Practical Applications of a Solution Focused Approach to Counseling and Intervention

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Practical Applications of a Solution Focused
Approach to Counseling and Intervention

• Leslie Cooley Michael Haas

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Tell me, and Ill forgetShow me, and I may not
rememberInvolve me, and I will understand

• Native American Saying

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A mind that is stretched by a new experience can
never go back to its old dimensions

• Oliver Wendell Holmes

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Change is inevitable

• Growth is an option

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What do you think creates change?

• How have these ideas influenced your choices in
  work with clients?

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Ask yourself.

• Can I tell if I am making a difference?
• Am I helping to create change?
• Is there anything I could do differently to help
  create change?

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If what you are doing isnt working..

• At least do something different
• Lipstick Story

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SFBT is a strength-based perspective

• Change is frequently connected to success.
• Success breeds success.

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Building on Success

• Notice what is strong in people instead of what
  is wrong in people

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How many of you quit smoking at some point in
your life even if it was a long time ago?

• Or quit some other habit you wanted to discard?

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About quitting something

• How did you do it?
• Compared to all the times in the past that you
  thought of quitting and wanted to but didnt, how
  did you make it happen this time?
• What helped you stick with it?
• What made the difference this time?
• Whats your theory about how you got this change
  to occur?

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In a strength-based approach, questions are

• Curious a posture of not knowing
• Look for exceptions to the problem most problems
  dont occur all the time
• Respectful must be genuine
• Complimenting directly or indirectly
• Future focused connect to goals

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From a problem-based approach, questions sound
quite different

• When did you first start smoking?
• How long did you smoke?
• How much?
• How many times have you tried to quit?
• What health problems has this caused for you?
• How has this impacted your relationships?

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The assumptions are different
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From a SFBT approach

• Clients have resources strengths to solve
  problem, even if they are unaware of these
  resources
• People have tried to solve their problems, but
  the attempts have not worked
• Expression of emotion does not necessarily bring
  about change

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More assumptions

• It is not always necessary to know the true
  cause, history, or function of a problem in order
  to resolve it
• Every problem pattern included examples of
  exceptions when the problem is not happening
  typically not seen as significant by the client

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What you focus on expands
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SFBT vs. Problem-focused

• Client as expert
• Focus on present future
• Client determines goals
• Change connected to success

• Tx. Is expert
• Focus on past
• Tx. Often has unspoken goals
• Change based on insight

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Insight

• In a problem-focused approach, the assumption is
  that if the person understood why they were
  stuck, that person would be able to change their
  behavior or thinking
• Story of the couple who were heavy smokers
• Story of the man who refused to wear his shirt to
  the dinner table
• Insight doesnt guarantee that change will occur

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Certainty vs. Curiosity

• We know what is best for our clients
• Clients can be resistant
• Concerned with why questions
• Client goals can be secondary

• Not Knowing, position of curiosity
• May not be asking the right questions
• Concerned with what how ?s
• Client goals are critical

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The Implications of Common Factor Research

• After reviewing hundreds of outcome studies
  involving a variety of clients and problems,
  Lambert (1992, 1999) concluded that positive
  outcomes in psychotherapy result primarily from

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Common Factors

• What clients bring to treatment
• Practitioners respect for these resources
• The quality of the relationship

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Client Factors 40

• Inner strengths, resources, and innate capacities
• Ability to enlist support and help from others
• Fortuitous events

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Relationship Factors 30

• Empathy, warmth, acceptance, and encouragement of
  risk taking lead to a cooperative working
  relationship
• Client perceptions of relationship are the most
  consistent predictor of improvement

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Expectancy Factors 15

• Expectation of help and improvement
• Faith and hope
• Emphasis on possibilities, personal agency and an
  internal locus of control

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Model Factors 15

• To be effective, techniques must match the
  clients view of what is helpful and the clients
  relationship to the problem

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Implications

• Focus on collaboration and assume a stance of
  not knowing
• Assume the client is competent and the expert
  in his or her own life.

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Implications

• Convey an attitude of hope and possibility
  without minimizing the problem or pain
• Encourage client's to focus on the present and
  future possibilities rather than past problems
• De-emphasize diagnosis and labels

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GOALS..

• Developing a future focus and well formed goals

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Goals

• I skate to where the puck is going,
• not to where its been.
• Wayne Gretsky,
• hockey champion

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Goals The agenda for counseling

• Focus on what the changed state will be like the
  non-problem future
• Concrete, specific, action positive language
• Meaningful important to the client
• Small and within easy reach, realistic

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Goals The agenda for counseling

• Within the clients control
• Viewed as the first step, rather than the end pt.
  
• Perceived by clients as involving hard work

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Goal Questions

• How will you know when you wont need to come
  here anymore?
• How will you know when things are better?
• When is a little of that already happening?

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Future certain language

• What WILL be different when this is no longer a
  problem for you?
• Quite different from
• What would be different if this were no longer a
  problem for you?

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Whose goals?

• The problem is other people think theres a
  problem
• Accepting the clients position
• Goalproving that I dont have a problem
• The sincerity question

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Miracle Question

• Suppose a miracle happened and the problem that
  brought you here today is solved. What would be
  different about your life?
• What part of that is already happening even a
  little?
• Give the client time to ponder
• Expect I dont know
• Ask clarifying follow-up questions

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If you dont know where you are going, how will
you know when you get there?
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Goal setting

• Imagine that a 16 yr. old girl has been referred
  to you for depression. Work in groups of 3 to
  develop some questions that would be appropriate
  to help develop a goal.
• See handout

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Asking questionsFrom a not knowing position

• Avoid embedded assumptions about how someone
  should be living their life
• How do you feel about being pregnant again?
• Did you use birth control?
• Do you find you are making the same mistakes in
  parenting as your mother?
• Would you be interested in hearing about how
  adoption works?

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Create questions for this pregnant client from a
position of curiosity or not knowing

• Refer to the questions in the handout if you find
  your self stuck

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Identifying the clients relationship to the
problem

• and establishing a collaborative working
  relationship

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Tools for Collaboration

• Adopt a stance of not knowing or respectful
  curiosity
• Match your responses to the students readiness
  for change

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Not Knowing

• Listen! Even if you dont agree
• Listen with the empathy of natural
  interruptions
• Ask questions rather than tell students what to
  do
• Assume the Colombo approach
• And rather than but
• How come? rather than why?

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Empathy

• Remember, you are trying to establish a
  collaborative relationship not come to a perfect
  understanding of a students experience

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Communicating Respect

• Ask permission to do what we are going to do
  anyway
• Announcing the change of topic - context marker
• Inform student about every step of what is
  happening

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Stage Model of Change

• Pre-contemplation No recognition of a problem
• Contemplation Thinking about change but not
  sure it is worth the time and effort
• Preparation Thinking about what change to make

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Stage Model of Change

• Action Ready to take action and make change
• Maintenance Maintaining changes already made,
  preventing relapse
• Termination 100 confident that client will not
  fall back into old behaviors

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Visitor RelationshipNo Problem No Goal

• Precontemplaton stage of change
• Often sent or mandated to come to counseling
• What am I doing here!?

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Responding in a Visitor Relationship

• Listen and acknowledge the clients point of view
  
• Expresses sympathy for the clients situation
• Use relationship questions to address the wishes
  and needs of referring party

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Relationship Questions

• What do you think _____ wants to be different as
  result of us talking
• Who do you need to convince that you dont need
  to be in counseling anymore?
• What would convince them?

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Responding in a Visitor Relationship

• Respectfully provide information about
  nonnegotiable requirements
• Notice small exceptions
• Refrain from offering suggestions to do
  anything

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Responding to I dont know

• I realize Im asking you some tough questions,
  (pause) So, suppose you did know, what you would
  you say?
• Ask relationship questions
• Use multiple choice questions

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Browser RelationshipProblem but No Role in
Solution

• Identifiable problem but no role for the client
  in building a solution
• Often in contemplation stage of change
• Someone else has the problem
• Client sees self as victim, powerless, an
  innocent by-stander to problem

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Responding in a Browser Relationship

• Listen, acknowledge POV, express sympathy for the
  clients situation, and use relationship
  questions
• Encourage reflection
• Notice small exceptions and refrain from offering
  suggestions to do anything

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Responding in a Browser Relationship

• Provide accurate information
• Instill hope that change is possible
• Explore the pros and cons of change without
  pressure

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Customer RelationshipProblem and Goal

• Preparation or action stage of change
• Client and counselor can jointly identify a
  problem and a goal
• Client sees him or herself as part of the
  solution and is willing to do something about the
  problem

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Responding in a Customer Relationship

• Counselor sells
• Brainstorm, problem solve, plan
• Help develop goals and a realistic plan
• Assess strength of commitment to change
• Action or doing tasks

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Working with exceptions and client resources
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Looking for Exceptions

• Problem descriptions are seldom useful for
  building solutions
• Exceptions times when the problem doesnt occur,
  especially if expected
• Ask Times when the problem is less severe?
• Suppose I asked your partner if you had any
  better days what might he/she say?
• Ask for details who, what, when, where

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Exceptions to the problem

• Much easier to talk about the problem but
  knowing more about the problem doesnt
  necessarily suggest what to do about it. (DSM Dx.
  Doesnt intervention)
• Search the past and present for solutions by
  focusing on times when the problem wasnt
  present, less frequent, less intense

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Focusing on Exceptions

• Shrinks problems Ask about details
• Demonstrate client abilitiesHow do you suppose
  you did this?
• Point towards solutions What would it take to
  repeat this?
• Focus on what is possible You already know what
  to do

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Case examples

• Dahlias victory over her anger and fighting
• Kid with the temper who played soccer
• Your life?
• Not as useful with young children

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Scaling Questions

• 1-10 or get creative faces, karate belts,
  circles
• On a scale of 1-10 where 10 means how you want
  things to be and 1 means the worst things have
  been, where would you say things are now?
• Whats the highest you have ever been?
• When was that? What were you doing then?
• How did that make things different?

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Advantages of scaling questions

• Makes things concrete
• Makes small successes noticeable
• Build into goals what would it take to move up
  one more number?
• Maintain gains what will it take for you to hold
  this position?
• See handout

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Scaling exercise

• On a scale of 1-10, where are you in your quest
  to be a competent therapist?
• What tells you that you are at a ___?
• What will it take for you to move up 10?
• What is something specific you can do to make
  that happen?
• What will be different for you when you are at a
  ___?

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Tasks and homework

• What kind of relationship do you have with the
  client?

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Types of Tasks

• View or think something different
• Observe, think, reflect, consider
• Insight, explanations, theories, interpretations
• Do something different
• Direct suggestions, homework
• Act, do, behave

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Tasks and Relationships
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Introducing Your Ideas Into a Conversation

• Offer suggestions or advise by invitation only
• Present suggestions or interpretations in a
  non-expert manner
• I wonder if
• Sometimes
• A lot of people in your situation might.

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Observational Tasks

• Observe for exceptions
• Pay attention to those times that are better so
  that next time we meet you can tell me about
  them
• Pay attention to those times when things are
  better and notice if you are doing anything
  different to make that easier
• Pay attention to those times when you overcome
  the urge to

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Observational Tasks

• Reflect on problem
• Pay attention to what will be different if this
  problem is solved or not solved
• Pay attention to what is happening in your life
  that tells you this problem can be solved

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Observational Tasks

• Reflect on consequences, for yourself or other
  people
• What would your mom say if you were able to
  ..?
• What would you able to do differently if.?
• What would it say about you if you were able to
  ?

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Action Tasks

• Public expression of intent to change
• Gathering information
• Dramatic Relief Talking, writing, art
• Countering or do this instead

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Action Tasks

• Changing the environmental or antecedent
  conditions
• Make internal and external rewards readily but
  contingently available
• Enlistment of help from others Ask relationship
  questions, exploring social resources
• Helping others

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Techniques for speeding up change

• Validate clients concerns
• Interrupt respectfully
• Assume clients can change
• Build on small changes
• Go lightly with archeological digs
• Begin each session focusing on what has worked