Listening for Openings. Amplifying Change

1. Listening for Openings. Amplifying Change Jeff Chang, Ph.D., R.Psych. Athabasca University & Calgary Family Therapy Centre Day 2: July 18, 2019

2. Miracle Question • Remember the trajectories: • general  specific • hypothetical to  real life • less personal agency (client’s passive voice)  more personal agency (client’s active voice) • Think of the Miracle Question as a proxy for hypothetical solutions – it’s not the only way to get there (more about this later) • Don’t move to real life (“Is there any part of this that is happening already?”) too quickly

3. Demonstration: Watch for: • How are we doing on the trajectories? • What am I choosing to focus on and ignore? • Did I miss any openings? • What might you have said or done differently?

4. Miracle Question Tag Team • You are the 35-headed therapist to me • Listen for openings • Listen for content • Your question must be based on the last answer, so it won’t be possible to formulate the next question or statement for sure until you hear what I say • It’s OK to go back

5. Common Factors and SFBT Psychotherapy Outcome • the good news: psychotherapy is effective • the bad news (if you're an advocate of a certain model with a certain commercial interest in promoting it): no specific differences in effect can be attributed to a given model • models that have more focused, behaviorally specific goals (behavioral, cognitive, brief) seem to be more effective when it comes to the specific goals themselves, but are no more effective that other approaches when general functioning is taken into consideration

6. Common Factors and SFBT • psychotherapy outcome can be attributed to:

7. Common Factors In Therapy and SFBT Client factors: • Social supports: influential others, friends, family • Beliefs about the problem • Values • Talents, hobbies • SES

8. Common Factors In Therapy and SFBT Hope and expectancy • Clients think that something will happen just because they enter therapy • Willingness/receptivity • Therapist’s confidence is part of this Model and technique approach: • Value of learning techniques lies in the therapist’s ability to be versatile and to tailor techniques or therapeutic activities to the client situation

9. Common Factors In Therapy and SFBT Alliance factors: • “The therapist took my ideas seriously”: the alliance is in the eye of the beholder (client) • A warm accepting bond • The relationship is the “delivery system”

10. Maximize the Model • A model is the vessel or container for the other common factors • You can be confident if you have a clear roadmap – it might not matter which roadmap it is • Knowing a model well enough so you can be truly present for the client – activates alliance factors • On the other hand, fumbling around with a model you don’t know interferes with your ability to attend • Confidence (not pushiness or arrogance) on your part inspires hope and expectancy.

11. Empower Extratherapeutic Factors and Client Characteristics • Listen for and focus on clients’ unique strengths and resources that are relevant to the problem; • Skills, talents, values, social supports, spirituality, positive character traits • Listen for and focus on when the problem is less severe/troubling – that may have absolutely nothing to do with what happens in the therapy room • Listen for and focus on what clients actually do to have some mastery over the problem or develop solutions

12. Empower Extratherapeutic Factors and Client Characteristics • Listen for clients’ about their beliefs regarding the problem and the potential solution; if it seems to make sense, ask. • Listen for extratherapeutic solution behavior: a trusted friend or family member (e.g., “My Aunt Sadie told me to stop feeling sorry for myself, so I did.”), purchasing a book or tape, spiritual practices, mutual-help group, “Damascus Road” experiences, etc.

13. Activate the Alliance • As possible, accept the client’s goals at face value instead of challenging them or altering them to fit a particular theoretical model • Where client goals are obviously inappropriate, listen carefully for openings • For involuntary clients “how to get the [authority figure] off your back” • For clients who persist in problematic behavior, understanding how the problematic behavior (e.g., aggression, substance misuse) helps • Be mindful that talking about something differently may permit clients to ‘buy in’ differently

14. Activate the Alliance • E.g., doing homework to ‘be successful in life’ may not invite motivation. Doing homework to ‘not get in trouble as much’ may. • Assume relationship stance with clients that is appropriate to their ‘readiness’ or ‘motivation.’ • More about this later when we view Dr. Norcross in session • Recognize that clients may be more interested in changing in one domain than in another – ‘readiness’ for change is not global

15. Activate the Alliance • Discuss material that is relevant to the client. • Work on goals that are relevant to the client • Seek frequent feedback on the alliance

16. Maximize Model and Technique • Listen carefully for clients’ assumptions about change, and select interventions that are compatible with the client’s beliefs and values (“client’s theory of change”) • Know your model, technique, or procedure well enough so you can: • Execute it confidently

17. Maximize Model and Technique • Understand the intent of the intervention and its purported mechanism of change • Know that it fits for you personally • Hold your model, technique, or procedure well enough to be good at it, and to believe in its utility for you, but not as ‘the only true way.’

18. Enhance Expectancy & Hope • Sound confident but not bossy. Say, “I’ve got lots of ideas for strategies, but first…” • “Tell me what you’ve done so far (because I don’t want to suggest ideas that will useless to you)” • Obtain a detailed description of attempted solutions and how they worked. • Work to implement previous solutions that worked (partially, temporarily, or that seemed promising) – maybe there is something they are forgetting to do, or did not try for long enough

19. Maximize Model and Technique • “Deliberately empower” this factor by asking future-focused, change-oriented questions • “Allegiance factors”: the therapist’s confidence in the model, connected with the sense that they are using a model that fits for them

20. Listening for Openings (3) 2:45