WALK-IN SINGLE SESSION COUNSELLING USING SOLUTION-FOCUSED ... · Solution Focused Brief Therapy Overview & Approach Solution Focused Brief Therapy §is future-focused, goal-directed,

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May 6, 2020

WALK-IN SINGLE SESSION COUNSELLING USING SOLUTION-FOCUSED BRIEF THERAPY

ELISE DURANTE – FOUNDRY CENTRAL

KOURTNEY BRISBOURNE – FOUNDRY KELOWNA

JOSH VAN DER MEER– FOUNDRY PRINCE GEORGE

DALE HANDLEY– FOUNDRY CENTRAL

May 6, 2020 2

HOUSEKEEPING

§ Online format with Zoom§ Break-out rooms§ Schedule for the Day (Breaks)

May 6, 2020 3

Training Overview

• Overview and Rationale of Solution Focused Brief Therapy• Background• Key Elements• Strengths Based Perspective• Team Collaboration Model• Therapist Stance

• Single Session Structure• Session Orientation and Opening• Beginning Session• Middle Session• Session Break• End Session

May 6, 2020 4

ACTIVITY

Introductions

1. Your name, pronouns and Foundry role

2. Where you're from (where you live and work)

3. Your previous experience with Solution-Focused Brief Therapy and/or single session walk-in counselling

4. Most important thing you want to learn in this training (write it down)

Overview of Foundry’s Walk-in Counselling Model

§ Solution Focused Brief Therapy (SFBT) offered at all Foundry centres as a walk-in service

§ SFBT is offered in a single-session format as well as a short-term intervention within the Stepped Care Model

§ Recommended to have more than one counsellor and a clinical supervisor available during walk-in sessions to allow for team collaboration/clinical consultation

§ Crisis intervention procedures will always be observed regardless of treatment received

May 6, 2020 6

Overview – Why single session?

§ Each session is a complete therapy

§ In all therapy models, the most frequently occurring number of sessions is one

§ Most clients want success in one session

§ Reduces wait lists

§ Clients make most improvement in the first few sessions: improvement declines with an increase of sessions

§ Clients report similar levels of satisfaction with brief as multi-session therapies; approx. 80% report that their presenting problem was solved

§ After the session note is complete, no follow up is required by therapist

May 6, 2020 7

Overview – Why walk-in?

§ Is low barrier as referrals or broad knowledge of mental health services are not required

§ Is accessible to a wider range of people, particularly those who face challenges to keep appointments

§ Walk-in clients are motivated to receive help and make change in the moment

§ Clients can get immediate help at times of crisis, or at their chosen moment

§ There are no “no shows”

May 6, 2020 8

Overview – Why SFBT?

§ It is a strengths-based brief therapy

§ There is evidence that supports the use of solution-focused therapy as a short-term intervention

§ Consistent approach needed across Foundry centres and providers that complements most counsellor's existing training

May 6, 2020 9

DISCUSSION

What do you know or what have you heard about Solution-Focused Brief Therapy? What concerns do you have or have you heard?

Solution Focused Brief Therapy Overview & Approach

Solution Focused Brief Therapy

§ is future-focused, goal-directed, and focuses on solutions, rather than on the problems that brought clients to seek therapy

§ is a competency-based model, focusing on clients’ strengths and previous successes rather than past failings and problems.

§ is based on over thirty years of theoretical development, practice, and research.

§ has some similarities to Motivational Enhancement Therapy, Cognitive Behavioural Therapy and Narrative Therapy

§ a cooperative therapeutic alliance with the client

§ a solution focus rather than problem focus

§ belief that the client is the expert in their problem and its solution already possesses the resources and solution behaviours needed to make change

§ client defines goal of their treatment

§ belief that the client setting measurable, changeable goals

§ a future-focus maintained through questions and paraphrasing

§ belief that change is inevitable and small increments of change lead to larger change.

Key Elements

May 6, 2020 12

ACTIVITY

5 minutes each - Without sharing what it is you’re talking about…

One person says: “I’m too embarrassed to talk about my problem but I need help because things can’t go on like this any longer!”

Other person responds: “Suppose there was a solution… what difference would that make for you? How would you know? How would that help you?”

§ After both conversations are complete, reflect with your partner on:§ What did you learn about the client’s skills, resources, values and

strengths?§ What type of solution or goal elements were raised?

Foundry’s Walk-in Counseling model

• Individuals accessing a Foundry centre will have access to walk-in Solution Focused Brief Therapy at specified times and days on a first come – first serve basis.

• All youth will complete Toolbox forms at time of registration which includes a health screener if they have requested or have been identified as needing MH/SU services including walk-in counselling.

• A clinical staff member reviews this information PRIOR to beginninga single session to identify any flags or concerns.

• Session breaks use team members for reflection/consultation

Foundry’s Walk-in Counseling model

• Youth may access a single session as many times as they wish, though may also be supported and encouraged to access other services where appropriate.

• May see a different therapist each time

§ Some Foundry centres have implemented team case review meetings/triaging to follow-up and monitor

Strengths Based Perspective

• Probably not a new concept for most anymore• Youth workers tend to be better attuned to noticing strengths in clients• SFBT= Attuning to the exceptions to the client’s own deficits based

perspective that is engrained in them• Noticing strengths offers a platform to jump off from into changing the

deficits based story• Moves the LOC from Therapist as fixer to Client as expert in their own

self improvement

Strengths-Based Perspective

Deficit Cycle

Negative Experience

Lower Expectations and

Affirmation of Labels

Negative Behaviours

Focus on Deficits

Labels and Negative

Expectations

Prescribed Interventions and

Opportunities Blocked

Difficulty(Change needed)

Strengths Based Cycle

Identification of Strengths

Continued Development of

Strengths/Capacities

Positive Valued/Meaningful Experience

Opportunities Provided for Successful

Development

Positive Expectations

Change Needed

May 6, 2020 19

ACTIVITY

Johnny Q walks into your centre. Johnny is assigned to you. During the first meeting, Johnny explains he is depressed, has back pain, and enjoys drinking alcohol daily. Johnny says drinking makes him feel good and relaxed. He also explains over the last year he has moved out of his family home to a basement apartment downtown. Johnny didn’t finish high school and is unemployed. Johnny wants to work although can’t find a job and reports he thinks he is “lazy” and “too much of a drunk”.

§ What are your assumptions of Johnny? § Using the deficit-based cycle what next steps would be helpful for Johnny? § Using the strengths-based cycle what next steps would be possible for

Johnny?

May 6, 2020 20

Therapist Stance

§ The conversational skills required of the therapist to invite the client to build solutions are different from those needed to diagnose and treat client problems; using a language of change

§ Practitioner focuses on client’s desired future rather than past problems or current conflicts

§ Practitioner maintains a positive, respectful and hopeful attitude

§ Practitioner encourages clients to increase the frequency of currently useful behaviours

§ Practitioner co-constructs solutions or alternatives with clients

May 6, 2020 21

Therapist Stance

§ the client is the expert, and the practitioner takes a stance of “not knowing” and of “leading from one step behind” through solution-focused questioning and responding.

§ Complimenting and validation are core practitioner techniques

• The practitioner's job is to identify and amplify change

• Focus on what is possible and changeable, rather than what is impossible and intractable

§ “Resistance” is a message rather than a problem

Single Session Structure Overview

Sessions are time limited 45-60 minutes and are highly structured.

They typically include:§ Session Orientation & Opening§ Beginning Session: Relationship Building, Defining Goals§ Middle Session: Story Development, SFBT Questioning§ Break§ End of Session: Feedback, Therapeutic Plan, Experiments

May 6, 2020 23

Problems in a Solution-Focused framework

The person isn’t the problem; the problem is the problem

§ Problems should be acknowledged and validated

§ Separate the problem from the person

§ The de-personalized problem is manageable and can be looked at from all angles

§ Skills and strengths can exist in relation to, or outside of the problem

§ SFBT progress should move away from problem focus to solutions as soon as client is ready

Session Orientation & Opening (5 to 10 minutes)

Building the relationship

§ Being attentive

§ Being responsive

§ Using compliments & validation

§ Demonstrating an interest

§ Ensuring basic needs are being met

§ Tending to what is important to the person in front of you


§ Review of Confidentiality

§ Review of SFBT format and Collaborative Team-Based Model –sessions are delivered by a team and the individual may see another counsellor if they choose to come back in future.

§ Explaining the session break and how the client and practitioner will use the break time

§ Asking opening and pre-session change questions to set the tone and begin goal identification

May 6, 2020 26

Video Demonstration – Session orientation & Opening

https://www.youtube.com/watch?v=owlb8wNJQYM&feature=youtu.be

https://www.youtube.com/watch%3Fv=owlb8wNJQYM&feature=youtu.be


Sample opening questions:

How can I be helpful to you today?

What is your hope for coming in today?

What would you like most to talk about today, for this conversation right now?

Tell me as much as you think I need to know what is going on with you?

What would need to happen to make this a really useful session today?

How would your best friend notice if /that this session was helpful to you?

What needs to be different in your life after this session for you to be able to say that it was a good idea you came in and talked with me?


Pre-Session Change

• Introducing the concept of change and growth at the outset of the sessions sets a tone for change

• Early in the first therapy session, asking:

What changes have you noticed, even little ones, that have happened or started to happen since you decided to come to this clinic or book this appointment?


Pre-Session Change

• If indicating that things started to improve, the client may say that things have started to change or get better. The therapist asks questions about the changes that have started, requesting a lot of detail, e.g. So, if these changes were to continue in this direction, would this be what you would like? prompting goal setting

• They may say that things are about the same. The therapist might ask, Is this unusual, that things have not gotten worse? or How have you managed to keep things from getting worse? cuing previous solutions and exceptions.

May 6, 2020 30

ACTIVITY – SKILLS SIMULATION

§ 25 minutes

§ Make up a problem that you can utilize for role playing. Choose a problem or concern that might be common to the youth that come to Foundry, that is "workable" in a walk-in counselling session.

§ In pairs, practice session opening and pre-session change questions. Switch roles midway (10 mins each, 20 mins total).

May 6, 2020 31

Beginning Session (5 to 10 minutes)

Moving out of Problem Lens: Preferred Future or Miracle Questions

§ Identifying the goal in positive terms, not just the absence of a problem, is integral to identifying the steps needed to reach it.

§ Traditionally, SFBT has relied on the “miracle question”Imagine that after you go to sleep tonight, a miracle occurs and you wake up and the problem is gone, what would you see different in your life?

§ Another way of asking is to seek a preferred or ideal future without the magical element of a miracle

If the problem no longer existed, what would your ideal day look like?

May 6, 2020 32


Goals

§ The SFBT session focuses on the goal and means to achieve it

§ Session work should focus on one goal which may have multiple aspects

§ Goals in SFBT are desired emotions, cognitions, behaviours and interactions; they are what clients want different in the future

§ The client’s goal must be salient and personally meaningful

§ The goal will state what the clients will be doing instead of what they won’t be doing

§ The goal will be within client’s control

May 6, 2020 33


Overarching and Session-Based goals

§ Client’s goal may be overarching or session-based

§ Overarching goal can involve working on multiple domains or issues

§ Overarching goal may be addressed in multiple sessions with progressive session-based goals

§ If client has overarching goal, the practitioner helps move it towards a session-based goal to inform the therapeutic plan for that day

§ Session-based goal will clear and possible so that a therapeutic plan can be developed to achieve all or some of it

May 6, 2020 34


Overarching Goal

§ Encompass a broad vision of a preferred future like “I want to be happier,” “I want to have a better relationship”

§ Can be a good place to start for clients who are having difficulty identifying a goal or moving away from a problem

§ Can be broken down into session goals for which a therapeutic plans/experiment will be developed

§ Can be teased out through preferred future or miracle questions

May 6, 2020 35


Session goal

§ Is the most pressing issue for the person to deal with that day§ Can be one element of an overarching goal§ Is discrete enough to plan a simple and achievable experiment around

Session goal questions

What can we work on improving today?

What would be the most important change to make?


Other Goal Setting Questions

§ What will you notice when the problem is better?

§ How will things be different when the problem is better?

§ What will you be doing differently when things are better?

§ What will you be doing instead?

§ How will your parents/friends tell that things are going better?

§ How will others tell when the problem is better? Tell me more about that?

May 6, 2020 37

Video Demonstration – Goal setting



May 6, 2020 38

ACTIVITY

§ 25 minutes

§ In pairs, role play goal setting. Use the same problem or concern that you used for the opening session activity. Switch roles midway (10 mins each, 20 mins total)

§ Debrief within your group (5 mins)

Middle Session: Story Development (15-20 minutes)

§ Exploration of values, beliefs, hopes, commitment, visions, exceptions, and resources

§ Main SFBT question types:

• Questions to identify previous solutions & exceptions

• Relationship questions

• Coping questions

• Scaling questions

• Note: these question types are options you have, not be used as a lock-stepped process!


Exceptions & Previous Solutions

“The SFBT therapist spends most of the session listening attentively for talk about previous solutions, exceptions and goals. When these come out, the therapist punctuates them with enthusiasm and support. The therapist then works to keep the solution-talk in the forefront”

-Trepper, McCollum, DeJong, Korman, Gingerich and Franklin



• An exception is thought of as a time when a problem could have occurred, but did not.

• Identifying previous solutions assumes that the person has solved their problem, or a similar one, even if for a short time.



With regards to exceptions and previous solutions, the practitioner will

§ Elicit by questioning

§ Amplify by getting more detail

§ Reinforce by showing interest and paying compliments

§ Explore how it came to be by asking more questions relating to the skill and resources of the client

§ Project the exceptions and previous solutions into the future by discussing likelihood of recurrence and how to repeat it

May 6, 2020 43

Video Demonstration – Middle session story development




Exception & Previous Solution Questions

• Tell me about times when the problem isn’t around (weeks, days, hours, minutes, times of the day)?

• Tell me about times when the problem is a little less troubling or when it’s not happening at all

• Tell me about the times when you’re coping a little bit better with the problem. Or, what’s different about the times when the problem’s better?

• Tell me about times when you… [don’t get angry, feel hopeless, etc.]


Exception & Previous Solution Questions cont.

§ When was the last time that you feel you had a better day?

§ Was there ever a time when you felt happy in your relationship?

§ What was it about that day that made it a better day?

§ Can you think of a time when the problem was not present in your life?

§ Have there been times in the past when you have been able to overcome the problem?

May 6, 2020 46

ACTIVITY

§ 25 minutes

§ In pairs, role play exception and previous solutions questions. Use the same problem or concern that you used for the opening and goal setting session activity. Switch roles midway (10 mins each, 20 mins total)



Relationship Questions

Ask clients to consider other persons’ (usually significant persons in the client’s lives) perceptions about answers to any of the above mentioned questioning strategies. Questions could include;

How would (any person in the client’s life) state that you have been able to cope?

What would people notice if things were different?


Coping Questions

If a client reports that the problem is not better, the therapist may sometimes ask coping questions such as:

§ What stopped total disaster from occurring?

§ How did you avoid falling apart?

§ How have you managed to prevent it from getting worse?

§ This sounds hard. How are you managing to cope with this as well as you are?


Scaling Questions

§ are useful for assessment

§ identifies the client’s evaluation of the situation as primary over the practitioner’s assessment

§ dialogue is focused on solutions and exceptions


Scaling Questions

§ invite clients to perceive their problem on a continuum

§ ask clients to consider their position on a scale (usually from 1 to 10, with one being the least desirable situation and 10 being the most desirable).

§ help to track client progress toward goal and monitor incremental change.



Scaling Questions

§ How have you stopped yourself from going to the bottom of the ladder?

§ How do you maintain staying in the middle?

§ What could you do to move one step up?

May 6, 2020 53

Video Demonstration – Story Development



May 6, 2020 54

ACTIVITY

§ 20 minutes

§ In pairs, role play relationship, coping and scaling questions. Use the same problem or concern that you used for the opening session and goal setting activities. Switch roles midway (7 mins each, 15 mins total)


May 6, 2020 55


What Else?

§ Questions about details are key§ Asking “what else?” implies that there is more, in terms of resources,

answers and success, that the client can tap into

May 6, 2020 56


Paraphrasing

§ Practitioner uses paraphrasing to turn impossibilities into possibilities§ Careful use of tense is important: problems stay in past tense,

possibilities in present or future tense§ Avoid conditional tenses

“it would be great if I could find a job,” becomes “it will be great when you find a job”“I can’t get sober” becomes “you haven’t managed to reach your goal to stop drinking yet”

May 6, 2020 57

ACTIVITY

§ 45 minutes

§ Role play story development including the use of exception, previous solution, coping, relationship, scaling and “what else” questions. Be mindful of paraphrasing. Use the same scenario you have used up to now or the one provided for this exercise. Switch roles midway (20 mins each; total 40 mins)


May 6, 2020 58

Session Break

In SFBT, therapists typically take a break near the session end to confer with a team (or with at least one colleague). The client is informed that this is an opportunity to bring the wisdom of the entire team to the challenges that the client is facing.

The team or colleague gives the therapist:

§ feedback about the session

§ a list of compliments for the client or family

§ some possible experiments for the client or family to try

If there is a not a team available to consult, the therapist will still take a break to collect their thoughts, and then come up with compliments and ideas for possible experiments

May 6, 2020 59

DAY 2 WRAP UP

May 6, 2020 60

ACTIVITY

§ 20 minutes

§ One person will act as the client, with a presenting problem/situation they are coming about

§ Everyone else will take turns being the therapist and go through the process of leading the session, starting at middle and working through to the session break.

§ Each “therapist” will ask no more than 5 questions and the next therapist will “tap in” to continue the session.

End Session: Feedback & Therapeutic Plan (15 minutes)

The end of session time encompasses:

1. Feedback looped back to the client referring to:

• the problem they came in for

• a review of how they described the problem

• reflection back to the client on their hopes for the future, what they had already been doing,

• offering compliments

2. Practitioner co-developing experiments, next possibilities

3. Crafting of a therapeutic or session note

May 6, 2020 62


Compliments

§ Can happen throughout the intervention

§ Will be part of the feedback from a team consultation

§ Can be questions or statements

How have you managed to be so strong when faced with this challenge?

The team wanted me to express how impressed they were at your perseverance and creativity in solving this issue

May 6, 2020 63


Experiments

§ help consolidate the change initiated during the session

§ are based on something the client is already doing (exceptions), thinking, feeling, etc., that moves them towards their goal.

§ emanating from client’s framework, rather than therapist’s ideas, usually incorporate what has worked already for them (a previous solution), or something they really want to do.

§ Will act as the first small step towards the overall goal

§ Will be a behavior that the client can practice regularly

May 6, 2020 64

Video Demonstration – End of session – Therapeutic Plan



May 6, 2020 65

ACTIVITY

§ 45 minutes

§ In your original pairs, role play providing feedback by describing the problem, how the client defined it, their hopes and goals, developing a therapeutic plan (experiments) and giving compliments. Use the original problem or concern that you have been using in most activities. Switch roles midway (15 mins each, total 30 mins)


May 6, 2020 66

ACTIVITY

§ 10 minutes

§ Individually, write the session or therapeutic note based on the site template

May 6, 2020 67

When might SFBT be the wrong approach?

§ When a client cannot identify a goal, even after multiple sessions

§ When focused interaction is not possible, as with a person in acute psychosis, serious depression or with severe intellectual disability

§ When a client perceives the approach to be too positive and not in step with their frame of mind

§ When previous attempts at SFBT have been unproductive

May 6, 2020 68

When you should seek immediate consultation?

§ When a vulnerable client discloses abuse of any kind, current or historical

§ When a client discloses an intent to harm themselves or others

§ When a client may be subject to sexual or other exploitation

§ When a client appears to be cognitively impaired or their responses suggests reality testing concerns (i.e. possible psychosis)

§ When you feel that the issues they are presenting are severe and/or complex and may require immediate attention

May 6, 2020 69

DISCUSSION

Any questions, thoughts, tips, wisdom to share around SFBT?

May 6, 2020 70

ACTIVITY

§ Choose a new partner and, using the scenarios provided, lead a full SFBT session

§ 1st session (45 minutes)

§ After 1st round, group debrief: 10 minutes

§ 2nd session (45 minutes), new scenario provided, partners switch roles

§ Final group debrief: 15 minutes

THANK YOU!

WALK-IN SINGLE SESSION COUNSELLING USING SOLUTION-FOCUSED ... · Solution Focused Brief Therapy Overview & Approach Solution Focused Brief Therapy §is future-focused, goal-directed,

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