Chapter 14 by pengxuebo

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									      Mastering Competencies in
      Family Therapy:
      A Practical Approach to Theories and Clinical
      Case Documentation



                       CHAPTER 14
                Solution-based Therapies

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Chapter 14
Mastering Competencies in Family Therapy

  Solution-Based Therapies

         Best known strength-based therapies
         Positive, active approach
            Help clients move toward desired outcomes.
       There are three strands of practice
        which share many similarities
         Solution Focused Brief Therapy
         Solution-Oriented Therapy
         Solution-Oriented, Erickson Hypnosis

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Chapter 14
Mastering Competencies in Family Therapy

  Solution-Based Therapies

  Overview
         Brief therapy approaches influenced by
            Mental Research Institute (MRI)
            Milton Erickson’s brief therapy and trance work
         Strength-based
            Popular with clients, insurance companies and mental
             health agencies
         Solution-focused
            Therapists spend a minimum of time talking about the
             problems
            Instead focus on moving clients towards solutions

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Chapter 14
Mastering Competencies in Family Therapy

  Common Myths
                            Solution-based Therapists
         Myth #1: They propose solutions to clients (which
          amounts to advice giving)
            Client identifies solutions, therapists assist client in
             identifying solutions and they identify exceptions to the
             problem, describe what is already working, and identify
             client resources
         Myth #2 They never talk about the problem
            They spend less time talking about the problem
            They take their lead from the client
            Hallmark techniques, such as exception questions
             require they talk about the problem
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Mastering Competencies in Family Therapy

  Common Myths                    (continued)
                              Solution-based Therapists
         Myth #3: They never talk about the past
              When they talk about the past, they focus on strengths
              Talking about the past is important – it helps to identify
               what has worked and what has not
         Myth #4: Emotions are not discussed in therapy
              They do not view the expression of emotions as curative
               in and of itself (as with humanistic therapies)
              Instead, emotions are used as clues for works and
               where they want to go


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Chapter 14
Mastering Competencies in Family Therapy

  Significant Contributions to the Field
         Assessing Client Strengths
              Strengths include resources in a person’s life,
               personally, relationally, financially, socially, or
               spiritually and may include family support, positive
               relationships and religious faith
              Clients often have greater difficulty identifying areas
               without problems in their life
              Strengths are assessed in two ways
                 By directly asking about strengths and areas of life that
                  are going well
                 By listening carefully for exceptions to problems and
                  for areas of unnoticed strength                         6
Chapter 14
Mastering Competencies in Family Therapy

  SBT Contributors
     Milton Erickson
         Hypnosis
         Brief
         Strength-based focused
         Bill O’Hanlon and Steve de Shazer’s
          Solution-Focused
     Steve de Shazer and Insoo
      Kim Berg
         Solution-Focused Brief Therapy
         Milwaukee Brief Family Therapy
          Center
              Scott Miller, Barry Duncan and Mark       7
               Hubble, Yvonne Dolan, and Linda Metcalf




Chapter 14
Mastering Competencies in Family Therapy

  Solution-Based Therapy Contributors
                              (continued)
         Solution-Oriented Therapy
         Bill O’Hanlon
         Michelle Weiner-Davis
         Collaborative, Strength-
          Based Therapy
         Matthew Selekman
         Solution-Focused Brief
          Therapy Associations
         SFBTA
         EBTA                                           8
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  Overview of Therapy Process
         Identify Clients’ Preferred Solutions:
            Identifying problem, exceptions, and desired
             outcomes
            Working with clients to take small active steps
             in this general direction each week
         Length of Treatment
            Can take 1 – 10 sessions or years
            Depends on the complexity of the case


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Chapter 14
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  The Therapeutic Relationship
 Beginner’s Mind
     Involves listening to a clients story as if you are
      listening for the first time not filling in blanks with
      personal or professional knowledge
 Echoing Client’s Key Words
     Using client language often makes the problem more
      “solvable” and engenders greater hope




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Chapter 14
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  The Therapeutic Relationship
                              (continued)
  Carl Rogers with a Twist: Channeling
     Language
         Reflections of feeling delimit the difficult feeling,
          behavior or thought by reflecting on a time, context,
          or relational limit
            Past tense rather than chronic state or characteristic
            Partial rather than global
            Perception rather than unchangeable truth
  Optimism and Hope
         Solution-based therapists assume that change is
          inevitable and that improvement - in some form -
          is always possible                              11




Chapter 14
Mastering Competencies in Family Therapy

  Case Conceptualization/Assessment
         Exceptions and “What Works”
         Strengths and Resources
         Client Motivation: Visitors, Complainant, and
          Customers
            Visitors: usually brought to therapy by an outside
             other such as spouse, parents, courts
            Complainants: identify a problem but expect
             therapy or some other person to be the primary
             source of change
            Customers: identify a problem and want to take
             action towards the problem                       12
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  Goal Setting
         Goal Language – Positive and Concrete
            “Increase sense of hope and positive mood in
             relationship with husband.”
         Meaningful to client
         Interactional
         Situational
         Small steps
         Clear role for client
         Realistic
         Legal and ethical
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Chapter 14
Mastering Competencies in Family Therapy

  Goal Setting (continued)
         Solution-Generating Questions:
        Miracle question,
        Crystal ball question,
        Magic wand question, and
        Time machine questions
      Work best when therapist:
        Prepares client for a solution-generating question
        Creates a compelling vision
        Asks for behavioral differences


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Chapter 14
Mastering Competencies in Family Therapy
Goal Setting (continued)

       Small steps: Scaling questions for goal
        setting
       One Thing Different: Client-generated
        change




Chapter 14
Mastering Competencies in Family Therapy

  Interventions
       Formula First Session Task
       Scaling Questions for weekly task assignments
       Pre-Suppositional Questions and Assuming
        Future Solution
       Utilization
       Coping Questions
       Compliments and Encouragement


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Chapter 14
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  Interventions for Specific Problems
         Couples Therapy and Divorce Busting
            Videotalk
            From Complaints to Requests
         Sexual Abuse
            Honoring the Agency of Survivors
            The Recovery Scale: Focusing on Strengths and Abilities
            3-D Model: Dissociate, Disown, and Devalue
            Constructive Questions
            Videotalk (Action Terms) with Abuse and Trauma Survivors




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Chapter 14
Mastering Competencies in Family Therapy

  Solution-Oriented, Ericksonian Hypnosis

         Evoke client strengths and resources to
          resolve client problems
         Different from traditional hypnosis in
          two significant ways:
            Permissive rather than Hierarchical
            Evoking Client’s Natural Resources rather than
             Directing Therapist–Defined Outcome



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Chapter 14
Mastering Competencies in Family Therapy

  Overview of Therapy Process
         Invitation
            Invites the client to go into a trance in
             order to evoke resources and strengths that
             the client already has
         Direct or Indirect Induction
            May be done with or without a clear
             induction into a hypnotic trance state
         Metaphorical
            Erickson is known for using stories, analogies,
             and directives to activate latent abilities to
             enable clients to resolve their problems          19




Chapter 14
Mastering Competencies in Family Therapy

  Techniques
         Permission to Do or Not Do
         Presuppositions of Change
         Splitting: e.g., Conscious/Unconscious Mind;
          Left/Right Brain
         Class of Problems/Class of Solutions
            Focus on evoking the class of solution rather
             than trying to solve the literal problem
            Most important to identify client strengths that are
             in the same class of solutions that relate to
             the presenting problem

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Chapter 14
Mastering Competencies in Family Therapy

  Snapshot: Research/Evidence Base
         Strong, growing evidence base for the model
         Three key practical and philosophical challenges
          of establishing solution-focused
            Difficult to adequately manualize and capture the spirit
             and epistemological positioning that is essence of the model
            Shallow adherence to techniques without grounding in the
             theory results in an inaccurate enactment of the therapy
            Certain philosophical principles such as honoring each
             clients uniqueness and recognizing change processes outside
             of therapy are at odds with the making global
             assessments of the effectiveness of this approach


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Chapter 14
Mastering Competencies in Family Therapy

  Working with Diverse Populations
         Widely used with diverse populations in the US,
          Canada, and internationally
         Easily adapted for a wide range of value
          systems and communication styles
         Has been studied with a range of client
          ethnicities in a wide range of contexts
         Approach can be used to identify strengths to
          access unique emotional, cognitive, and/or
          social resources inherent within diversity

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