Theories and Methods of Family Therapy: Post-Modern Models

1. Theories and Methods ofFamily Therapy:Post-Modern Models University of Guelph Centre for Open Learning and Educational Support William Corrigan, MTS AAMFT Approved Supervisor (519) 265-3599 williamcorrigan@rogers.com

2. Day Two • Check-in • Solution-Focused Therapy • Principles and assumptions • Types of relationships • Setting goals • Use of questions • Work on debate for Day 5 • Evaluation

3. Checking In • Reflecting can create new meanings • A chance for collaborative dialogue re. Day One: • What was it like for you? • What did you like/not like? • What are you curious about? • Any new ideas/learnings? • How will you take this into practice? 3

4. Important Contributors • Milton Erickson • Gregory Bateson • “the difference that makes the difference” • MRI group: Jackson, Haley, Watzlawick, Weakland, Fisch • Problem-focused approach • Steve de Shazer & Insoo Kim Berg; Scott Miller • BFTC, Milwaukee • Bill O’Hanlon; Michelle Weiner-Davis

5. Paradigm Shift • De Shazer • Causes of problems may be complex • Solutions need not be • Insight does not always lead to change • Related ideas • Problems are clients’ attempts at solutions • Start with a new solution and go from there

6. Strengths Perspective • All people possess strengths that can be marshalled to improve the quality of their lives. Practitioners should respect these strengths and the directions in which clients wish to apply them. • Client motivation is increased by a consistent emphasis on strengths as the client defines them. Saleebey in de Jong & Berg (2002), p. 10

7. Strengths Perspective • Discovering strengths requires cooperative exploration between clients and helpers; expert practitioners do not have the last word on what clients need to improve their lives. • Focusing on strengths turns practitioners away from the temptation to judge or blame clients for their difficulties and toward discovering how clients have managed to survive, even in the most difficult of circumstances. • All environments – even the most bleak – contain resources.

8. Problem-focused approach (7+1) • Focus on disease/illness/dysfunction • Give the client what she/he needs to get well • Learn as much theory as possible and use the latest, best, evidence-based approach • Don’t be too simple or clients won’t trust you

9. Problem-focused approach (7+1) • Clients don’t change on their own – that’s why you have a job • Need to understand the root cause of the problem or it won’t change • The client must cooperate, and some clients just don’t want to be better

10. Problem-focused approach (7+1) • Keep to the code: • No pain, no gain • If it works too fast, the client isn’t really better yet – you’re missing something • If it doesn’t work, either you or the client are doing it wrong – try again

11. Solution-Focused Approach (7+1) • Focus on health/function/competence • Use what the client has (e.g. Stone Soup) • Not bound by theory • Keep it simple • Trust in change • Stay in the now (and tomorrow) • Cooperation makes it happen

12. Keep to the Code(core philosophy) • If it ain’t broke, don’t fix it! • If it works, do more of it • If it doesn’t work, do something different! (de Shazer & Berg, 1989) • Insanity (def’n): doing the same thing over and over again expecting different results (A.A.)

13. 1. Focus on Health • Explore client strengths • What’s going right and how to use it? • If you’re breathing, there’s more right with you than wrong with you • Despite the problem, healthy patterns exist in the client’s life. Can you find them?

14. 2. Use what the client has • Stone soup • You provide the pot, the stones and the water • Your client(s) brings everything else • What is the client particularly good at? • How can I use this to help find solutions? • Example (Erickson) • Problem: alcohol, tobacco and food • Strength: likes walking • Intervention?

15. 3. Not bound by one theory (including this one) • Learn different theories of self, relationship, and problem formation • Do not take any one theory too seriously • Tailor what you know to the client’s needs • Do what works!!!

16. 3. Not bound by one theory • Example • Problem: drinking • Theories • AA: alcoholism is a disease, abstinence is the cure • CAMH: people are in control of their own drinking and can “Say When” (harm reduction) • Which stand would you use with client?

17. 4. Keep it Simple (parsimony) • Take the presenting problem at face value, not as the “tip of the iceberg” • Don’t look for additional problems • Find the simplest solution • What is the minimal intervention necessary to get the client unstuck? • Then get out of the way

18. 5. Trust in Change • Change is inevitable; you cannot not change • Believe in people’s ability and desire to change • Avoid the fallacy that people can’t change or that some problems are intractable • Ask them in the first appointment, “How have things improved since you first called?”

19. 5. Trust in Change • If they did this much before their first appointment, imagine how much more they will change with you! • Problem-based approach assumes falsely and reinforces that problems take forever to change – but they don’t! • e.g. paradoxical prescription: “Don’t change too fast!”

20. 5. Trust in Change • Instead of asking, “How long has this been a problem?” ask, “When is this not a problem?” • Examples • To a problem drinker: “When don’t you drink?” • re. defiant child: “When does he listen to you?” (very important to reinforce: Barkley)

21. 6. Present and Future Orientation • Most people assume that they have to understand their past in order to move forward, e.g. “Those who do not understand history are doomed to repeat it.” • Is this always true?

22. 6. Present and Future Orientation • Response to low mood • Think, “Why am I feeling this way?”, start to ruminate, low mood is prolonged • Distract by doing something you enjoy or trying to think about something positive, mood is elevated • Zindel V. Segal et al. (2002), Mindfulness-Based Cognitive Therapy for Depression (Guilford), pp. 33-34

23. 6. Present and Future Orientation • “Why am I this way?” is a question about the present leading one into the past • “Try to find something positive” or “Do something that you enjoy” is about the present • present orientation can lead to better outcomes for depression

24. 6. Present and Future Orientation • It might not be necessary to understand the past in order to move forward • Excessive time spent trying to understand the past may make things worse • Envisioning a change in the present or near future engenders hope, one of the four main factors in client change

25. 7. Cooperation • Cooperating with the client is a central organizing principle of SFT • Help the client with their goals, even if you see things that you think the client should work on instead • Example • Elmer the glue head (Miller)

26. BREAK10:30 – 10:45

27. Solution-Focused Therapy Types of Relationships

28. Types of Relationships • Customer Relationship • Complainant Relationship (Observer Relationship) • Visitor Relationship • Note that customer, complainant and visitor describe the relationship, not the client

29. Customer Relationship • A complaint or goal has been identified jointly by client and therapist • The client sees himself as part of the solution and is willing to do something about it • The therapist cooperates with what the client wants to do

30. Complainant (Observer) Relationship • A complaint or goal has been identified jointly by client and therapist • The client does not see himself as part of the solution and often believes that someone else has to change • The therapist cooperates with the client

31. Complainant Relationship • Client is a victim of somebody else’s behaviour (e.g. drinking) • The problem is the kids my kid hangs out with • Disempowering: problem in one place, solution lies somewhere else • Challenge: how to turn complainant rel’n into customer rel’n?

32. Visitor Relationship • The client and the therapist have not yet agreed upon a goal or complaint • The client says either that there is no problem, or that somebody else has the problem • Challenge: to change visitor rel’n into customer rel’n

33. Visitor Relationship • Why do visitors come to therapy? • Usually because someone (who would be in a complainant relationship with you if they were in your office) told them to come • e.g. parole officer, CAS, lawyer, court, employer, spouse, parent

34. Cooperating = recognizing type • Customer relationship • Client and therapist work together on the goal • Complainant relationship • Therapist agrees to explore the complaint further with the client • Visitor relationship • Goal may be to get complainant off their back • “What would we have to do so that X wouldn't complain anymore?”

35. Customer Relationship • Straightforward • You both agree on a problem and a goal and the person willing to work on the goal is in the room

36. Complainant relationship • A little more difficult • The person in the room agrees with you on the goal • The solution is outside of the room • Your client feels disempowered • Empower the client

37. Complainant Relationship • Bypass the problem as much as possible • Don’t force ownership (= resistance) • Compliment and build alliances • Reframe the client’s behaviours as “sacrifice” and positively motivated

38. Complainant Relationship • Example • “My son is controlling our house. We’re scared of him – he’s really angry” • “He won’t go for help. He says we make him mad, that we’re bugging him all the time” • “I just want him to stop getting angry all the time. It stresses everyone in the house”

39. Visitor Relationship • Bracket the reason for the referral • What does the client want? • Agree with the goal and sympathize with the client’s plight of having to see you • Compliment the client • Ask about the client’s view of the referring person’s demands

40. Visitor Relationship • Example • “I don’t know why I’m here. My probation officer said I have to come or I’d be breached. I’m not angry and I don’t have a problem. My ex wanted me out of the house so she called the police and told them some bullshit story about me threatening her. So here I am. I need you to write a letter for me for court saying I came here. Can I go now?”

41. Solution-Focused Therapy Setting Goals

42. Setting Goals • Salient • Small • Specific • Something • Start • Sensible • Serious

43. Salient • Treatment goal must be important to the client • Client sees goal as personally beneficial • Example • Husband wants wife to stop drinking • Wife wants husband to stop nagging • Both want to get along better…have more of a social life…have friends (benefits)

44. Small • Something the client can achieve in a reasonable time (even before the next session) • Example • Client: “I need to get my life together” • Therapist: “What do you think would be the first small step?” • Client: “Get up at 11am”

45. Specific • Best goals are concrete, specific and behavioural • “We need to improve our communication” • “What would that look like?” • “I will call my husband on his cell phone when I am going to be late for dinner”

46. Something • The presence rather than the absence of something • Most clients want to stop doing something: smoking, drinking, affairs, fighting, etc. • What will they do instead? • Positive, proactive language • Easier to determine when goal is met • Reverse psychology: when you try to tell yourself not to do something, you want it even more

47. Start • Many clients want to be all done, e.g. “Have my life together” or “Have the perfect marriage” • Negotiate a “first small step”, a start • When the client starts, he will feel better • Example: “What will be the first small sign that will show you that he is beginning to live up to his potential?”

48. Sensible • The goal makes sense in the context of the client’s life • What is realistic and achievable for this client? • Example: becoming a doctor vs. taking a course in biology

49. Serious • The goal should be perceived as involving “hard work” • “This will be difficult to do, but…” • Compliment them on small steps accomplished • Allows face-saving in case of failure • Allows for a sense of pride

50. Case Study:The African Violet Queen