Chapter 14 - Solution Focused Brief Therapy/Narrative Family Therapy (Chap 15 in My Book)

Question 1

Solution-focused brief therapy (SFBT)

Answer 1

grew out of strategic therapy’s Mental Research Institute (MRI) model

informed by post-modern and constructivist frameworks, and thus values the phenomenological world of the client”

a departure from a focus on pathology-driven approaches to therapy

a change-oriented intervention that uses a strengths-based approach

Question 2

Steve deShazer

Answer 2

established the Brief Family Therapy Center.

the emphasis in therapy on solutions instead of problems.

influenced by the work of Milton Erickson but also of Gregory Bateson and the staff of the MRI

The 1980s forward, the writings and presentations of DeShazer and Berg became distinct.

Question 3

inSoo Berg

Answer 3

set up the BRIEF FAMILY THERAPY CENTER IN MILWAUKEE

help found the SOLUTION FOCUSED BRIEF THERAPY ASSOCIATION

developed the MIRACLE QUESTION a hallmark of solution-focused therapy

Question 4

O’Hanlon

Answer 4

set out to become a major proponent of solution-oriented therapy, which he now prefers to call POSSIBILITY THERAPY

His motivation was to shift the focus of family therapy from problems to solutions.

He characterizes his approach as one that is PRAGMATIC AND FULL OF MIDWESTERN VALUES

Question 5

Michele Weiner-Davis

Answer 5

She has written some of the most popular books on solution-oriented family therapy, including Divorce Busting and Healing from infidelity: The divorce busting® guide to rebuilding your marriage after an affair

Question 6

social constructionism

Answer 6

This theory states that KNOWLEDGE IS TIME AND CULTURE BOUND.

Emphasizes that LANGUAGE INFLUENCES THE WAY PEOPLE VIEW THE WORLD

THERAPEUTIC TREATMENT OF PERSONS MUST INCLUDE THEIR SOCIAL, HISTORICAL, AND CULTURAL CONTEXT.

he philosophy underlying this position states that reality is not an objective entity, but a reflection of observation and experience

Question 7

Solutions Focused Family Therapy

Answer 7

Built on the philosophy of SOCIAL CONSTRUCTIONISM.

At the foundation of this approach is the BELIEF THAT DYSFUNCTIONAL FAMILIES GET “STUCK” in dealing with problems (DeShazer, 1985). families basically use an unsatisfactory method to solve their difficulties. They rely on patterns that do not work.

THREE BASIC RULES

1. If it is not broken, do not fix it.
2. Once you know what works, do more of it.
3. If something does not work, do not do it again. Do something different.

It is believed that all families have resources and strengths with which to resolve complaints
Another premise of solution-focused family therapy is that families really want to change. A final concept underlying solution-focused family therapy is that only a small amount of change is necessary.

Question 8

EIght Treatment Techniques for Solutions Focused Family Therapy

1. COCREATE A PROBLEM:
2. ASK A FAMILY FOR A HYPOTHETICAL SOLUTION
3. FOCUS ON EXCEPTIONS:
4. USE SCALING QUESTIONS:
5. SECOND-ORDER (QUALITATIVE) CHANGE:
6. COMPLIMENT:
7. CLUE:
8. SKELETON KEY:

Answer 8

1. COCREATE A PROBLEM: An initial agreement must be made as to which issues they want to solve.
2. ASK A FAMILY FOR A HYPOTHETICAL SOLUTION to their situation.
3. FOCUS ON EXCEPTIONS: looking for “negative” or “positive” space when achieving a family goal may be happening
4. USE SCALING QUESTIONS: questions asked using a scale of 1 (low) to 10 (high) to help move clients toward their goals. The therapist might say, “On a scale of 1 to 10…
5. SECOND-ORDER (QUALITATIVE) CHANGE: The goal is to change the family’s organization and structure. Can be accomplished by planning interventions in accordance with the order of events within a family’s life or altering the frequency and duration of a dysfunction OR The Big Reframe - centered on identifying an interactive definition of the problem a couple comes with and persuading the couple to see their individual complaints as one and the same issue.
6. COMPLIMENT: written message designed to praise a family. A compliment is always planned as a lead-in to giving a family a task or assignment.
7. CLUE: an intervention that mirrors the usual behavior of a family. It is intended to alert a family to the idea that some behavior is likely to continue. The idea behind clueing is to build mutual support and momentum for carrying out later interventions
8. SKELETON KEY: Use procedures that have worked before and have universal application. These skeleton keys will help families unlock a variety of problems.

Question 9

Role of Therapist in Solutions Based Family Therapy

Answer 9

1. Determine how active clients will be in the process of change. Are they:
   a. Visitors
   not involved in the problem, are not motivated to make changes and are not part of the solution. The therapists will respect them, try to establish rapport with them, and hope that they will eventually become customers.
   b. Complainants
   complain about situations but can be observant and describe problems even if they are not invested in solving them. The therapist should assign them activities in which they focus on exceptions to complaints. With respect, complainants and do not push them, complainants become open to becoming customers
   c. Customers
   are individuals who are not only able to describe a problem and how they are involved in it, but also are willing to work to solve it. A therapist’s role is to engage the person in solution-oriented conversations, “compliment the client, and cocreate assignments to reproduce those behaviors that are exceptions to the problem

Question 10

Process and Outcome for Solution Focused Family Therapy

Answer 10

Concentrates on encouraging client-families to seek solutions and tap internal resources

It encourages, challenges, and sets up expectations for change. The concept of pathology does not play a part in the treatment process.

Solution-focused therapy takes Milton Erickson’s position that change is inevitable; it is only a matter of when it will happen. This type of therapy is oriented toward the future and helps client families change their focus and reframe their situations positively.

Question 11

Unique Aspects of Solution Focused Family Therapy

Answer 11

1. concentrate on and are directed by a family’s theory (i.e., their story). Before any attempt is made to help families change, their experiences are accepted.
2. therapists assist families in defining their situations clearly, precisely, and with possibilities. The defined problem should be achievable
3. does not focus on the clinical understanding of the family situation by the family or the therapist. Rather, the focus is on change. The therapist’s job is to produce change by helping the family to focus on what it sees as solutions to the problems it has reported.
4. it is empowering and meant to assist families in assessing and utilizing their resources. Formula tasks, such as “Do something different,” and awareness exercises, such as “Find times when symptoms do not occur,” help families help themselves.
5. achievable goals are emphasized, such as small changes in behavior. These changes are seen as the basis for larger, systemic changes.

Question 12

Comparing Solution-Focused Family Therapy with Other Theories

Answer 12

1. VIRTUALLY NO ATTENTION IS PAID TO HISTORY. Perception and minimal change are the focus. If families change their views on situations, they behave differently or more functionally Unlike Bowen or psychoanalytic theory,
2. is BRIEF in regard to the situation focused on and the amount of time allotted to it. Structuring the sessions in a way that emphasizes the therapist’s expectations regarding doing something differently encourages rapid change.
3. The therapy ENDS WHEN AN AGREED-ON BEHAVIORAL GOAL IS REACHED rather than when a hypothetical therapeutic issue is discussed
4. The EXPENSE may be high even though there are generally fewer sessions
5. used as an ADJUNCT TO CONVENTIONAL MEDICAL TREATMENT. For example, it is being used in the treatment of migraines, and the therapy holds promise as an effective approach for other types of headache symptoms
6. Finally, solution-focused therapy is ONE OF THE THREE APPROACHES MOST OFTEN CITED BY NORTH AMERICAN FAMILY THERAPISTS AS A PERSPECTIVE “VALUABLE TO THEIR WORK” (together with Bowen family systems theory and cognitive-behavioral therapy)

Question 13

Narrative Family Therapy

Answer 13

A postmodern approach to working with families that focuses on helping families solve difficulties by depersonalizing them and rewriting family stories.

Focuses on externalizing problems so families can work together on them and physically celebrate their successes as they reauthor their lives.

Difficulties are externalized, and families are asked to work together as a team to develop strategies for overcoming problems.

Narrative family therapy has a Pacific Rim genesis with global usefulness.

Question 14

Michael White

Answer 14

Leader in Narrative Family Theory who set up the Adelaide Narrative Therapy Centre as a facility for counseling and training.

Question 15

David Epston

Answer 15

In the late 1970s, Epston met Michael White; they started collaborating and were strong proponents for family therapy in New Zealand and Australia respectively. Together they created what is now known as Narrative Therapy.

Epston with his colleagues set up the website Narrative Approaches (www.narrativeapproaches.com/).

Question 16

Premise of Narrative Family Therapy

Answer 16

nonsystemic approach to working with individuals and families based on a liberation philosophy consistent with postmodernism and social constructionism

It eschews attempts to formulate universal, generic principles. Note that people internalize and judge themselves in a logical and normative way that limits their options.

narrative therapy approach distinguishes between logico-scientific reasoning, which is characterized by empiricism and logic, and narrative reasoning, which is characterized by stories, substories, meaningfulness, and liveliness

Question 17

reauthoring

Answer 17

empowering client-families to develop their unique and alternative stories about themselves in the hope that they will come up with novel options and strategies for living

Question 18

8 Treatment Techniques for Narrative Family Therapy

1. EXTERNALIZATION:
2. INFLUENCE (EFFECT) OF THE PROBLEM ON THE PERSON
3. INFLUENCE (EFFECT) OF THE PERSON ON THE PROBLEM
4. RAISING DILEMMAS:
5. PREDICTING SETBACKS
6. THE USE OF QUESTIONS
7. LETTERS:
8. CELEBRATIONS AND CERTIFICATES

Answer 18

Narrative therapy is a process-oriented as opposed to a technique-driven approach. It does not seek to change behavior as much as it seeks to recognize and bring out strengths already present in individuals, couples, or families.

1. EXTERNALIZATION: therapists seek to separate problems from people. The results
   (1) a decrease in the unproductive conflict between persons,
   (2) a lessening of the sense of failure an unresolved problem places on persons,
   (3) an increase of cooperation among family members to problem solve and engage in dialogue with each other
   (4) an opening up of new possibilities for action
   (5) a freeing of persons to be more effective and less stressed in approaching problems
2. INFLUENCE (EFFECT) OF THE PROBLEM ON THE PERSON The goal of asking how a problem has influenced a person is to increase the person’s awareness and objectivity. This type of awareness can best be generated by the therapist asking each family member to give a detailed, no-holds-barred account of how the problem has affected them.
3. INFLUENCE (EFFECT) OF THE PERSON ON THE PROBLEM The purpose of asking family members how they have influenced a problem is twofold. First, it makes them increasingly aware of their response to a problem. Second, it helps them realize their strengths or potential in facing such a situation.
4. RAISING DILEMMAS: The effect of raising dilemmas is to get client-families to examine possible aspects of a problem before the need arises.
5. PREDICTING SETBACKS Setbacks in family therapy are almost inevitable. Narrative family therapy takes the approach that setbacks are best dealt with when they are planned for or anticipated (White, 1986). By doing so, families can decide ahead of time how they will act in the face of adversity.
6. THE USE OF QUESTIONS, therapists can challenge families to examine the nature of the difficulties they bring to therapy and what resources they have and can use to handle their problems. two of the most prevalent types are those that explore exceptions and those that deal with significance.
   a. Exceptions questions are directed toward finding instances when a situation reported to be a problem was not true.
   b. Significance questions are “unique redescription questions, they search for and reveal the meanings, significance, and importance of the exceptions”
7. LETTERS: Writing letters to individuals or families after therapy sessions is an important part of narrative therapy. A client can hold a letter in hand, reading and rereading it days, months, and years after the session. Letters can serve as a medium for the continuation of the dialogue between the therapist and family members and as a reminder of what occurred in the therapy session.
8. CELEBRATIONS AND CERTIFICATES Celebrations and certificates are a unique and important part of narrative therapy and are used to bring closure to therapy. They serve as tangible affirmations of the defeat of a problem.

Question 19

Role of the Therapist in Narrative Family

Answer 19

is primarily a COLLABORATOR who assumes the role of a nonexpert.

therapist position as INFLUENTIAL BUT DECENTERED OR CENTRIFUGAL

use the basic relationship skills of attending, paraphrasing, clarifying, summarizing, and checking to make sure they hear each client’s story or problem correctly

counselors HELP NEW STORIES emerge by looking for unique outcomes. Unique outcomes [empasis added] are defined as clients’ storied experiences that do not fit the problem saturated story” that they already told the therapist

Question 20

Process and Outcome with Narrative Family Therapy

Answer 20

individuals and families are aided in learning to value their life experiences and stories. There is a restoration of value where there was a sense of emptiness.

The process consists of three phases:

(1) DECONSTRUCTING THE DOMINANT CULTURAL NARRATIVE: In deconstruction, individuals and families are challenged to examine exceptions to problems they bring in
(2) EXTERNALIZING THE PROBLEM: The externalization of the problem unites the family in attacking it and thus helps the family to avoid scapegoating
(3) REAUTHORING THE STORY: By marshaling family resources, expecting setbacks, and raising dilemmas, narrative family therapists help families construct new stories and meaning in their lives without falling into old and unproductive patterns of perception and behavior.

Question 21

Unique Aspects of Narrative Family Therapy

Answer 21

Narrative family therapy emphasizes the REAUTHORING by families of their life stories. A key component of family therapy is a deconstruction, which involves “procedures that subvert taken-for-granted realities and practices

individuals and families are asked to LOOK FOR EXCEPTIONS to the difficult situations they are experiencing.

The EXPECTATION OF SETBACKS AND THE RAISING OF DILEMMAS are built into narrative family therapy so that the people involved can realize ahead of time some of the problems they might have in creating new lifestyles. Expecting setbacks may be especially helpful in lowering resistance to making changes.

LETTERS are sent to families about their progress.

Question 22

Comparing Narrative Family to Other Theories

Answer 22

1. expectation of setbacks and the raising of dilemmas are built into narrative family therapy so that the people involved can realize ahead of time some of the problems they might have in creating new lifestyles. Expecting setbacks may be especially helpful in lowering resistance to making changes.
2. Letters are sent to families about their progress.