Brief Therapy Professor Craig A Jackson Head of

Brief Therapy Professor Craig A. Jackson Head of Division of Psychology Craig. Jackson@bcu. ac. uk

Solution Focused Brief Therapy Social Constructionist Focus on what clients want to achieve Doesn't focus on problems Doesn't focus on past

Solution Focused Brief Therapy

Solution Focused Brief Therapy 1980 s USA Steve de Shazer & Insoo Kim Berg "Solution Behaviour" not "Problem Behaviour"

Initial Session Find out what client wants from sessions "Best hopes of our work together? " Find out small details of life if problems solved Miracle question What do they already do that is successful "Tell me about when the problem is not there" What might change by asking a small step towards hopes "What would others notice about you? "

How Brief a Therapy? Aim for 5 sessions 45 mins each session Rarely beyond 8 sessions Sometimes 1 session enough Any improvements after 3 sessions? Increase gap between sessions as time goes on

Solution Focused Brief Therapy Principle 1 Nobody's perfect all the time - even in their problems What can these "exceptions" tell us Things people ordinarily do can contribute to solution

Solution Focused Brief Therapy Principle 2 Knowing where you wish to be makes getting there easier Problems cloud our view of future Lose sight of what we want apart from ending problem Clearer it becomes, greater chance of making solution

Solution Focused Brief Therapy Ask questions about. . . Client's story Client's strengths Client's resources Client's exceptions Relationships Self-esteem issues

Solution Focused Brief Therapy Uses "Respectful Curiosity" Requires client to see their preferred future Begin steps to change Small increments

Solution Focused Brief Therapy Sees change as a constant & natural entity Help people identify things they wish to change Help people attend to what is currently happening D Help people attend to what they want to continue happening Create a concrete version of their preferred future

Plan for Sessions

A Preferred Future Therapist identifies times in current life that are close to the preferred future. Focus on what is different on such occasions Bring small successes to client's awareness Help client repeat successful things

Enabling the Preferred Future Focus on. . . a) Support to explore preferred future b) Explore (when, where, with whom, how) bits of it already happen Practical No "theory" beyond social constructivism Intuitive - stick to the above principles

Resources & Tools Miracle Question Scaling Exception-seeking questions Coping questions Problem-free talk

Miracle Question How the future may be Helps establish goals Ask slowly Pay attention to NVCs Give time to answer Ignore "Don't knows"

Scaling Question Identify differences for client Usually range 0 - 10 Helps client identify resources Helps identify referred future "How would you improve things by 1 point? " "Where on the scale would you be if. . . ? "

Coping Question Identify clent resources they dont even acknowledge Can be used even in most pessimistic situations Genuine curiosity helps Genuine admiration for client helps Helps identify referred future Ensure client doesn't feel you're contradicting them "Despite all the problems you still work. How you do it? "

Problem-free Talk Identify client resources helping them relax or be effective Talk about mundane life or irrelevant experiences All probes - leisure, friends, relaxing, conflct resolution Can use strengths and resources to move forward Ordinary achievements & Everyday responsibilities "you describe you're successful a work dealing with conflicts. Could the skills be used at home with your child? "

Playful ideas: Time Machine “If you had a time machine which time would you go to? ” Rich / creative question which can yield possibilities: More info about the client’s interests and enthusiasm Resource identification – “When I won an art prize" Regret – “when I said yes to my future husband". Risk of being hi-jacked into problem saturated stories. A time when a trauma could have been prevented – this gives an opportunity to use The Rewind Technique A future time: may be used to identify goals – another form of the miracle question.

Playful ideas: Imaginary Machine “If you had a machine to do anything” A woman conjured up a “chill machine” which was installed in her basement. You stepped through it and it had green lights with a relaxing humming nose. After filling out the description she decided that her son and husband would also benefit. A teenage boy had a sort of "anger radar" in his pocket which beeped, so that only he could hear it. It gave him an early warning signal so that he could dig himself out of a difficult situation and do his deep breathing

Playful ideas: Super sleuth Imagine you are a Solution Detective – you could invoke your favourite sleuth to find a solution to your problem Do something different for 5 minutes a day Doesn’t matter what it is (as long as legal and safe) – it is the regularity of the practice: Give someone a pleasant surprise Practice random acts of kindness The compliments box A special box is set up in the home and members encouraged to post complimentary comments about each other.

Internal Resources Help clients attend to their resources, skills and abilities Helps make a narrative of cent as a competent individual Empowers client in identifying their own strengths Skills Strengths Qualities Beliefs Tenacity Capacity

External Resources Supportive relationships Friends Partners Faith Workplace Unions Social services

Compliments End sessions with compliment of client abilities Focus on positive points Set tasks using those abilities Ordinary achievements & responsibilities

Agoraphobia case Mrs Brown Agoraphobic and was seen at home. It is unusual for agoraphobic patients not to go out at all (children have to be taken to school, dogs walked, shopping done) but it seemed that Mrs Brown's case was so severe she had not stepped out of her front door for several months. It turned out that Mrs Brown could not even bring her milk in off the step because being near the front door could set off a panic attack. The therapist had noticed that the stairs came down right beside the front door and after listening very seriously to Mrs Brown's worries, asked about the courage that it must take her to come down stairs each day.

Agoraphobia case Mrs Brown Agoraphobic and was seen at home. The more her daily courage was explored and acknowledged the stronger became her voice. She then began to remember other acts of courage, like saying to herself the day before ‘Don't be silly’ and bringing in the milk or some months earlier when she had made herself attend her aunt's funeral because her aunt had loved her. As she became aware of this hidden but persistent courage, Mrs Brown began to put it to greater use and over the following weeks, with two more clinic sessions to support her, she made her way back into the outside world.

Self-change Model Pre-contemplation: The client does not recognize that they have a difficulty and will blame others: “it’s your problem not mine. ” People may be in this stage because they lack awareness or they may have tried to change a number of times and become demoralized about their ability to change. Both groups tend to avoid reading, talking or thinking about their problems. They may characterized as resistant or unmotivated or as not ready for any intervention.

Self-change Model Contemplation: The client starts to recognize that they have a problem and is the stage in which people are intending to change in the near future. They are more aware of the pros of changing but are also acutely aware of the cons. This balance between the costs and benefits of changing can produce profound ambivalence that can keep people stuck in this stage for long periods of time.

Self-change Model Preparation: The stage in which people are intending to take action soon. They may have made that initial phone call to therapist and have turned up for the first session. These individuals have a plan of action, such as consulting a counsellor, talking to their doctor, buying a self-help book or relying on a self-change approach.

Self-change Model Action: Clients have committed to a course of action and have taken steps to change their behaviour, modifying thoughts and feelings. They may now have a sense of timescale, how long the change process may last. Maintenance: Clients are working at keeping the changes going; it is important not to allow relapse to take place. Relapse: Possible and may be of different degrees of severity. Ideally people can move back into the action phase as soon as possible.

Brief Solution Focused Therapy MCQ 1. Solution-focused brief therapy is based on: A. clear diagnostic formulation B. appreciating the client's resources C. detailed description of the client's problem D. the scientific study of personality E. the use of language as a creative process.

Brief Solution Focused Therapy MCQ 2. Solution-focused techniques involve: A. the ‘miracle’ question B. paradoxical injunctions C. complimenting the client D. careful administration of medication E. the patient's acceptance of the problem.

Brief Solution Focused Therapy MCQ 3. Solution-focused techniques have been effective in treating: A. drug and alcohol misuse B. agoraphobia C. adolescent behavioural problems D. eating disorders E. chicken pox

Brief Solution Focused Therapy MCQ 4. Solution-focused authors include: A. de Shazer B. Lethem C. Rollnick D. O'Hanlon E. White

Brief Solution Focused Therapy MCQ 5. Scaling questions explore: A. the patient's achievements B. the patient's description of the symptoms C. medication requirements D. possible areas for progress E. goals of therapy.

Useful References Berg, I. K. (1991) Family Preservation: A Brief Therapy Workbook. London: BT Press. Berg, I. K. & Miller, S. (1992) Working with the Problem Drinker: A Solution Focused Approach. New York: Norton. de Shazer, S. (1985) Keys to Solution in Brief Therapy. New York: Norton. George, E. , Iveson, C. & Ratner, H. (1999) Problem to Solution: Brief Therapy with Individuals and Families. London: BT Press. Hawkes, D. , Marsh, T. & Wilgosh, R. (1998) Solution-Focused Therapy: A Handbook for Health Care Professionals. Oxford: Butterworth–Heinemann. Hoyt, M. F. (1984) Single session solutions. In Constructive Therapies (ed. M. F. Hoyt). New York: Guilford.

Useful References Jacob, F. (2001) Solution-Focused Recovery from Eating Distress. London: BT Press. Lethem, J. (1994) Moved to Tears, Moved to Action: Brief Therapy with Women and Children. London: BT Press. Mac. Donald, A. J. (1994) Brief therapy in adult psychiatry. Journal of Family Therapy, 16, 415– 426. O'Connell, B. (1998) Solution-Focused Therapy. London: Sage. Rhodes, J. & Ajmal, Y. (1995) Solution-Focused Thinking in Schools. London: BT Press. Sharry, J. (2001) Solution Focused Groupwork. London: Sage. Talmon, M. (1993) Single Session Solutions. New York: Addison-Werlely.