Nick Bowles

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Becoming Solution Focused Ablett Unit

• Nick Bowles
• Preferred Futures

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Exercise

• IN PAIRS
• Ask your partner to describe when they are at
  their best professionally or personally
• How do they think, talk, behave, feel?
• What do they and others notice?
• If their best is 10 and the worst its been is 0,
  where are they today?
• and how would it be at one point higher?

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A Quote from Ireland

• Free your mind
• and your ass will follow
• Bernadette Finn Cork, 2005

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Constructive Feedback

• INTERVIEWERReflect on the strengths / attributes
  the interviewee demonstrates
• INTERVIEWEEIdentify and describe a skill shown
  by the interviewer

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Your preferred futures

• Suppose this workshop is useful to you- what
  will we have done / talked about / how will you
  feel?
• Suppose the way you communicate changed
  positively after this training, what would be
  different? What would you / what would others
  (patients-staff etc) notice different?

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1 2 Exercise

• 1 Something you have long wanted to do and one
  day will
• 2 An achievement of which you are proud / glad
• FEEDBACK
• For each person, what quality struck you about
  them, during this exercise - tell them

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Admirable Qualities

• Identify a person you know (even better if you
  both know this person) and comment on one or more
  of their best qualities / characteristics
• Talk about what it is about their qualities that
  you admire
• Reflect on how your view positively affects your
  interactions with this person

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Principles

• Being solution focused requires a shift from
  problem-dominated talk, thinking and description
  to solution-oriented talk, thinking and
  description
• The aim is to amplify the solution behaviours
  until they outweigh the problem patterns (do more
  of what works)

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Origins

• First developed by Steve de Shazer and Insoo Kim
  Berg in the 1980s in Milwaukee - from flukes,
  accidents and listening to clients
• First used in the UK in the late 1980s in family
  therapy and mental health applications
• Now used across primary, secondary and acute
  settings with wider range of clients

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Key assumptions

• Person as problem
• Deficit focus
• Victim
• Complaint
• Whats wrong?
• Stuckness
• Resistance
• Hopelessness

• Person is more than problem
• Resource focus
• Survivor
• Preferred future
• Whats right?
• Movement
• Partnership
• Expectation of change

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Therapy?
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Story telling

• Problems are like stories the more they are
  told the more real they become
• Problems can be Habits
• Your job is to help new stories to be told

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Solution Forks

• Choose a real issue, describe to your partner
• In conversation, ask
• When it is better how will it be?
• What will you notice what will others notice?
  What else?
• How have you been coping so far?
• What tells you change is possible?
• How committed to making a change are you? (0 to
  10)
• What might be some of the first, small steps you
  can take to move towards a more positive outcome
  - detail detail detail
• Interviewer Summarise goal and strengths in
  your partner
• Interviewee Tell the interviewer which aspects
  of this conversation have been helpful to you

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Constructive Feedback

• INTERVIEWERReflect on the skills, strengths,
  attributes the interviewee demonstrates
• INTERVIEWEEIdentify and describe a skill or
  attribute shown by the interviewer

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Clinical Application

• In pairs
• This is a first consultation - take patient and
  clinician role or be your selves
• Problem free talk (what and who is important)
• Now ask business question 1 and 2 (what do we
  need to spend our time talking about and how will
  the patient know when things improve for them)?

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Constructive Feedback

• INTERVIEWERReflect on the skills, strengths,
  attributes the interviewee demonstrates
• INTERVIEWEEIdentify and describe a skill or
  attribute shown by the interviewer

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Use your ears

• Elicit
• Amplify
• Reinforce
• Start again or Scale (0 to 10)

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Scale Questions

• How will it be at 10? (Detail)
• How was it at 0?
• Where are you now? (Number)
• What tells you that this is where you are now?
• How will it be at one point higher? (Detail)
• Is there a point which would be good enough for
  you?
• What might be some of the small steps that will
  move you up one point higher?

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Clinical - next session

• In pairs, as before but swop roles, this is a
  follow on consultation
• Review whats gone well, whats been
  different?
• Use your EARS(elicit, amplify, reinforce, scale
  or start again)
• Develop and use scales assess and plan next
  steps
• Close with usual summary, feedback, compliment

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Constructive Feedback

• INTERVIEWERReflect on the strengths / attributes
  the interviewee demonstrates
• INTERVIEWEEIdentify and describe a skill shown
  by the interviewer

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Feedback and Strengths

• INTERVIEWERDescribe / write down the skills,
  strengths, attributes the interviewee
  demonstrates (key words, brief)
• INTERVIEWEEQuietly reflect on what the patient
  believes the worker thinks about him / her
  share this with your partner when s/he is ready

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What do patients experience?

• Confident, clear cut engagements
• No contraindications
• Personal responsibility up
• Disabling impact of illness reduced
• Patients coping skills amplified reinforced
• Help seeking behaviours reduced
• Self image moves towards adaption and capability

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Elements of a session

• Introduction
• Problem Free Talk
• Business Question 1 and 2
• Miracle Question (modify to suit self client)
• Exceptions
• Scaling
• Break
• Ending the conversation (AVCT)

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Constructive Feedback

• INTERVIEWERReflect on the skills, strengths,
  attributes the interviewee demonstrates
• INTERVIEWEEIdentify and describe a skill or
  attribute shown by the interviewer

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Miracle Question

• IN PAIRS
• Ask your partner to describe their perfect day,
  in which they experience life without the small
  real problem they are presently thinking about
• Id like to ask you a long question, it may sound
  a little strange and it takes some imagination to
  answer, I think it is important, so take your
  time..
• Suppose tonight something happens that takes the
  problems you are thinking about away, what will
  be the first things you notice that tell you
  these problems have gone away

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Ending the conversation

• Acknowledge Problem
• Validate (the persons strengths)
• Compliment (on something you have noticed in
  todays conversation)
• Task

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Putting it into practice

• In threes
• Take roles - patient, observer, worker
• Work for 10 minutes, then rotate roles
• Pick up where you left off
• When it feels right, take a BREAK and plan
  closure
• Deliver AVCT

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Formula tasks

• Observe between now and the next time we meet
  (that which you want to continue to happena
  coping skill etc)
• Do something, anything different about the
  problem that hasnt been done before
• Pay attention to what you do to overcome the urge
  to.
• Pretend the miracle has happened
• Pretend you are one point higher on the scale

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Constructive Feedback

• INTERVIEWERReflect on the skills, strengths,
  attributes the interviewee demonstrates
• INTERVIEWEEIdentify and describe a skill or
  attribute shown by the interviewer

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Why workers and clients like it

• A focus on wellness and health not pathology
• Empowerment people see their strengths and
  competence
• Clients are more responsive when speaking of
  achievements and the future (Iveson 1995)
• Bias to action
• Moving on (problems as habitual behaviours)
• Tell new stories about ourselves
• ReferenceIveson, C. (1995) SFBT a tool for
  HVs. Health Visitor 68(6) 236-238

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Effectiveness

• Summary of Evidence
• Average number of sessions between 3 and 5,
  sessions can last between 20 and 33 minutes
• High proportion of clients report significant
  improvement in their terms
• Tasks trigger improvement in over 80 of cases
• Long term change demonstrated
• Equal success rate for all social classes
• Staff changes better communication, teamwork
  and goal oriented practice

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Summary

• Solution conversation is brief and effective
• It provides a framework within which to work
• Each key technique can be used separately
• None of the key techniques can do harm
• Small interventions can lead to big changes

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Do This!

• Dont think of a pink elephant

Do this!
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Scaling Task 1

• Place yourself on a scale from 0 to 10 where
• 10 is a solution focus suits you
• 0 is it is not for you
• Now, imagine you are one point higher what
  will be different?

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Scaling Task 2

• Place yourself on a scale from 0 to 10 where
• 10 is you will use SFC
• 0 is no interest in using it at all
• Now, imagine you are one point higher what
  will be different?

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Your Patient Says

• I feel so much better and its all down to you..

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Your worker says

• Its you thats done all the hard work, well done
  to you

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Your Patient Says

• I just want to get better..

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Your worker says

• What will be different when you feel better?

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Your Patient Says

• Life will never be the same again, not after what
  happened..

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Your worker says

• Of course, so given what has happened how would
  you like life to be from here on.

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Your Patient Says

• I just want to get out of this stinking hospital
  and go home..

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Your worker says

• Great! I can see that you want to go home, whats
  the next step? How can we make this happen?

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Your Patient Says

• I dont feel anything at all, its like being
  dead inside..

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Your worker says

• When was the last time you did feel alive? How
  was this, what was happening then etc.
• How are you coping right now?
• What might be the first signs that you are
  coming alive again?

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Your Patient Says

• My drinking is getting out of control..

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Your worker says

• How will it be when your drinking is under
  control?

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Your Patient Says

• I feel like cutting myself but thought I would
  talk to you first..

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Your worker says

• Im glad you came to speak to me instead of
  cutting (cup of tea)..
• suppose talking to me is helpful to you what will
  we talk about

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Your Patient Says

• I just dont know what good talking to you can
  do..

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Your worker says

• If it was helpful to you, how would you know,
  what would you like us to talk about.

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Your Patient Says

• I dont know what I want to change.

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Your worker says

• When things have changed for the better, what
  will be different (or use miracle question) Aoife
  OLeary 2005

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Your Patients Relative says

• Well.hes just mental isnt he, what can you
  expect?

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Your worker says

• Being clear about what we expect might be really
  helpful, how would you like things to be?

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Your Patient Says

• I dont want to be coming to see you forever.

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Your worker says

• Great, delighted to hear it..how will you know
  when the time is right?

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Your Patient Says

• I cant imagine a time when I will ever be able
  to stop coming for help.

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Your worker says

• Tell me about some of the things that will help
  you to cope when we are no longer meeting

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Your Colleague Says

• I like being solution focused, how can I continue
  to get better at it?

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Ending our time together

• A Acknowledge the issues this group have come
  together to face
• V Validate the strengths we have displayed to
  date, i.e. that you brought in with you
• C Compliment the group on an aspect of your
  performance on these two days
• T Task - give us one or more tasks to keep us on
  track with the issues and goals we have set
  ourselves

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A Quote from Ireland

• Free your mind
• and your ass will follow
• Bernadette Finn Cork, 2005