Corey Ch 16 Yalom Ch 14

Concepts Common to SFBT and MI

A nonpathological, health-promoting emphasis A social constructionist, postmodern philosophy that argues for the existence of multiple social realities Belief that labeling clients "resistant" prevents understanding and developing collaborative partnerships Belief that clients are allies who play a major role in their present and future success Emphasis on client strengths and resources Time-sensitive Nonpathological, Health-Promoting Emphasis Both SFBT and MI emerged as a reaction against the prevailing medical model that focuses on problems. Neither approach gives much credence to diagnostic labels because of the dehumanizing aspect of attaching a label to a client. SFBT and MI practitioners believe in client abilities, strengths, resources, and competencies. The assumption is that clients want to be healthy and desire positive change. Multiple Perspectives Lewis and Osborn (2004) state that both MI and SFBT reflect a social constructionist, postmodern philosophy that argues for the existence of multiple social realities. MI exemplifies a phenomenological approach in which the counselor attempts to see life from the client's perspective and to identify goals from that vantage point. In MI clients are not persuaded to adopt advice by the counselor, rather they are invited to consider a menu of alternative interventions or options. Reframing "Resistance" MI and SFBT hold that labeling clients "resistant" gets in the way of understanding clients' behavior and impedes development of a collaborative partnership with clients. MI encourages counselors to reflect on their style of interacting with clients to better understand their own part in creating relationships where there is resistance or dissonance. By viewing resistance as something that emerges from the interactions between clients and counselors, the functions resistance serves are illuminated and counselors can adapt their approach to it. Cooperation Is Key MI therapists avoid arguing with clients; instead they roll with resistance, express empathy, and listen reflectively. In SFBT therapists also work cooperatively and collaboratively with clients; clients experience support from therapists, which facilitates openness toward future possibilities and new directions. MI and SFBT therapists do not view clients as opponents to be defeated, but as allies who play a major role in their present and future success. Use of Client Strengths and Resources Both MI and SFBT rest on the premise that people have strengths and resources that can be tapped in their efforts to bring about positive change. Temporal Sensitivity Both SFBT and MI are time-sensitive counseling approaches, with their respective ties to brief interventions in addiction counseling and to brief therapy. Strategies for Bringing About Change Both SFBT and MI share techniques aimed at helping clients make changes. A few of the interventions frequently employed by both SFBT and MI group practitioners are reflective listening and demonstrating empathy, using summaries to highlight key aspects of a session, using open-ended questioning, employing scaling or ruler questions to measure progress, exploring client goals and values, and asking clients to look forward to the kind of future they want.

Contributions and Strengths of Motivational Interviewing

An extensive amount of research confirms that MI is an effective treatment for a wide range of clinical problems MI can be a significant factor in assisting clients in committing to the therapy process A major strength of motivational interviewing is the vast research that has been conducted, which confirms that MI is an effective treatment for a wide range of clinical problems. Miller and Rose (2009) describe motivational interviewing as a psychotherapeutic method that is evidence-based, relatively brief, specifiable, applicable across a wide variety of problem areas, complementary to other active treatment methods, and useful for a broad range of mental health professionals.

Group Leader Feedback to Group Members

At the end of a session, the solution-focused group leader often gives feedback to group members in the form of compliments and suggestions. The feedback is based on information that group members have revealed in their interactions in the group and what they need to do more of or what they need to do differently to increase their chances of successfully meeting their goals

Looking for What Is Working

Counselors assist clients in paying attention to the exceptions to their problem patterns, or their instances of success. There are various ways to assist clients in thinking about what has worked for them. De Shazer (1991) prefers to engage clients in conversations that lead to progressive narratives whereby people create situations in which they can make steady gains toward their goals. He might say, "Tell me about times when you felt a little better and when things were going your way." It is in these stories of life worth living that the power of problems is deconstructed and new solutions are manifest and made possible.

Exception Questions

Exception questions direct members to times when the problem does not occur, or occurs less often or less intensely. Exceptions are those past experiences in a member's life when it would be reasonable to have expected the problem to occur, but somehow it did not (de Shazer, 1985; Murphy, 2008). Once identified by a group member, these instances of success can be useful in making further changes. Change-focused questions explore what group members believe to be important goals and how they can tap their strengths and resources to reach their goals (Murphy, 2008). This exploration reminds people that problems are not all-powerful and have not existed forever; it also provides a field of opportunity for evoking resources, engaging strengths, and positing possible solutions.

Terminating

From the first session, the leader is mindful of termination Members discuss ways to continue making changes Members identify perceived hurdles or barriers that could get in the way of maintaining their progress The group leader assists group members in monitoring their progress and eventually determining when they have accomplished their personal goals. Prior to ending a group experience, leaders assist members in identifying things they can do to continue the changes they have already made into the future (Bertolino & O'Hanlon, 2002). Members can also be helped to identify hurdles or perceived barriers that could get in the way of maintaining the changes they have made. If such barriers are recognized, the group leader can ask the other group members for solutions, thereby empowering the group members to see past barriers.

The Stages of Change

In the precontemplation stage, there is no intention of changing a behavior pattern. In the contemplation stage, people are aware of a problem and are considering overcoming it, but they have not yet made a commitment to take action to bring about the change. In the preparation stage, individuals intend to take action immediately and report some small behavioral changes. In the action stage, individuals are taking steps to modify their behavior to solve their problems. During the maintenance stage, people work to consolidate their gains and prevent relapse.

Evaluation of Solution-Focused Brief Therapy and Motivational Interviewing in Groups

It rests on the optimistic assumption that people are competent It focuses on possibilities rather than limitations It operates from a nonpathologizing stance The use of questioning is the centerpiece of this approach It is brief, which makes each session count I especially value the optimistic orientation of SFBT that rests on the assumption that people are competent and can be trusted to use their resources in creating better solutions and more life-affirming stories. I think the nonpathologizing stance characteristic of solution-focused practitioners is a major contribution to the counseling profession. Group counselors assist members in developing a new level of awareness of aspects of themselves that are often underappreciated and overlooked. Regardless of the specific theoretical orientation of the counselor, brief therapy has been shown to be effective for a wide range of problems. Research that supports the successful outcomes of solution-focused brief therapy approaches is increasing SFBT is widely accepted among mental health practitioners working in a managed care environment due to its focus on strengths and solutions and because it offers a framework for practicing brief therapy A major strength of the solution-focused approach to group work is the use of questioning, which is the centerpiece of this approach. Open-ended questions about the group member's attitudes, thoughts, feelings, behaviors, and perceptions during the times when the problem occurs less or is less intense are one of the main interventions.

The Principles and Clinical Strategies of Motivational Interviewing

MI emphasizes reflective listening and understanding the subjective world of members Discrepancies between behaviors and values are examined to increase motivation to change and explore ambivalence Leaders support members' self-efficacy Reluctance to change is viewed as normal and part of the therapeutic process When clients are ready for change, a critical phase of MI begins focuses on strengthening their commitment to change and implementing a change plan In both person-centered therapy and MI, the counselor provides the conditions for growth and change by communicating attitudes of accurate empathy and unconditional positive regard. In MI, the therapeutic relationship is as important in achieving successful outcomes as the specific theoretical model or school of psychotherapy from which the therapist operates

Motivational Interviewing

MI is a humanistic, client-centered, directive approach developed in the 1980s MI originally was designed as a brief intervention for problem drinking MI has been applied to a wide range of problems Group motivational enhancement therapy is an adaptation of MI MI is considered cost-effective Like SFBT, MI emphasizes the relational context of therapy, known as the MI spirit Subsequently, this approach has been applied to a wide range of other problems including compulsive gambling, eating disorders, anxiety disorders, depression, suicidality, chronic disease management, and health-related practices (Arkowitz & Miller, 2008; Arkowitz & Westra, 2009). MI has been applied to individual counseling more so than to group work, but the practice of group MI (and group motivational enhancement therapy, an adaptation of MI) is gaining momentum as an efficient and cost-effective preventive method and an intervention for court-mandated individuals and college students referred to campus educational programs because of alcohol violations

Limitations of Motivational Interviewing

MI isn't designed to address all problems raised in therapy, nor is it meant to address making existential choices People who are already ready for change do not need MI Becoming skilled in MI requires practice with supervision over time; It requires a great deal of skill MI is clearly not designed to address all problems that people bring to counseling, nor is it meant to address making existential choices. Miller and Rollnick claim: "People who are already ready for change do not need MI, and there is some evidence that it may slow down their progress relative to action-oriented treatment". Another limitation involves the level of training required to effectively implement MI. MI is not a technique that is easily mastered through self-study or by attending a workshop. Becoming skilled in MI requires practice with supervision over time. It takes a great deal of skill for therapists to guide a client to engage in change talk and to make a commitment to change.

Applying Solution-Focused Brief Therapy With Multicultural Populations

Many characteristics of SFBT make it an ideal approach with diverse populations: e.g., it is an individualized and collaborative form of therapy The approach stresses learning about the experiential world of the members Some techniques must be adapted to meet the needs of culturally diverse clients Sklare (2005) contends that many characteristics of solution-focused brief counseling (SFBC) make it an ideal counseling approach with diverse populations: the emphasis on the experience of clients rather than working from the counselor's framework, the discussion of solutions rather than problems, the use of the client's words rather than the counselor's terms and phrases, and the focus on strengths rather than weaknesses. Some specific aspects of solution-focused counseling that lend themselves to culturally competent practice include treating each client as a unique individual; collaborating on the goals of counseling; tailoring services to each client; and obtaining ongoing feedback from clients on the usefulness of interventions and adjusting them accordingly. Concepts particularly useful for this population were working from the client's frame of reference, emphasizing wellness, and acknowledging the client as the expert on his or her past and present. Meyer and Cottone suggest that the miracle question may need to be adapted in counseling American Indians. Because the miracle question is geared to the future, it may conflict with the present focus of American Indian culture. To conform to the clients' time orientation, the miracle question could be stated: "Remember a time when you experienced harmony with all people and all things. What would need to be different for you to feel that way now?" Because humility is valued in the American Indian community, scaling questions also may need to be adapted to focus on what clients describe as their resources and strengths.

Creating Member Goals

Members are assisted in creating clear, well-defined goals Goals should be: stated in the positive in the client's language process or action-oriented structured in the here-and-now attainable, concrete, and specific controlled by the client Leaders concentrate on clear, specific, observable, small, realistic, achievable changes that may lead to additional positive outcomes. Because success tends to build upon itself, modest goals are viewed as the beginning of change. Murphy (2008) emphasizes the importance of assisting clients in creating clear, well-defined goals that are (1) stated in the positive in the client's language, (2) are process or action oriented, (3) are structured in the here and now, (4) are attainable, concrete, and specific, and (5) are controlled by the client. However, it is important that leaders avoid rigidly imposing an agenda of getting precise goals before clients have a chance to express their concerns. Members need to first feel that their concerns have been heard and understood so they will be willing to formulate meaningful personal goals. Sharing concerns assists the group in developing cohesiveness, and that sense of belongingness encourages engagement within the group.

The MI Spirit

Motivational interviewing is rooted in the philosophy of client-centered therapy, but with a "twist." The twist is that, unlike the nondirective person-centered approach, MI is deliberately directive and has the specific goals of reducing ambivalence about change and increasing intrinsic motivation (Arkowitz & Miller, 2008). MI emphasizes being purposeful and getting to the point—the direction, purpose, and point is to guide group members toward positive change. Like solution-focused brief therapy, MI involves more than using a set of technical interventions; it emphasizes the relational context of therapy, which is known as the "MI spirit." When this MI spirit is applied to group counseling, it involves the group leader establishing collaborative partnerships with members, drawing on the ideas and resources of group members, and preserving the autonomy of the members (recognizing that all choices ultimately rest with the members rather than with the leader's authority). Both MI and SFBT emphasize the internal frame of reference of clients, their present concerns, and discrepancies between values and behavior. Wagner and Ingersoll (2013) note that MI is therapeutically valuable because it increases a client's energy for change, eases reluctance, and lessens natural defenses that hinder change. The readiness to change begins when people recognize and accept a gap between where they are and where they would like to be.

Pretherapy Change

Pretherapy change addresses any changes made before the initial session. Simply scheduling an appointment often sets positive change in motion. During the initial therapy session, it is common for solution-focused counselors to ask, "What changes have you noticed that have happened or started to happen since you called to make the appointment for this session?"

Questioning

Questions become the primary communication tool and main intervention. Solution-focused group leaders use questions as a way to better understand a group member's experience rather than simply to gather information. Group leaders do not raise questions to which they think they know the answer. Questions are asked from a position of respect, genuine curiosity, sincere interest, and openness. Other group membersare encouraged to respond along with the group leader to promote group collaboration. Creating a collaborative group process is critical to the success of a group. As the leader helps members identify exceptions and begin to recognize personal resiliency and competency, group members begin to feel the context as different from that of a problem-focused group.

Role and Functions of Group Leader

SFBT group leaders adopt "a not knowing position" Members think about their future and what they want to be different in their lives The group leader has expertise, but is not an expert in how members should live Members are experts on their own lives Emphasis is given to creating a therapeutic partnership The leader prefers a collaborative stance Care, interest, respectful curiosity, openness, contact, and fascination are seen as relational necessities Leaders keep members on a "solution" track instead of "problem" track

Solution-Focused Brief Therapy

SFBT is a future focused, goal-oriented therapeutic approach to group work SFBT looks at the strengths of a person and past successes In a solution-focused group, the member, not the therapist, is the expert SFBT leaders engage members in conversations about what is going well, their resources, and future possibilities SFBT is based on the optimistic assumption that members are: resilient and resourceful able to construct solutions to change their lives

SFBT Groups in Schools

SFBT is a practical and time-effective approach SFBT offers school counselors a collaborative framework for achieving small, concrete changes SFBT is appropriate for counselors with large caseloads of students dealing with a multitude of issues This approach helps students develop positive goals instead of negative ones and is strength based SFBT encourages the acceptance and accommodation of diverse opinions and beliefs SFBT is based on clear concepts that are easy to learn Counselors are able to provide effective counseling to more students in lesstime. The model underscores the importance of small changes and co-constructed goals. The approach helps students develop positive goals rather than negative "stop doing it" goals. SFBC is perceived as effective and practical because it emphasizes "what works" rather than "why" something is a problem. The approach encourages the acceptance and accommodation of diverse opinions and beliefs, which is appropriate for many school counselors who work in schools with diverse student groups. SFBC is based on clear concepts and is relatively easy to learn. It is a strength-based approach rather than a model based on psychological disorders and dysfunctional behaviors. Students identify a well-defined goal that has meaning to them. Students then say what their lives would be like without the problem that gets in the way of attaining their goals. The counselor facilitates students' recognition of times when their problem did not exist and how they brought about exceptions to a problem. The counselor asks students to establish a baseline rating that reflects the severity of their situation at the present time, which can be accomplished by asking scaling questions. The counselor then encourages students to think of how they might move slowly up the scale. Tasks are very specific so that students have a clear direction toward change. The counselor constructs written messages to students that compliments their efforts and identifies a task to complete.

Key Concepts of SFBT

SFBT is grounded on a positive orientation—people are healthy and competent The past is downplayed while the present and future are highlighted Therapy is concerned with looking for what is working Group leaders assist members in finding exceptions to their problems There is a shift from "problem-orientation" to "solution-focus" The emphasis of SFBT is on constructing solutions rather than problem solving

Steps in the change process

Set the tone for the group Begin to set goals Search for exceptions to the problem Encourage motivation Assist group members with task development (1) Find out what group members want rather than searching for what they do not want. (2) Do not look for pathology, and do not attempt to reduce members' abilities by giving them a diagnostic label. Instead, look for what they are doing that is already working and encourage them to continue in that direction. (3) If what members are doing is not working, encourage them to experiment with doing something different. (4) Keep therapy brief by approaching each session as if it were the last and only session. Setting the Tone for the Group Facilitators help members to keep the problem external in conversations, which tends to be a relief to members because it gives them an opportunity to see themselves as less problem-saturated. Beginning to Set Goals The group leader works with members in developing well-formed goals as soon as possible. Questions that might be posed include "What will be different in your life when this problem is no longer prominent, has become irrelevant, or has even disappeared?" and "What will be going on in the future that will tell you and the rest of us in the group that things are better for you?" Searching for Exceptions to the Problem The facilitator asks members about times when their problems were not present or when the problems were less severe. The members are assisted in exploring these exceptions, and special emphasis is placed on what they did to make these events happen. Encouraging Motivation Hope is a powerful source of motivation, which is a key therapeutic factor in groups. Facilitators may pose questions like these: "Someday, when your concerns are less problematic to you, what will you be doing?" "As each of you listened to others today, is there someone in our group who could be a source of encouragement for you to do something different?" "Inthis group session, who did you notice who became less preoccupied with the problem and appeared to be more problem free?" Assisting Group Members With Task Development At the end of each solution-building conversation, the leader offers members summary feedback, provides encouragement, and suggests what they might observe or do before the next session to further solve their problems. The leader encourages members to give one another feedback, especially on small steps members may have taken. Before the close of the meeting, the group leader and members can evaluate the progress being made in reaching satisfactory solutions by using a rating scale. Members are also asked what needs to be done before they see their problem as being solved and also what their next step will be. The Next Group Session At the next group meeting the leader might ask, "Who wants to begin today by telling us what has gone better for you since our last meeting?"

Questions in SFBT Groups

Skillful questions allow members to utilize their resources Asking "how questions" that imply change can be useful Effective questions focus attention on solutions Questions can get members to notice when things were better Useful questions assist members in paying attention to what they are doing and what is working Questions can open up possibilities for members to do something different

Basic Assumptions of SFBT

Solution talk enables groups to be brief; Concentrating on successes leads to beneficial changes Problem-focused thinking prevents people from recognizing effective ways they have dealt with problems It is important to consider exceptions to every problem, or times when the problem was minimal or absent Group members often present only one side of themselves They are encouraged to examine another side of the story they present CBT No problem is constant and change is inevitable Small changes pave the way for larger changes Leaders need to adopt a cooperative stance because people are trying their best to change Each individual is unique, so solutions must be unique People are doing the best they can There are advantages to a positive focus on solutions and on the future. Ifgroup members can reorient themselves in the direction of their strengths using solution-talk, there is a good chance group counseling can be brief. Byconcentrating on successes, beneficial changes are likely to occur. Individuals who come to a counseling group have the capability of behaving effectively, even though this effectiveness may be temporarily blocked by negative cognitions and negative language. Problem-focused thinking prevents people from recognizing effective ways they have dealt with problems. There are exceptions to every problem, or times when the problem was minimal or even absent. By talking about these instances of success, members can gain control over what had seemed to be an insurmountable problem. The climate of these exceptions allows for the possibility of creating solutions. When the group leader asks, "What have you done in the past that worked?" group participants develop a new perspective on their situation. Participants often present only one side of themselves. Solution-focused group leaders invite members to examine another side of the story they are presenting. No problem is constant, and change is inevitable. Small changes pave the way for larger changes, and such changes are often all that is needed to resolve the problems clients bring to counseling (Guterman, 2013). Any problem is solved one step at a time. People want to change, have the capacity to change, and are doing their best to make change happen. Group leaders should adopt a cooperative stance with members rather than devising strategies to control resistive patterns. Group members can be trusted in their intention to create solutions to their problems. There are no universal solutions to specific problems that can be applied to all people. Each individual is unique and so, too, is each solution.

Introduction

Solution-focused brief therapy (SFBT) is a future-focused, goal-oriented therapeutic approach to brief therapy developed initially by Steve de Shazer and Insoo Kim Berg at the Brief Family Therapy Center in Milwaukee, Wisconsin, in the early 1980s. SFBT emphasizes the strengths and resiliencies of the individual by focusing on exceptions to their problems and listening to their ideas about solutions. Through a series of interventions, therapists encourage clients to increase those behaviors that have worked for them in the past Group practitioners can combine principles and techniques of solution-focused brief therapy with motivational interviewing when working with a variety of groups. An effective integration of these two approaches facilitates change through a collaborative and respectful therapeutic relationship. By honoring client stories, recognizing client strengths and preferences, and enhancing intrinsic motivation, SFBT and MI provide multiple ways to address the impasses clients often experience during the change process

Focus on Solutions, Not Problems

Solution-focused brief therapy differs from traditional therapies by eschewing the past in favor of both the present and the future (Franklin, Trepper, Gingerich, & McCollum, 2012). Information about the past is primarily used to identify times when the presenting problem occurred less often or to acknowledge the client's struggle. Gathering information about a problem is not necessary for change to occur. If knowing and understanding problems are unimportant, so is searching for "right" solutions. Any person might consider multiple solutions, and what is right for one person may not be right for another (O'Hanlon & Weiner-Davis, 2003). Clients choose the goals they wish to accomplish, and little attention is given to diagnosis, history taking, analysis of dysfunctional interactions, or exploration of the problem

Positive Orientation

Solution-focused brief therapy, or solution-focused counseling as it is sometimes called, is grounded on the optimistic assumption that people are resourceful and competent and have the ability to construct solutions that can change the direction of their lives. The role of the counselor is to help clients recognize the resources they already possess, such as resilience, courage, and ingenuity. Because clients often come to therapy in a "problem-oriented" state, even the few solutions they have considered are wrapped in the power of the problem orientation. Clients often tell a story that is rooted in a deterministic view that what has happened in their past will certainly shape their future. They reinforce this problem orientation by reliving their story over and over. Solution-focused practitioners counter this negative client presentation with optimistic conversations that highlight a belief in clients' abilities to discover their own achievable and usable goals.

Scaling Questions

Solution-focused therapists use scaling questions when changes in human experiences are not easily observed, such as feelings, moods, or communication. For example, a group member reporting feelings of panic or anxiety might be asked, "On a scale of zero to 10, with zero being how you felt when you first came to this group and 10 being how you feel the day after your miracle occurs and your problem is gone, how would you rate your anxiety right now?"

Limitations of Solution-Focused Brief Therapy

Some inexperienced or untrained group leaders may be enamored with particular techniques of the solution-focused approach and may glorify a technique and make it an end in itself. The attitude of group counselors and their ability to use questions that are reflective of genuine respectful interest are crucial to the process and outcomes of a group, and it may be difficult for some counselors to generate this level of collaboration with members. Some solution-focused therapists now acknowledge the problem of relying too much on a few techniques, and they are placing increased importance on the therapeutic relationship and the overall philosophy of the approach Some key figures of solution-focused therapy present the theory as something revolutionary and new, yet the similarities between the Adlerian approach and SFBT are striking (Carlson, Watts, & Maniacci, 2006). Many solution-focused writers have criticized traditional theories for their focus on pathology, deficits, exploring the past, and ignoring clients' competencies and resources. However, Adlerians have long objected to the medical model, promoted the values of brief therapy, talked more about growth than curing clients' problems, given more attention to the present and the future than to a client's past, and have made the encouragement process central in therapy.

Application: Therapeutic Techniques and Procedures

Some of the key techniques that solution-focused group practitioners are likely to employ include looking for differences in doing, exception questions, scaling questions, and the miracle question. Murphy (2008) reminds us that these solution-focused techniques should be used flexibly and tailored to the unique circumstances of the members. The group counseling process is best guided by the members' goals, perceptions, resources, and feedback. Techniques should never be given prominence over the work of members in a group.

Formula First Session Task

The formula first session task (FFST) is a form of homework a group leader might give members to complete between their first and second sessions. The leader might say, "Between now and the next time we meet, I would like for each of you to observe, so that you can describe to all of us next time, what happens in your (family, life, marriage, relationship) that you want to continue to have happen"

Creating a Therapeutic Partnership

The qualities of the therapeutic relationship are at the heart of the effectiveness of SFBT. The therapeutic outcome is significantly related to the alliance formed between group members and the group facilitator (Bertolino, 2010; Murphy, 2013). One way of creating an effective therapeutic partnership is for the group facilitator to show members how they can use the strengths and resources they already have to construct solutions. The process of identifying problems and goals is a collaborative process of negotiation between client and counselor (Guterman, 2013). If group members are involved in the therapeutic process from beginning to end, the chances are increased that therapy will be successful. Metcalf (1998) maintains that the solution-focused group practitioner believes that people are competent, and that given a climate in which they can experience their competency, they are able to solve their own problems, which will enable them to live a richer life. The concepts of care, interest, respectful curiosity, openness, empathy, contact, and even fascination are seen as relational necessities. Group leaders create a climate of mutual respect, dialogue, inquiry, and affirmation in which clients are free to create, explore, and coauthor their evolving stories A counselor's main task involves helping clients imagine how they would like life to be different and what it would take to bring about these changes. One of the functions of the leader is to ask questions of members and, based on the answers, generate further questions. The group counselor helps clients construct a preferred story line. The therapist adopts a stance characterized by respectful curiosity and works with clients to explore both the impact of the problem on them and what they are doing to reduce the effects of the problem

The Miracle Question

These goals are developed by using what de Shazer (1985, 1988) calls the miracle question, which is generally presented as follows: "If a miracle happened and the problem you have disappeared overnight, how would you know it was solved, and what would be different?" Group members are then encouraged to enact "what would be different" in spite of perceived problems. The miracle question is aimed at enabling group members to visualize what life would look like if their problem did not exist. It can be most helpful for group counselors to encourage the members to dream, for dreams say a great deal about where people want to go and the kind of life they want. Indeed, members can be invited to dream the impossible dream. If they have the courage to pursue their dreams, they are more likely to meet with success than if they limit their imagination. The miracle question is one example of a future-oriented exception question and is a goal-setting technique that is useful when a member has no clue of what a miracle might look like. The miracle question is a way to discover the client's goal that conveys respect for the client's situation and assists the individual in identifying smaller, more manageable goals

Motivational Interviewing as an Integrative Approach

Westra and Arkowitz (2011) state that MI can be used as a prelude to CBT, and MI can lead to enhanced results from CBT. MI assists clients in making a commitment to the therapeutic process, which leads to increased client engagement, adherence, and retention in cognitive behavioral and other action-oriented therapies. Many of MI's principles are compatible with cognitive behavioral therapy techniques. The purposeful or directive approach of MI (its "twist") is to shape client behavior. CBT group practitioners also use a structured approach and have an agenda for helping group members make behavioral changes. also see many possibilities of an integration of MI and reality therapy. As you will recall, reality therapy emphasizes the importance of group members making their own evaluation of their current behavior. Members are asked to determine for themselves the degree to which what they are doing in the present is working for them and is meeting their needs. Once members in a reality therapy group decide that they want to change some of their behaviors, they are ready to create an action plan. Both reality therapy and MI share common notions of how to best establish and implement a change plan.

A Not Knowing Position

n this approach, the therapist-as-expert is replaced by the client-as-expert, especially when it comes to what he or she wants in life. Group counselors continuously deflect questions asked of them to the other group members and follow the lead of the members. Although group participants are viewed as experts on their own life, they are often stuck in patterns that are not working for them. Solution-focused practitioners prefer a more collaborative or consultative stance and see their job as creating the opportunity for clients to see themselves as the experts. In the not-knowing position, group leaders still retain all of the knowledge and personal, experiential capacities they have gained over years of living, but they allow themselves to enter the conversation with curiosity and with an intense interest in discovery. The aim here is to enter a group member's world as fully as possible and to elicit the perspectives, resources, strengths, and unique experiences of each group member. Empathy and the collaborative partnership in the therapeutic process are seen as more important than assessment or technique. Functions such as diagnosis and assessment often grant priority to the practitioner's "truth" over clients' knowledge about their own lives. Solution-focused counselors tend to avoid using language that embodies diagnosis, assessment, and intervention. Instead, they believe that the way problems and solutions are talked about makes a difference. Using language can assume major importance in how problems are conceptualized; indeed, language creates reality.