PSY3120 - Post-modern therapy

Listening with an open mind

*All social constructionist theories emphasize listening to clients without judgment or blame, affirming and valuing them. *Normalising judgment: any kind of judgment that locates a person on a normal curve and is used to assess intelligence, mental health, or normal behavior. *Deconstruction: turning the tables and asking what clients think of the judgments they have been assigned. *Narrative therapists strive to listen to the problem-saturated story of the client without getting stuck. *During the narrative conversation, totalizing language is actively avoided. *Double listening: therapists begin to separate the person from the problem in their mind as they listen and respond.

Narrative therapeutic relationship

*Collaboration, compassion, reflection, and discovery characterize this therapeutic relationship. *This therapist uses their authority by treating clients as experts in their own lives. *The therapist assists the client in their pursuit by entering a dialogue and asking questions in an effort to elicit the perspectives, resources, and unique experiences of the client. *The therapist supplies the optimism and sometimes a process, but the client generates what is possible and contributes the movement that actualizes it.

Narrative therapy - mapping the effects of the problem

*In this part of the narrative therapeutic process, clients discuss the influences and consequences of the problem in all areas of their life, including home, school, work, familial relationships, peer relationships, relationship with oneself, identity formation, and future possibilities. *You identify the problem, externalise the problem, and emphasize that it has had a big effect on all of these areas. *Afterwards, you can create a new way of being in all those areas. *So it's taking away the problem - creating a new narrative in all those areas of life.

SFBT applications to group counselling

*In this theraoy, the group facilitator sets a tone of focusing on solutions in which group members are given an opportunity to describe their problems briefly. *It is the facilitator's role to create opportunities for the members to view themselves as being resourceful. *The group leader works with members in developing well-formed goals as soon as possible (small, realistic, achievable changes). *The facilitator asks members about times when their problems were not present or when the problems were less severe. *The art of questioning is a main intervention used in solution-focused groups. *This group counselling offers a great deal of promise for practitioners who want a practical and time-effective approach to interventions in school settings (eg: school counsellors).

Questions in narrative therapy

*In this therapy, questions are always asked from a position of respect, curiosity, and openness, and from a not-knowing stance. *Questions are the search of a difference that will make a difference. *Can lead to taking apart problem-saturated stories. *Eg: what problems can the person make to overcome these stories? *Whatever the purpose, the questions are often circular, or relational, and they seek to empower clients in new ways. *Narrative therapists use questions as a way to generate experience rather than to gather information. *Through the process of asking questions, therapists provide clients with an opportunity to explore various dimensions of their life situations.

Positive orientation of SFBT

*It is grounded on a positive orientation: people are healthy and competent, so this therapy helps clients recognise their competencies and build up the strengths they already have. *Shares similarities with positive psychology. *It is optimistic, anti-deterministic. *We ALREADY HAVE the ability to resolve the challenges that life brings us. *By emphasizing positive dimensions, clients quickly become involved in resolving their problems, which makes this a very empowering approach.

Narrative therapy application to group counselling

*Many of this therapy's techniques can be applied to group counselling. *The emphasis on creating an appreciative audience for new developments in an individual's life lends itself to group counselling. *New identities can be rehearsed and tried out into a wider world.

Documenting the evidence

*Narrative practitioners believe that new stories take hold only when there is an audience to appreciate and support them. *One technique for consolidating the gains a client makes involves a therapist writing letters to the person. *Letters can be read again at different times, and the story that they are part of can be reinspired. *Narrative letters reinforce the importance of carrying what is being learned in the therapy office into everyday life.

Questions in SFBT

*Skillful questions allow people to utilize their resources. *Asking "how questions" that imply change can be useful (they are practical, lead to action/ solutions). *Effective questions focus attention on solutions. *Questions can get clients to notice when things were better. *Useful questions assist people in paying attention to what they are doing and can open up possibilities for them to do something different.

Characteristics of brief therapy

*The average length of therapy is 3-8 sessions, with the most common length being only one session. *The main goal of brief therapy is to help clients efficiently resolve problems and to move forward as quickly as possible. *The core task is for SFBT practitioners to learn how to rapidly and systematically identify problems, create a collaborative relationship with clients, and intervene with a range of specific methods.

Narrative therapy techniques

*The effective application of this therapy is more dependent on therapists' attitudes or perspectives than on techniques. *When externalizing questions are approached mainly as a technique, the intervention will be shallow, forced, and unlikely to produce significant therapeutic effects. *These therapists emphasize their willingness to see beyond dominant cultural norms and to appreciate clients' differences. *Externalising questions, deconstruction, alternative stories, re-authoring.

Looking for what's working

*The emphasis of SFBT is to focus on what is working in clients' lives, which stands in stark contrast to the traditional models of therapy that tend to be problem-focused. *SFBT focuses on finding out what people are doing that is working and then helping them apply this knowledge to eliminate problems in the shortest amount of time possible. *A key theme of SFBT is, When you know what is working, do more of it.

SFBT therapist

*Therapists believe that every client is motivated in the sense that they want something as a consequence of meeting with a therapist. *Therapists strive to create a climate of mutual respect, dialogue, and affirmation in which clients experience the freedom to create, explore, and co-author their evolving stories. *Therapists note the language clients use, so they can increase their clients' hope, optimism and openness to possibilities and change.

Development of post modern therapies

*There is no one founder for this therapy. *It was a collective effort by many; Michael White, Insoo Kim Berg. *This new social movement includes diversity, multiple frameworks and integration; which provides a aider range of perspectives in counselling practice.

SFBT therapeutic relationship

*This therapy assumes a collaborative approach with clients in contrast to the educative stance that is typically associated with most traditional models of therapy. *The quality of the therapeutic relationship is a determining factor in the outcomes of this therapy, so relationship building or engagement is a basic step. *The attitude of the therapist is crucial to the effectiveness of the therapeutic process; is essential to create a sense of trust. *If clients are actively involved in the therapeutic process from beginning to end, therapy works best, and then the chances are increased that therapy will be successful.

Unique focus of SFBT

*This therapy differs from traditional therapies by eschewing the past in favor of both the present and the future. *Unlike other therapies, behaviour change is viewed as the most effective approach to assisting people in enhancing their lives. *Can still have a BRIEF exploration of past, but little attention is given to diagnosis, history taking, or exploring the emergence of the problem.

The role of stories

*We live our lives by stories we tell ourselves, and what others tell us. *These stories shape our reality of what we see, feel and do. *We create narratives internally, or society/ family can create them for us (we buy into it if it's told enought to us). So they are in a social and cultural context, but are particularly powerful within a family context. *Problems are also manufactured in social, cultural, and political contexts. *The client is not the victim leading a hopeless life, they instead emerge as courageous victors who have vivid stories to recourt. *Change occurs by exploring how language is used to create and maintain stories.

Narrative therapy goals

1. A general goal of this therapy is to invite people to describe their experience in new and fresh language. This new language enables clients to develop new meanings for problematic thoughts, feelings, and behaviours 2. These practitioners also seek to enlarge the perspective and facilitate the discovery or creation of new options that are unique to their clients.

Contributions of post-modern therapies

1. A major strength of both solution-focused and narrative therapies is the use of (open-ended) questioning (the centerpiece of both approaches). 2. Brief therapy has been shown to be effective for a wide range of clinical problems (solution-focused is better than narrative). 3. Perhaps due to the optimistic orientation of these approaches, clients are able to make significant moves toward building more satisfying lives in a relatively short period of time. 4. The postmodern approaches' dim view of diagnosis remind us that people cannot be reduced to a specific problem (non-pathologizing stance characteristic of practitioners with a social constructionist, solution-focused, or narrative orientation is a major contribution). 5. Very tolerant, embraces diversity. 6. Shows promise in group treatment with domestic violence offenders.

Relationships in SFBT

1. Customer-type relationship (client and therapist jointly identify and problem and a solution to work toward). 2. Complaisant relationship (client describes a problem but is unwilling or unable to take an active role in construcing a solution). 3. Visitors (come to therapy because someone else thinks they have a problem).

Post-modern therapy goals

1. Generate new meaning in the lives of clients. 2. Co-develop, with clients, solutions that are unique to their situation. 3. Enhance awareness of the impact of various aspects of the dominant culture on the individual (dominant culture is in charge of social constructions of what is true and acceptable, so this is enhancing awareness that 'trusts' are just popular constructions). 4. Help people develop alternative ways of being, acting, knowing, and living.

Exemples of social constructionism

1. Is tomato a fruit or vegetable (has feeds but is in vegetable section)? 2. Is pumpkin a fruit or vegetable? 3. Is a female not wanting to have sex classified as a disorder? *A pharmaceutical company created a cure for women who lacked libido and then wanted to claim it as a disorder (process was reversed) —> so the disorder was a construction in itself.

Techniques in SFBT

1. Pre-therapy change (what have you done since you made the appointment that has made a difference in your problem?). *Some people find that their situations improve even from the time they book the appointment, before actually having the therapy, because therapy is a solution for them —> they're working towards improvement. *By asking about such changes, the therapist can elicit, evoke, and amplify what clients have already done by way of making positive change. 2. Exception questions (direct clients to times in their lives when the problem did not exist). 3. Miracle question (if a miracle happened and the problem you have was solved while you were asleep, what would be different in your life?). 4. Scaling questions (on a scale of zero to 10, where zero is the worst you have been and 10 represents the problem being solved, where are you with respect to your problem?) *Shows them they're not at 0. *Asks them what they need to do to move up the scale. 5. Formula first session task (between now and the next time we meet, I would like you to observe...). 6. Therapist feedback to clients (solution-focused practitioners generally take a break of 5 to 10 minutes toward the end of each session to compose a summary message for clients; compliments, a bridge, and a suggestion of a task). 7. Terminating (what needs to be different in your life as a result of coming here for you to say that meeting with me was worthwhile?). *Therapy is best guided by the client's goals, perceptions, resources, and feedback (not rigid).

Limitations of post-modern therapies

1. SFBT can be jarring, patronising, people feel like the therapist was useless and that they could have come up with the solutions themselves. 2. It is essential that therapists are skilled in brief interventions. 3. There is concern over counsellors who attempt to employ narrative ideas in a mechanistic fashion. 4. Reliance on techniques may detract from building a therapeutic relationship. 5. Narrative therapists must be careful to approach client's stories without imposing a preconceived notion of the client's experiences. 6. More empirical research is needed.

Post-modern therapies diversity strengths

1. Social constructionism is congruent with the philosophy of multiculturalism. 2. The postmodern approaches are a good fit with diverse worldviews (emphasis on multiple realities). 3. The social constructionist approach to therapy provides clients with a framework to think about their thinking and to determine the impact stories have on what they do. 4. Narrative therapy is grounded in a sociocultural context, which makes this approach especially relevant for counselling culturally diverse clients. 5. Narrative therapy is a relational and anti-individualistic practice. 6. This emphasis creates a context for providing culturally responsive services.

Postmodern perspectives

1. Solution-focused brief therapy. 2. Solution-oriented therapy. 3. Narrative therapy. 4. Feminist therapy.

Post-modern therapies diversity limitations

1. The not-knowing stance the therapist assumes, along with the assumption of the client-as-expert, may lead clients from some cultures to lose confidence in the therapist (can lead to more questions than answers). *To rectify this, postmodern-oriented therapists must convey to clients that they have expertise in the process of therapy but clients are the experts in knowing what they want in life. 2. Individuals from many different cultural groups tend to elevate the professional as the expert who will offer direction and solutions for the person seeking help (unhealthy).

Social constructionism

A theory of knowledge that examines the development of jointly constructed understandings of the world, which form the basis for shared assumptions about reality. *The view that any understanding of reality is based on the use of language, and is largely a function of the situations in which people life. *The use of language in stories creates meaning. *The idea that the client's reality exists without disputing if it is accurate or rational. *Society creates things that are 'true'. There are multiple trusts. *Eg: the DSM/ diagnosis is a social construct. *Post-modernists think that the DSM causes people's reality to shift; people look at the world through the lens of the DSM (rather than the DSM describing a fixed reality). *The idea of power is also really important, as well as the idea of groupthink (we can all convince ourselves that something is true and ok if there is social consensus about it). *Change begins by deconstructing the power of cultural narratives and then co-constructing of a new life of meaning.

Search for unique outcomes

Externalizing questions are followed by questions searching for unique outcomes. *The therapist talks to the client about moments of choice or success regarding the problem. *These questions are aimed at highlighting moments when the problem has not occurred or when the problem has been dealt with successfully. *Asking permission of the client to use persistent questioning tends to minimize the risk of inadvertently pressuring the client.

Deconstruction and Creating Alternative Stories

In this part of the narrative therapeutic process, problem-saturated stories are deconstructed before new stories are co-created. *Narrative therapists help clients deconstruct these problematic stories by disassembling the taken-for-granted assumptions that are made about an event, which then opens alternative possibilities for living. *The assumption is that people can continually and actively re-author their lives. *This offers a unique possibility for questions to enable clients to focus on their future. *An appreciative audience also helps new stories to take root. *Constructing counter stories goes hand in hand with deconstruction, and the narrative therapist listens for openings to counter stories. *A turning point in the narrative interview comes when clients make the choice of whether to continue to live by a problem-saturated story or to state a preference for an alternative story.

Narrative therapy

In this therapy, clients construct the meaning of life in interpretive stories, which are interpreted as 'truth'. *Michael White/ David Epston. *Used for people who have a negative interpretation bias about everything; people who are stuck/ down on themselves. *Therapists listen to the narrative that the client has constructed for themselves (their life). *Similar to CBT; there are situational facts, and the thought is the narrative you base around those facts. *The adoption of a postmodern, narrative, social constructionist view sheds light on how power, knowledge, and "truth" are negotiated in families and other social and cultural contexte *This therapy emphasizes collaboration between client and therapist to help clients view themselves as empowered and live the way they want (therapists have a special interest in listening respectfully to clients' stories).

SFBT therapeutic process

In this therapy: 1) Clients are given an opportunity to describe their problems. 2) The therapist works with clients in developing well-formed goals as soon as possible. 3) The therapist asks clients about those times when their problems were not present or when the problems were less severe. 4) At the end of each solution-building conversation, the therapist offers clients summary feedback, provides encouragement, and suggests what clients might observe or do before the next session to further solve their problem. 5) The therapist and clients evaluate the progress being made in reaching satisfactory solutions by using a rating scale.

SFBT basic assumptions

Textbook: 1. Individuals who come to therapy do have the capability of behaving effectively. 2. There are advantages to a positive focus on solutions and on the future. 3. There are exceptions to every problem, or times when the problem was absent. 4. Clients often present only one side of themselves. 5. No problem is constant, and change is inevitable. 6. Clients are doing their best to make change happen. 7. Clients can be trusted in their intention to solve their problems. Lecture: 1. (Eradicating) the problem itself may not be relevant to finding effective solutions. 2. People can create their own solutions. 3. Small changes lead to large changes. 4. The client is the expert on his or her own life (not about the therapist having all the answers). 5. The best therapy involves a collaborative partnership. 6. A therapist's "not knowing" affords the client an opportunity to construct a solution.

Functions of narrative therapist

These therapists: *Listen to clients (their narratives) with an open mind. *Encourage clients to share their stories. *Show care, interest, respectful curiosity, openness, empathy, contact, and even fascination. *Listen to a client's problem-saturated story without getting stuck. *Demonstrate respectful curiosity and persistance. *Believe the person is not the problem; the problem is the problem. *Become active facilitators. *Believe in the client's abilities, talents and positive intentions. *Adopt a not-knowing position that allows being guided by the client's story. *Help clients construct a preferred story line/ rewrite the narrative of the past (not the facts, but how one perceives it). *Create a collaborative relationship, with the client being the senior partner. *Use questions as a way to engage clients and assist them in separating themselves from the dominant stories so they can create alternative life stories. Then generate further questions based on the answers. *Place great importance on the values and ethical commitments that they bring to the therapy venture. *Help clients construct a preffered storyline.

Collaborative language systems approach

This approach dictates that therapy is a conversational system that becomes therapeutic through its "problem-organizing, problem-dissolving" nature. *In the not-knowing position, therapists 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 is to enter a client's world as fully as possible. *Clients become the experts who are informing and sharing with the therapist the significant narratives of their lives. *Based on the referral or intake process, the therapist enters the session with some sense of what the client may wish to address. *The questions the therapist asks are informed by the answers the client-expert has provided.

Solution-Focused Brief Therapy

This is a future-focused/ goal-oriented therapeutic approach to brief therapy. *Developed initially by Steve de Shazer and Insoo Kim. *It emphasises people's strengths and resiliences by focusing on exceptions to their problems and their conceptualised solutions. *The past is downplayed, while the present and future are highlighted; little interest in how the problem has emerged. *It's all about co-creating solutions now so that you can focus on getting what you want, rather than just focusing on the problems. *Therapy is concerned with looking for what IS working. *Usually ranges from 3-6 sessions; gets people 'unstuck' from their problems quickly. *Non-pathologising approach (competencies > deficits), no diagnosis. *Focus on what's in their control (not out of it), and on construction solutions ("solution-focused) rather than problem-solving ("problem-orientation"); no particular right or absolute solutions. *People have the ability to define meaningful personal goals and have the resources required to solve their problems. *Talking about problems can produce ongoing problems, but talking about change can produce change.

Externalisation

This is a process of separating the person from identifying with the problem. *Narrative therapists believe it is not the person that is the problem, but the problem that is the problem. *These problems often are products of the cultural world or of the power relations in which this world is located. *Living life means relating to problems, but not being fused with them. *These conversations help people to free themselves from being identified with the problem. *They can also assist clients in recognizing times when they have dealt successfully with the problem. *But a downside is that it reduces the client's responsibility. *This is one process for deconstructing the power of a narrative (separates the person from identification with the problem).

Therapeutic process in narrative therapy

This therapy involves: *Collaborating with the client in identifying (naming) the problem. *Separating the person from their problem (externalizing). *Personifying the problem and attributing oppressive intentions/ tactics to it. *Investigating how the problem has been disrupting or dominating the person. *Iniviting the client to see their story from a different perspective by inquiring into alternative meanings for events. *Searching for exceptions to the problem. *Asking clients to speculate about what kind of future they could expect from the competent person that is emerging. *Building a new story of competence by having "re-authoring conversations" (how can you turn your narrative into a narrative of triumph over adversity?). *Creating an audience to support the new story (therapist, family, friends). *Mapping the effects of the problem. *Listening for signs of strengths of the clients. *Finding historical evidence to booster a new view of the client as competent enough to have stood up to, defeated, or escaped from the dominance or oppression of the problem. *Documenting clients' achievements.

SFBT goals

This therapy's goals are: 1. Unique to each client and are constructed by the client to create a richer future. 2. Small, realistic, achievable changes that can lead to additional positive outcomes. 3. Stated positively. 4. Action-oriented. 5. Structured in the here and now. 6. Specific/ controlled by the client.

Postmodern definition

This word describes changes in ways people think, especially in the way they view truth and reality. *As a worldview, it refuses to allow any single defining source for truth and reality. *There is no universal truth; 'truth' is dead. We construct our own truths. *Emphasis is on difference, plurality and selective forms of tolerance. *Reality does not exist independent of any attempt to observe it. *Language does not describe reality; it creates reality. *Modernism was about getting to the true facts of life, things that are provable empirically. So post-modernism is a step beyond this; you actually can't prove anything. *Our understanding of truth and reality often come from points of view influenced by history and context rather than objective facts. *There is no singular, universal theory will entirely explain human behavior and the systems in which we live. *Realities do not exist independent of observational processes and of the language systems within which they are described.