Minnesota Child Welfare Training System Solution-Focused Brief Therapy Treatment Strategies & Interventions Bob Bertolino, Ph.D. Assistant Professor, Rehabilitation Counseling Maryville University – St. Louis, Missouri Sr. Clinical Advisor, Youth In Need, Inc. – St. Charles, Missouri

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Creating A Culture of Care and Respect Philosophy, Research, & Practice

Creating A Culture of Care and Respect Philosophy Ideas/principles that inform change. Philosophy reflects one’s core beliefs about the world and the human condition. It precedes and informs theory. Research Comes from different agendas. Although it is influenced by economics, politics, society, etc., we owe it to our clients and to ourselves to search for what each has to offer and how that can influence ethical, effective, and respectful practice. Practice Evolves from philosophy and research and should fit with and be respectful of clients’ worldviews including their cultural backgrounds, preferences, and expectations. Modes of practice should also assist with helping clients to meet their needs, achieve goals, and experience improved outcomes.

No More Boxes Recalibrating Compasses and Expanding Personal Worldviews

“You must be the change you wish to see in the world” – Mahatma Gandhi

Recalibrating Compasses 1. 1.What are the core beliefs you have about the people with whom you work? 2. 2.How have you come to believe what you believe and know what you know? What have been the most significant influences on your beliefs? 3. 3.How have your beliefs and assumptions affected your work with clients? With colleagues? With the community? 4. 4.Do you believe that change is possible even with the most “difficult” and “challenging” clients? 5. 5.How do you believe that change occurs? What does change involve? What do you do to promote change? 6. 6.Would you be in this field if you didn’t believe that the clients with whom you work could change?

H. O. P. E.

H Humanism O Optimism P Possibilities E Expectancy “Optimism is the faith that leads to achievement. Nothing can be done without hope or confidence.” - Helen Keller

Experience as a Catalyst: The Presence of H.O.P.E. What inspires or moves you?What inspires or moves you? How does that increase your sense of hope?How does that increase your sense of hope? What does an increased sense of hope allow you to do?What does an increased sense of hope allow you to do? How can you promote hope with others?How can you promote hope with others? How do you maintain your sense of hope when you are struggling with clients?How do you maintain your sense of hope when you are struggling with clients?

What Does The Data (Research) Say?

What Does The Data Say? The most significant portion of change occurs earlier rather than later in services Dose-Response Effect The client’s rating of the therapeutic relationship is the best and most consistent predictor of outcome One of the best predictors of negative outcome is lack of structure Most clients are making some form of progress

What Does the Data Say? (cont.) “Real-Time” feedback increases factor of fit Long-term services without an improved outcome combined with “more of the same” on the part of the therapist equals an “impossible” case Long-term services with high alliance scores and no improvement in outcomes can indicate dependence Practitioners whose clients do not seem to be making progress tend to do similar things: More of the same, “Clients must get worse before they get better,” More severe diagnosis, Return to their models

What Does the Data Say? (cont.) Non-model-specific factors account for 8-12x more than methods and models and up to 92% of the variance Although models (approaches) account for very little of the variance in outcome, the person of the practitioner can significantly affect change Among effective approaches it is the similarities not the differences that account for the significant portion of change (e.g., MST, FFT, BSFT, MI, CBT, etc.) Through different mechanisms of change, effective approaches are vehicles for activating and transporting common factors

Strengths and Solution- Based Outcome Management (OM) Common Factors (CF) Empirically- Supported/ Evidence- Based (EST/EBP) Empirically- Supported Relationships (ESR)

Hubble, M. A., Duncan, B. L., & Miller, S. D. (Eds.) (1999). The heart and soul of change: What works in therapy. Washington, D.C.: American Psychological Association. Lambert, M. J. (1992). Psychotherapy outcome research: Implications for integrative and eclectic therapists. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp ). New York: Basic Books.

Ingredients of Change Wampold, B. E. (2008). The great psychotherapy debate: Models, methods, and findings (2 nd ed.). New Jersey: Lawrence Erlbaum.

Points of Convergence Culturally sensitive Relationship-oriented Client-informed Collaborative Change-oriented Outcome-oriented Strengths and solution-based

Martin Seligman “ W hat we have learned is that pathologizing does not move us closer to the prevention of serious disorders. The major strides in prevention have largely come from building a science focused on systematically promoting the competence of individuals…. Fifty years of working in a medical model on personal weakness and the damaged brain has left mental health professionals ill-equipped to do effective prevention. We need massive research on human strength and virtue. We need practitioners to recognize that much of the best work they do is amplifying the strengths rather than repairing their patient’s weakness.”

Principles of SSB Philosophy 1. 1.Client Contributions 2. 2.The Therapeutic Relationship and Alliance 3. 3.Cultural Competence 4. 4.Change as a Process 5. 5.Expectancy and Hope 6. 6.Model and Factor of Fit

Active Client Engagement (A.C.E.) Principles in Motion

Create a Context of Collaboration Point Start services by offering options that are respectful of clients and their cultures and incorporate their preferences and perceptions Preparatory How Be prepared Keys to Collaboration

Strengthen Through Presence

The Therapeutic Relationship in Context… Even for those who are convinced that the therapeutic relationship is healing by and of itself, there are strategies that can foster its impact. In other words, since not all kinds of relationships are likely to bring about change, one needs to be aware of interventions (including modes of relating) that should be encouraged or avoided for the relationship to become a corrective experience. (Castonguay & Beutler, 2006, p. 353) Castonguay, L. G., & Beutler, L. E. (2006). Common and unique principles of therapeutic change: What do we know and what do we need to know? In L. G. Castonguay & L. E. Beutler (Eds.), Principles of therapeutic change that work (pp ). New York: Oxford University Press.

Strengthen Through Presence Point Listen and Attend to Clients’ Stories and Strengths Engagement How Acknowledge and validate Consider the influence of words Use possibility-laced language Separate experience from action Summarize, validate, and soften Avoid platitudes or trying make things more “positive” Be aware of stories of impossibility Be a “life witness” Strengths-Based Engagement and Practice Creating Effective Helping Relationships Allyn & Bacon February, 2009

The Influence of Words

Sad. Helpless. Inconvenience. Defeat. Tired. Oppressed. Doubtful. Uninterested. Life is so hard. Nothing seems to go my way. There is no one to turn to. It feels like I’ve been forgotten. Times are hard. Nothing seems to help. Things will not get better. In fact, they will probably get worse. There is no hope.

The Influence of Words Exciting. Fun. Laughter. Joy. Anticipation. Possibility. Aliveness. Love. Peace. When I think about the future I become energized. There is so much I can accomplish. Life is wonderful. There are so many possibilities in the world.

Being a Valuing or Life Witness

Learn Clients’ Orientations Point Gain an improved understanding of clients’ perceptions, perspectives, and theories Words and Pictures How Ask questions as to what clients attribute problems to and possible solutions Assess clients’ readiness for change (Stage of Change)

Address Case Management Matrix Point Explore services and program parameters Monitor relationship and outcome Interim Family Safety Guidelines How Provide information Collaborate and negotiate Concurrent planning Introduce outcome measures Use feedback processes to client perceptions of the alliance

Eliciting Client Feedback In Initial Sessions and Interactions… In Initial Sessions and Interactions… Are there certain things that you want to be sure we talk about? Are there certain things that you want to be sure we talk about? What is most important for me to know about you and/or your situation/what you’ve been experiencing? What is most important for me to know about you and/or your situation/what you’ve been experiencing? What ideas do you have about how therapy/coming here/coming to see me might be helpful to you? What ideas do you have about how therapy/coming here/coming to see me might be helpful to you? “Checking In” –As Sessions and Interactions Progress… “Checking In” –As Sessions and Interactions Progress… Have we been talking about what you want to talk about? Have we been talking about what you want to talk about? Are we moving in a direction that seems right for you? Are we moving in a direction that seems right for you? Are there other things that we should be discussing instead? Are there other things that we should be discussing instead? What, if anything, should I do differently? What, if anything, should I do differently? At the End of Sessions and Interactions… At the End of Sessions and Interactions… How did the session go for you? How did the session go for you? How was the pace of our conversation/interaction/session? How was the pace of our conversation/interaction/session? Did we work on what you wanted? Was there anything missing? Did we work on what you wanted? Was there anything missing?

Accommodate Services to Clients’ and Others Goals Point Create focus and direction Gain clarity regarding goals and indicators of change and progress How Determine what needs to change Determine how it will be known that sufficient change has been made and goals have been met Determine what will indicate that progress is being made

Be Change-Oriented and Solution-Focused Points Consider strategies that offer the best possible “fit” for clients Methods should fit with and be sensitive of clients’ cultures, beliefs Focus on processes that enhance change Similar-But-Different Role Play How Reassess clients’ readiness for change Collaborate on tasks/way to achieve goals and improve outcomes

Evaluate Plan Points Ensure expectations are clear Ensure plans are clear Final Family Safety Plan How Discuss benefits of positive change Discuss possible consequences of lack of follow-through Encourage feedback

Monitor Progress Points Determine progress and gains Identify barriers to change Determine next steps Follow-Up How Identify, amplify, and extend change Reassess goals Determine outcomes Explore transitions Check in with self and remain aware of pathways of impossibility The Therapist’s Notebook for Strengths and Solution- Based Therapies Homework, Handouts, and Activities Bob Bertolino Michael Kiener Ryan Patterson Routledge Summer, 2009

“It’s not enough to be compassionate. You must act.” “It’s not enough to be compassionate. You must act.” – Tenzin Gyatso 14 th Dalai Lama, 1992

Thank You

Bob Bertolino, Ph.D. TCCT, LLC – P.O. Box 1175 – St. Charles, Missouri – – Maryville University 650 Maryville University Drive Saint Louis, Missouri USA (Phone) Youth In Need, Inc. 516 Jefferson Saint Charles, Missouri USA (Phone) (Fax)