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The Belief Behind the Power…
• Change is a natural process
• Can be facilitated or sped up with relatively brief interventions
• A little counseling can lead to significant change
• Change occurs early on
Why Brief Therapy?
• Greater Access
• One hour to you….
• Research that it works
Why?...Research
• In a naturalistic study of over 9,000 patients seeking therapy, the modal number of psychotherapy visits was one (Brown & Jones, 2004)
• Clients seek treatment when psychological distress is high and stop coming when distress level drops; for most this is within 5 visits (Brown & Jones, 2004)
Why?...Research
• Research shows 40-45 percent of depressed patients have large gains within the first two to four sessions (Doane, Feeny, & Zoellner, 2010)
• 30 to 40 percent drop out of treatment without consulting their therapist (Talmon, 1990, Olfson et.al., 2009) *
Features of Effective Brief Interventions
• Clearly defined goals that are related to specific behavior change
• Active and empathetic therapeutic style
• Patients values and beliefs are incorporated into the intervention
• Measurable outcomes (utilizes rating systems)
• Enhance patient’s self efficacy
• Responsibility for change is with the patient
Focused Acceptance and Commitment Therapy
(FACT)
A New Model of Brief Therapy that is a Highly Condensed Version of Acceptance and Commitment
Therapy.
Acceptance and Commitment Therapy
• “A core conception of ACT is that psychological suffering is usually caused by avoidance and cognitive entanglement and rigidity that leads to a failure to take needed behavioral steps that are in accord with core values.”
FACT…helps the patient…
• Focus on unworkable results of avoidance
• Accept the presence of distressing, unwanted private experiences
• Choose a life path based in personal values
• Take actions which propel the them down that path
LoveWhere do you live? With whom?How long have you been there?Are things okay at your home?Do you have loving relationships with your family or friends?
WorkDo you work? Study? If yes, what is your work?Do you enjoy it? If no, are you looking for work?If no, how do your support yourself?
PlayWhat do you do for fun? For relaxation?For connecting with people in your neighborhood or community?
HealthDo you use tobacco products, alcohol, illegal drugs?Do you exercise on a regular basis for your health?Do you eat well? Sleep well?
Assessment
Directives
• Validation of emotions; validation of behaviors
• Understand and acknowledge function of the problem
• Connect pain and values
• Create new relationship to symptoms importance, usefulness
Keeps them clean and sober!
True North Worksheet
• What are your values?
• What are your current strategies and are they working?
• What skills will you need to make the journey?
Problem Solving Therapy (PST)A form of brief psychotherapy where patients are
taught a structured approach to recognizing problems and finding workable solutions
Problem Solving Therapy in Primary Care
• Research has shown that minor life events or problems are strongly associated with psychological symptoms, in particular depression, possibly even more so than major life events (Nezu, 1987).
• Problems are defined as any situation in which an immediate and easily recognizable solution is not apparent
Core Principles
• EFFECTIVE PROBLEM- SOLVING RESULTS IN REDUCED SYMPTOMS
• INEFFECTIVE PROBLEM-SOLVING RESULTS IN INCREASED SYMPTOMS
Research
• PST-PC is a brief treatment, it can be as brief as 4 sessions and as many as 12 sessions.
• Research shows that the smallest effective dose of PST-PC is 4 sessions, offered over an 8-week period of time.
• 9 sessions seems to be the PST-PC sweet spot for most patients.
• Each session is 30 minutes in primary care medicine.
PST-PC First Session is Important
• Develop as much trust and engagement as possible within the first session. If by the end of the first session the patient is not convinced that you or the model will be helpful, therapists will find themselves struggling to get patients to use the model in subsequent sessions and in the homework assignments.
• Careful attention must be paid to the first visit so that the patient does not leave the session confused or unconvinced about the efficacy of PST
• Present a confident, knowledgeable, and professional image and maintain appropriate professional boundaries
• Explain the basic framework for treatment • Establish that symptoms are related to their diagnosis
Problem Solving Treatment
• PST-PC is divided into three phases:
• Introduction/Education, Training, and Prevention phases. The first 1-2 PST-PC sessions is spent getting to know the patient, creating a problem list and how their symptoms interfere with daily activities.
• Middle sessions are spent encouraging the use of the PST-PC skills.
• The last session or two is spent helping patients develop a relapse prevention plan based on the PSTPC format.
Seven Stages
(1) Selecting and defining the problem
(2) Establishing realistic and achievable goals
(3) Generating alternative solutions
(4) Implementing decision making guidelines,
(5) Evaluating and choosing solutions
(6) Implementing the preferred solution
(7) Evaluating the outcome.
Resources
• Strosahl, Robinson & Gustavsson. (2012) Brief Interventions for Radical Change: Principles & Practice of Focused Acceptance & Commitment Therapy. New Harbinger Publications, Inc..
• Robinson &Y Reiter. (2016) Behavioral Consultation and Primary Care: A Guide to Integrating Services. Springer International Publishing
• Burdick, D. (2013). Mindfulness Skills Workbook for Clinicians and Clients: 111 tools, techniques activities and worksheets. Pesi Publishing & Media
• Bourne, E. (1990). The Anxiety & Phobia Workbook. New Harbinger Publications, Inc.
• https://aims.uw.edu/collaborative-care/behavioral-interventions/problem-solving-treatment-pst
