Minnesota Child Welfare Training System SolutionFocused Brief Therapy Strategies

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Minnesota Child WelfareTraining System
Solution-Focused Brief TherapyStrategies
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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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

• What are the core beliefs you have about the
  people with whom you work?
• How have you come to believe what you believe and
  know what you know? What have been the most
  significant influences on your beliefs?
• How have your beliefs and assumptions affected
  your work with clients? With colleagues? With
  the community?
• Do you believe that change is possible even with
  the most difficult and challenging clients?
• How do you believe that change occurs? What does
  change involve? What do you do to promote change?
• 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
• 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 worker 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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Strengths and Solution-Based (SSB) Principles
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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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What is Strengths-Based?

• A strengths-based perspective is not a theory,
  but an overarching philosophical position in
  which people are seen as having capabilities and
  resources within themselves and their social
  systems. When cultivated, activated, and
  integrated with new experiences, understandings,
  ideas, and skills, these strengths help such
  persons to reduce pain and suffering, resolve
  concerns and conflicts, and cope more effectively
  with life stressors. This contributes to improved
  sense of well-being and quality of life, and
  higher levels of relational and social
  functioning. Strengths-based helpers promote
  change through respectful educational,
  therapeutic, and operational processes and
  practices that encourage and empower others.

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Principles of SSB

• Client Contributions
• The Therapeutic Relationship and Alliance
• Cultural Competence
• Change as a Process
• Expectancy and Hope
• Model and Factor of Fit

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Active Client Engagement (A.C.E.)Building
Strengths and Solutions
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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
• Separate experience from action
• Summarize, validate, and soften
• Avoid platitudes or trying make things more
  positive
• Be aware of stories of impossibility
• Consider the influence of words
• Use possibility-laced language
• 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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Possibility-Laced Language

• Reflect client statements in the past tense.
• From Its always that way.
• To Its been that way.
• Move from global (everybody, nobody, always,
  never) to partial (recently, somewhat more,
  a lot).
• From Hes always in trouble.
• To He gets in trouble a lot.
• Move from truth/reality to perception (It seems
  to you, Youve gotten the idea).
• From Things will never get better.
• To From where your standing it really seems
  that it will never get better.

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Possibility-Laced Language

• Assume the possibility of future change and/or
  solutions by using words such as yet and so
  far.
• From Its always going to be this way.
• To So far you havent found any evidence that
  things will be different than the way they are
  now.
• Recast the problem statement into a statement
  about a preferred future or goal.
• From Ill never be able to have the life I
  really want.
• To So youd like to be able to move toward the
  life you really want.
• Presuppose that changes and progress toward goals
  will occur by using words such as when and
  will.
• From No one wants to be around me.
• To So when you begin to notice that there are
  people who enjoy your company and want to be
  around you what will be different for you?

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Possibility-Laced Language

• Give Permission to, not to have to, and both
• From I shouldnt be angry.
• To Its okay to be angry.
• From People keep saying that it really should
  make me angry.
• To Its okay to not be angry about it.
• From Sometimes Im angry and sometimes Im not.
  I must be crazy!
• To Its okay to be angry and you dont have to
  be angry and youre not crazy.

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Possibility-Laced Language

• Include any parts, objections, feelings, aspects
  of self, or clients concerns that might have
  been left out or seen as barriers to
  change/goals.
• From Nothing will change until people get off
  my case.
• To Things can change while people are
  continuing to look after you.
• From I cant concentrate when these kids are
  always screaming!
• To You can find a way to concentrate even
  though the kids may be loud.

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Utilization

• Take what clients bring to services, no matter
  how small, strange, or negative the behavior or
  idea seems and use it as a resource to open up
  the possibilities for change.
• From Hes always doodling and playing around.
• To So hes a creative and playful kid.

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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
• Collaborate and Negotiate
• Concurrent planning
• Track outcomes (impact)
• Information-Gathering (Assessment)
• Use feedback processes to client perceptions of
  the alliance

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Information-Gathering (Assessment)

• Pre-session/Pre-meeting change
• Primary Areas (Spokes of Life)
• Exceptions
• Scaling Questions
• Rate Intensity and variations
• Effects of Problem of Person
• Effects of Person over Problem

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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
• Action-talk
• 3-Point Strategy

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Goal-Setting

• Non-Action Talk
• Cab driver talk
• Opinions, evaluations, assessments, judgments
• Politician talk
• Vague, general, not specific as to person, place,
  time, thing, or action
• Someday talk
• Vague as to time or frequency

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Goal-Setting (cont.)

• Action-Talk/Videotalk
• Move from vague, non-sensory-based descriptions
  to clear, observable, behaviors
• Using Action-Talk to Clarify Meanings
• Action complaints specifics about what one
  doesnt like or one wants to have change
• Action requests specifics about what one would
  like to have happen
• Action appreciation specifics about what has
  liked about something and would like more of
• Specific to person, place, time, thing, action,
  or result
• Who is to do what by when?
• Who did what, when?

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3-Point Strategy

• Problem Description What needs to change?
• Scaling questions (with all 3 points)
• Vision of the Future How will we know that
  change has been achieved?
• Miracle question, crystal ball, time machine,
  etc.
• General future-oriented questions
• Movement How will we know 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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Reflecting Consultation Exercise
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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

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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