1. Listening for Openings. Amplifying Change
Jeff Chang, Ph.D., R.Psych.
Athabasca University & Calgary Family Therapy Centre
Day 2: July 18, 2019

2. Miracle Question Remember the trajectories:
general  specific
hypothetical to  real life
less personal agency (client’s passive voice)  more personal agency (client’s active voice)
Think of the Miracle Question as a proxy for hypothetical solutions – it’s not the only way to get there (more about this later)
Don’t move to real life (“Is there any part of this that is happening already?”) too quickly

3. Watch for: Demonstration: How are we doing on the trajectories?
What am I choosing to focus on and ignore?
Did I miss any openings?
What might you have said or done differently?

4. Miracle Question Tag Team
You are the 35-headed therapist to me
Listen for openings
Listen for content
Your question must be based on the last answer, so it won’t be possible to formulate the next question or statement for sure until you hear what I say
It’s OK to go back

5. Common Factors and SFBT
Psychotherapy Outcome
the good news: psychotherapy is effective
the bad news (if you're an advocate of a certain model with a certain commercial interest in promoting it): no specific differences in effect can be attributed to a given model
models that have more focused, behaviorally specific goals (behavioral, cognitive, brief) seem to be more effective when it comes to the specific goals themselves, but are no more effective that other approaches when general functioning is taken into consideration

6. Common Factors and SFBT
psychotherapy outcome can be attributed to:

7. Common Factors In Therapy and SFBT
Client factors:
Social supports: influential others, friends, family
Beliefs about the problem
Values
Talents, hobbies
SES
Do you have particular stories about how client factors have empowered therapy? Feel free to solicit ideas from the students.
Re: alliance factors – when you’ve been helped, how did the your helper approach you? What kind of relational stance di he/she take?

8. Common Factors In Therapy and SFBT
Hope and expectancy
Clients think that something will happen just because they enter therapy
Willingness/receptivity
Therapist’s confidence is part of this
Model and technique approach:
Value of learning techniques lies in the therapist’s ability to be versatile and to tailor techniques or therapeutic activities to the client situation
Fit between model and person is critical – how did you come to find a model that fits for you? How did it feel to practice a model (perhaps when you were a new therapist) that did not fit for you? What is it about you that ‘makes’ your model of choice fit.

9. Common Factors In Therapy and SFBT
Alliance factors:
“The therapist took my ideas seriously”: the alliance is in the eye of the beholder (client)
A warm accepting bond
The relationship is the “delivery system”
Do you have particular stories about how client factors have empowered therapy? Feel free to solicit ideas from the students.
Re: alliance factors – when you’ve been helped, how did the your helper approach you? What kind of relational stance di he/she take?

10. Maximize the Model
A model is the vessel or container for the other common factors
You can be confident if you have a clear roadmap – it might not matter which roadmap it is
Knowing a model well enough so you can be truly present for the client – activates alliance factors
On the other hand, fumbling around with a model you don’t know interferes with your ability to attend
Confidence (not pushiness or arrogance) on your part inspires hope and expectancy.
Some examples from your own experiences would help flesh it out for students.

11. Empower Extratherapeutic Factors and Client Characteristics
Listen for and focus on clients’ unique strengths and resources that are relevant to the problem;
Skills, talents, values, social supports, spirituality, positive character traits
Listen for and focus on when the problem is less severe/troubling – that may have absolutely nothing to do with what happens in the therapy room
Listen for and focus on what clients actually do to have some mastery over the problem or develop solutions
Re: the first three bullets, I think this is an important distinction – perhaps I am making too much of this. The strength-focused approach is, in my view, generally a good development. But if we reify strengths strictly as something inherent to the client, logically, we have to do the same with deficits. Both White and de Shazer distanced themselves from the “strength-focused” approaches for this reason. The second bullet pertains to what solution focused therapists call spontaneous exceptions – sometimes clients are not quite ready to take credit for these and may even be put off by the implication that they can “do more of the same.” The third bullet relates to clients who actually see themselves a contributing to the solution.

12. Empower Extratherapeutic Factors and Client Characteristics
Listen for clients’ about their beliefs regarding the problem and the potential solution; if it seems to make sense, ask.
Listen for extratherapeutic solution behavior: a trusted friend or family member (e.g., “My Aunt Sadie told me to stop feeling sorry for myself, so I did.”), purchasing a book or tape, spiritual practices, mutual-help group, “Damascus Road” experiences, etc.
Any examples you or the class can provide of self-change stories can be useful here.

13. Activate the Alliance
As possible, accept the client’s goals at face value instead of challenging them or altering them to fit a particular theoretical model
Where client goals are obviously inappropriate, listen carefully for openings
For involuntary clients “how to get the [authority figure] off your back”
For clients who persist in problematic behavior, understanding how the problematic behavior (e.g., aggression, substance misuse) helps
Be mindful that talking about something differently may permit clients to ‘buy in’ differently

14. Activate the Alliance
E.g., doing homework to ‘be successful in life’ may not invite motivation. Doing homework to ‘not get in trouble as much’ may.
Assume relationship stance with clients that is appropriate to their ‘readiness’ or ‘motivation.’
More about this later when we view Dr. Norcross in session
Recognize that clients may be more interested in changing in one domain than in another – ‘readiness’ for change is not global

15. Activate the Alliance Discuss material that is relevant to the client.
Work on goals that are relevant to the client
Seek frequent feedback on the alliance

16. Maximize Model and Technique
Listen carefully for clients’ assumptions about change, and select interventions that are compatible with the client’s beliefs and values (“client’s theory of change”)
Know your model, technique, or procedure well enough so you can:
Execute it confidently
Ericksonian therapist Stephen Gilligan uses this story to illustrate this (Imagine someone telling this to you in a low voice with a slow rhythmic cadence): Errol Flynn, the actor of the 1930s to 1950s played many roles (e.g.. Robin Hood, pirates) where he was expected to engage in sword play, and legend has it, was actually quite a good swordsman. When asked how he became such a good swordsman, he is reported to have replied, “You must hold your sword like a bird,” and became quiet. When asked to elaborate, he responded, “If you hold a bird too tightly you will kill it, and if you hold it too loosely, it will get away.” Stephen would then say, “That’s how we must hold out theories of therapy.”

17. Maximize Model and Technique
Understand the intent of the intervention and its purported mechanism of change
Know that it fits for you personally
Hold your model, technique, or procedure well enough to be good at it, and to believe in its utility for you, but not as ‘the only true way.’
Ericksonian therapist Stephen Gilligan uses this story to illustrate this (Imagine someone telling this to you in a low voice with a slow rhythmic cadence): Errol Flynn, the actor of the 1930s to 1950s played many roles (e.g.. Robin Hood, pirates) where he was expected to engage in sword play, and legend has it, was actually quite a good swordsman. When asked how he became such a good swordsman, he is reported to have replied, “You must hold your sword like a bird,” and became quiet. When asked to elaborate, he responded, “If you hold a bird too tightly you will kill it, and if you hold it too loosely, it will get away.” Stephen would then say, “That’s how we must hold out theories of therapy.”

18. Enhance Expectancy & Hope
Sound confident but not bossy. Say, “I’ve got lots of ideas for strategies, but first…”
“Tell me what you’ve done so far (because I don’t want to suggest ideas that will useless to you)”
Obtain a detailed description of attempted solutions and how they worked.
Work to implement previous solutions that worked (partially, temporarily, or that seemed promising) – maybe there is something they are forgetting to do, or did not try for long enough
Fit between model and person is critical – how did you come to find a model that fits for you? How did it feel to practice a model (perhaps when you were a new therapist) that did not fit for you? What is it about you that ‘makes’ your model of choice fit.

19. Maximize Model and Technique
“Deliberately empower” this factor by asking future-focused, change-oriented questions
“Allegiance factors”: the therapist’s confidence in the model, connected with the sense that they are using a model that fits for them

20. Listening for Openings (3)
2:45