Date post: | 21-Jan-2016 |
Category: |
Documents |
Upload: | anabel-houston |
View: | 214 times |
Download: | 0 times |
SFBT, CBT, and New Directions
Coaching: SFBT or CBT
Specific task or goal – both
Relationship is to task – both
Collaborative approach – SFBT
Defined desired outcome – both
Great minds think alike, or whose techniques are
whose?: • Both:
• Goal setting
• Homework
• SFBT:
• Visualizing the goal or thickening the description
• Scaling
• Noting exceptions
• Building on spontaneous exceptions
CBT is an individual approach, so:
Not Miracle question
Not Genogram
Not Expanding the system
Not the same idea of the interactional cycle
Techniques common to both, especially in groups and
coaching :
Giving information - from multiple perspectives, without attachment
Developing step by step strategies
A Mini Example • 17 year old in alternative to suspension program for cursing teacher
• Catalyst was learning music program had been cut
• Deceased father was jazz musician; 17 year old has strong interest
• Outcomes: Mother and 17 year old worked together as team to apply him to music magnet program ( one of several options we brainstormed with them), and to produce multiple mutually exciting college plans
• Referral to family therapy at their request for grief issues
It would have been wrong (in my view):
To ignore request for family therapy and desire to talk about grief issues
Or to ignore immediate need to give 17 year old educational options and mother hope for future
In this case, dividing line between coaching and therapy relatively clear
Mother referred to her son's "advocate" and to her own desire for a "therapist"
In this case, two locations and two teams - but can be two stages of work with one person
What would a CBT person have done different?
Taught specific coping skills (whereas I preferred to work within client’s reality);
Most probably not have expanded the system (i.e. same school)
More individual focus
EARS (SFBT) :
Elicit positive changes
Amplify (may include resources)
Reinforce
Start again
(Berg & Szabo, 2005)
SMART (CBT):
S pecific goal
Measurable outcome
Attainable goal – don’t make it too hard
Realistic goal – example given is 5 percent fewer anxiety attacks, not no anxiety attacks
Time - set a deadline
What do you notice?
SMART goal looks like outcomes you learned about in assessments
SMART goal is not necessarily tied to a spontaneous exception or to the client’s world view
SMART goal does not necessarily expand the system (whereas the best SFBT goals do)
ROPE (SFBT journaling exercise):
Recall at least three times when you were the person you want to be
Organize your memories - what do these times have in common?
Present and future - what can you do now that is like that? What can you do in the future that is like that but more? (Resources)
Expand on these goals - tell others about them
(Systemic Change in Schools, 2012- note use of second person voice, also used as reflective journaling task)
CBT journaling:
Situation
Automatic Negative Thought
Resulting Emotion
Evidence against Automatic Negative Thought
New Emotion
So: CBT is more directive, educational,
and:
Therapist is right, client is most likely wrong
BUT:
A funny thing happened on the way to the 22nd
century…
Recent developments in CBT mirror/echo recent developments in brief therapy
Classic behaviorism: Behavior is repeated when it is
reinforced
Training pigeons and dogs
This always works!! IF one can avoid reinforcing what one doesn’t want to reinforce; if the reinforcement is valid and suits the individual ; if the desired behavior occurs and can be noticed
Classic pedagogy
Usually mis used in practice (e.g. name on board example)
Has given birth to its own field – applied behavior analysis
Most evidence based treatment for autism
Second Wave: Cognitive/Behavioral Because most of our behaviors are not directly and immediately reinforced;
Because what we think of ourselves and others matters
The idea is to model appropriate behaviors, and teach appropriate cognitions
Beck Depression Inventory
Isolation
Negative thoughts
Idea is to replace
Equally effective as couples therapy – but requires more work on the part of the client
Third Wave: This is where the interest and focus is
today
ACT: Acceptance and Commitment Therapy
DBT: Dialectical Behavioral Therapy
ACT Hayes & Wilson, Jacobsen & Christiansen, 1990’s.
Encourage acceptance of feelings in the present
You don’t want to go to work because you are anxious; you can go to work and fully experience your anxiety; both are valid
Mindfulness, living in the present
Mindfulness Exercise Pause for a moment
Look around and notice five things you can see
Now notice five things you can hear
Notice five things in contact with your body
Allow yourself to experience both the negatives and positives of these things
Fully experience them
Now take a deep breath and decide what your focus will be
DBT Marsha Linehan, 1990’s, out of own painful adolescent experience
Non pathologizing resolution of common dilemma: instead of who’s telling the truth, self definition of “unusually sensitive”
Accept unusual sensitivity and go with what works
Intense support – weekly groups plus individual plus phone contact
DBT Exercise
Panic list for feeling overwhelmed:
Bite a hot pepper;
Thrust finger into ice until it hurts;
Cover your arm with a layer of Elmer’s Glue and let it harden, then peel it off slowly
These are alternatives to cutting and self mutilation
More DBT self help exercises:
Eat a raisin mindfully and slowly
Choose a random object and list 30 different uses for it
Crank up loud music and dance
Rip up a phone book
Again, these are self generated “what works” to handle strong emotion, but are also therapist suggestions
Different and the Same:
Third Wave still more likely to be “teach”-y
But comes much closer to entering client’s reality
Interesting additions related to entering client’s reality in the moment
Interesting additions (esp. DBT) to “what works”
Equifinality SFBT came through cybernetics and interactional cycle through hypnosis to entering client’s reality, expanding system, and focusing on what works
Third Wave CBT came through behavioral reinforcement through cognitive teaching to accepting client’s reality, expanding system in the case of DBT (through self help groups), and focusing on what works
Positive Psychology
Martin Seligman, 1990’s – through learned helplessness to resilience to the study of happiness
Now a full fledged movement within psychology
Evidence based
The Equation
S + C + V = Happiness
Easiest to manipulate is V
Similar to SFBT and expanding the system, similar to all family therapy, but also perhaps different (need not be related)
Convergence of ideas Individuals create their own reality more than was previously thought
The most effective therapies work within that client’s reality
What you pay attention to gets bigger, in life as well as in specific situations
Reality is more varied and open to interpretation than we thought
Motivational Interviewing
W.R. Miller, behavioral psychologist interested in problem drinking
Analyzed more successful therapists in program
Focus on goals and reinforcement of change talk - less focus than SFBT on interactional context and on spontaneous exceptions
Evidence based, in wide use in mandated contexts
Appreciative Inquiry: Coaching for a whole
organization www.appreciativeinquiry.case.edu
Affirmative topic choice
4 steps: Discovery (correlates with exceptions); Dream (correlates with expansions or miracle); Design (how can organization do more of what is working); Destiny (formerly delivery)
www.ovation.net to contact David Cooperrider
Registration process
Appreciative inquiry – divide into 4 groups