Solution Focused Psychotherapy in a Mother-Baby Residential Unit.

Presented by Dr Ian Harrison Karitane Continuing Education Program

April 14th 2010

What is Solution-Focused Therapy?

PART 1

The Solution-Focused Approach

short-term (brief), not long-term therapya focus on:solutions (not problems), strengths (not weaknesses), on what’s going well (not what’s gone wrong) &what to do next (not who is to blame).

The Problem-Focused Approach

So what is the problem... with your baby?Why does... your baby become so

unsettled?What other problems… does her

unsettledness cause?Who is to blame… for her difficulties in

sleeping?What other things… make the problem hard

to solve?

Some solution-focus “rules” and principles.

S.I.M.P.L.E….

Don’t ask “Why”. Instead ask “What”.

Avoid problem talk.

Solutions (not problems)

Asking …What?

What might the solution look like?How would we know when we have the

solution?What would we see?What would others notice?

What is the future desired state? (The miracle question).

Problem Talk vs. Solution TalkSo, what’s the problem?

Why does it happen?

What is the root cause?

What other problems does it cause?

Who is to blame?

Why?

What things make the problem hard to solve?

How would you like things to be going between you and your baby?

When is the problem not occurring? What might also be happening at

those time?

What other good things are occurring when things are going better?

Who has been helping at times?

What do they do?

How does it help?

etc

Problem Talk vs. Solution Talk So, what’s the problem with your

baby?(She’s never settled. She cries all the time

and she won’t let me do anything.)

Why does your baby become so unsettled?

(Because she’s just like my uncle on my

mother’s side.)

What is the root cause? (Because I’m a crap mother.)

What other problems does it cause?

(My marriage is falling apart)

How would you like things to be going between you and your

baby?

When is the problem not occurring? What might also be

happening at those time?

What other good things are occurring when things are going

better

Problem focused and Solution focused Conversations.

I can’t find any time to play with my baby!

I want to find time to play with my baby!

When is playing with your baby a problem?

All the time! I seem to get side-tracked with washing and even e-mails, there is

so much to do!

When do you manage to find time to play with her?

When I do it first before the washing and cleaning and the e-mails.

OK. So, how to play with her as a regular routine?

Play with her first thing and delay doing the washing for an hour or any e-mails.

So what is the cause of this lack of ability to focus on your baby?

Well I’ve always been easily distracted and I’m a great procrastinator!

So it’s going to be really difficult for you to play with her then.

Yes. I’m thinking I’ll just have to wait till she’s a bit older and I’ll either have more

time then or I’ll be more disciplined.

What else will help?

Well, I can arrange other things for the afternoon rather than the morning. Keep

the first part of each morning free. Actually that sounds really good. I’m

going to try it tomorrow.

The action is in the interaction.

In-between

Avoid “underlying” problems

People act in contexts created by their interactions and those of others.

What appears is what we work withEverything that is important is tangible,

visible, audible.

Find out when the solution is already happening.

All problems have exceptions.

Make use of what’s there.

The “detective” approach

No “problem” happens all the timeThe solution may already be occurring

albeit to a minor, “invisible” degree.At what times is your baby settled or more

settled How did you do that? (not why)Since change is always occurring we

identify and amplify useful change

What you focus on grows. Focus on possibilities not problems,

resources not deficits.

Possibilities – past, present and future

Past, Present and Future

Future: We are used to thinking of future possibilities

Present: we uncover and highlight current resources.” Possibility Machines”. (We don’t make them up)

Past: We try to highlight positive experiences from the past

Make use of solution-focussed language,

$5 words, not $200 words.

Language – simply said.

“Words are not reality”

People like the sound of their own wordsDon’t argue over words (which are only

symbolic in any case) Instead agree on what we want to

happen.Scaling can help with subtle descriptions

“Oh he’s shocking! It’s terrible!”What is the difference between 4 and 5?

Mind your Language

The words we use direct our attention and our thinking

How do we direct attention to the solution?Don’t ask “WHY”We look for the positive in the client’s

statements and we respond to that.Assume a desire to move forward and

look for that desire.

Solution Focused Language and Reframing

Reframing is not… “SPIN”Reframing doesn't get rid of the problem.

It puts the problem in a new light.Reframing gives you a boost along the

way towards the solution. It helps to remove barriers.

There is no “right” way of looking at things. Different views may fit the facts just as well.

The Solution Focus does Not Mean

“SPIN!”“Count your blessings!”“I don’t want to listen to your whinging!”“You don’t really have a problem.”

Solution Focused Language and Reframing

Client: “It sounds good in theory but I don’t think I’m going to be able to do it.”

“OK. You like the sound of what I’m saying. But you think it will take a lot of work and some skill”.

“It sounds good in theory but I don’t think the baby is going to agree to it.”

“OK. You like the idea a lot. Can you be completely sure that the baby won’t agree to it as well? Perhaps with a bit of time they will like the idea as well. Let’s give it a try and see how we go.”

Solution Focused language and Reframing

Client: “The last time we tried that it didn’t work.” “It’s disappointing that it didn’t work last time.

Every time is different though. I wonder if the next few times that we try, here at Karitane, that you might have more success.”

“The baby has just woken up again (tears) and all the work I put in is completely wasted.”

“I know it’s disappointing that she has woken when you’ve been so hopeful but has it really been completely wasted? I wonder: what did you learn that we could use again next time?”

Only do what works.If it is not working, stop doing it!

Every case is different.

Some more solution-focus “rules” and principles.

There is always a better way.There is no failure, only feedback.People are resourceful. Look for strengths.Flexibility works. Be ready to change the game.Give praise whenever you can.Keep it simple. Change the minimum possible to

achieve the goal.The client is the “expert” in his or her life

IT’S “SIMPLE”

Solutions not problems

Inbetween - the action is in the interaction

Make use of what’s there

Possibilities – past, present, future

Language – simply said

Every case is different

Let’s take a ….PEEP at the Solution

The PEEP Method.

…PEEP

1. Preferred outcome

2. Exceptions to the problems

3. Existing resources

4. Progress made so far

END OF PART 1

Some Notes on Goal Setting

LETS GO BOWLING!

Bowling and Goal Setting

Goal Setting and SMART Goals

SpecificMeasureableAttractive/AuthenticRealisticTime Frame

Avoid “unsolvable” problems! Only engage in solvable

problems.

Areas of:

Concern

Influence

Control

Realistic Goals

Approach Goals

Moving away from this Moving towards this

Avoidance Goal Approach Goal

Goal Setting

Vague goals produce vague efforts. “I want things to be better between my

baby and me.”“I want my baby to be more settled.”OK, but what would you like to have

achieved by the end of today?“Frankly I’d like to have tried something

new. I would have liked to have stopped doing what’s not working.”

Goal Setting Strategies

Outcome goals vs. Learning goalsDistal goals vs. Proximal goals

T1 T2 T3 T4 T5 T6 T7

Long Term (Distal)Short Term Proximal

Moving on. Name the new game.

Are you getting into struggle with the client? Are they just not getting it?

“This doesn’t seem to be working. Is there something else we could be working on?”

Don’t ask why is this happening?We don’t imply that there is something

more relevant or useful we just ask “Should we move on?”

Scaling

Used to measure how close we are to our goals

But AlsoTo motivate clientsTo help plan the next stepsTo stimulate solution thinking

We use a scale of 1…….10

Scaling

Where are you now “About a 4” Using small steps we ask how would you know if

you had got to a “5”? What would be different? What would you notice with just a small improvement from 4 to 5?

What would you need to do to get there.

By the way how did you get from 3 to 4? What has helped so far?

Probing for…Solutions

Probing for…Solutions

Reframe the Problem: Express it in terms of a Preferred OutcomeWhen is the problem already less intense?

Probing for…Solutions

Look for exceptions: When does the solution already exist?When is the problem already less intense?What resources does the client already have?What options exist?

Probing for…Solutions

Keep action steps simple and small Are they really do-able?Can they be written down?“What can’t be written, can’t be done!”“If it ain’t written, it ain’t coachin’ .”

The GROW Model

The Coaching Conversation

HAPPY SOLUTION-FOCUSED COACHING!

THE END

Activity Problem Focus Solution Focus

1.

Planning Change

Emphasis on Diagnosis

“Can you tell me about the problem?”

“Can you describe all the aspects of the problem?”Identify all the blocks to

changeA negative catalogue

Focus on what you don’t want to do.

“Don’t fall off!”

Emphasis on desired outcome

“How would you like it to be?Helps client describe the

positivesIdentify progress already made

Highlight strengths and resources

When is the solution already occurring?

Focus on what you do want.

“Hold on tight!”

How to Plan in a Solution Focused Way

How to Think in a Solution Focused Way

Activity Problem Focus Solution Focus

2.

Thinking About People

Sees people as sources of dysfunction.

People represent “trouble” and potential

problems e.g. the baby

Who is the weakest link?“How can we minimise the risks that people

represent?”

Sees people as functional and enhancing and the sources of solutions.

Where are the hidden strengths?

How can we grow our people/family?

Activity Problem Focus Solution Focus

3.

Monitoring Progress

Emphasis on identifying weaknesses and

failures.

“What went wrong last week?”

Record and react to undesirable behaviour

and trouble.Looking at how far we

have to go.

Emphasis on identifying what works and gains

made.

“How did you cope so well last week?”

“When it works well what is different about those

times?”Looking at how far we

have come.

How to Work in a Solution Focused Way

Activity Problem Focus Solution Focus

4.

Trouble-shooting

Emphasis on explaining problems.

Uncovering the cause and effect chain.

“I wonder if lack of

progress is a sign of something deeper?”“Who is to blame this

time?”

Emphasis on improving progress and identifying

do-able goals.

“What else might help?” “Have we identified the

right goal?” “How do others

overcome this?” “What other ways can it

be done?”

How to Work in a Solution Focused Way