Family & Couple Therapy PPT 5 - Solution-Focused and Narrative Therapies

Disadvantages/Criticisms of SFT

Critics say it is too simplistic and does not have enough empirical research to support it. It may be contraindicated with dependent clients. It may not adequately address clients with serious mental issues. It may not develop the therapist-patient relationship in enough depth to be therapeutic. The practice denies clients the opportunity to explore presenting problems in greater depth Its encouragement of clients to "think positively" may induce denial or minimization of problems Clients may feel discouraged from sharing important details or negative feelings about the presenting issue SFT may create a false impression on young practitioners that intervention is relatively "easy" or straightforward

Basic Tenets

Developed mostly by *Steve De Shazer, Insoo Kim Berg*, Eve Lipchek and Michele Weiner-Davis, Bill O'Hanlon, and drawing from Milton Erickson. It looks at the positive side of problems and what works. It can be used in a variety of settings with a variety of problems. *Places emphasis on the future* rather than the present or past. All people are free to make choices. Client's are their own experts who know what is best for them. The therapist accepts the client's view of reality. Therapy is collaborative and cooperative. Uses the resources available to the client. Goals are specific, behavioral and obtainable. Problems are reframed in a more positive way.

Premises of the Theory 3

Does *not focus on a detailed family history of problems* *Causal understanding is unnecessary* Assume that *families really want to change* *Only a small amount of change is necessary*

Origin of Narrative Therapy

Emerged in the *1970s and 1980s* Derived from *postmodern theory* "*White and Epston* have been influenced by the postmodern movement within philosophy, anthropology and psychology .... " (Carr 2006, 135)

Goals of Treatment/Main Strategies The Miracle Question

Encourage clear problem definition Prioritize (work on only one problem at a time) *The Miracle Question - "Imagine when you go to sleep one night a miracle happens....... but you don't know it...... what would be the first signs for you that things were different ......" - De Shazer*

Unique Aspects of SFT

Experiences are accepted before any attempt at change Therapists assist families in defining their situations clearly and with possibility Does not focus on clinical understanding of the family situation by the family or therapist Empowering and meant to help families access their resources Achievable goals are emphasized

Unique Aspects of Narrative Family Therapy

Families learn to value their life experience and stories to reauthor their lives Families learn to find exceptions to their regular patterns of interaction Problems are externalized and worked on collaboratively Expectations of setbacks and the raising of dilemmas help to lower resistance Celebrations are held when goals are reached Strengths of this approach include: (1) Ability to "move clients from passivity and defeatism towards realizing that they already have some power over the problems that plague them" (Nichols 2009, p. 291); (2) Does not place blame; and (3) Separates the problem from the individual

Advantages of SFT

Fits in nicely with managed care and the pressure to provide effective counseling in a briefer time frame. Emphasizes the positive attributes in clients. It can be used effectively with a variety of clients and issues.

Underlying Views and Assumptions of Treatment

Focus on what is right and what is working. Every problem has exceptions that can be turned into solutions. Little changes lead to bigger changes. Goals are always set in positive terms. People do want to change for the better. People are highly susceptible and dependent. Don't ask a client to do something that he or she has not succeeded at before. Avoid analyzing the problem. Be efficient! Don't look for problems or solutions that won't work. Be a survivor not a victim. Focus on the present and the future, not the past.

FFST de Shazer (1985) describes this intervention as solution focused rather than problem focused.

He maintains that families usually have at their disposal the solutions to their own problems but have not been able to recognize them. The FFST was designed to shift the clients' focus from past to present and future events, from problems to strengths, and implicitly to promote positive expectations of change Clients often expect things to go poorly; the solution focused FFST, according to de Shazer, suggests otherwise. de Shazer (1985) believes the FFST intervention, along with a treatment focus which emphasizes family resources and strengths, creates a context in which *"change is not only possible but inevitable" (p. 137).*

Goals of Treatment/Main Strategies 3

If someone tells me that on Tuesday they felt they were at 4 on a depression scale (where 10 was the happiest they could be), I might ask something like: Think really carefully now. What *prevented* you from being a 3? Or if someone tells me their motivation to quit smoking is at 8 when 10 indicates that they are fully motivated and committed to stop, I might ask something like: And what would you need to be different so you're able to get up to that 10? Careful targeting of such questions helps us find out what they're already doing that helps them cope better or what they need to do differently. We can then encourage those behaviors. Similarly, we can ask what will it be like when they are at a 5 and so forth.

Incorporating a Strengths-based Approach to the Client

Important because: -Non-compliant -Hopeless -"different aspects of their lives that do not have anything to do with those problems, such as their skills, talents, and strengths" (Hull & Mather 2006, 177). -Areas for possible strengths: extended family, spiritual or religious strengths and a high tolerance for stress -Strengths will naturally emerge

Outsider Witness (Reflection Team)

In this particular narrative practice or conversation, outsider witnesses (reflection team) are invited listeners to a consultation. Often they are friends of the consulting person or past clients of the therapist who have their own knowledge and experience of the problem at hand. During the first interview, between therapist and consulting person, the outsider listens without comment. Then the therapist interviews them with the instructions not to critique or evaluate or make a proclamation about what they have just heard, but instead to simply say what phrase or image stood out for them, followed by any resonances between their life struggles and those just witnessed. Lastly, the outsider is asked in what ways they may feel a shift in how they experience themselves from when they first entered the room.

Between Sessions Inquire about Pre-Session Change

Inquire about Pre-Session Change "Has anything changed relative to the presenting problem since you set up this appointment?" "Are these the kinds of changes you would like to continue see happen?" Do not minimize the significance of any efforts the client has made, or any changes that may have occurred prior to the first meeting

Method 2

Intertwined with this problem investigation is the uncovering of *unique outcomes or exceptions to its influences,* exceptions that lead to rich accounts of key values and hopes—in short, a platform of values and principles that provide support during problem influences and later an alternate direction in life. The narrative therapist, as an *investigative reporter,* has many options for questions and conversations during a person's effort to regain their life from a problem. These questions might examine how exactly the problem has managed to influence that person's life, including its voice and techniques to make itself stronger. On the other hand, these questions might help restore exceptions to the problem's influences that lead to naming an alternate direction in life. Here the narrative therapist relies on the premise that, though a problem may be prevalent and even severe, it has not yet completely destroyed the person. So, there always remains some space for questions about a person's resilient values and related, nearly forgotten events. To help retrieve these events, the narrative therapist may begin a related remembering conversation.

Diversity

It does not attend to many multicultural tenets (e.g., understanding the client within his or her culture and worldview). It does not attend to the fact that problems may indeed be out of the client's ability to change them because the problems are system-bound. It works well for clients and cultures who like a fast, no-nonsense, down-to-earth approach and who are not interested in the cognitive, behavioral or affective components of a problem. But because the client is seen as the expert, it can work well for some clients of other cultures.

Review Template Assessment Process/ Goals: (Gurman. Pg.260-261)

Meet patients where they are (Begin session with "What brings you in" or "What are you hoping to accomplish coming here?") Take patient's version of what is-and is not-a problem. The thrust of the session is present-to future oriented. Goals should be : (1) Small rather than large; (2) Salient to patients; (3) Described in specific, concrete behavioral terms; (4) Achievable within the practical contexts of clients' lives; (5) Perceived by the patients as involving their "hard work"; (6) Described as the "start of something" and not as the "end of something"; (7)Treated as involving new behavior(s) rather than the absence or cessation of existing behavior(s).

Review Template Assessment Processes/Goals (Gurman Ch. 8):

Meeting times are arranged at the end of each session and are done so one session at a time (Gurman p.233) At the end of each session the process is evaluated by each member and he/she is asked whether the session was useful and in which way (Gurman p. 233) The assessment process is more about generating experiences rather than gathering information (Gurman p.234) Focused on detailed narratives and new expressions from each person (Gurman p.235) Goal setting: "...to collaborate with people in living out, moment-by-moment, choice-by-choice, life stories that they prefer, that are more just, and that make their worlds more satisfying. We are more interested in opening up possibilities than in closing them down" (Gurman p.236)

Overview 5

Narrative Therapy utilizes the power of people's personal stories to discover the life purpose of the narrator. Clients are encouraged, through a respectful and cooperative relationship, to address the problems in their lives that exist amidst social, political, and cultural storylines. This method of externalization is applied to behaviors, values, beliefs, and ideals. Narrative Therapy explores what roles these elements play in the client's narrative and then works with the client to rewrite the negative areas depicted in the narrative. Through objectification, a client can view problematic situations from a new perspective.

Review Template Applicability: Appropriate Populations for Treatment Approach (Gurman p.246):

Narrative therapy has general applicability, although it may not be for people who want to dig up their past, find the "root" of issues. They've found that most people are less concerned with therapy and more concerned with improving their relationships

Overview 2

Narrative therapy is for individuals, couples, or families. In a couple or family setting, the narrative process provides an environment for respect and value to flourish. Rather than reverting to demeaning behaviors, reactions or remarks, the therapist guides the members of the groups through the narrative in a way that allows them *to separate the problem from the individual.*

Appropriate Candidates for Narrative Therapy

Narrative therapy is often used with: -Anorexia nervosa -HIV/Aids -ADHD -Schizophrenia Narrative therapy is particularly useful when dealing with trauma and addictions because: -It separates the individual from the disease Roth and Epston (1989) state that *narrative therapy is useful in addressing trauma and addictions* because externalising the problem counteracts the effects of labeling. This will aid in *no longer seeing the person as the problem,* but rather *the problem is the problem* (Roth & Epston 1995).

Overview

Narrative therapy was developed by Michael White and David Epston. A method of therapy that *attempts to separate the person from the problem.* Encourages people to rely on their own skill sets to minimize the problems that exist in their everyday lives. It holds the belief that a person's identity is formed by our experiences or narratives. Because the problem is seen as a separate entity from the person, a therapist can help a client *externalize sensitive issues.* This *objectification dissipates resistance* and defenses and allows a client to address this entity in a more productive manner.

Outsider Witness (Reflection Team) 2

Next, in similar fashion, the therapist turns to the consulting person, who has been listening all the while, and interviews them about what images or phrases stood out in the conversation just heard and what resonances have struck a chord within them. In the end, an outsider witness conversation is often rewarding for witnesses. But for the consulting person the outcomes are remarkable: *they learn they are not the only one with this problem, and they acquire new images and knowledge about it and their chosen alternate direction in life.* The main aim of the narrative therapy is to engage in people's problems *by providing the alternative best solution.*

Review Template Termination Issues: (Gurman. Pg. 278)

No termination issues where available Termination is appropriate when: (1) Goal(s) are met/achieved (2) Designating a limited number of sessions (3) No movement in the case (4) Leaving things open-ended in response to outside restrictions. Termination can occur when the therapist is confident that the patient will know when and where to go to seek help, and not when he/she is confident the patient will never have problems.

"Postmodern" 2

Postmodernism relies on concrete experience over abstract principles, knowing always that the outcome of one's own experience will necessarily be fallible and relative, rather than certain and universal. Postmodernism is "post" because it is denies the existence of any ultimate principles, and it lacks the optimism of there being a scientific, philosophical, or religious truth which will explain everything for everybody - *a characterisitic of the so-called "modern" mind.* The paradox of the postmodern position is that, in placing all principles under the scrutiny of its skepticism, it must realize that even its own principles are not beyond questioning.

Goals of Treatment/Main Strategies: How to Conceptualize the Goal of Treatment

Realistic Concrete, measurable Focus on the presence of desirable behavior rather than the absence of a behavior Enable a focus on "steps" rather than a final result *Client recognizes a role for him- or herself*

More on Exception Questions

Recent exceptions are more useful to intervention Random versus deliberate exceptions Identify the client's areas of competence, strengths Identify protective factors that can be mobilized Has anything been better since the last appointment? What's changed? What's better? Can you think of a time in the past (month/year/ever) that you did not have this problem? What would have to happen for that to occur more often? When doesn't the problem happen? What's different about those times? What are you doing or thinking differently during those better times? When have you been able to stop doing....? Are there times when you expect to...but you remember something that helps you calm down? What else?

Intervention Techniques Technique 1: Problem-Saturated Stories

Refers to the personal stories that individuals express which are based on their experiences These stories are characterized by problems Clients only think of themselves in terms of these problems The therapist needs to utilize listening skills and specific language to draw out the story

Overview 8

This can be a thoroughly revealing process, resulting in an insight that cannot be achieved through other traditional forms of therapy. Having one's life story spoken aloud can be illuminating. And through narrative therapy, *a client is given the opportunity to edit and rewrite the remainder of their story.* *Narrative therapy is not systemic in origin.* Focus is considered a *"postmodern and social constructionist" perspective that rejects traditional classification systems of empiricism.* Geared toward the *empowerment of persons based on the telling and retelling of their stories.* Clients and families *"re-author"* their lives.

Three Types of Narratives Progressive Stability Regressive

Three Types of Narratives *Progressive:* Indicates that clients are moving forward and acting on goals. *Stability:* Indicates client's are keeping the status quo. *Regressive:* Indicates client's are retreating from goals.

Criticisms of Narrative Therapy

To date, there have been several formal criticisms of Narrative Therapy over what are viewed as its theoretical and methodological inconsistencies, among various other concerns. Narrative therapy has been criticized as holding to a social constructionist belief that there are no absolute truths but only socially sanctioned points of view, and that Narrative therapists therefore privilege their client's concerns over and above "dominating" cultural narratives. Several critics have posed concerns that Narrative Therapy has made gurus of its leaders, particularly in the light that its leading proponents tend to be overly harsh about most other kinds of therapy. Others have criticized Narrative Therapy for failing to acknowledge that the individual Narrative therapist may bring personal opinions and biases into the therapy session. Narrative therapy is also criticized for the lack of clinical and empirical studies to validate its many claims. Etchison and Kleist (2000) state that Narrative Therapy's focus on qualitative outcomes is not congruent with larger quantitative research and findings which the majority of respected empirical studies employ today. This has led to a lack of research material which can support its claims of efficacy.

Overview of SFT 2 Two Primary Activities & The Process

Two Primary Activities (1) Development of well-formed goals within the client's frame of reference (2) Development of solutions based on exceptions The Process -Describe the problem -Develop goals -Explore for exceptions -End of session feedback -Evaluate client progress (each session)

Formula First Session Task (FFST)

de Shazer (1984, 1985) formulated an *intervention designed to assist both families and therapists in obtaining a clearer idea of the goals of treatment and in creating a positive context for change.* He has termed this intervention the "formula first session task. de Shazer (1985) describes the FFST as follows: *Between now and the next time we meet, we would like you to observe, so that you can describe to us next time, what happens in your (pick one: family, life, marriage, relationship) that you want to continue to have happen. (p. 137)*

de Shazer's Major Works

de Shazer, Steve (1982). Patterns of Brief Family Therapy: An Ecosystemic Approach. New York, NY: The Guilford Press. ISBN 0-89862-038-4. de Shazer, Steve (1984). "The death of resistance". Family Process 23: I 1-17. de Shazer, Steve (1985). Keys to Solution in Brief Therapy. New York, NY: W W Norton & Company. ISBN 0-393-70004-6., W W Norton page de Shazer, Steve (1988). Clues: Investigating Solutions in Brief Therapy. New York, NY: W W. Norton & Company. ISBN 0-393-70054-2., W W Norton page de Shazer, Steve (1991). Putting Difference to Work. New York, NY: W W Norton & Co Inc. ISBN 0-393-70110-7. de Shazer, Steve (1994). Words Were Originally Magic. New York, NY: W W Norton & Company. ISBN 0-393-70170-0., W W Norton page de Shazer, Steve (2005). More than Miracles: The State of the Art of Solution-focused Therapy. Binghamton, NY: Haworth Press. ISBN 0-7890-3398-4.

After Each Session Evaluation Questions

"Is our work together helpful to you? Are the changes along the lines that you hoped? Have your goals changed? What should we be doing differently?" During each session ask the client (on a 0 to 10 scale) what number will signify good-enough problem resolution After a goal is achieved, set additional goals or end the intervention Remind the client at the end of each session how progress toward goal achievement is being demonstrated

Other Techniques Ask Future- Oriented Open-Ended Questions: The Pessimistic Stance (gets clients to argue for their own change):

*Ask Future- Oriented Open-Ended Questions:* The therapist's language should always imply the likelihood of change; emphasis is on the future when the problem no longer exists: "What will you be doing when _____" *The Pessimistic Stance (gets clients to argue for their own change):* "It sounds like the problem is serious. How come things are not worse?" "What are you (or your family) doing to keep things from getting worse? "How has that been helpful? Would _____ agree?"

Review Template Major Therapeutic Goals:

*Break repetitive, nonproductive behavioral patterns.* (Gladding. Pg.307) Get families to use the abilities they already have in more constructive ways. (Gladding. Pg.308) Only the smallest change is necessary. Small amounts of change can also be reinforcing to families in helping them realize that they can make progress.(Gladding. Pg. 308) Change previously dysfunctional methods of solving difficulties. (Gladding. Pg.307) Individuals learn to identify what is a problem versus what is a nonproblem or exception.(Gladding, Pg. 307) Resolve the presenting complaint as quickly and efficiently as possible so that patients can get on with life. (Gurman, Pg 260) Goals such as promoting personal growth, working through underlying emotional issues, or teaching couples better problem-solving and communication skills are not emphasized. (Gurman, Pg 260)

Goals for First Session

*Build positive feelings and a sense of hope: "Tell me what will be different for you when our time here has been successful."* *Assessment Topics* Client's perceptions of the problem Client's beliefs about the sources of the problem How the problem affects the client How the client has coped with the problem thus far What the client has tried already What the client's experiences have been with other helpers

Other Techniques Clue Skeleton Key Questions

*Clue:* An intervention that mirrors the usual behavior of a family. Intended to alert the family to the idea that some behavior is likely to continue. Sensitizes the family to the idea that the process of growth will continue. *Skeleton Key Questions:* A task assigned by the therapist, often prior to meeting in person, where the client is asked to come up with one thing in the relationship or family system that they want to stay the same (in the context of other attitudes/behaviors getting in the way):

Other Techniques Combating Resistance Scaling Questions

*Combating Resistance:* There is less resistance when we cooperate with the client. *Scaling Questions:* Helps clients to quantify their concerns. "If you were to rate yourself on a scale of 1-10 with zero being your worst day and 10 being after your miracle, where would you be right now?" *On a scale of 1 to 10 how far have they come in solving the problem. If for example it is a "6," ask what it would take to make it a "7"?*

Review Template Mechanisms of Change: (Gurman, Pg. 279) Connection Curiosity Collaboration Co-Construction of Solution Ideas Closure

*Connection* - Listening, affirming and acknowledging each partner's story while joining with both around a set of mutually agreed-upon goals. *Curiosity* - Opening space for a discussion of multiple perspectives while attending to the couple's resources. *Collaboration* - Working together with both members in the direction of their preferred futures. Highlighting success and generating hope. *Co-Construction of Solution Ideas*- (a) introducing novel ideas that emerge from the clinical conversations (b) defining actions steps (homework). *Closure*- Giving compliments, celebrating and applauding change, offering each partner an opportunity to acknowledge and comment on changes in the other, offering future availability.

Assumptions Constructive Alternativism: Phenomenological/Humanistic/Existential Basis:

*Constructive Alternativism:* As problems are reframed, they form new solution-oriented alternatives. *Phenomenological/Humanistic/Existential Basis:* SFT does not believe in the therapist as expert. SFT does not believe that a person's perception is incorrect or maladjusted or in need of change.

More on the Miracle Question

*De Shazer's (1988) miracle question: "Suppose that one night, while you are asleep, there is a miracle and the problem that brought you here is solved. However, because you are asleep you don't know that the miracle has already happened. When you wake up in the morning, what will be different that will tell you that the miracle has taken place? What else?"* *Erickson's* original version of the question involved asking his client to look into the future and see themselves as they wanted to be, problems solved, and then to explain what had happened to cause this change to come about. *He might also ask clients to think of a date in the future, then worked backwards, asking them what had happened at various points on the way.* *O'Hanlon* suggests other variations of the question: a time machine, crystal ball, rainbow bridge and a letter from a future self Building on the miracle question, the therapist may ask: What difference would you (& others) notice? What are the first things you notice? Has any of this ever happened before? Would it help to recreate any of these miracles?  What would need to happen to do this? What else?

Major Assumptions and Foci

The assumption that narratives or stories shape a person's identity, as when a person assesses a problem in his life for its effects and influences as a "dominant story." An *"externalizing"* emphasis, such as by naming a problem so that a person can assess its effects in his life, come to know how it operates or works in his life, relate his earliest history, evaluate it to take a definite position on its presence, and in the end choose his relationship to it. A focus on *"unique outcomes"* or exceptions to the problem that wouldn't be predicted by the problem's narrative or story itself. A strong awareness of the impact of power relations in therapeutic conversations, with a commitment to checking back with the client about the effects of therapeutic styles in order to mitigate the possible negative effect of invisible assumptions or beliefs held by the therapist

Technique 3: Unique Outcomes

The client(s) is asked to identify times in the past when the problem did not exist: -Helps in assisting the client(s) in creating new personal stories based on those unique occurrences -Reminds them that there were times that, despite this problem, they were able to overcome it -explore alternative possibilities *The therapist will help clients to focus on life stories which are contrary to the problem-saturated narrative.* This is where the whole *postmodernism* perspective becomes relevant. Narrative therapy would suggest that you create a negative reality by focusing your attention and perceptions on storylines which substantiate your self-created negative reality. *This means that storylines which are contrary to the dominant negative storyline are not perceived (though they are available) or they are not given attention.*

Method

The focus of narrative therapy is on the relationship *between experience and interpretation revealed in the client's narrative.* Attention by the therapist should be paid to the way people tell their stories, rather than the accuracy of the account. In narrative therapy a person's beliefs, skills, principles, and knowledge in the end help them *regain their life from a problem.* In practice a narrative therapist helps clients examine, evaluate, and change their relationship to a problem by acting as an "investigative reporter" who is not at the centre of the investigation but is nonetheless influential; that is, this therapist poses questions that *help people externalize a problem and then thoroughly investigate it.*

Goals of Narrative therapy 1 2 3

The goal in narrative therapy is to *draw out stories that clients have held of themselves that prevent them from moving on.* To reshape client's perceptions of themselves and their surroundings, *thereby reshaping or changing their life narratives:* (1) Deconstructing the dominant cultural narrative; (2) Externalizing the problem; (3) Re-authoring the story.

Social Constructionism 2

The major focus of social constructionism is to uncover the ways in which individuals and groups participate in the construction of their perceived social reality. The social construction of reality is an ongoing, dynamic process that is (and must be) reproduced by people acting on their interpretations and their knowledge of it. Because social constructs as facets of reality and objects of knowledge are not "given" by nature, they must be constantly maintained and re-affirmed in order to persist. This process also introduces the possibility of change!

Technique 2: Mapping the Problem's Domain:

The therapist and client(s) discuss how the problem has affected various aspects of the client(s) lives: exploring *"reciprocal patterns that become apparent and that are shown to have been supporting the problem"* (Williams 2006, 203) scrutinizing the impact that the problem has had on their lives in all respects -- will serve to be an eye-opening experience asking for a full, detailed account of the effect that the problem has had

Other Techniques Writing the Message

There are three components to the message: compliments, the bridging statement and tasks. *Compliments:* Used to encourage the client and points out clients' strengths and efforts. *Bridging Statement:* Summarizes what the client wants from counseling and sets up the discussion for the task. *Task:* The homework the therapist will ask the client to do between sessions.

Technique 3: Deconstruction 2

*Deconstruction Questions* - used to help client's understand their problems from different perspectives. Deconstructive questions encourage clients to situate their narratives within larger systems and through time. Deconstructive questions are used to reveal the history, context, and effect's of the client's narrative. When a story is deconstructed, the client is separated from the story and by doing this, the client is asked to think about the unique outcomes when the problem is not influencing them in a problematic manner. Invite clients to see:-Problems from different perspectives -How problems are constructed -That problems are constructed (if did not realize before)-The limits of problems *-Other possible narratives exist* Say, *" Our brains overlay our beliefs onto our perceptions. This means we unintentionally see things the way that we have been educated to see them. We take information from our senses and try to make sense of that information with what we already believe to be true... narrative therapy allows people to apply new positive narratives to their perceptions ...... Narrative therapy allows you to focus your attention on alternate beliefs... there is no truth according to postmodernism and therefore nothing would ever need to be disputed.* *Unique outcomes technique - encourage people to talk about storylines that are different or contrary to the dominant negative storyline.* Because the therapist believes in this alternate storyline, the new reality is validated and can be integrated. Example: "Tell me about when the problem was not able to influence your relationship"; *"I would like to hear about how you fell in love... tell me what you love so much about your partner."*

Technique 4: Externalizing the Problem:

*Externalizing the Problem:* focuses on how the problem impacts a person or family, opposed to how the problem stems from a family. -name the problem Roth & Epston (1995) state that *"externalising establishes a context where people experience themselves as separate from the problem."* Roth & Epston (1995) find that externalizing *"changes a persons' relationship to problems, and shifts the conversation to a focus on the relationship between the person and the problem instead of a focus on a problem-person."*

Review Template Theoretical View of Cause/Maintenance of Disorder or Pathology (Gladding Ch. 14 & Gurman Ch. 8):

*Focused on changing present behaviors, not examining past histories* (Gladding p.325) The terms "pathological" and "healthy" are rarely used in order to get away from using generalizing terms and society's way of measuring others by using standardized norms and measurements (Gurman Ch. 8) Rather than focusing on pathology, sessions are spent focusing on people's own evaluation of what is problematic and what they should change (Gurman) *Problems are seen as external to persons and families* (Gladding p. 326) Once people are able to reauthorize their stories, the problems (pathology) will diminish

Other Techniques Focusing Positive Blame Don't Know

*Focusing:* Tangential issues are not important and complex problems can still have simple solutions. *Positive Blame:* Blame positive changes on the client and work within the client's worldview. *Don't Know:* Don't let the client discount his or her success and when the client says "I don't know," ask him or her, "what if you did know?"

Main Strategies for Helping Clients Goals: Miracle Question:

*Goals:* Helps focus the client and session immediately on goal identification. Co-create a problem (therapist and family must agree on what the problem to be treated is). *Miracle Question:* Ask the family for a hypothetical solution. It invites family members to suspend their present frames of reference and enter into a reality they wish to achieve. *Ex. "Suppose one night a miracle happened and your problem was solved. How would you know? What would be different?"*

Review Template Issues of Resistance:

*In solution-focused therapy there is no resistance*, which is based on the belief that *all families/couples really want to change.* Therefore when families/couples do not follow the therapists' directions, they are "cooperating" by teaching therapists the best way to help them. (Gladding. Pg.308)

Technique 3: Deconstruction

*It is difficult to solve problems when those problems are over-generalized... Deconstruction is used to make the issue specific and manageable.* *Deconstruction* is used to *reveal meaning or significance that may not have been evident during the client's initial telling of their story* (Payne, 2006). Therapist *listens for gaps in understandings and ambiguities in meanings* to get better a understanding of the client's situation and problem-saturated narrative.  *Example:* If a person were to say, "My wife is messy and I'm pissed," there is no clear solution nor is it clear what emotion needs empathy. The therapist would help the client to be more specific, "when my wife doesn't put her dishes away I feel unimportant and as it is really important to me to have the kitchen clean... I have a difficult time with my stress and her putting the dishes away would really help me to feel like she understands the stress I am carrying." *The therapist could then say something like, " so you are looking for your wife to empathize with the stress you are carrying so that stress might give you a break?"* *Deconstruction technique - help us to understand what the problem means to you.* "Tell me what you see... what is going on when the problem is present. Tell us what we will see when the problem has gone away. Tell us what emotions you tend to experience when you think about these examples of the problem. If your family members where able to understand how this all affects you, what would they understand?"*

Other Techniques Labeling Normalizing Insight Externalize

*Labeling:* Externalize the problem so that the person is not the problem but the problem is the problem. *Normalizing:* Clients have complaints, issues and concerns not symptoms, problems or pathologies. *Insight:* Insight is not needed to solve the problem. *Externalize:* Discuss the problem as something apart from the client, rather than something that is central to the client's nature. Ex. "You struggle with substance abuse" vs. "You are a substance abuser"

Review Template Therapeutic Techniques: (Gladding. Pg.307-310) A primary treatment technique is to co-create a problem. For the therapeutic process to be productive, initially, an agreement must be made as to which problem the patient(s) want to solve. Miracle Question Scaling Second-order change Compliment Clue Skeleton keys

*Miracle Question*- Asking the family for a hypothetical solution to their situation. *Scaling*- Questions are asked using a scale of 1 (low) to 10 (high) *Second-order change*- An emphasis of doing something in a different way. Goal is to change the family's organization and structure. *Compliment*- A written message designed to praise a family for its strengths and built a "yes set" within it. *Clue*- Provide the family with a clue or an intervention that mirrors the usual behavior of the family. *Skeleton keys*- Use procedures that have worked before and that have a universal application.

Review Template Therapeutic Techniques (Gurman Ch. 8 & Gladding Ch. 14) 2 Raising dilemmas Predicting setbacks Using questions Letters Celebrations and Certificates

*Raising dilemmas*- allows families/couples assess how they would approach a situation before it occurs, thus preparing them if an incident were to occur (Gladding p. 318) *Predicting setbacks*- setbacks are best dealt with when they are planned for or anticipated. Therefore the family/couple decides how they would approach a setback (Glassing p.319) *Using questions*- questions are directed toward finding exceptions in a family/couple's negative story so that it brings hope to them and so they realize the problem doesn't occur in all situations(exception questions). Significance questions are directed towards finding the significance importance of the exceptions (Gladding p. 319) *Letters*- The therapist writes letters to the family/couple after the sessions in order to serve as a way to continue therapy outside of sessions. It also serves as a concrete way of communication; people can easily forget conversations in sessions, so the letters enable them to "see" and access the information/dialogue (Gladding p. 319) *Celebrations and certificates*- used to bring closure to the therapy and affirmations of the couple/family's dedication and defeat (Gladding p. 320)

Other Techniques Reframing Cheerleading

*Reframing:* Introduce clients to new ways of looking at themselves or the problem issue; reframing problems into more positive terms can help encourage resolution. *Cheerleading:* Support and encourage the client's success.

Social Constructionism

*Social constructionism*, or the social construction of reality, is a theory of knowledge in sociology and communication theory that examines the development of jointly constructed understandings of the world. It assumes that *understanding, significance, and meaning are developed not separately within the individual, but in coordination with other human beings.* The elements most important to the theory are (a) the assumption that human beings rationalize their experience by creating a model of the social world and how it functions and, (b) that language is the most essential system through which humans construct reality.

Main Strategies for Helping Clients The Nightmare Question Exception Questions

*The Nightmare Question:* "Think about having a terrible nightmare where your problem was amplified. What would be happening to let you know your nightmare came true?" This might be used when client minimizes or denies his or her problem. *Exception Questions:* The therapist attempts to identify "positive" examples of when the family goal may be happening or moving toward actually occurring.

Review Template Role of the Therapist (Gladding Ch. 14):

*Works as a collaborator rather than an expert* Does not assume symptoms serve a function for the family/couple Therapist sees problems as oppressive for families and they need to be addressed and eliminated ASAP Examines the meaning of situations and questions the family in order to find unique outcomes or exceptions for the family/couple's problems *Helps the family focus on constructing new stories*, which are rid of conflict and focused more on the family/couple having control

"Postmodern"

A general and wide-ranging term which is applied to literature, art, philosophy, architecture, fiction, and cultural and literary criticism, among others. Postmodernism is largely a *reaction to the assumed certainty of scientific, or objective, efforts to explain reality.* In essence, it stems from a recognition that reality is not simply mirrored in human understanding of it, but rather, *is constructed as the mind tries to understand its own particular and personal reality.* For this reason, postmodernism is highly skeptical of explanations which claim to be valid for all groups, cultures, traditions, or races, and instead focuses on the relative truths of each person. In the postmodern understanding, interpretation is everything; *reality only comes into being through our interpretations of what the world means to us individually.*

Overview of Solution-Focused Therapy (SFT)

A short-term approach to intervention in which the *clinician and client attend to solutions or exceptions to problems more so than to problems themselves.* It helps clients identify and amplify their strengths and resources toward the goal of finding solutions to presenting problems. There is *no necessary connection between problems and solutions.* Events in a *person's past and present* are *not necessarily causally connected*. *One need not understand a problem in order to resolve it.*

Overview 6

Although the narrative is intact, the character dynamic has shifted. Each component of a story can be manipulated and altered as to create a new ending to the narrative. Narratives are definitive at first glance, but are pliable and fluid when offered in the therapeutic environment. Each narrative is multi-dimensional and often times a client will not be aware of certain plots, themes, or even characters until the narrative has been fully explored.

Overview 7

An example of narrative therapy would be when a therapist allows a client to verbalize their problems and *then re-phrases the narrative in a disconnected way.* For instance, if a client believes suffers with depression and feels like a failure, a narrative therapist may offer the suggestion that rather than being a failure, the client had succeeded in living with depression. One of the biggest benefits of engaging in this form of therapy is being able to sift through the past to uncover things that had previously remained hidden. Acting as a facilitator and an investigator, the therapist is able to pose questions that challenge prior conceptions and reveal maladaptive behaviors.

Subsequent Sessions

Ask: "What's better?" Client should be encouraged to report positive and negative developments (clients may be ambivalent about "positive" changes that involve loss) Ask questions about: Maintenance strategies "What needs to happen for these changes to keep happening? What obstacles may get in your way, and how might you overcome those?" Learning strategies "What have you learned so far from what you've been doing? What have you learned not to do?"

Overview 4

At the *core of Narrative Therapy is the belief that the problem is separate and distinctly apart from the person.* A problem does not define a person. *A problem is something that a person has, not something that a person is.* The goal of treatment is not to transform who you are, but rather to transform the effect that the problem has on your life.

Review Template Theoretical View of Cause / Maintenance of Disorder or Pathology:

At the foundation of this approach is the belief that *dysfunctional families get "stuck" in dealing with problems and that these families use an unsatisfactory method to solve their difficulties.* (Gladding, Pg.307) Also another premise of the solution-focused therapy is that *families really want to change.* Therefore, the *maintenance of their problems is due to their repetitive, nonproductive behavior patterns.* There is an overall avoidance of traditional diagnostic categories and preconceived notions of what may be healthy/unhealthy or functional/dysfunctional. (Gurman. Pg. 261). The concept of pathology does not play a part in the treatment process. (Gladding. Pg.312)

Review Template Applicability: Appropriate Populations for Treatment Approach: (Gurman. Pg.284)

Based on the overall approach and the emphasis on identifying and working patient's own goals, motivations etc, it is widely applicable. Patients who are too psychiatrically impaired to participate in talking therapy are not expected to do well. Situations involving severe sociopathy and/or domestic violence may require partners to be seen separately until safety can be assured.

Premises of the Theory 2

Belief that families get "stuck" in dealing with problems Focus on breaking dysfunctional patterns Three simple rules --If it is not broken, do not fix it. --Once you know what works, do more of it. --If something does not work, do not do it again. Do something different. Small change leads to larger change Keep intervention as simple (concrete) as possible

Premises of the Theory

Built on the philosophy of social constructionism Knowledge is time and culture bound *Emphasizes that language influences the way people view the world* *Treatment* must *include clients' social, historical, and cultural context* Reality is not an objective entity, but a reflection of observation and experience

Review Template Theoretical Rationale for Intervention Approach (Gladding Ch. 14): logico-scientific reasoning Re-authoring

Other types of approaches generalize and classify people according to social standards (ill or pathological) thus repressing personal experiences. (Gladding p. 316) *Logico-scientific reasoning* - empirical data and logic, whereas narrative reasoning= stories, sub-stories, meaningfulness and liveliness. *Re-authoring* - When people are able to see their story from a different point of view with more options, they are then able to change (Gladding p. 316)

Review Template Theoretical Rationale of Intervention Approach:

Overall, solution-focused therapy interventions help the patient-family to view their situation/problem differently. Interventions can provide them with hope, thereby assisting them in powerful ways. (Gladding. Pg310) Useful when "problem talk" between the couple/family starts to escalate. Interventions helps to redirect attention toward their role in achieving past, present and, future solutions.

Goals of Treatment/Main Strategies 2

Partialize problems into discreet, measurable units Scaling questions (for goal setting and assessing motivation) *Ask questions that precipitate change (from Mark Tyrrell)* Now, it's not enough just to get these numbers. We can use these numbers to really help our clients start to think more flexibly and feel hope in the immediate future. Once we have started to break down the 'all or nothing' perception by using numbers, we can ask questions that presuppose (and possibly even precipitate) positive change. I recall asking a man in chronic pain to tell me how he would know when his pain had gone down from a 7 to a 6. What difference would he notice? He described the exact difference to me in great detail and actually found himself "slipping down to a 5!" as he was speaking.

Technique 3: Unique Outcomes 2

Rewrite self defeating narratives: which means that clients will begin to allow positive story-lines into their life *(the premise is that if you have a negative story about your life you unconsciously will "look for" negatives to substantiate the "truth" of the dominant story about your life that you tell yourself... by doing so you unintentionally miss many of the positive stories that are "contrary'"to the dominant story.)* How were you able to defy (the problem) when you did not let it affect you? Was it easier than you thought, standing up to (the problem)? Could your presence here today be a unique outcome and, thus, a step towards you overcoming (the problem)? These questions invite clients to make sense of exceptions that they might have not considered as significant - gives clients a sense of self-agency- provides client with some hope for future, preferred story - ask client to consider what personal qualities led them to accomplish this instance of exception to the problem, and how they can use these qualities in the present and future to live out their subordinate story, or preferred narrative. *The therapist is persistent in looking for expressions of contradiction to the dominate story and/or points of entry to the subordinate story.*

Nature of Maladjustment

SFT is focused on finding solutions not problems and therefore does not look at a person in the sense of being maladjusted. It is *behavior that causes maladjustment* and not the innate qualities of the person. The client's narrative determines much about the repeated patterns of dysfunctional behavior.

Review Template Role of the therapist: (Gurman. Pg.263)

Serves essentially as a consultant, interviewing purposefully to influence the patients' view of the problem in a manner that leads to solution. Serves as a "guardian" of the conversation between the couple/family to prevent possible "problem talk" Serves as a skillful facilitator, assisting patients to better utilize their own strengths and competencies that perhaps are overlooked. Therapist assumes a posture of "not knowing" allowing the patients to be "experts" rather than the therapist telling them what is "really" wrong and how to fix it.

Technique 5 Spreading the News

Spreading the News: the client(s) expresses their new personal narrative with other people --Reaffirms the new view --Spreading the news of a difference gives clients a chance to recognize the changes that they have made --This will allow for the family members to experience being heard (Williams 2006, 205) Tell others

Review Template Mechanisms of Change (Gurman Ch. 8):

The *mechanism of change* is *each member's listening, witnessing, retelling, and living out stories* (Gurman p. 245) In successful therapy, *members find new meaning to their stories*

Overview 3

The *technique of externalizing* sets the stage for creating positive interactions and transforming negative communication or responses into more accepting, non-judgmental and meaningful exchanges. In narrative family therapy, as well as couple therapy, the therapist strives to help the clients identify with their experiences in a more adaptive and healthy manner that benefits all members of the group.

End of First Session The Formula First Session Task ****** (VERY IMPORTANT!!):

The End-of-Session "Message" Compliments Summary statement of positive strategies Tasks -Personal functioning -Interactions with others -Interactions with resource systems *The Formula First Session Task ****** (VERY IMPORTANT!!): "Between now and the next time we talk, notice the things in your life that you would like to continue to have happen/occur, etc. ...."*

Review Template Therapeutic Techniques (Gurman Ch. 8 & Gladding Ch. 14) Externalization Influence of the problem on the person- Influence of the person on the problem

Use of letters and documents to keep stories alive. The therapist might ask questions in order to keep the couple/family focused on a particular story (Gurman p.233) *Externalization * - having a couple/ family view the problem as a separate entity/ objectively. Instead of blaming one another, they form a team in order to solve the problem (Gladding p. 317) *Influence of the problem on the person* - ask how the problem has influence each member in order for him/her to gain awareness and objectivity *Influence of the person on the problem* - By asking each member how he/she has influenced the problem it makes them aware of their response to the problem and also helps him/her become aware of his/her strengths and weaknesses and how to approach the problem (Gladding p. 318)

*Michael White and David Epston* are known as the *fathers of narrative therapy.* Major Works

White, M. & Epston, D. (1990). Narrative means to therapeutic ends. New York: WW Norton. White, M. (2007). Maps of narrative practice. NY: W.W. Norton. White, M. (2005). Narrative practice and exotic lives: Resurrecting diversity in everyday life. Adelaide: Dulwich Centre Publications. pp 15. Fish, V., Post Structuralism in Family Therapy: Interrogating the Narrative/Conversational Mode. Journal of Family Therapy 19(3) 221-232 (1993) Minuchin, S. (1998). Where is the Family in Narrative Family Therapy? Journal of Marital and Family Therapy, 24(4), 397-403 (1998) Etchison, M., & Kleist, D.M (2000). Review of Narrative Therapy: Research and Review, Family Journal 8(1), 61-67.