Solutions Intensive Day 4

1. Solutions IntensiveDay 4

2. Being a Life Witness

3. Service Planning Point • Information-gathering • Learning clients’ perceptions and perspectives • Understanding problem-severity • Gaining Focus How • Formal IG: Assessment • Informal IG: Establishing directions and goals • Primary Matching: Assess clients’ readiness for change • Real-time feedback mechanisms (Outcome and Alliance)

4. Formal-Information Gathering: Establishing Directions and Goals • Problem Description: What needs to change? • Action-talk (all 3 points) • 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?

5. Informal 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

6. Primary Matching: Exploring Client Readiness for Change • Stage of Change • Motivational Interviewing • Clients’ relationships with concerns and problems • Be culturally-sensitive

7. Real-Time Feedback • Alliance • The client’s rating of the alliance • HAq-II; WAI; SRS (every session) • In Initial Sessions and Interactions; “Checking In” –As Sessions and Interactions Progress; At the End of Sessions and Interactions • Outcome • The client’s rating of the subject impact of services on majors areas of life (functioning) • OQ-45 /LSQ; OQ/Y-OQ 30.2; ORS (session 1-3 then minimally every third subsequent session) • Measures: paper or electronic; data management

8. Focus on Change Points • Consider strategies that offer the best possible “fit” and are sensitive of clients’ cultures, beliefs • Focus on processes that enhance change How • Secondary Matching • Collaborate on tasks/way to achieve goals and improve outcomes • Focus on processes that enhance change

9. Secondary Matching • Culture (including disabilities, development) • Listen for client expressions of change experiences and expectations (i.e., experiential, cognitive, behavioral, interactional, etc.) • Explore clients’ coping styles (internal or external) • Match methods with clients’ ideas, expectations, and previous change processes • Reassess Client Readiness

10. Evaluate and Monitor Progress, and Respond Points • Evaluate progress • Explore benefits and highlight gains • Create a responsive climate How • Identify and amplify change • Address alliance ruptures • Address lack of progress, deterioration • Change approach methods • Transitions • Pathways of Impossibility

11. Responding to Alliance Ruptures • Discuss the here-and-now relationship with the client. • Ask for feedback about the therapeutic relationship. • Create space and allow the client to assert any negative feelings about the therapeutic relationship. • Engage in conversations about the client’s expectations and preferences. • Discuss the match between the therapist’s style and client’s preferred ways to relate. • Spend more time learning about the client’s experience in therapy. • Readdress the agreement established about goals and tasks to accomplish those goals. • Accept responsibility for his or her part in alliance ruptures. • Normalize the client’s responses by letting him or her know that talking about concerns, facing challenges, taking action, and/or therapy in general can be difficult.

12. Responding to Alliance Ruptures (cont.) • Provide rationale for techniques and methods. • Attend closely to subtle clues (e.g., nonverbal behaviors, patterns such as one-word answers) that may indicate a problem with the alliance. • Offer more positive feedback and encouragement (except when the client communicates either verbally or nonverbally that this is not a good match). • Engage in further supervision and/or training Safran, J. D., Muran, J. C., Samstag, L. W., & Stevens, C. (2002). Repairing alliance ruptures. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients (pp. 235–254). New York: Oxford University Press.

13. Lack of Progress/Deterioration • Revisit the current stage of the client’s change. (Ask: What is the client’s state of readiness for change?) • Focus more on the client’s view of the problem or situation—this will not require action. • Ask open-ended questions that will allow the client to notice one or more aspects that have been downplayed or have gone unnoticed about the situation (take care not to imply that the client’s perspective is “wrong”; try only to introduce other ways of viewing that may offer new possibilities or will encourage the client to talk about the problem or situation differently). • Help the client to weigh the possible positive and negative effects of his or her behavior. • Help the client to weigh the possible benefits and drawbacks of change. • Demonstrate genuine confidence that the client has the strength to face his or her challenges. • Reorient to the client’s concerns to ensure that you and the client are focusing on the same issue.

14. Lack of Progress Deterioration (cont.) • Offer straightforward feedback without imposing it (for example, “From where I am standing, I’m concerned about what might happen if this continues. Of course, that is for you to decide, but I believe it’s my responsibility to speak about it.”) (Note: Always provide more directive feedback and make necessary safeguards if there is risk of harm to self or other.) • Avoid a “solution-forced” situation when the client’s conversational preference is to talk more about problems and his or her ambivalence. • Acknowledge further—ensure that the client feels heard and understood and verifies this either verbally or nonverbally (ask questions or use an alliance measure as needed). • Discuss with the client whether the level of services is a good fit and/or whether he or she is ready to be in therapy. Bertolino, B. (2010). Strengths-based engagement and practice: Creating effective helping relationships. Boston: Allyn & Bacon.