Practical Applications of a Solution Focused Approach to Counseling and Intervention Leslie Cooley...

Practical Applications of a Solution Focused Approach to Counseling and Intervention

Leslie Cooley & Michael Haas

Tell me, and I’ll forgetShow me, and I may not rememberInvolve me, and I will understand

Native American Saying

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

Oliver Wendell Holmes

Change is inevitable

Growth is an option

What do you think creates change?

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

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?

If what you are doing isn’t working…..

At least do something different

Lipstick Story

SFBT is a strength-based perspective

Change is frequently connected to success.

Success breeds success….

Building on Success

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

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?

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 didn’t, how did you make it happen this time?

• What helped you stick with it?• What made the difference this time?• What’s your theory about how you got this

change to occur?

In a strength-based approach, questions are

• Curious… a posture of “not knowing”• Look for exceptions to the problem…

most problems don’t occur all the time• Respectful… must be genuine• Complimenting… directly or indirectly• Future focused… connect to goals

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?

The assumptions are different

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

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

What you focus on expands

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

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 doesn’t guarantee that change will

occur

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

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:

Common Factors

• What clients bring to treatment

• Practitioners’ respect for these resources

• The quality of the relationship

Client Factors 40%

• Inner strengths, resources, and innate capacities

• Ability to enlist support and help from others

• Fortuitous events

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

Expectancy Factors 15%

• Expectation of help and improvement

• Faith and hope

• Emphasis on possibilities, personal agency and an internal locus of control

Model Factors 15%

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

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.

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

GOALS…..

Developing a future focus and well formed goals

Goals

• “I skate to where the puck is going,

… not to where it’s been.”

Wayne Gretsky,

hockey champion

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

Goals: The agenda for counseling

• Within the client’s control• Viewed as the first step, rather than the

end pt. • Perceived by clients as involving hard

work

Goal Questions

• How will you know when you won’t need to come here anymore?

• How will you know when things are better?

• When is a little of that already happening?

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?

Whose goals?

• “The problem is other people think there’s a problem”

• Accepting the client’s position

• Goal=proving that I don’t have a problem

• The sincerity question

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 don’t know” • Ask clarifying follow-up questions

If you don’t know where you are going, how will you know when you get there?

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

Asking questions…From 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?”

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

Identifying the client’s relationship to the problem

and establishing a collaborative working relationship

Tools for Collaboration

• Adopt a stance of “not knowing” or respectful curiosity

• Match your responses to the student’s readiness for change

Not Knowing

• Listen! Even if you don’t 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?”

Empathy

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

Insoo Kim Berg BFTC Web Site

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

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

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

Visitor RelationshipNo Problem – No Goal

• Precontemplaton stage of change

• Often “sent” or mandated to come to counseling

• “What am I doing here!?”

Responding in a Visitor Relationship

• Listen and acknowledge the client’s point of view

• Expresses sympathy for the client’s situation

• Use relationship questions to address the wishes and needs of referring party

Relationship Questions

• What do you think _____ wants to be different as result of us talking

• Who do you need to convince that you don’t need to be in counseling anymore?

• What would convince them?

Responding in a Visitor Relationship

• Respectfully provide information about nonnegotiable requirements

• Notice small exceptions • Refrain from offering suggestions to “do”

anything

Responding to “I don’t know”

• “I realize I’m asking you some tough questions, (pause) So, suppose you did know, what you would you say?”

• Ask relationship questions

• Use multiple choice questions

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

Responding in a Browser Relationship

• Listen, acknowledge POV, express sympathy for the client’s situation, and use relationship questions

• Encourage reflection

• Notice small exceptions and refrain from offering suggestions to “do” anything

Responding in a Browser Relationship

• Provide accurate information

• Instill hope that change is possible

• Explore the pros and cons of change without pressure

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

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

Working with exceptions and client resources

Looking for Exceptions

• Problem descriptions are seldom useful for building solutions

• Exceptions= times when the problem doesn’t 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

Exceptions to the problem

• Much easier to talk about the problem… but knowing more about the problem doesn’t necessarily suggest what to do about it. (DSM Dx. Doesn’t = intervention)

• Search the past and present for solutions by focusing on times when the problem wasn’t present, less frequent, less intense

Focusing on Exceptions

• Shrinks problems… Ask about details• Demonstrate client abilities…How 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

Case examples

• Dahlia’s victory over her anger and fighting

• Kid with the temper who played soccer

• Your life?

• Not as useful with young children

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?

• What’s the highest you have ever been?• When was that? What were you doing then?• How did that make things different?

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

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 ___?

Tasks and homework

What kind of relationship do you have with the client?

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

Tasks and Relationships Visitor Relationship Compliment only

Browser Relationship

Observational task

Customer Relationship

Action task

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….

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…”

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”

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 …?”

Action Tasks

• Public expression of intent to change

• Gathering information

• Dramatic Relief – Talking, writing, art

• Countering or “do this instead”

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

Techniques for speeding up change

• Validate client’s concerns

• Interrupt respectfully

• Assume clients can change

• Build on small changes

• Go lightly with archeological digs

• Begin each session focusing on what has worked