There is More to See

1. Minnesota Child WelfareTraining SystemSolution-Focused Brief TherapyStrategies & InterventionsBob Bertolino, Ph.D.Assistant Professor, Rehabilitation CounselingMaryville University – St. Louis, MissouriSr. Clinical Advisor, Youth In Need, Inc. – St. Charles, Missouri

2. There is More to See

3. No More BoxesRecalibrating Compasses and Expanding Personal Worldviews

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

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

6. H. O. P. E.

7. HHumanismOOptimismPPossibilitiesEExpectancy “Optimism is the faith that leads to achievement. Nothing can be done without hope or confidence.” - Helen Keller

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

9. What Does The Data (Research) Say?

10. What Does The Data Say? • The most significant portion of change occurs earlier rather than later in services • 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

11. 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 worker 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

12. 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

13. 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. 94-129). New York: Basic Books.

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

15. Strengths and Solution-Based (SSB) Principles

16. Martin Seligman “What 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.”

17. What is Strengths-Based? A strengths-based perspective is not a theory, but an overarching philosophical position in which people are seen as having capabilities and resources within themselves and their social systems. When cultivated, activated, and integrated with new experiences, understandings, ideas, and skills, these strengths help such persons to reduce pain and suffering, resolve concerns and conflicts, and cope more effectively with life stressors. This contributes to improved sense of well-being and quality of life, and higher levels of relational and social functioning. Strengths-based helpers promote change through respectful educational, therapeutic, and operational processes and practices that encourage and empower others.

18. Principles of SSB • Client Contributions • The Therapeutic Relationship and Alliance • Cultural Competence • Change as a Process • Expectancy and Hope • Model and Factor of Fit

19. Active Client Engagement (A.C.E.)Building Strengths and Solutions

20. 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

21. Strengthen Through Presence

22. 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. 353-369). New York: Oxford University Press.

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

24. The Influence of Words

25. 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.

26. 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.

27. Possibility-Laced Language • Reflect client statements in the past tense. • From: “It’s always that way.” • To: “It’s been that way.” • Move from global (“everybody,” nobody,” “always,” “never”) to partial (“recently,” “somewhat more,” “a lot”). • From: “He’s always in trouble.” • To: “He gets in trouble a lot.” • Move from truth/reality to perception (“It seems to you,” “You’ve gotten the idea”). • From: “Things will never get better.” • To: “From where your standing it really seems that it will never get better.”

28. Possibility-Laced Language • Assume the possibility of future change and/or solutions by using words such as “yet” and “so far.” • From: “It’s always going to be this way.” • To: “So far you haven’t found any evidence that things will be different than the way they are now.” • Recast the problem statement into a statement about a preferred future or goal. • From: “I’ll never be able to have the life I really want.” • To: “So you’d like to be able to move toward the life you really want.” • Presuppose that changes and progress toward goals will occur by using words such as “when” and “will.” • From: “No one wants to be around me.” • To: “So when you begin to notice that there are people who enjoy your company and want to be around you what will be different for you?”

29. Possibility-Laced Language • Give Permission “to,” “not to have to,” and both • From: “I shouldn’t be angry.” • To: “It’s okay to be angry.” • From: “People keep saying that it really should make me angry.” • To: “It’s okay to not be angry about it.” • From: “Sometimes I’m angry and sometimes I’m not. I must be crazy!” • To: “It’s okay to be angry and you don’t have to be angry and you’re not crazy.”

30. Possibility-Laced Language • Include any parts, objections, feelings, aspects of self, or clients’ concerns that might have been left out or seen as barriers to change/goals. • From: “Nothing will change until people get off my case.” • To: “Things can change while people are continuing to look after you.” • From: “I can’t concentrate when these kids are always screaming!” • To: “You can find a way to concentrate even though the kids may be loud.”

31. Utilization • Take what clients bring to services, no matter how small, strange, or negative the behavior or idea seems and use it as a resource to open up the possibilities for change. • From: “He’s always doodling and playing around.” • To: “So he’s a creative and playful kid.”

32. Being a Valuing orLife Witness

33. 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)

34. Address Case Management Matrix Point • Explore services and program parameters • Monitor relationship and outcome • Interim Family Safety Guidelines How • Collaborate and Negotiate • Concurrent planning • Track outcomes (impact) • Information-Gathering (Assessment) • Use feedback processes to client perceptions of the alliance

35. Information-Gathering (Assessment) • Pre-session/Pre-meeting change • Primary Areas (Spokes of Life) • Exceptions • Scaling Questions • Rate Intensity and variations • Effects of Problem of Person • Effects of Person over Problem

36. Eliciting Client Feedback • In Initial Sessions and Interactions… • 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 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… • Have we been talking about what you want to talk about? • Are we moving in a direction that seems right for you? • Are there other things that we should be discussing instead? • What, if anything, should I do differently? • At the End of Sessions and Interactions… • How did the session go for you? • How was the pace of our conversation/interaction/session? • Did we work on what you wanted? Was there anything missing?

37. Accommodate Services to Clients’ and Others Goals Point • Create focus and direction • Gain clarity regarding goals and indicators of change and progress How • Action-talk • 3-Point Strategy

38. Goal-Setting • Non-Action Talk • Cab driver talk • Opinions, evaluations, assessments, judgments • Politician talk • Vague, general, not specific as to person, place, time, thing, or action • “Someday” talk • Vague as to time or frequency

39. Goal-Setting (cont.) • Action-Talk/Videotalk • Move from vague, non-sensory-based descriptions to clear, observable, behaviors • Using Action-Talk to Clarify Meanings • Action complaints – specifics about what one doesn’t like or one wants to have change • Action requests – specifics about what one would like to have happen • Action appreciation – specifics about what has liked about something and would like more of • Specific to person, place, time, thing, action, or result • Who is to do what by when? • Who did what, when?

40. 3-Point Strategy • Problem Description: What needs to change? • Scaling questions (with all 3 points) • Vision of the Future: How will we know that change has been achieved? • Miracle question, crystal ball, time machine, etc. • General future-oriented questions • Movement: How will we know that progress is being made?

41. 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

42. Reflecting Consultation Exercise

43. 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

44. 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

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

46. ThankYou

47. Maryville University 650 Maryville University Drive Saint Louis, Missouri 63141 USA +01.314.529.9659 (Phone) +01.314.529.9139 rbertolino@maryville.edu www.maryville.edu Youth In Need, Inc. 516 Jefferson Saint Charles, Missouri 63301 USA +01.636.946.0101 (Phone) +01.636.925.0125 (Fax) rbertolino@youthinneed.org www.youthinneed.org Bob Bertolino, Ph.D.TCCT, LLC – P.O. Box 1175 – St. Charles, Missouri 63302+01.314.852.7274 – bertolinob@cs.com – www.bobbertolino.com