A Study of Intake and Assessment in Solution-Focused Brief Therapy

A STUDY OF INTAKE AND ASSESSMENT IN SOLUTION-FOCUSED BRIEF THERAPY Christopher J. Richmond & Gary Bischof Background of the Study • SFBT Outcome Research • In a review of SFBT outcome research, Gingerich and Eisengart (www.gingerich.net) located 18 controlled outcome studies of SFBT reported in the literature through Summer, 2001. • 7 of the 18 were strongly controlled studies. • The European Brief Therapy Association’s (EBTA) website (www.ebta.nu) lists 54 SFBT Published Follow-Up Studies. • Of these studies 5 were randomized controlled studies and 16 were comparison studies. • Some comparison studies have matched SFBT with no treatment, a problem-focused treatment, or an empirically validated or conventional form of treatment. Background of the Study • SFBT is gaining support for its efficacy in a variety of settings and in the treatment of an array of disorders and problem situations. • Currently, there is no other outcome study that has examined an SFBT intake in comparison to a problem-focused interview. Overview of the Study • Purpose of the Study: the aim of this study was to investigate the relative effects of an SFBT intake and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) assessment on measures related to the counselor, session, outcome optimism and goal clarity, and current level of distress. • SFBT Intake: This intake included the following SFBT core interventions: Pre-Treatment Change Question Complimenting Miracle Question (and goal setting) Exception Question or Coping Question Scaling Question End of session task to encourage client to use their strengths/resources toward reaching their desired goals. Overview of the Study • SCID-I Intake (First, Gibbon, Spitzer, & Williams, 2002) This problem-focused intake assessed: Overview of the Presenting Problem, Course of Present Illness, Onset of Present Illness, and Other Current Problems. • The counselors utilized SFBT and SCID-I intake assessment forms which proceduralized the process of both, and prompted the counselor to ask all relevant questions during the treatment session. • It is important to note that this study assessed SFBT as an intake assessment and not as a treatment spanning multiple counseling sessions. Training: SFBT & SCID-I • Training: Each counselor received the SFBT and SCID-I Training. These trainings were comparable, lasting approximately 90 minutes. • SFBT Training: Conducted by Dr. Bischof, this training utilized journal articles, and excerpts from the Interviewing for Solutions (2002) book by De Jong & Berg. • The content included: basic theoretical formulations, goals of therapy, conditions for change, and SFBT techniques. • Counselors were asked to conduct two practice SFBT intakes, the second was video or audio taped and then reviewed for treatment adherence, prior to being permitted to begin data collection for this study. Training: SFBT & SCID-I • SCID-I Training: Conducted by Dr. Eric Sauer, this training utilized the SCID-I User’s Guide (2002) by First et al., case vignettes, and journal articles. • The SCID-I was modified for this study to include the Overview and Screening Modules. • Similarly, counselors were asked to conduct two practice SCID-I intakes, the second was video or audio taped and then reviewed for treatment adherence, prior to beginning data collection for this study. • When the counselors had successfully completed both trainings they were then cleared to begin consenting clients for the purposes of this study. Treatment Adherence • WMU, Two doctoral students served as trained raters under the direction of Dr. Bischof. • The doctoral students were trained in both intake measures • The raters utilized SFBT and SCID-I Evaluation Forms • Inter-rater reliability was enhanced via the doctoral students rating practice sessions along with Dr. Bischof. • SFBT and SCID-I intakes were reviewed and passed the evaluation process if the counselor closely followed the intake script and asked adequate follow-up questions. Treatment Adherence • FSU, Dr. Mark VanLent served as the sole trained rater. Dr. VanLent participated in both trainings. • The counselors at FSU tape recorded their study intake sessions and made them available to Dr. VanLent for review. • Dr. VanLent utilized SFBT and SCID-I Evaluation Forms • Similarly, SFBT and SCID-I intakes were reviewed and passed the evaluation process if the counselor closely followed the intake script and asked adequate follow-up questions. • Following the rating process, the video and audio tapes were transcribed and then destroyed. Data Collection • Data Collection Sites: • WMU Center for Counseling and Psychological Services (CCPS)Grand Rapids, MI. Clients primarily consist of community referrals and court mandated clients. • WMU CCPS-Kalamazoo, MI. Clients primarily consist of community referrals and WMU students. • Ferris State University-Big Rapids, MI. All clients are FSU undergraduate and graduate students. • All clients seeking individual counseling were asked to participate, unless they reported being suicidal, homicidal or experiencing symptoms of a psychotic disorder. SCID-I • SCID-I Intake (First, Gibbon, Spitzer, & Williams, 2002) . The SCID-I included the Overview and Screening modules. This problem-focused intake assessed: Overview of Present Illness, Description of Presenting Problem, Onset and Course of Present Illness, Precipitants of Present Illness, and Treatment History. • The SCID-I began with the counselor reading the following verbatim, “I’m going to be asking you about problems or difficulties you may have had, and I will be making some notes as we go along” • “What is the major problem you have been having trouble with?” And, “Tell me more about that.” Research Design • Mean Comparison Design • Random Assignment: Participants were randomly assigned to Treatment A (SFBT) or Treatment B (SCID-I) • Each counselor followed a random assignment list of administration. • Participants completed (in private) the Counselor Rating Form (CRF-S), Session Evaluation Questionnaire (SEQ) and Immediate Outcome Rating Scale (IORS) outcome measures immediately following the conclusion of the SFBT or SCID-I intake. Following the counselor proceeded with their clinic’s standard intake procedures. Research Design • Participants were administered the Outcome Questionnaire (OQ-45) twice, once prior to the intake and then again at the beginning of the subsequent counseling session. • The mean length of the SFBT intake was 20 minutes and the SCID-I was 18 minutes. • The principal student investigator and the trainers were not involved in providing the intake treatments, in order to prevent against the effects of therapist allegiance and expectancy. Outcome Measures • Outcome Questionnaire (OQ-45.2; Lambert, Hansen, Umphress, Lunnen, Okiishi, Burlingame, & Reisinger, 1996). • Assesses client’s current level of distress. The OQ-45 is the 3rd most frequently used measure of treatment outcome (Ellsworth et al., 2006). • Responses are on a 5-point Likert scale (0-4) that range from “Never” to “Almost Always” • Example items: “I feel no interest in things” and “I feel worthless.” • Counselor Rating Form-Short Version (CRF-S; Corrigan & Schmidt, 1983) 12 items, e.g., client’s evaluation of counselor attractiveness, expertness, trustworthiness, and total effectiveness. • Responses are on a 7-point Likert scale that range from “not very” to “very.” • Example items: “Friendly, Expert, and Trustworthy.” Outcome Measures • Session Evaluation Questionnaire (SEQ; Stiles, 1980; Stiles, Gordon, & Lani, 2002) 22 items, e.g., client’s evaluation of session depth, smoothness, positivity, and arousal. Responses are noted on a 7point bipolar adjective format. • Example items: The session was: “valuable - worthless” and Right now I feel: “happy - sad.” • Immediate Outcome Rating Scale (IORS; Adams, Piercy, & Jurich, 1991) 16 items that assess client’s level of outcome optimism and goal clarity. • Responses are on a 7-point rating scale that range from “Yes, I strongly believe it is true” to “No, I strongly believe it is not true.” • Example items: “I believe treatment is helping” and “I know what needs to be done in order to solve the problem.” Participant Sample • N=30, a total of 15 participants in both treatment groups completed all of the outcome measures. • Seven participants did not return for counseling following the intake, and thus did not complete the second administration of the OQ-45. Three were administered the SFBT intake and four were administered the SCID-I. – Sex = 16 female and 14 male participants – Mean Age = 26.27 – Race = 22 Caucasian/White, 3 Hispanic-American, 2 African-American, 2 Multiracial, 1 American Indian Results • A series of T-tests were conducted on each of the 11 dependent variables. • There were no statistically significant findings indicating differences between the two intakes. • However, data from the OQ-45 indicated that the mean change in OQ scores from the first to second administration was -9.67 for those administered the SFBT intake and -4.80 for those administered the SCID-I. • Thus, those receiving the SFBT intake experienced more than twice the reduction in distress than compared to those in the SCID-I treatment group. Results • The OQ-45 has identified a Reliable Change Index, which notes that if a score changes by 15 points (in either direction) or more it represents reliable change. • Of those administered the SFBT intake only 1 participant had an increase (+2) in current level of distress between sessions • In comparison, there were 6 participants who received the SCID-I that reported an increase in current level of distress between sessions. The mean increase in distress was +14.17. • 3 of the 6 experienced an increase of 15 or greater points, indicating reliable change related to an increase in distress. Results • Gender differences: In grouping all female participants (N=16) (across both treatment intakes) their mean change in OQ scores was -12.69 compared to the male participants’ (N=14) -1.00. Gender Differences 80 70 60 50 40 30 20 10 0 1st OQ 2nd OQ OQ Difference 22 Female Male OQ Change Scores 60 40 20 0 -20 -40 CLIENTS (N = 30) Change Deterioration Reliable Change 30 25 20 15 10 5 0 1 -5 OQ Change Scores 60 40 20 0 -20 -40 CLIENTS (N = 30) 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Reliable Change Change OQ Change Scores: SFBT OQ Change Scores: SCID 50 40 30 20 10 Change Deterioration 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 0 -10 Reliable Change -20 -30 -40 Discussion • The non-significant findings suggest that the SFBT intake is at least comparable to the SCID-I, which is the most widely used diagnostic interview and reflects a “gold standard” in formulating accurate diagnoses (Spitzer et al., 1992). Non-significant findings may be due to a small N and a substantial amount of variance within group scores. Common Factors: “To date, there is less than modest evidence to suggest the supremacy of one treatment modality over another.” (Ahn & Wampold, 2000). This study was ambitious in looking for changes between the two treatments • • • so early in the counseling process. Future Recommendations • Replication of this study utilizing a larger and more diverse sample. • The use of more robust assessment tools that evaluate concepts specific to SFBT such as hopefulness, optimism, and goal clarity. • Other forms of assessment could be used such as observational reports from counselors and family members familiar with the participant. • The treatment intakes could be extended to a more traditional 50-minute session, with assessments following.