Implementing Change through Alternative
Methods: Part 1) Brief Therapy and Dialectical
Behavioral Therapy; Part 2) Psychoeducational Group Work with Adolescents as
Performance ArtMarilee Wasell, PhD
Center Mental Health Consultant, San Diego JCC
Joe Farese, CADCTEAP Specialist, Penobscot JCC
Bridging the Gap
Treatment Solutions that Work
Dr. Marilee Wasell (PSY20864)Center Mental Health Consultant
San Diego Job Corps
Scaling Question
On a scale of 1 to 10 with 10 being the best and 1 being the worst, rate your mood right now
Ice Breaker
Get together with four or five of your neighbors and say something about the question below
What is some small but precious accomplishment you have had in the last 24 hours?
Objectives Participants will be able to describe the basic tenets of
solution focused brief therapy
Participants will be able to describe the skills that are taught in both solution focused therapy and dialectical behavior therapy
Participants will be able to implement these skill based interventions during their interactions with students at Job Corps
Participants will be able to describe the benefits in using these skills and this type of therapeutic intervention with the Job Corps Population
The Importance of Solution Focused Brief Therapy
Newsome WS (2005) The Impact of Solution-Focused Brief Therapy with At-Risk Junior High School Students. Children & Schools, 87:83-91. 26 preteens;
improved social skills after minimum 5 of 8 group sessions at 6 wk follow-up. Classroom behavior and homework completion had also improved.
Perkins R (2006) The effectiveness of one session of therapy using a single-
session therapy approach for children and adolescents with mental health problems. Psychology and Psychotherapy: Theory, Research and Practice (Leicester), 79:215-227.
78 exp single session / 88 no treatment; follow-up 4 wks. Severity improved 74.3% vs 42.5%; frequency improved 71.45% vs 48.3%.
Perkins R, Scarlett G (2008) The effectiveness of single session therapy in child and adolescent mental health. Part 2: an 18-month follow-up study. Psychology & Psychotherapy: Theory, Research & Practice, 81(2):143-56.
Follow-up of 2006 cohort:. No increase in frequency or severity of symptoms after 18 months.
Solution Focused Brief Therapy
Solution-building rather than Problem-solving
The therapeutic process is focused on the future
Clients are encouraged to increase the frequency of current useful behaviors
No problem happens all the time; there are exceptions
Therapists help clients find alternatives
Solution Focused Brief Therapy
Views client as…• Capable of change• Already doing some things right• Possessing strengths• Insight oriented• Motivated for change
Major Tasks In SFBT
Major task is to help the client do something different. Make CHANGE.
The focus on the problem is redirected toward solutions already existing.
Only small change is necessary because any change, no matter how small, creates the context for further change.
Goals are framed in positive terms with an expectancy for change. HOPE
Major Change Principles
Co-operating Engaging with clients in ways which build & sustain collaborative
relationships (rapport, nurturing, genuine, honesty, optimism, positive, on-side).
Negotiating Inviting clients to explore & describe their concerns & requests in ways
which avoid verbal closure, establish a focus, & create a space for future possibilities (identify things they can change, stay where you can make a difference, “what can you live with”).
Major Change Principles
Evoking
Inviting clients to access, elaborate & draw upon areas of personal knowledge, experience, competence & imagination which will facilitate desired change (people are experts who have strengths/capacity, finds exceptions, guide client).
COMPARISON OF Counseling APPROACHES
“TRADITIONAL” Focus is on client’s
*deficits *weaknesses *limitations *problems
Client is the expert and counselor is the student.
“How will I know if the session is helpful to you?”
“SOLUTION-FOCUSED” Focus is on client’s
*competence *strengths *possibilities *attempted solutions
COMPARISON OF Counseling APPROACHES
“TRADITIONAL” Talk is focused on
client’s problems client’s past & present stability
“SOLUTION-FOCUSED” Talk is focused on
possible solutions client’s future change
Comparison
Problem Talk Attention-deficit/
hyperactivity disorder Anger problems Depressed Oppositional Rebellious
Solution Talk Very energetic at times, or
short attention span Sometimes gets upset Sometimes sad Argues a point often Developing his/her own
way
Comparison
Problem Talk Co-dependent Disruptive Family issues Shy Negative peer pressure Feelings of rejection Isolated
Comparison Talk People are important to
them Often forgets the class rules Worries about home life Takes time to know people People try to influence them People forget to notice them Likes being by themselves
Techniques of SFBT
• The “Miracle Question”• Scaling Questions• Exception Finding Questions• Coping Questions
The Miracle Question
“If you woke up tomorrow, and a miracle happened so that your problem (always feeling angry/bad attitude) no longer existed, what would you (or your friends) see differently?”
What would be the SIGNS that a miracle had occurred?
This question is used to aid the client in envisioning how the future will be different when the problem is no longer present and helps establish goals.
Example of the Miracle Question
“If you woke up tomorrow, and a miracle happened so that you no longer easily lost your temper, what would you see differently?” What would be the first signs be that the miracle occurred?”
Student may respond by saying: “I would not get upset when somebody calls me names.”
The counselor wants the client to develop positive goals, or what they will do, rather than what they will not do…to better ensure success. So, the counselor may ask the client, “What will you be doing instead when someone calls you names?”
Scaling Questions
“Rate your behavior, feeling, thoughts, on a scale of 1-10” (e.g., anger/frustration) Questions can then be used to help the client identify:
“What’s stopping you from slipping one point lower down the scale? Or moving from 4 to 5?”(resources)
“On a day when you are one point higher on the scale, what would tell you that it was a ‘one point higher’ day? (exceptions)
“Where on the scale would be good enough? What would a day at that point on the scale look like?” (describes a preferred future)
Exception Finding Questions
Encourage the client to describe what they did differently when they were not angry, depressed, anxious, acting compulsively, etc.
Minimizes the pervasive nature of the issue
“Is there a time when you are NOT ‘angry enough to spit nails’”
Coping Questions
Give the client credit for any small success
“Even though you were so sad, how were you able to get up and get dressed for work?”
“Even though you were so frustrated with your boyfriend, how were you able to calm yourself down?”
Plants the seeds for success
SFBT Critical Points
1. Nonpathological approach to open up possibilities.
2. Not necessary to know a great deal about the complaint.
3. Fitting into the client’s world-view lessens resistance and encourages co-operation.
4. Motivation is a key and can be encouraged by aligning with the client against the problem.
SFBT Critical Points
5. Focusing on the possible and changeable lessens frustration.
6. Go slowly and focus on tasks that lead to success.
7. Rapid change is possible when we identify exceptions.
8. Every complaint pattern contains some sort of exception, so keep looking.
9. Looking at problems differently can encourage their resolutions.
Brief Techniques with DBT
Is a large collection of techniques that collectively are powerful in helping clients build “a life worth living”.
DBT skills teach 4 modules: Mindfulness, Emotional Regulation, Distress Tolerance, and Interpersonal Effectiveness.
Throughout the skills will be found the fundamental balancing act (dialectic) between acceptance and change.
Why should we use DBT?
Dramatically reduces suicide attempts and parasuicide behaviors over Treatment as Usual (TAU) or Treatment by Experts (TBE).
Decreases anger and anxiety related impulsive behaviors.
Reduces hopelessness. Improves coping skills. Provides Solutions!
Goals of Skills Training
Behaviors to Increase
Mindfulness Skills
Interpersonal Skills
Emotion Regulation Skills
Distress Tolerance Skills
Behaviors to Decrease
Identity ConfusionEmptinessCognitive Dysregulation
Interpersonal ChaosFears of Abandonment
Labile AffectExcessive Anger
Impulsive BehaviorsSuicide Threats
Tasks in Core Mindfulness
1. Increase sense of self and decrease emptiness
2. Increase control over thoughts/emotions
3. Increase spontaneity and personal decision making
States of Mind
Wise Mind
From: Mindfulness Handout I : Taking Hold of Your Mind
Tasks in Interpersonal Effectiveness
1. Learn to say no
2. Learn how to balance over-commitment and involvement with undercommitment and isolation.
3. Learn how to balance assertiveness and joining with others to increase interpersonal relationships and self-acceptance.
Tasks in Emotion Regulation
1. Decrease (or increase) physiological arousal associated with emotion
2. Re-orient attention3. Inhibit mood dependent behavior4. Experience emotions without escalating or
blunting5. Organize behavior in the service of
external, non-mood-dependent goals
Tasks in Distress Tolerance
1. Replace maladaptive coping that works in the moment with non-destructive in the moment coping devices.
2. Learn to Accept on-going events and discomfort in order to reduce severe misery.
Video
Video will show distress tolerance skills by Marsha Linnehan, Ph.D.
