Among effective approaches it is the similarities
  not the differences that account for the
  significant portion of change (e.g., MST, FFT,
  BSFT, MI, CBT, etc.)
• Through different mechanisms of change, effective
  approaches are vehicles for activating and
  transporting common factors

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Hubble, M. A., Duncan, B. L., Miller, S. D.
(Eds.) (1999). The heart and soul of change
What works in therapy. Washington, D.C.
American Psychological Association. Lambert, M.
J. (1992). Psychotherapy outcome research
Implications for integrative and eclectic
therapists. In J. C. Norcross M. R.
Goldfried (Eds.), Handbook of psychotherapy
integration (pp. 94-129). New York Basic Books.
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Ingredients of Change

• Wampold, B. E. (2008). The great psychotherapy
  debate Models, methods, and findings (2nd ed.).
  New Jersey Lawrence Erlbaum.

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Points of Convergence

• Culturally sensitive
• Relationship-oriented
• Client-informed
• Collaborative
• Change-oriented
• Outcome-oriented
• Strengths and solution-based

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Martin Seligman

• What we have learned is that pathologizing does
  not move us closer to the prevention of serious
  disorders. The major strides in prevention have
  largely come from building a science focused on
  systematically promoting the competence of
  individuals. Fifty years of working in a medical
  model on personal weakness and the damaged brain
  has left mental health professionals ill-equipped
  to do effective prevention. We need massive
  research on human strength and virtue. We need
  practitioners to recognize that much of the best
  work they do is amplifying the strengths rather
  than repairing their patients weakness.

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Principles of SSB Philosophy

1. Client Contributions
2. The Therapeutic Relationship and Alliance
3. Cultural Competence
4. Change as a Process
5. Expectancy and Hope
6. Model and Factor of Fit

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Active Client Engagement (A.C.E.)Principles in
Motion
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Create a Context of Collaboration

• Point
• Start services by offering options that are
  respectful of clients and their cultures and
  incorporate their preferences and perceptions
• Preparatory
• How
• Be prepared
• Keys to Collaboration

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Strengthen Through Presence
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The Therapeutic Relationship in Context

• Even for those who are convinced that the
  therapeutic relationship is healing by and of
  itself, there are strategies that can foster its
  impact. In other words, since not all kinds of
  relationships are likely to bring about change,
  one needs to be aware of interventions (including
  modes of relating) that should be encouraged or
  avoided for the relationship to become a
  corrective experience. (Castonguay Beutler,
  2006, p. 353)
• Castonguay, L. G., Beutler, L. E. (2006).
  Common and unique principles of therapeutic
  change What do we know and what do we need to
  know? In L. G. Castonguay L. E. Beutler (Eds.),
  Principles of therapeutic change that work (pp.
  353-369). New York Oxford University Press.

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Strengthen Through Presence

• Point
• Listen and Attend to Clients Stories and
  Strengths
• Engagement
• How
• Acknowledge and validate
• Consider the influence of words
• Use possibility-laced language
• Separate experience from action
• Summarize, validate, and soften
• Avoid platitudes or trying make things more
  positive
• Be aware of stories of impossibility
• Be a life witness

• Strengths-Based
• Engagement
• and Practice
• Creating Effective
• Helping Relationships
• Allyn Bacon
• February, 2009

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The Influence of Words
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The Influence of Words

• Sad. Helpless. Inconvenience. Defeat. Tired.
  Oppressed. Doubtful. Uninterested.
• Life is so hard. Nothing seems to go my way.
  There is no one to turn to. It feels like Ive
  been forgotten. Times are hard. Nothing seems
  to help. Things will not get better. In fact,
  they will probably get worse. There is no hope.

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The Influence of Words

• Exciting. Fun. Laughter. Joy. Anticipation.
  Possibility. Aliveness. Love. Peace.
• When I think about the future I become energized.
  There is so much I can accomplish. Life is
  wonderful. There are so many possibilities in
  the world.

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Being a Valuing orLife Witness
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Learn Clients Orientations

• Point
• Gain an improved understanding of clients
  perceptions, perspectives, and theories
• Words and Pictures
• How
• Ask questions as to what clients attribute
  problems to and possible solutions
• Assess clients readiness for change (Stage of
  Change)

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Address Case Management Matrix

• Point
• Explore services and program parameters
• Monitor relationship and outcome
• Interim Family Safety Guidelines
• How
• Provide information
• Collaborate and negotiate
• Concurrent planning
• Introduce outcome measures
• Use feedback processes to client perceptions of
  the alliance

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Eliciting Client Feedback

• In Initial Sessions and Interactions
• Are there certain things that you want to be sure
  we talk about?
• What is most important for me to know about you
  and/or your situation/what youve been
  experiencing?
• What ideas do you have about how therapy/coming
  here/coming to see me might be helpful to you?
• Checking In As Sessions and Interactions
  Progress
• Have we been talking about what you want to talk
  about?
• Are we moving in a direction that seems right for
  you?
• Are there other things that we should be
  discussing instead?
• What, if anything, should I do differently?
• At the End of Sessions and Interactions
• How did the session go for you?
• How was the pace of our conversation/interaction/s
  ession?
• Did we work on what you wanted? Was there
  anything missing?

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Accommodate Services to Clients and Others Goals

• Point
• Create focus and direction
• Gain clarity regarding goals and indicators of
  change and progress
• How
• Determine what needs to change
• Determine how it will be known that sufficient
  change has been made and goals have been met
• Determine what will indicate that progress is
  being made

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Be Change-Oriented and Solution-Focused

• Points
• Consider strategies that offer the best possible
  fit for clients
• Methods should fit with and be sensitive of
  clients cultures, beliefs
• Focus on processes that enhance change
• Similar-But-Different Role Play
• How
• Reassess clients readiness for change
• Collaborate on tasks/way to achieve goals and
  improve outcomes

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Evaluate Plan

• Points
• Ensure expectations are clear
• Ensure plans are clear
• Final Family Safety Plan
• How
• Discuss benefits of positive change
• Discuss possible consequences of lack of
  follow-through
• Encourage feedback

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Monitor Progress

• Points
• Determine progress and gains
• Identify barriers to change
• Determine next steps
• Follow-Up
• How
• Identify, amplify, and extend change
• Reassess goals
• Determine outcomes
• Explore transitions
• Check in with self and remain aware of pathways
  of impossibility

The Therapists Notebook for Strengths and Solution-Based Therapies Homework, Handouts, and Activities Bob Bertolino Michael Kiener Ryan Patterson Routledge Summer, 2009
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Its not enough to be compassionate.You must
act. Tenzin Gyatso 14th Dalai Lama, 1992
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ThankYou
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Bob Bertolino, Ph.D.TCCT, LLC P.O. Box 1175
St. Charles, Missouri 6330201.314.852.7274
bertolinob_at_cs.com www.bobbertolino.com

• Maryville University
• 650 Maryville University Drive
• Saint Louis, Missouri
• 63141 USA
• 01.314.529.9659 (Phone)
• 01.314.529.9139
• rbertolino_at_maryville.edu
• www.maryville.edu

• Youth In Need, Inc.
• 516 Jefferson
• Saint Charles, Missouri
• 63301 USA
• 01.636.946.0101 (Phone)
• 01.636.925.0125 (Fax)
• rbertolino_at_youthinneed.org
• www.youthinneed.org