Jacqueline Kappelman, MS, LPC
Reminder The following sides are my original slides for my
workshiop. Per request many changes were made during the actual presentation. For more information in general or related to the conference please feel free to contact me.
210-246-2174
Overview Highlight 2 Main
Components of SFBT
Pre-Session Change
Goal Setting
Incorporate Multicultural and Animal Assisted Therapy Concepts
Cultural Case Vignette
Pre-Session Change/Joining
Breakout/Case Vignette
Goal Setting
Breakout
Discussion/Q & A
Education and Training Final year of Psy D at
Our Lady of the Lake University in San Antonio, Texas
Licensed Practicing Counselor
Populations of Experience:
Veterans
Dual Diagnosis
At Risk Teens
Domestic Violence
Substance Abuse
Latino Population
Underserved Populations
Behavioral Health
Research Interests
Solution Focused Therapy with Domestic Violence
Solution Focused Therapy with the Latino Population
SFT with Latino Sexual Minorities
Solution Focused Animal Assisted Therapy
Pre-Session Change & Joining Joining and exploring for Pre-Session Change can be
one of the most essential steps of therapy process
Eventual aim of session to build a goal, find exceptions to problem, highlight client strengths
Pre-Session Change can begin as early as setting the appointment, and through joining and exploring for Pre-Session Change many SFBT concepts are elicited for use later in the session.
Common Factors in Therapy
Asay & Lambert, 1999
ExtratherapeuticChange
40%
Therapeutic Relationship
30%
Expectancy 15%
Technique15%
Extratherapeutic ChangeExtratherapeutic Change
40%
Therapy may affect change more indirectly than directly.
Biggest impact out of session so try to include the client’s worldview or life into session.
Joining & Pre-Session Change incorporate Multicultural components naturally by finding out about work, family, activities just as a standard way of building rapport.
This exploration also includes MC components useful for goal setting (collectivistic cultures).
Therapeutic RelationshipTherapeutic Relationship
30 %
SFBT concepts such as joining, exploring for pre-session change, normalizing instead of pathologizing,
highlighting exceptions and strengths are built on strengthening the therapeutic relationship.
Ethnic matching research shows clients value respect of culture and beliefs and need to feel heard and connected.
Power differential changed
ExpectancyExpectancy
15 %
SFBT instills hope: BRIEF therapy
SFBT concepts like exceptions, small goals, highlighting client strengths shows clients they can maneuver through challenges.
Use of client’s worldview and language makes problems more “everyday” and not severe pathologies.
When learn how to handle these problems clients transfer skills to more chronic conditions.
TechniqueTechnique
SFBT, although only one factor of the four common factors is built into and strengthens the previous three factors.
15 %
Joining Through Gathering Background Information
Many clients want to jump right into the problem.
Want to know who the client is as a person, outside of the presenting problem.
Builds therapeutic relationship, sets the tone for the therapy process to be collaborative and conversational.
Opportunity to learn about sociocultural components such as family, roles, and spiritual/religious activities.
Chance to obtain strengths, exceptions, support systems, and components for goal setting that can be used for reframing later in the session
*The solution may not be directly related to the problem.
Joining: Framing a Solution Focused Session while Integrating Sociocultural Components
Getting to know the client’s system Who does the client live with?
(MC* - some cultures have extended family members residing in the same home. These individuals may be a source of support or culturally it may be relevant to invite these members into session)
Names, Ages, Occupations of other members in the household (personalization)
Where does the client work? (Even though client may not work, make an assumption the client does something
with his/her life. This often leads to more details)
Who referred client? If a referral this person is a part of the client’s system and may be useful in the
therapy process, either through setting goals, identifying strengths and exceptions
How did the client know now was the time for therapy? Also a chance for strengths since the client knew to come in (even if mandated) Could possibly will lead to the presenting problem, but can also tell what is different
from where the client would like to be (goal setting)
*If it’s not working, do something different.
Examples of Pre-Session Change A few ways to view this concept
Directly asking for Pre-Session Change What has gotten better since set up the appointment? Tell me about the times when you have been handling the problem
better since (it started, you set up the appointment, etc). *If it works, do more of it.
Another way to look at this idea is pre-session exception exploration and observation Presenting Problem on intake depression Client made appointment, arrived on time, engaged in the joining
process, identified support systems and activities involved with (work, school, etc.)
No outward asking for change but through joining explored for exceptions which indicate change and vice versa (noticed changes which indicate exceptions).
* Small change leads to big change.
Pre-Session Change Examples Continued A different way to view pre-session change is by exploring the
fact that things have not gotten worse. How have you managed to keep things from getting worse?
How have you managed to survive this long with things this bad?
Pre-Session change is more than just having previously made changes before arriving to session. Pre-Session Change can be a change in thinking about the problem prior to delving into the session (framing SF therapy session). What would need to happen today to make this session helpful?
What are you hoping to get out of therapy?
*The future is both created and negotiable
* No problem happens all the time; there are always exceptions that can be utilized
*The language for solution development is different from that needed to describe a problem.
SFBT and Culture SFBT has a natural “covert” cultural sensitivity.
By exploring background during joining learn some aspects that are tied to culture
Support system
Who client lives with
Client’s role in the home, family, community
Although not directly cultural questions these are opportunities to link in culture
Client lives with parents, would client find it beneficial to include parents?
Cultural Considerations
SFBT offers the opportunity to address cultural issues subtly or more openly.
The systemic example above allows for respect of collectivistic cultures but without overtly addressing this.
Also important to go into the session considering cultural components
• Cultural Considerations: Collectivistic culture vs
Individualistic
Advice Seeking
Acculturation
Immigration
Loss of Face
Shame in seeking treatment
Mental illness as human weakness
Language
Hierarchy
Slow to warm
Animals in Therapy Animals have been used for therapeutic purposes
either directly or indirectly as far back as 1699 and possibly earlier.
Today volunteers may utilize animals in Animal Assisted Activities (AAA) .
Animals are currently used in therapies such as psychotherapy, occupational therapy, physical therapy, and speech therapy among other professional settings.
Animal Assisted Therapy (AAT) "AAT is a goal-directed intervention in which an animal
that meets specific criteria is an integral part of the treatment process. AAT is directed and/or delivered by a health/human service professional with specialized expertise, and within the scope of practice of his/her profession.
AAT is designed to promote improvement in human physical, social, emotional, and/or cognitive functioning [cognitive functioning refers to thinking and intellectual skills]. AAT is provided in a variety of settings and may be group or individual in nature. This process is documented and evaluated.“
- Delta Society
AAT and Theory
AAT has been grounded in many theoretical orientations including SFBT.
Research identified 18 major AAT techniques grounded in theory, 16 of the techniques were grounded in SFBT.
Matching AAT Techniques withCounseling Guiding Theories
AAT Technique AAT Technique
Counselor and client engage with therapy animal outside of traditional therapeutic environment (taking animal outside for a walk)
Using the client’s worldview, building rapport, exceptions, reducing power differential
Counselor reflects/comments on client’s relationship with therapy animalIdentifying client strengths, exceptions, normalizing
Counselor encourages client to perform commands with therapy animalExceptions, solution building, empowering
Excerpt adapted from Chandler, C., Portire-Bethke, T., Minton, C., Fernando, D., & O’Callaghan, D. , 2010
AAT, Theory, and Goals
Matching AAT Intentions with Counseling Guiding Theories
INTENTIONS/GOALS INTENTIONS/GOALS
Building rapport in the therapeutic relationship
Modeling specific behaviors
Enhancing client’s self confidence
•Research identified 10 major AAT intentions/goals grounded in theory, 8 of the goals/intentions were grounded in SFBT.
Excerpt adapted from Chandler, C., Portire-Bethke, T., Minton, C., Fernando, D., & O’Callaghan, D. , 2010
General AAT Goals and Techniques
Animal Assisted Goals and Techniques in the Four Functional Domains
PSYCHOLOGICAL/SOCIAL GOALS AAT Technique
Improve Socialization, Communication,Reduce Isolation, Boredom, Loneliness,Increase Self Esteem
empowering, goal setting, within client’s worldview, and exceptions
•Practice commands with therapy animal•Engage in play with an animal•Learn about animal, then take animal around and verbally introduce animal to others•Take animal for a walk (outside, around unit, around room, etc)•Receive apparent acceptance from an animal•Give appropriate affection to an animal
•There can be general overarching goals with various specific interventions to utilize and combine within the theory.
Excerpt adapted from Gammonley, J., Howie, A., Kirwin, S., Zapf, S., Frye, J., Freeman, G., & Stuart-Russell, R. 1997
Utilizing AAT to enhancePre-Session Change
Interaction with therapy animal in the waiting room, the hall, or while first entering therapy room.
Ability to make use of SFBT principle of working within the client’s worldview.
Natural opportunity to elicit pre session changes of strengths, exceptions, and characteristics for empowerment or normalizing.
Client presents for depression but interacts with therapy animal. She overcomes her depressed mood during the moment and engaging with the animal.
Breakout
Goal Setting Clients can present with what may seem like
large, overwhelming problems
SFBT tries to shift collaboratively from problem focused discussion to solution focused discussion
Helping a client develop an attainable goal instills hope (one of the common factors)
Goal Formulation
Goals should be
Small
Concrete
Observable/Measurable
Within the client’s control
Present Centered
In process form(not the absence of something)
SFBT Concepts to Remember with Goal Formulation and Follow Through
Client is the expert (expert
on their life and experiences)
Change is always occurring
Exceptions suggest solutions
Small change leads to big change
People are resourceful
• Clients are always cooperating (not resistant client, client trying to tell you something that you are missing)
• If it’s not working, do something different
• If it works, don’t fix it• Once you know what
works, do more of it• Small change leads to big
change
Ways to Identify Goals Elicit and reinforce exceptions
How did you do that?
That must have been difficult, I don’t think I could have done that!
Utilizing Deconstructing Questions including:
Scaling
Relational Questions
Hypothetical solutions
Miracle Question
Cultural Considerations
Action oriented vs Insight oriented
Family oriented/collectivistic
Spiritual/Religious
AAT and Goal Setting The action of including a therapy animal in session
often interrupts the feedback cycle clients are “stuck” in.
*If it’s not working do something different.
Can make use of the therapy animal in a relational way
Once you are less depressed what will Spot notice about you? What about your own dog that sees you more often?
SFAAT: Application of Goals In session activities
Challenges faced can be normalized and paralleled to obstacles outside of therapy room.
Successes open space for deconstructing steps taken, scaling confidence at various steps along the way, and amplifying solution talk.
“How were you able to motivate yourself to keep trying when Spot would not listen to you at first?
How can you apply that idea to the goal we set a little bit ago?
How does this relate to how you handle/can handle things with your daughter?
SFAAT: Application of Goals
If something is working, do more of it.
Impromptu interactions imply exceptions.
The language necessary for solution talk is different from problem talk.
Have to learn a new way of communicating.
Learn to take on multiple viewpoints.
Goal Setting Breakout Out
Question and Answer
References Assay, T.P., & Lambert, M.J. (1999). The empirical case for the
common factors in therapy: Quantitative findings. In M.A. Hubble, B.L. Duncan, & S.D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 33-56). Washington, DC: American Psychological Association.
Atkinson, D. (2004). Counseling American minorities (6th ed.).Dubuque: McGraw Hill.
Chandler, C. (2005). Animal assisted therapy in counseling. New York: Routledge, Taylor & Francis Group.
Chandler, C., Portire-Bethke, T., Minton, C., Fernando, D., & O’Callaghan, D. (2010). Matching Animal-Assisted Therapy Techniques and Intentions with Counseling Guiding Theories. Journal of Mental Health Counseling, 32, 354-374.
References Corcoran, J. (2000). Solution-focused family therapy with
ethnic minority clients. Crisis Intervention, 6, 5-12.
de Shazer, S., Dolan, Y., Korman, H., Trepper, T., McCollum, E., & Berg, I.K. (2007). More than Miracles. New York: Routledge, Taylor & Francis Group.
Delta Society (2009). Retrieved on November 10, 2011 from http://www.deltasociety.org/
Gammonley, J., Howie, A., Kirwin, S., Zapf, S., Frye, J., Freeman, G., & Stuart-Russell, R. (1997). The Human Animal Health Connection Animal-Assisted Therapy: Therapeutic Interventions. Delta Society, Bellevue, WA.
Nelson, T. & Thomas, F. (Eds.) (2007). Handbook of
solution-focused brief therapy. New York: Haworth Press.
References Parshall, D. (2003). Research and reflection: Animal-
assisted therapy in mental health settings. Counseling and Values, 48, 47-56.
Pichot, T., & Coulter, M. (2007). Animal-Assisted Brief Therapy: A solution-Focused Approach. New York: Routledge, Taylor & Francis Group.
Walter, J. L. & Peller, J. E. (1992). Becoming Solution-
Focused in Brief Therapy. New York: Routledge, Taylor & Francis Group.