Ch 13: Postmodern Approaches Flashcards
founders
no single founder; multiple founders
modernists
believe in the ability to desire the objective reality accurately and assume that it can be observed and systematically known throughout the scientific method
people seek therapy for problems they believe have deviated from normal
postmodernists
do not believe realities exist independent of observational processes and of the language systems within which they are described
social constructionism
psychological expression of postmodern worldview
values the client’s reality without disputing whether it is accurate or reasonable
client Is the experts of their own lives
narratives
the focus for both understanding individuals and helping them construct desired changes
social constructionist theory
grounded on the premise that knowledge is constructed through social processes
postmodernist thought
influencing the development of many psychotherapy theories and contemporary psychotherapeutic practice
socially storied lives
best-known postmodern perspectives
collaborative language systems approach (anderson and goolishian)
solution-focused brief therapy (de Shazer)
solution-oriented therapy
narrative therapy
motivational interviewing
feminist therapy
three of the most significant postmodern approaches
solution-focused brief therapy
motivational interviewing
narrative therapy
collaborative language systems approach
not-knowing position
client is the expert
not-knowing position
therapists retain their knowledge and experiential capacities, but allow themselves to enter the conversation with curiosity and with an intense interest in discovery
Pioneers of solution-focused brief therapy
Insoo Kim Berg
Steve de Shazer
solution-focused brief therapy (SFBT)
future-focused, goal oriented therapeutic approach to brief therapy
emphasizes strengths and resiliences of people by focusing on exceptions to their problems and their conceptualized solutions
optimistic
clients have the potential to find alternative possibilities for change
solution-focused philosophy
rests on the assumption that people can become mired in unresolved past conflicts and blocked when they focus on past or present problems rather than on future solutions
positive orientation
solution-focused brief therapy is grounded on the optimistic assumption that people are healthy and competent and have the ability to construct solutions that can enhance their lives
looking for what is working
SFBT focuses on what is working in a clients life
assist clients to identify exceptions t their problem patterns, or their instances of success
basic assumptions of SFBT
individuals have the capability of behaving effectively, effectiveness blocked by negative cognitions
there are advantages to a positive focus on solutions and on the future
there are exceptions to every problem, or times when the problem was absent
clients often present only one side of themselves
no problem is constant, and change is inevitable
clients are doing their best to make change happen
clients can be trusted in their intention to solve their problems
characteristics of brief therapy
rapid working alliance between therapist and client
clear specification of achievable treatment goals
clear division of responsibilities between client and therapist
emphasis on clients strengths, competencies, and adaptive capacities
expectation that change is possible and realistic and that improvement can occur in the immediate future
here-and-now orientation with a primary focus on current functioning unthinking, feeling, and behaving
specific, integrated, and pragmatic/eclectic techniques
periodic assessment of progress toward goals and outcomes
time sensitive, making the most of each session
Steps to SFBT
- clients are given the opportunity to describe their problems
- the therapist works with clients in developing well-formed goals or preferred futures as soon as possible “what will be different in your life when your problems are solved”
- the therapist asks clients about those times when their problems were not present or less severe
- therapist offers clients summary feedback, provides, encouragement, and suggests what clients might observe or do before the next session to future solve their problem
- the therapist and clients evaluate the progress being made in reaching satisfactory solutions by using a rating scale
therapeutic goals
goals are dependent and unique to the client
therapist must have clarity and be in agreement with client on goals to be worked on
3 main criteria of creating well-defined goals
- start-based (stated in positive terms/something client wants)
- specific (concrete, observable, measurable, detailed, behavioral description)
- social (description of what significant others would notice, how they might respond, and how their responses would affect the client)
forms of goals
changing the viewing of a situation
changing the doing of the situation
tapping clients strengths and resources
therapists function and role
adopt a not-knowing position; client is the expert
create equal environment
help client imagine life differently
three kinds of relationships that may develop between therapists and clients
customer: jointly identify a problem and solution to work toward
complainant: client describes a problem but it not able or willing to assume a role in constructing a solution, believing that a solution is dependent on someone else’s actions
visitor: the client comes to therapy because someone else thinks the client has a problem
therapeutic techniques and procedures
pre-therapy change
questioning
exception questions
the miracle question
scaling questions
formula first session task
feedback
terminating
pre-therapy change
ask what changes have happened since booking the appointment/session
can amplify things clients have already done by way of making positive change
questioning
used to better understand a clients experience rather than simply gather information
exception questions
direct clients to times when the problem did not exist or was not as intense
can be useful in considering further changes
miracle question
main SFBT technique
“if a miracle happened and the problem you have was solved overnight, how would you know it was solved, and what would be different?”
are encouraged to enact their answer
three solution-focused questions
- what were the times when you felt empowered
- if a miracle happened and the world in which you live no longer oppressed or marginalized people, what would you be able to do differently with your life
- if there were improvement in the community in which you live with regard to racism, sexism, and other form s of discrimination, what differences would you notice?
scaling questions
used when change in human experiences are not easily observed, such as feelings, moods, or communication, and to assist clients in noticing that they are not completely defeated by their problem (0-10)
formula first session task (FFST)
form of homework a therapist might give clients to complete between they first and second sessions
emphasized future solutions rather than past problems
teaches clients that change is inevitable
therapist feedback
end of session/break to compose a summary message for the clients
identify strengths noticed during sessions, signs of hope, and identifying exceptions to a problem, and a commentary on what the client is already doing that is useful in moving in a desired direction
three basic parts to the structure of summary feedback
compliments: done in an encouraging manner/lead towards effective solutions
a bridge: links the initial compliment to the suggested task that will be given
suggesting a task: homework; pay attention. to some aspects of their lives; or a behavioral tasks
terminating
due to short nature of this therapy, this is considered from the beginning
use scaling to determine when to terminate
motivational interviewing (MI)
humanistic, client centered, psychosocial, and modesty directive counseling approach
developed by William Miller and Stephen Rollick
assists clients in making a commitment to the therapy process
based on the belief that clients possess abilities, strengths, resources and competencies; therapists role is to evoke it
goal is to reduce client ambivalence about change and increase their motivation towards it
MI spirit
bedrock attitude of therapists as they apply their skills based on person-centered philosophy
basic principles of motivational interviewing
- therapists strive to experience the world from the clients perspective without judgment or criticism
- MI is designed to evoke and explore discrepancies and ambivalence
3.reluctance to change is viewed as an expected part of the therapeutic process - practitioners support clients’ self-efficacy, mainly by encouraging them to use their own resources to take necessary actions that can lead to success in changing
- when clients show signs of readiness to change through decreased resistance to change, a resolution of ambivalence to change, and increased talk of change, a critical phase of MI begins
six common characteristics of good action plans
- they are specific, rewarding, observable, and measurable
- goals are clear, concrete, and achievable
- the client is responsible for making the plan to bring about change
- specific steps are identified to facilitate change
- the client assumes ownership of the plan
- the client must be committed to implement the plan
stages of change model
pre-contemplation stage: no intention of changing behavior
contemplation stage: people are aware of a problem and are considering overcoming
preparation stage: intend to take action immediately and report some small behavioral changes
action stage: individuals take steps to modify their behavior
maintenance stage: people work to consolidate their gains and prevent relapse
not linear and may go backwards
common ground between MI and SFBT
non-pathological, health-promoting emphasis
reframing resistance
use of clients strengths and resources
skills improve with deliberate practice
reframing resistance
interactional phenomenon between clients and counselors, the functions resistance serves are illuminated and counselors can adapt their approach
narrative therapy
Michael white and David Epston
strengths-based approach that emphasizes collaboration between client and therapist to help clients view themselves as empowered and living the way they want
therapists are encouraged to (narrative therapy)
listen respectfully to clients stories
search for times client was resourceful
use questions to engage clients and facilitate their exploration
avoid diagnosing and labeling clients or accepting a totalizing description based on a problem
assist clients in mapping the influence a problem has had on their lives
assist clients in separating themselves from their dominant stories they have internalized
the role of stories
we live our lives on stories we tell ourselves or stories others told about us
shapes reality
listening with an open mind
no judgement or blame
totalizing language
to avoid
reduces the complexity of the individual by assigning an all-embracing, single description to the essence of the person
double listening
therapist begins to separate the person from the problem in their mind as they listen and respond
the therapeutic process (not in order)
- collaborate with the client to come up with a mutually acceptable name for the problem
- personify the problem and attribute oppressive intentions and tactics to it
- investigate how the problem haas been disrupting, dominating, or discouraging to the client
- invite clients to see their story from a different perspective by inquiring into different meanings
- discover moments when the client wasn’t dominated or discouraged by the problem by searching for exceptions
- find historical evidence to bolster a new view of the client as competent enough to have stood up to, defeated, or escaped from the dominance of problem
- ask clients to speculate about what kind of future could be expected from the strong, competent person who is emerging
- find or create an audience for perceiving and supporting the new story
therapy goal of narrative therapy
invite people to describe their experience in new and fresh language to open new vistas of what is possible (develop new meaning)
therapists function and role of narrative therapy
active facilitators
not-knowing position
help clients construct a preferred story line
avoid using language that diagnosis
coauthoring
sharing authority
used by narrative therapists
therapeutic techniques and procedures
questions and more questions
externalizing and deconstruction
search for unique outcomes
alternative stories and reauthoring
documenting the evidence
questions and more questions
used to empower clients in new ways and generate experiences
not-knowing position
externalization and deconstruction
narrative therapists help clients deconstruct problematic stories by disassembling the taken-for-granted assumptions that are made about an event, which then opens alternative possibilities for living
externalization
one process for deconstructing narratives
separates the person from identification with the problem
externalizing conversations
counteract oppressive, problem-saturated stories and empower clients to feel competent to handle the problems they face
two stages
two stages of externalizing conversations
- to map the influence of the problem in the persons life
- to map the influence of the persons life back on the problem
mapping-the-influence questions
consists of inviting clients to explore the consequences of the problem in all areas of their life
“when did this problem first appear in your life”
lays foundation for co-authoring a new story line with client
unique outcomes
after externalizing questions
when therapist talks to client about moments of choice or success regarding the problem
posing questions
follows description of a unique outcome that leads to the elaboration of preferred identity stories
EX: how do you think knowing this has affected my view of you as a person
circular questions
facilitates the development of unique outcome stories into solution stories
EX: now that you have reached this point in life, who else should know about it?
reauthor
therapist invite clients to author alternative stories through unique outcomes
documenting the evidence
the new stories need an audience to support and appreciate them
EX: therapist writing letters to the person
strengths from a diversity perspective
good fit since social constructionism is congruent with multiculturalism
clients can look at their beliefs and reconstruct them
grounded in a sociocultural context
shortcoming from a diversity perspective
the not-knowing stance and the client-as-expert stance (not good with clients who see therapists as the professional)
