Overview of Solution-Focused Brief Therapy: Helping Approach for Ohio Youth in Transition (OYIT) Program

1. Overview of Solution-Focused Brief Therapy: Helping Approach for Ohio Youth in Transition (OYIT) Program January 14, 2011 Patricia B. Mares, MEd, LSW Alvin S. Mares, PhD, MSW

2. Overview of Solution-Focused Brief Therapy (SFBT) • Developed by Steve de Shazer, Insoo Kim Berg, and their team at the Brief Family Therapy Center, an urban clinic in Milwaukee, WI, in the mid-1980’s • Key elements • Problem ~ motivation • Miracle question ~ possibility/hope • Scaling ~ goal formation • Exceptions & coping ~ confidence/strengths • Break • Feedback • Compliments • Bridge • Suggestions/homework/experiments • Current “owner” of model: Solution-Focused Brief Therapy Association (SFBTA) … www.sfbta.org

3. SFBT Theory of Change • Type of talking therapy based upon social constructionist philosophy. • Focuses on what clients want to achieve through therapy rather than on the problem(s) that made them to seek help. • The approach does not focus on the past, but instead, focuses on the present and future. • SFBT therapists help their clients to construct a concrete vision of a preferred future for themselves. • The SFBT therapist then helps the client to identify times in their current life that are closer to this future and examines what is different on these occasions. • By bringing these small successes to their awareness, and helping them to repeat these successful things they do when the problem is not there or less severe, the therapists helps the client move towards the preferred future they have identified. • Solution focused work can be seen as a way of working that focuses exclusively or predominantly at two things: • 1) Supporting people to explore their preferred futures. • 2) Exploring when, where, with whom and how pieces of that preferred future are already happening. • While this is often done using a social constructionist perspective the approach is practical and can be achieved with no specific theoretical framework beyond the intention to keep as close as possible to these two things. Source: Wikipedia

4. Clinical Applications of SFBT • Couples (Chpt. 4) • Depression (Chpt. 5) • Domestic violence offenders (Chpt. 6) • Public school settings (Chpt. 7) • Children (Chpts. 8 & 9) • Faith-based communities (Chpt. 10) • Helping professionals (Chpt. 11) • Mental health practice (Chpt. 12) • Child welfare youth (Chpt. 13) • Low income, independent young adults (Ohio Youth in Transition/OYIT) • www.oyit.org Source: Nelson & Thomas, 2007

5. Evidence Base for SFBT • Literature review articles • Gingerich, W.J., & Eisengart, S. (2000). Solution-focused brief therapy: A review of the outcome research. Family Process, 39(4):477-498 • Corcoran, J., & Pillai, V. (2007). A review of the research on solution-focused therapy. British Journal of Social Work, 10:1-9 • Kim, J.S. (2008). Examining the effectiveness of solution-focused brief therapy: A meta-analysis. Research on Social Work Practice, 18:107-116 Source: Nelson & Thomas, 2007

6. Approaches to Helping Problem Solving (Norm) Solution Building (Alternative) Description of problem by youth Development of well-formed goals (by youth) Exploring for exceptions (adult helps identify & focus on youth strengths and abilities) Adult provides feedback (i.e., compliments & suggestions) Evaluation/discussion of youth progress Youth as experts of own lives, in “driver’s seat” (rather than adult) • Stages • Description of problem by youth • Analysis & assessment of problem by helping adult • Intervention planning (relying on experience & knowledge of adult) • Intervention implementation • Evaluation and follow-up, modification of intervention as needed Source: De Jong & Berg, 2007; Chpts. 1 & 2

7. Solution Building Interviewing Skills(Ordered from beginning to end; simpler to more complex) Self-disclosing Complimenting Affirming youths’ perceptions Natural empathy Normalizing Returning the focus to the youth Noticing hints of possibility Exploring youths’ meanings Relationship questions Amplifying solution talk • Listening • Formulating questions • Getting details • Echoing clients’ key words • Asking open-ended questions • Summarizing • Paraphrasing • Awareness of own non-verbal behavior • Use of silence • Noticing youths’ non-verbal behavior Leading from one step behind Source: De Jong & Berg, 2007; Chpt. 3

8. Individual sessions(“50-minute” in-person meetings with intern or mentor)

9. Getting Started: How to Pay Attention to What the Youth Wants • Clarify names (youth & adult) • Describe “session” structure • Example for individual case management, in-person session • Talk for 30-40 minutes • 10 minute break • End with some feedback and possibly suggestion or two • Note structure for phone contacts, group sessions, mentoring activities to be developed Source: De Jong & Berg, 2007; Chpt. 4

10. Getting Started: How to Pay Attention to What the Youth Wants • Problem description • How can I help? • How is this a problem for you? • If more than one problem mentioned…which is most important for you to work on first? • What have you tried so far to solve the problem? Was it helpful? • Development of well-formed goals • What would have to be different as a result of our meeting today for you to say that our talking was worthwhile?

11. How to Amplify What Clients Want: The Miracle Question “Now, I want to ask you a strange question. Suppose that while you are sleeping tonight and the entire house is quiet, a miracle happens. The miracle is that the problem which brought you here is solved. However, because you are sleeping, you don’t know that the miracle has happened. So, when you wake up tomorrow morning, what will be different that will tell you that a miracle has happened and the problem which brought you here is solved?” Source: De Jong & Berg, 2007; Chpt. 5

12. How to Amplify What Clients Want: The Miracle Question After asking miracle question… • What will you notice that’s different? What will be the first thing that you notice? What else? • Who else will notice when the miracle happens? What will he or she notice that is different? What else? • When he or she notices that, what will he or she do differently? What else? • When he or she does that, what will be different for you? Source: De Jong & Berg, 2007; Chpt. 5

13. Exploring for Exceptions: Building on Client Strengths and Successes • Exception questions • Are there times when the problem does not happen or is less serious? When? How does that happen? Are there times that are a little like the miracle picture you describe? • Scaling questions • Here is a different kind of question, one which puts things on a scale from 0 to 10. Let’s say 0 equals the problem at its worst and 10 is the miracle you described to me earlier. • Where are you on that scale now? • Where would you like to be on this scale a week (or month or 3 months) from now? What would that look like? • What could you do between now & then to get there? • Compliment when number is higher (That’s great!); also when number is lower (What keeps you from sliding lower down the scale?) Source: De Jong & Berg, 2007; Chpt. 6

14. Formulating Feedback for Clients • Take a thinking break (10 minutes) • Structure • Compliments: summary of youth strengths, successes • Bridge • I agree with you, [name], that [youth’s goal in his/her own words] is an important goal. So I suggest that you... • Task or suggestion • Observational and/or behavioral suggestion(s) • Based on problems, goals, exceptions, motivation, etc. • Deciding about the next meeting • So when do you think it would be most useful for us to meet/talk next? Source: De Jong & Berg, 2007; Chpt. 7

15. Later Sessions: Finding, Amplifying, and Measuring Client Progress • What’s better? • EARS • Eliciting the exception • Amplifying it • Difference between exception time & problem times • Exploring how exception happened, especially youth’s role in making it happen • Reinforcing the successes and strengths the exception represents, complimenting when appropriate • Start again (i.e., What else is better?) Source: De Jong & Berg, 2007; Chpt. 8

16. Later Sessions: Finding, Amplifying, and Measuring Client Progress • Doing more of the same • What will it take for you to keep on with what you have been doing to make yourself feel better? • Scaling progress • Using the numbers again, where 10 equals the miracle and 0 was where you were when you decided to come-in for help, where would you say you are at this week? • Note: If number seems lower or higher than expected given exceptions (What’s better?), discuss apparent discrepancy with youth Source: De Jong & Berg, 2007; Chpt. 8

17. Later Sessions: Finding, Amplifying, and Measuring Client Progress • Next steps • Reviewing goals to decide whether to increase scale value and/or identify other goals to work on • Setbacks and relapses • Accept and normalize disappointments, then focus on successes/strengths within disappointments (i.e., ways in which things could have been worse, but weren’t) Source: De Jong & Berg, 2007; Chpt. 8

18. Individual sessions(Crisis intervention)

19. Crisis Interviewing (or when nothing is better) • Getting started • I’m glad you came here today (or called/contacted me)…What kind of help do you need first? • Current coping efforts • Find and compliment strengths • What are you doing to take care of yourself in this situation? • What else has been helpful to you? • Could it be worse than it is? How come it is not worse? • Who (and what) do you think would be most helpful to you at this time? • What about them/that would be so helpful to you? Source: De Jong & Berg, 2007; Chpt. 10

20. Crisis Interviewing (or when nothing is better) • Scaling coping progress • Suppose 10 means you are coping as well as you could possibly imagine, and 0 means you are not coping at all, where would you say you are right now? • Goal formation: co-constructing the next step • Suppose things moved up one number on the scale. What would be different that would tell you that you were coping just that much better? What would it take for that to happen? • Suppose things moved 2 or 3 numbers on the same scale. What would be different that would tell you that you were coping that much better? What else? What would it take to make those things happen? What else? • What is the single most important thing for you to remember to continue coping with this situation?

21. Support group sessions(interns and/or mentors)

22. Assumptions for SF Group Work • Given a cooperative context, youth are capable of solving their own problems. • Youth can create or discourage situations in which problems occur. • Youth feel more competent when they design their own strategies to solve problems. • When a youth seems resistant, the helping adult should change strategies. • Problems do not cripple youth; youths’ perception of their problem cripples them. • Reflecting competency in a group seeds the unconscious for later actions. • Symptoms are problems that clients are unable to articulate and, instead, act on. • Problem “dis-solving” is a collaborative process during which youth remember times when problems happened less frequently.

23. Guidelines for Facilitating SF Groups • Keep the group nonpathological, redescribing problems to open-up possibilities

24. Guidelines for Facilitating SF Groups • Focus on exceptions to the problems discussed in group interactions • When you notice a group member’s competency in the group process, comment on it intermittently and gather other group members’ thoughts on your discovery • Focus on participants’ ability to survive problem situations • Attempt to see group members as people who have complaints about their lives, not as persons with symptoms Source: Metcalf, 1998; Chpt. 1

25. Guidelines for Facilitating SF Groups • Remember that complex problems do not necessarily require complex solutions; an opportunity to help think in simpler ways • Frame alternative actions and behaviors as those which may be less dangerous and interfering than those problematic actions/behaviors currently being used • Help group members view their problem as external to themselves – as a separate entity that influences but does not always control their life

26. Guidelines for Facilitating SF Groups • Focus only on the possible and changeable; assist group members in thinking more specifically and less emotionally when setting goals • Go slowly and encourage group members to ease into solutions gradually • Help them to see each new strategy as an experiment, not as a technique that guarantees success; whatever happens as a result of a new strategy is simply part of an experiment toward change

27. Keeping the Group on the SF Track • What do youth hope to achieve during group therapy? • What are the clues about how youth function in life, as indicated by the way they speak in group sessions regarding their strategies for conducting relationships with family members, friends, bosses, etc.? How do youth approach group members and respond to other situations of concern? • What would participants like the significant others in their lives to know about them? How would that new knowledge be beneficial to the youth? • What past successes in solving previous difficult problems have the youth had? How do they explain their past successes? Source: Metcalf, 1998; Chpt. 2

28. Keeping the Group on the SF Track • What are the goals and dreams of the youth? What does this say about priorities, needs and personhood? What is obvious in group interactions regarding their interpersonal strengths with others? • How quickly and efficiently do clients perform the tasks discussed in group? How agreeable are they to suggestions made by other group members or the helping adult? • What have others (other helping adults, friends, or family members) tried that have helped or hindered a group youth’s progress toward solutions?

29. SF Group Meeting Agenda -- Initial • Welcome youth to group • Introductions • As you introduce yourself, give us a brief idea as to why you are here and tell us what you think we should know. • Suggest goal setting • What will be going on in the future that will tell you and each of us that things are better for you? • Search for exceptions to youths’ problems • Briefly acknowledge clients’ struggles with their problems and express respect for their decision to attend group • Direct attention to what life was like before the problem appeared • Let’s talk about those times before the problem started to interfere in your life and what you were doing then that kept it away. How did you do that? Where were you? Who was there? How did that keep the problem smaller and not as intrusive?

30. SF Group Meeting Agenda -- Initial • Encourage motivation • Someday, when the problem that brought you here to group is less of a problem in your life, what will you get to do more of? • As you listen to your peers, is there someone in our group whom you might like to encourage to do something different? • As we talked today, who noticed a peer who had a problem and appeared to be more problem free during our conversations? • Assist group members with task development • Now let’s talk about what you think you might do until we meet again, to keep these problems smaller? • As we stop today, I would like each of you to watch your day-to-day activities closely until we meet again and notice when your situations are not bothering you as often. Keep track of these exception behaviors and be ready to describe them to the group next time. Source: Metcalf, 1998; Chpt. 2

31. SF Group Meeting Agenda -- Initial • Scaling questions (optional) • If a 10 means that you are in charge of your life and a 1 means the problem is in charge of you, where would you say you are today on the scale? • Where would you like to be before our group meets again? • What did you learn about yourself today in group that would help you get there? • Does anyone have a suggestion for any particular group member? • Adjourn

32. SF Group Meeting Agenda -- Ongoing • Who would like to start our time together by telling us what’s gone better for you since we last met? • If nothing better…Tell us about your worst day. Now tell us about a day that was slightly better. • Let’s suppose that more of that happens. What do you want to happen for you by the time we see you again? • In spite of things being rough, you still came back to the group. What do you all think that says about this member? • I’m really not surprised that your progress is taking more time. The events that brought you to our group last time were quite challenging. I wouldn’t be surprised at all if your change is slow – yet steady. We will be here for you as that process continues.

33. SF Group Example: Waikiki Youth Circles for Homeless Youth • Operated by Waikiki Youth Outreach Center, a day shelter for homeless youth in Hawaii • One-hour groups, meeting bi-weekly, for 4 months • Agenda • Began with each youth sharing exceptions (i.e., what went well for them during the last 2 weeks, and how their efforts went toward achieving the goals they had set for themselves the last time the Circle met) • Goal-setting question presented: • What do you want different in your life? (followed by…) • What’s a little baby step you can take in the next 2 weeks. What will bring you closer to your goal? • If youth “don’t know” then If you did know, what would it be? Or pretend you know. Or what would the person who loves you most in the world say you should do? Source: Walker, 2008

34. SF Group Example: Waikiki Youth Circles for Homeless Youth • Agenda (con’t) • Complimenting: Circle concludes with all of the youth complimenting each other one at a time on strengths they noticed in each other (e.g., “He is a hard worker”, “She is compassionate and caring”) • After the Circle, helping adult gives each youth slip of paper with his/her goal written on it to take home • Results • Average size of circle = 5; 16 youth participants total • Average cost per session: $400 (incl. facilitator’s fee, pizza cost, and youth incentives (e.g., bus passes, department store gift certificates)) • Illustrative youth goals • Filling-out job applications; making appointments; going to job interviews; looking in the newspaper for rentals; getting medical clearance to get back on methadone; calling a friend about a place to stay

35. Group activities/events(educational/life skills & mentoring-related) Individual Contacts(5-15 minute “well-being” checks, typically by phone, email, text, facebook, etc.) SF approach for these two elements of OYIT to be developed in 2011 and refined in 2012-2014

36. References • De Jong, P., & Berg, I.K. (2008). Interviewing for solutions.3rdEd. Belmont, CA: Brooks/Cole • Metcalf, L. (1998). Solution focused group therapy: Ideas for groups in private practice, schools, agencies, and treatment programs. New York: The Free Press • Walker, L. (2008). Waikiki Youth Circles: Homeless youth learn goal setting skills. Journal of Family Psychotherapy 19(1):85-91 • Nelson, T.S., & Thomas, F.N. (2007). Editors. Handbook of solution-focused brief therapy: Clinical applications. New York: Routledge