SFBT, CBT, and New Directions

Coaching: SFBT or CBT Specific task or goal – both Relationship is to task – both Collaborative approach – SFBT Defined desired outcome – both

Great minds think alike, or whose techniques are whose?: Both: Goal setting Homework SFBT: Visualizing the goal or thickening the description Scaling Noting exceptions Building on spontaneous exceptions

CBT is an individual approach, so: Not Miracle question Not Genogram Not Expanding the system Not the same idea of the interactional cycle

Techniques common to both, especially in groups and coaching : Giving information - from multiple perspectives, without attachment Developing step by step strategies

A Mini Example 17 year old in alternative to suspension program for cursing teacher Catalyst was learning music program had been cut Deceased father was jazz musician; 17 year old has strong interest Outcomes: Mother and 17 year old worked together as team to apply him to music magnet program ( one of several options we brainstormed with them), and to produce multiple mutually exciting college plans Referral to family therapy at their request for grief issues

It would have been wrong (in my view): To ignore request for family therapy and desire to talk about grief issues Or to ignore immediate need to give 17 year old educational options and mother hope for future In this case, dividing line between coaching and therapy relatively clear Mother referred to her son's "advocate" and to her own desire for a "therapist" In this case, two locations and two teams - but can be two stages of work with one person

What would a CBT person have done different? Taught specific coping skills (whereas I preferred to work within client’s reality); Most probably not have expanded the system (i.e. same school) More individual focus

EARS (SFBT) : Elicit positive changes Amplify (may include resources) Reinforce Start again (Berg & Szabo, 2005)

SMART (CBT): S pecific goal Measurable outcome Attainable goal – don’t make it too hard Realistic goal – example given is 5 percent fewer anxiety attacks, not no anxiety attacks Time - set a deadline

What do you notice? SMART goal looks like outcomes you learned about in assessments SMART goal is not necessarily tied to a spontaneous exception or to the client’s world view SMART goal does not necessarily expand the system (whereas the best SFBT goals do)

ROPE (SFBT journaling exercise): Recall at least three times when you were the person you want to be Organize your memories - what do these times have in common? Present and future - what can you do now that is like that? What can you do in the future that is like that but more? (Resources) Expand on these goals - tell others about them (Systemic Change in Schools, note use of second person voice, also used as reflective journaling task)

CBT journaling: Situation Automatic Negative Thought Resulting Emotion Evidence against Automatic Negative Thought New Emotion

So: CBT is more directive, educational, and: Therapist is right, client is most likely wrong BUT:

A funny thing happened on the way to the 22 nd century… Recent developments in CBT mirror/echo recent developments in brief therapy

Classic behaviorism:  Behavior is repeated when it is reinforced  Training pigeons and dogs  This always works!! IF one can avoid reinforcing what one doesn’t want to reinforce; if the reinforcement is valid and suits the individual ; if the desired behavior occurs and can be noticed

Classic pedagogy Usually mis used in practice (e.g. name on board example) Has given birth to its own field – applied behavior analysis Most evidence based treatment for autism

Second Wave: Cognitive/Behavioral Because most of our behaviors are not directly and immediately reinforced; Because what we think of ourselves and others matters The idea is to model appropriate behaviors, and teach appropriate cognitions

Beck Depression Inventory Isolation Negative thoughts Idea is to replace Equally effective as couples therapy – but requires more work on the part of the client

Third Wave: This is where the interest and focus is today ACT: Acceptance and Commitment Therapy DBT: Dialectical Behavioral Therapy

ACT Hayes & Wilson, Jacobsen & Christiansen, 1990’s. Encourage acceptance of feelings in the present You don’t want to go to work because you are anxious; you can go to work and fully experience your anxiety; both are valid Mindfulness, living in the present

Mindfulness Exercise Pause for a moment Look around and notice five things you can see Now notice five things you can hear Notice five things in contact with your body Allow yourself to experience both the negatives and positives of these things Fully experience them Now take a deep breath and decide what your focus will be

DBT Marsha Linehan, 1990’s, out of own painful adolescent experience Non pathologizing resolution of common dilemma: instead of who’s telling the truth, self definition of “unusually sensitive” Accept unusual sensitivity and go with what works Intense support – weekly groups plus individual plus phone contact

DBT Exercise Panic list for feeling overwhelmed: Bite a hot pepper; Thrust finger into ice until it hurts; Cover your arm with a layer of Elmer’s Glue and let it harden, then peel it off slowly These are alternatives to cutting and self mutilation

More DBT self help exercises: Eat a raisin mindfully and slowly Choose a random object and list 30 different uses for it Crank up loud music and dance Rip up a phone book Again, these are self generated “what works” to handle strong emotion, but are also therapist suggestions

Different and the Same: Third Wave still more likely to be “teach”-y But comes much closer to entering client’s reality Interesting additions related to entering client’s reality in the moment Interesting additions (esp. DBT) to “what works”

Equifinality SFBT came through cybernetics and interactional cycle through hypnosis to entering client’s reality, expanding system, and focusing on what works Third Wave CBT came through behavioral reinforcement through cognitive teaching to accepting client’s reality, expanding system in the case of DBT (through self help groups), and focusing on what works

Positive Psychology Martin Seligman, 1990’s – through learned helplessness to resilience to the study of happiness Now a full fledged movement within psychology Evidence based

The Equation S + C + V = Happiness Easiest to manipulate is V Similar to SFBT and expanding the system, similar to all family therapy, but also perhaps different (need not be related)

Convergence of ideas Individuals create their own reality more than was previously thought The most effective therapies work within that client’s reality What you pay attention to gets bigger, in life as well as in specific situations Reality is more varied and open to interpretation than we thought

Motivational Interviewing W.R. Miller, behavioral psychologist interested in problem drinking Analyzed more successful therapists in program Focus on goals and reinforcement of change talk - less focus than SFBT on interactional context and on spontaneous exceptions Evidence based, in wide use in mandated contexts

Appreciative Inquiry: Coaching for a whole organization Affirmative topic choice 4 steps: Discovery (correlates with exceptions); Dream (correlates with expansions or miracle); Design (how can organization do more of what is working); Destiny (formerly delivery) to contact David Cooperrider

Registration process Appreciative inquiry – divide into 4 groups