Postmodern approaches - Systems and Postmodern Approaches Flashcards
Founders
A number of key figures are associated with the development of these various approaches to therapy. Steve de Shazer and Insoo Kim Berg are the cofounders of solution-focused brief therapy. Michael White and David Epston are the major figures associated with narrative therapy.
Theory
Social constructionism, solution-focused brief therapy, and narrative therapy all assume that there is no single truth; rather, it is believed that reality is socially constructed through human interaction. These approaches maintain that the client is an expert in his or her own life.
Basic Philosophies
Based on the premise that there are multiple realities and multiple truths, postmodern therapies reject the idea that reality is external and can be grasped. People create meaning in their lives through conversations with others. The postmodern approaches avoid pathologizing clients, take a dim view of diagnosis, avoid searching for underlying causes of problems, and place a high value on discovering clients’ strengths and resources. Rather than talking about problems, the focus of therapy is on creating solutions in the present and the future.
Key Concepts
Therapy tends to be brief and addresses the present and the future. The person is not the problem; the problem is the problem. The emphasis is on externalizing the problem and looking for exceptions to the problem. Therapy consists of a collaborative dialogue in which the therapist and the client co-create solutions. By identifying instances when the problem did not exist, clients can create new meanings for themselves and fashion a new life story.
Goals of Therapy
To change the way clients view problems and what they can do about these concerns. To collaboratively establish specific, clear, concrete, realistic, and observable goals leading to increased positive change. To help clients create a self-identity grounded on competence and resourcefulness so they can resolve present and future concerns. To assist clients in viewing their lives in positive ways, rather than being problem saturated.
The Therapeutic Relationship
Therapy is a collaborative partnership. Clients are viewed as the experts on their own life. Therapists use questioning dialogue to help clients free themselves from their problem-saturated stories and create new life-affirming stories. Solution-focused therapists assume an active role in guiding the client away from problem-talk and toward solution-talk. Clients are encouraged to explore their strengths and to create solutions that will lead to a richer future. Narrative therapists assist clients in externalizing problems and guide them in examining self-limiting stories and creating new and more liberating stories.
Techniques of Therapy
In solution-focused therapy the main technique involves change-talk, with emphasis on times in a client’s life when the problem was not a problem. Other techniques include creative use of questioning, the miracle question, and scaling questions, which assist clients in developing alternative stories. In narrative therapy, specific techniques include listening to a client’s problem-saturated story without getting stuck, externalizing and naming the problem, externalizing conversations, and discovering clues to competence. Narrative therapists often write letters to clients and assist them in finding an audience that will support their changes and new stories.
Applications of the Approaches
Solution-focused therapy is well suited for people with adjustment disorders and for problems of anxiety and depression. Narrative therapy is now being used for a broad range of human difficulties including eating disorders, family distress, depression, and relationship concerns. These approaches can be applied to working with children, adolescents, adults, couples, families, and the community in a wide variety of settings. Both solution-focused and narrative approaches lend themselves to group counseling and to school counseling.
Contributions to Multicultural Counseling
Focus is on the social and cultural context of behavior. Stories that are being authored in the therapy office need to be anchored in the social world in which the client lives. Therapists do not make assumptions about people and honor each client’s unique story and cultural background. Therapists take an active role in challenging social and cultural injustices that lead to oppression of certain groups. Therapy becomes a process of liberation from oppressive cultural values and enables clients to become active agents of their destinies.
Limitations in Multicultural Counseling
Some clients come to therapy wanting to talk about their problems and may be put off by the insistence on talking about exceptions to their problems. Clients may view the therapist as an expert and be reluctant to view themselves as experts. Certain clients may doubt the helpfulness of a therapist who assumes a “not-knowing” position.
Contributions of the Approaches
The brevity of these approaches fit well with the limitations imposed by a managed care structure. The emphasis on client strengths and competence appeals to clients who want to create solutions and revise their life stories in a positive direction. Clients are not blamed for their problems but are helped to understand how they might relate in more satisfying ways to such problems. A strength of these approaches is the question format that invites clients to view themselves in new and more effective ways.
Limitations of the Approaches
There is little empirical validation of the effectiveness of therapy outcomes. Some critics contend that these approaches endorse cheerleading and an overly positive perspective. Some are critical of the stance taken by most postmodern therapists regarding assessment and diagnosis, and also react negatively to the “not-knowing” stance of the therapist. Because some of the solution-focused and narrative therapy techniques are relatively easy to learn, practitioners may use these interventions in a mechanical way or implement these techniques without a sound rationale.
Group Therapy
Group therapy based on the SFBT approach is focused on identifying solutions and, through highlighting the competency of group members, provides an opportunity for members to develop and implement these solutions themselves. The counsellor acts a facilitator for group progress while group members provide a supportive audience to assist other members to develop their confidence and competencies. This dynamic allows group members to work collaboratively towards their desired outcome through questioning where they can point out exceptions to another member’s problematic situation and help them to develop realistic, achievable and clear goals that will assist in achieving a more productive direction in their lives.
Whilst narrative approaches to group therapy share many similarities to SFBT approaches, the emphasis is on the ready-made audience to witness changes to an individual’s story. Members can discuss novel developments in their lives in a supportive and appreciative space, providing an opportunity to reshape and refine their personal stories. In doing so, members can rehearse new identities within the group and can discuss how they have been able to implement the desired changes in other parts of their lives, reinforcing their new story and helping to create lasting change. Such narrative approaches to group therapy have been used effectively in schools with anger management, grief counselling, academic management and adventure-based programs.
Solutions-Focused Brief Therapy - SFBT
future-focused, goal-orientated therapeutic approach to brief therapy. Focus on what is possible, and have little to no interesting in gaining an understanding of how the problem emerged.
Positive orientation - 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 - what is working in the clients lives, which stands in stark contrast to the traditional models of problem-focused
Basic Assumptions guiding practice - explains how people change and how they can reach their goals
Characteristics:
3 - 8 sessions
-rapid working alliance between the therapist and client
- clear specification of achievable treatment goals
- clear division of the responsbilities of the client and therapist
- emphasis on the clients strenghts
- here and now
- specific
- periodic assessment
Therapeutic Goals - goals are unique to the client
3 types of relationships between therapist and client:
- customer - good relationship
- complainant - customer isn’t will to change
- visitor - is coming to therapy for someone else
Solution-focused brief therapy (SFBT) focusses primarily on the present and future rather than on the past, with the main aim to develop solutions rather than to solve problems. Underlying this approach is an assumption that people are healthy and competent and are already capable of resolving the challenges in our lives. Solutions to problems are found through analysing what is currently working and utilising our strengths to overcome challenges. Exceptions to the client’s self-definition can be identified, and these exceptions provide the basis for the development of effective solutions.
Therapy from this approach is based on a cooperative relationship between client and counsellor that provides the client with an opportunity to construct their own solution. The counsellor adopts a Socratic approach and asks questions of the client to help them identify the resources available to them and make use of these resources. Clients can be directed to recognise the usefulness of change, as well as any barriers to change, through skilful use of ‘how’ questions, focussing on solutions as opposed to problems. Such questioning can also uncover new possibilities and help the client to pay attention to what they are currently doing and assists them to focus on more positive, productive times in their life.
Techniques of SFBT
- pretherapy change
- Exception questions address those moments where the presented problems were perceived as less severe or non-existent to help the client recognise possible solutions and alternatives.
- Miracle questions ask the client how their life would be different if their problems no longer existed to assist them in identifying the changes they most want to see.
- scaling questions - allows clients to see that they are not entirely defeated by the problem
- Formula first session task - homework to complete in the first or second session
- therapist feedback to client - 5 - 10 min break at the end of the session to compose a summary
- terminating - therapeutic relationship
