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 therapy a 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. S olutions (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 Talk So, 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 s, 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 s. 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 s. 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. I n-between

Avoid “underlying” problems People act in contexts created by their interactions and those of others. What appears is what we work with Everything that is important is tangible, visible, audible.

Find out when the solution is already happening. All problems have exceptions. M ake use of what’s there.

The “detective” approach No “problem” happens all the time The 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. P ossibilities – 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. L anguage – simply said.

“Words are not reality” People like the sound of their own words Don’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! E very 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” S olutions not problems I nbetween - the action is in the interaction M ake use of what’s there P ossibilities – past, present, future L anguage – simply said E very case is different

Let’s take a ….PEEP at the Solution The PEEP Method.

…PEEP 1. P referred outcome 2. E xceptions to the problems 3. E xisting resources 4. P rogress made so far

END OF PART 1

Some Notes on Goal Setting LETS GO BOWLING!

Bowling and Goal Setting

Goal Setting and SMART Goals Specific Measureable Attractive/Authentic Realistic Time Frame

Avoid “unsolvable” problems! Only engage in solvable problems.

Areas of: Concern Influence Control Realistic Goals

Approach Goals Moving away from thisMoving 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 goals Distal 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 Also To motivate clients To help plan the next steps To 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

Reframe the Problem: Express it in terms of a Preferred Outcome When 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

ActivityProblem FocusSolution 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 change A 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 positives Identify 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 ActivityProblem FocusSolution 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?

ActivityProblem FocusSolution 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

ActivityProblem FocusSolution 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