Minnesota Child WelfareTraining System

Solution-Focused Brief Therapy

Treatment Strategies & Interventions

Bob Bertolino, Ph.D.Assistant Professor, Rehabilitation Counseling

Maryville University – St. Louis, MissouriSr. Clinical Advisor, Youth In Need, Inc. – St. Charles, Missouri

There is More to See

Creating A Culture of Care and Respect Philosophy, Research, &

Practice

Creating A Culture of Care and Respect

• Philosophy• Ideas/principles that inform change. Philosophy

reflects one’s core beliefs about the world and the human condition. It precedes and informs theory.

• Research• Comes from different agendas. Although it is

influenced by economics, politics, society, etc., we owe it to our clients and to ourselves to search for what each has to offer and how that can influence ethical, effective, and respectful practice.

• Practice• Evolves from philosophy and research and should

fit with and be respectful of clients’ worldviews including their cultural backgrounds, preferences, and expectations. Modes of practice should also assist with helping clients to meet their needs, achieve goals, and experience improved outcomes.

No More Boxes Recalibrating Compasses and Expanding Personal

Worldviews

“You must be the change you wish to see in the world”

– Mahatma Gandhi

Recalibrating Compasses1. What are the core beliefs you have about the

people with whom you work?2. How have you come to believe what you believe

and know what you know? What have been the most significant influences on your beliefs?

3. How have your beliefs and assumptions affected your work with clients? With colleagues? With the community?

4. Do you believe that change is possible even with the most “difficult” and “challenging” clients?

5. How do you believe that change occurs? What does change involve? What do you do to promote change?

6. Would you be in this field if you didn’t believe that the clients with whom you work could change?

H. O. P. E.

HHumanism

OOptimism

PPossibilities

EExpectancy

“Optimism is the faith that leads to achievement.

Nothing can be done without hope or confidence.”

- Helen Keller

Experience as a Catalyst:The Presence of H.O.P.E.

• What inspires or moves you?What inspires or moves you?• How does that increase your sense of How does that increase your sense of

hope?hope?• What does an increased sense of hope What does an increased sense of hope

allow you to do?allow you to do?• How can you promote hope with others?How can you promote hope with others?• How do you maintain your sense of hope How do you maintain your sense of hope

when you are struggling with clients?when you are struggling with clients?

What Does The Data (Research) Say?

What Does The Data Say?

• The most significant portion of change occurs earlier rather than later in services

• Dose-Response Effect• The client’s rating of the therapeutic

relationship is the best and most consistent predictor of outcome

• One of the best predictors of negative outcome is lack of structure

• Most clients are making some form of progress

What Does the Data Say? (cont.)

“Real-Time” feedback increases factor of fit Long-term services without an improved

outcome combined with “more of the same” on the part of the therapist equals an “impossible” case

Long-term services with high alliance scores and no improvement in outcomes can indicate dependence

• Practitioners whose clients do not seem to be making progress tend to do similar things:• More of the same, “Clients must get worse before they

get better,” More severe diagnosis, Return to their models

What Does the Data Say? (cont.)

• Non-model-specific factors account for 8-12x more than methods and models and up to 92% of the variance

• Although models (approaches) account for very little of the variance in outcome, the person of the practitioner can significantly affect change

• Among effective approaches it is the similarities not the differences that account for the significant portion of change (e.g., MST, FFT, BSFT, MI, CBT, etc.)

• Through different mechanisms of change, effective approaches are vehicles for activating and transporting common factors

Empirically-

Supported Relationsh

ips(ESR)

Empirically-

Supported/

Evidence-Based

(EST/EBP)

Common Factors

(CF)

OutcomeManagem

ent(OM)

Strengths and

Solution-Based

Common Factorsin Change

40%

30%

15%

15%

Client Factors

Relationship Factors

Expectancy and Placebo

Model and Technique Factors

Hubble, M. A., Duncan, B. L., & Miller, S. D. (Eds.) (1999). The heart and soul of change: What works in therapy. Washington, D.C.: American Psychological Association.Lambert, M. J. (1992). Psychotherapy outcome research: Implications for integrative and eclectic therapists. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 94-129). New York: Basic Books.

Ingredients of Change

70%

8%

22%GeneralEffects

SpecificEffects

UnexplainedVariance

Wampold, B. E. (2008). The great psychotherapy debate: Models, methods, and findings (2nd ed.). New Jersey: Lawrence Erlbaum.

Points of Convergence

• Culturally sensitive• Relationship-oriented• Client-informed• Collaborative• Change-oriented• Outcome-oriented• Strengths and solution-based

Martin Seligman“What we have learned is that pathologizing does

not move us closer to the prevention of serious disorders. The major strides in prevention have largely come from building a science focused on systematically promoting the competence of individuals…. Fifty years of working in a medical model on personal weakness and the damaged brain has left mental health professionals ill-equipped to do effective prevention. We need massive research on human strength and virtue. We need practitioners to recognize that much of the best work they do is amplifying the strengths rather than repairing their patient’s weakness.”

Principles of SSB Philosophy

1. Client Contributions2. The Therapeutic Relationship

and Alliance3. Cultural Competence4. Change as a Process5. Expectancy and Hope6. Model and Factor of Fit

Active Client Engagement (A.C.E.)

Principles in Motion

Create a Context of Collaboration

Point• Start services by

offering options that are respectful of clients and their cultures and incorporate their preferences and perceptions

• Preparatory

How• Be prepared• Keys to Collaboration

Strengthen Through Presence

The Therapeutic Relationship in Context…

Even for those who are convinced that the therapeutic relationship is healing by and of itself, there are strategies that can foster its impact. In other words, since not all kinds of relationships are likely to bring about change, one needs to be aware of interventions (including modes of relating) that should be encouraged or avoided for the relationship to become a corrective experience. (Castonguay & Beutler, 2006, p. 353)

Castonguay, L. G., & Beutler, L. E. (2006). Common and unique principles of therapeutic change: What do we know and what do we need to know? In L. G. Castonguay & L. E. Beutler (Eds.), Principles of therapeutic change that work (pp. 353-369). New York: Oxford University Press.

Strengthen Through Presence

Point• Listen and Attend to Clients’

Stories and Strengths• Engagement

How• Acknowledge and validate• Consider the influence of

words• Use possibility-laced

language• Separate experience from

action• Summarize, validate, and

soften• Avoid platitudes or trying

make things more “positive”• Be aware of stories of

impossibility• Be a “life witness”

Strengths-BasedEngagementand Practice

Creating EffectiveHelping Relationships

Allyn & BaconFebruary, 2009

The Influence of Words

The Influence of Words

Sad. Helpless. Inconvenience. Defeat. Tired. Oppressed. Doubtful.

Uninterested.

Life is so hard. Nothing seems to go my way. There is no one to turn to. It feels

like I’ve been forgotten. Times are hard. Nothing seems to help. Things will not

get better. In fact, they will probably get worse. There is no hope.

The Influence of Words

Exciting. Fun. Laughter. Joy. Anticipation. Possibility. Aliveness.

Love. Peace.

When I think about the future I become energized. There is so much I can accomplish. Life is wonderful.

There are so many possibilities in the world.

Being a Valuing orLife Witness

Learn Clients’ Orientations

Point• Gain an improved

understanding of clients’ perceptions, perspectives, and theories

• Words and Pictures

How• Ask questions as to

what clients attribute problems to and possible solutions

• Assess clients’ readiness for change (Stage of Change)

Address Case Management Matrix

Point• Explore services and

program parameters• Monitor relationship and

outcome • Interim Family Safety

Guidelines

How• Provide information• Collaborate and negotiate• Concurrent planning• Introduce outcome

measures• Use feedback processes

to client perceptions of the alliance

Eliciting Client Feedback In Initial Sessions and Interactions…In Initial Sessions and Interactions…

Are there certain things that you want to be sure we talk Are there certain things that you want to be sure we talk about?about?

What is most important for me to know about you and/or What is most important for me to know about you and/or your situation/what you’ve been experiencing?your situation/what you’ve been experiencing?

What ideas do you have about how therapy/coming What ideas do you have about how therapy/coming here/coming to see me might be helpful to you?here/coming to see me might be helpful to you?

““Checking In” –As Sessions and Interactions Progress…Checking In” –As Sessions and Interactions Progress… Have we been talking about what you want to talk about?Have we been talking about what you want to talk about? Are we moving in a direction that seems right for you?Are we moving in a direction that seems right for you? Are there other things that we should be discussing instead?Are there other things that we should be discussing instead? What, if anything, should I do differently?What, if anything, should I do differently?

At the End of Sessions and Interactions… At the End of Sessions and Interactions… How did the session go for you?How did the session go for you? How was the pace of our conversation/interaction/session?How was the pace of our conversation/interaction/session? Did we work on what you wanted? Was there anything Did we work on what you wanted? Was there anything

missing?missing?

Accommodate Services to Clients’ and Others Goals

Point• Create focus and

direction• Gain clarity regarding

goals and indicators of change and progress

How• Determine what needs to

change• Determine how it will be

known that sufficient change has been made and goals have been met

• Determine what will indicate that progress is being made

Be Change-Oriented and Solution-FocusedPoints

• Consider strategies that offer the best possible “fit” for clients

• Methods should fit with and be sensitive of clients’ cultures, beliefs

• Focus on processes that enhance change

• Similar-But-Different Role Play

How• Reassess clients’

readiness for change• Collaborate on tasks/way

to achieve goals and improve outcomes

Evaluate PlanPoints

• Ensure expectations are clear

• Ensure plans are clear

• Final Family Safety Plan

How• Discuss benefits of

positive change• Discuss possible

consequences of lack of follow-through

• Encourage feedback

Monitor ProgressPoints

• Determine progress and gains

• Identify barriers to change

• Determine next steps• Follow-Up

How• Identify, amplify, and

extend change• Reassess goals• Determine outcomes• Explore transitions• Check in with self and

remain aware of pathways of impossibility

The Therapist’s Notebook for Strengths and Solution-Based

Therapies

Homework, Handouts,and Activities

Bob BertolinoMichael KienerRyan Patterson

RoutledgeSummer, 2009

““It’s not enough to be It’s not enough to be compassionate.compassionate.You must act.”You must act.”

– Tenzin Gyatso14th Dalai Lama,

1992

ThankYou

Bob Bertolino, Ph.D.TCCT, LLC – P.O. Box 1175 – St. Charles, Missouri 63302

+01.314.852.7274 – bertolinob@cs.com – www.bobbertolino.com

Maryville University650 Maryville University

DriveSaint Louis, Missouri

63141 USA+01.314.529.9659 (Phone)

+01.314.529.9139rbertolino@maryville.edu

www.maryville.edu

Youth In Need, Inc.516 Jefferson

Saint Charles, Missouri 63301 USA

+01.636.946.0101 (Phone)+01.636.925.0125 (Fax)

rbertolino@youthinneed.org

www.youthinneed.org