E1142Mental Health7 Recovery and self advocacy7.1 Approaches to practice7.1.2 Solution-focused approachesThe solution-focused approach was developed by Steve de Shazer and Insoo Kim Berg at theirMilwaukee Brief Family Therapy Center in the first half of the 1980s, and it is now widely used inpsychotherapy and coaching. Some of the ideas of Solution-Focused Therapies (SFT) go backfurther, possibly even to the 1950s (Visser, 2013).The team of the therapy centre developed their approach out of a desire to find an alternative tomany other treatment models which require clients to be in therapy for a long time. SFT is a briefform of therapy and the techniques contained in this model can be applied to interventions in thecommunity services sector, including in mental health and AOD services.If you woke up tomorrow and a miracle had happened overnight and made your problemdisappear, what would your life look like? How would you know the miracle had happened? The Miracle Question is one of the keytechniques of solution-focused practice– it invites the person to reframe theunderstanding of their problem andmove to a search for solutions instead.Much like in the Miracle Question, therole of the practitioner is to work in acreative way with consumers to create“ Reading 44560The history of SFTThe Origin of the Solution-Focused Approach[https://www.solutions-centre.org/what-is-the-solution-focused-approach/]article provides you with an overview of the history of SFT, including the key components of thisapproach.SFT requires empathy and basic counselling skills.ACTIVITY 44560 TYPE ReadingSCENARIO The history of SFT The solution-focused approach relies on structured questions which allow the consumer to movefrom problem-orientation to solution-focus.Different types of questions include:the Miracle QuestionException QuestionsScaling QuestionsCoping Questions.The Miracle Question tries to evoke a future where the person’s problem has disappeared andthis enables them to be guided towards an exploration of different solutions by allowing them tolook at the problem as if it was already solved.Exception Questions open up an exploration of resources and spaces where the person hasalready found small solutions to the problem at hand. This question is usually worded aroundsituations where the problem does not happen. For example, if a person was working on theiranger as a problem, the practitioner could ask them about a situation where they did not getangry or were able to manage their anger in a more positive way. In essence, ExceptionQuestions remind people of situations when things went well and they had a good experience.visions of a future where they havefound solutions for problems that arecurrently impacting on their lives andhappiness.| Topic – 2 / 11© Open Colleges Pty Ltd, 2020.Scaling Questions allow the person and the practitioner to gain a better understanding of thesituation by inviting the person to see their problem on a continuum, rather than as a scenariowhere the problem either exists or does not exist. This also allows for smaller solutions to bedeveloped on the way to the overall solution to the problem. Scaling can also be an effective wayof tracking progress and making sure that things are moving the right way.Again, using anger as an example, a practitioner might ask the person where they see themselvesin their skill to manage anger, 10 being the best possible way to manage anger, one being nothaving any skills at all to undertake this task. A person might offer that they see themselves at‘4’ which gives an assessment of the person’s perception and offers options to further exploresolutions, such as asking where the person was at in the past and what strategies they used toget to a higher number on the scale. It is also possible to then look at how the person could movefrom their current number to an even higher number on the scale. Basic step Example foundationIntroduction of the scaleThe scale is explained Imagine a scale from 0 to 10. The 10 represents the desiredsituation, how would you like things to become. 0 represents thesituation in which nothing has yet been realised of the desiredsituation.Current positionThe coach asks where theclient is on the scale now Where are you now on this scale?| Topic – 3 / 11© Open Colleges Pty Ltd, 2020.PlatformThe coach focuses on whatis already there and whathas already worked“How did you manage to go from 0 to where you are nowon the scale?”“What has helped?”“What worked well?”“How did you accomplish that?”“What else has helped?”Earlier successThe coach asks about asituation in which things havealready been better“What is the highest position on the scale at which you havebeen recently?”“What was different then?”“What did you do differently?”“What worked well in what you did?”Visualise a higher positionInvite the client to describehow things look at higherpositions on the scale“How would things look at …?”“How would you notice you would be at … on the scale?”“What will be different at …?”“What could you do then?”“How would that help?”Step forwardThe coach invites the clientto mention what small stepforward he could take on thescale“Has what we talked about been useful?”“What was useful in particular?”“How could you use that to take a small forward?”“What could that step look like?” Basic step Example foundation| Topic – 4 / 11© Open Colleges Pty Ltd, 2020.Retrieved from:solutions-centre.org[https://www.solutions-centre.org/what-is-the-solution-focused-approach/], 2016.Coping Questions are a way presupposing change. Despite the presence of the problem, theperson has somehow managed to cope with the situation and has prevented worse things fromhappening. This technique does not look for exceptions, rather it looks at usually overlooked orhidden skills and solutions that the person is already applying to their situation.Examples of these questions are:“How come things aren’t worse for you?What stopped total disaster from occurring?How did you avoid falling apart?” (Baxter, 2009,forum.psychlinks.ca[http://forum.psychlinks.ca/showthread.php?19542-Presupposing-Change-Solution-Focused-Therapy]).Another more challenging way of asking this question could be to ask the person how they couldmake the problem bigger and make the situation worse. This technique is especially useful whenthe person finds it difficult to come up with solutions and the practitioner is trying to access skills,resources and coping mechanisms that the person is unaware they have and this can lead to thepossibility for developing solutions. The main aim is to empower the person to move out of‘victimhood’ to.All of these questions are intended to find things that work and encourage the person to do moreof what works rather than focusing on the problem.Last but not least, practitioners of solution-focused approaches also see it as an important taskto compliment clients on the things they are doing well. This helps the person to become awareof their strengths and resources and lead to further positive changes.| Topic – 5 / 11© Open Colleges Pty Ltd, 2020.Activity 44561Practitioner tasks in the Stages of ChangeThe Royal College of Psychiatrists[http://apt.rcpsych.org/content/8/2/149]website provides an excellent overview of Solution-focused work, including how to work withdifferent sets of questions.HintsIt is important to also adjust your language to model solution-focused thinking.ACTIVITY 44561 TYPE ConsumeSCENARIO Practitioner tasks in the Stages of Change Activity 44562Research about solution-focused approachesThis paper, ‘Solution Focused Therapy Treatment Manual for Working with Individuals Research Committee ofthe Solution Focused Brief Therapy Association[https://www.solutionfocused.org.au/sf]‘ includes research about solution-focused practice.Read the verbatim examples to develop a more practical understanding of Solution-Focusedapproaches.ACTIVITY 44562 TYPE ResourceSCENARIO Research about solution-focused approaches Solution-focused work| Topic – 6 / 11© Open Colleges Pty Ltd, 2020.Watch this video to see an example of solution-focus in practice.[https://youtube.com/watch?v=T33j_ZETzUs]Think about how you might use the questions we’ve covered above.Activity 44563Miracles happenThink about something you would like to change in your life. Then imagine what it would be likewaking up and the change has already happened: your problem has disappeared. What haschanged? How would you know that the problem is no longer there?Write down what comes to mind. How might you use this technique with consumers?HintsRemember that the Miracle Question is used in combination with other questioning techniques.ACTIVITY 44563 TYPE Contribute| Topic – 7 / 11© Open Colleges Pty Ltd, 2020.SCENARIO Miracles happen Activity 44564Remember Jacob?Jacob recently came to see you at the service. He has only recently started attending after havingmoved into a housing program that requires him to be engaged with support services to retainhis tenancy.Jacob became homeless last year when his relationship with his partner broke down. Jacob had| Topic – 8 / 11© Open Colleges Pty Ltd, 2020.lived with his partner for over 10 years and helped her raise her 2 children from anotherrelationship.Jacob is very angry about the break-up, especially because his ex-partner is stopping him fromseeing her son Larni who Jacob helped raise almost since birth.Jacob spent the past few months in emergency accommodation and he is very clear that he hatedhis time there. Despite multiple challenges, Jacob managed to keep his job as a salesman for alarge electronics chain.As you build your relationship with Jacob, you find out a bit more about his story. Jacob has livedwith anxiety ever since he can remember and he was diagnosed with panic disorder. He says thatwhile he has always been anxious, the condition became much worse about 8 years ago. Jacobwas working in the public service and was climbing the career ladder when he had a breakdownthat meant he was admitted to inpatient services for several weeks.Jacob says that he cannot put his finger on what caused the breakdown, only that he thinks therewas a build-up until he simply could not cope anymore. Jacob says that his partner, Rose, helpedhim through the tough times but he now feels that she only did this in the hope that he would beback on his feet soon to support the family financially. He says that he now sees Rose asheartless and he is very worried about his own anger, saying that he tries very hard to make it goaway but lately nothing seems to work.Jacob’s anger recently spilled over at work where he started shouting at a customer. He was puton a warning for this. Jacob is very worried that he might lose his job and he is not sure that hewould be able to deal with this. He says that he knows he’s ‘simply a waste of space’ and that hewould ‘lose any reason to live’ if he lost his job as well as his family.Jacob admits that he’s always been okay with a drink or two now and then; since his breakup hehas been drinking a few beers every day after work. He says that he sometimes feels the alcoholis having a negative impact on him, he also says that it seems to be the only thing that works tocalm his anxiety.Following the incident at work, Jacob’s psychiatrist put him on a new drug regimen to improve thecalming effects. Jacob says that the new medication is not good for him, he feels that they aremaking him depressed and irritable. They also make him feel nauseous every time he has to take| Topic – 9 / 11© Open Colleges Pty Ltd, 2020.them and that he has had trouble sleeping since starting this new treatment. Jacob claims to havespoken about this with his psychiatrist; he was told to stay on the medication as the psychiatristwas concerned that Jacob could be ‘a risk to himself and others’.Jacob was determined to see another psychiatrist to get a second opinion, however, when heraised the issue with his case worker in housing she said that Jacob was at risk of loosing histenancy if he did not comply with his current treatment. Jacob is upset about this.Jacob says that he reminds himself of his father. Jacob grew up with four older sisters. He wasvery close to his mother who died when he was 13. Jacob’s father then raised the family byhimself which was difficult for all involved. Jacob’s father was a veteran from the Vietnam war andspent 2 years as a prisoner of war. Even though Jacob has no clear memories of his Dad beforehe went away, however, he remembers clearly that his father was very different when hereturned from the war. Jacob clearly remembers his father’s angry outbursts that were usuallydirected toward his mother. He also targeted Jacob who he accused of being ‘soft’. Jacob saysthat he sometimes thinks his mother ‘gave up’ when she was diagnosed with cancer because hermarriage had ‘robbed her of the will to live’.Jacob is very upset that his psychiatrist contacted his father when he was unwell. The psychiatristexplained to Jacob that he needed to gather information to provide treatment, however, Jacobcontinues to believe that this was a breach of his privacy.When you start working with Jacob, he challenges you straight away, asking you fordetailed information about confidentiality in the service.What issues might you be able to address using a Solution-Focused approach?How might you work with Jacob, following the key principles of the Solution-Focusedapproach?HintsThink about what Jacob might have to say in response to the Miracle Question.ACTIVITY 44564 TYPE Contribute1 2| Topic – 10 / 11© Open Colleges Pty Ltd, 2020.SCENARIO Remember Jacob?| Topic – 11 / 11© Open Colleges Pty Ltd, 2020.
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