Solution Focused Narrative Therapy [1 ed.] 082613176X, 9780826131768

Table of contents :
Cover
Title
Copyright
Contents
Foreword
Preface
References
Share Solution Focused Narrative Therapy
Chapter 1: Meaningful Solutions
The Search Is On . . .
From Modern to Postmodern: Seeing Clients as Experts
Postmodern Models at Work
Narrative Therapy
Solution Focused Therapy
Applying the Blend of Ideas to Valerie’s Case
Rebuilding a New Presentation
Adding Noteworthy Encouragement
The New Brand Sells
The Power of Redescription
Using Redescription to Create New Presentations
Results of the Blend
Summary
Personal Exercise
References
Chapter 2: Solution Focused Stories
Combining Strengths of Both Models
Guiding Constructs of Solution Focused Narrative Therapy
Putting the Constructs to Work
Summary
Personal Exercise
References
Chapter 3: Action-Filled Narratives
Solution Focused Narrative Therapy: Conversational Ideas
Best Hopes
Mapping the Effects of the Problem
Constructing the Preferred Story
Exception Gathering: Getting Distance From the Problem
Preparing the Presentation of the Preferred Future and Moving Up the Scale
Summarizing and Inviting Clients to Watch for Success
What About the Next Session?
Summary
Personal Exercise
References
Chapter 4: Triumph Over Trauma
Storytelling 101: Finding Resolution to a Plot
Seventy-Seven Years: A Timeline to a Preferred Future
Composing a New Chapter After Trauma
From Trauma to Resolutions: Let the Words of the Client Guide the Way
Dear Client: Teach Me How to Talk to You
Summary
Personal Exercise
References
Chapter 5: Relationship Presentations
Therapists Make Presentations, Too
Changing the Rules
To Change Someone, Change Yourself
Relatable Moments That Build Trust
Doing Things Differently With Adolescents
Packing Up the Baggage and Reclaiming a Relationship
Summary
Personal Exercise
References
Chapter 6: Dangerous Habits
Habits Happen as a Method of Coping
Gaining Personal Control
There’s a Monster in My Head
Coping Safely
Assumptions About Clients With Dangerous Habits
Substance Abuse Habits
Moving Beyond the Roadblocks
Rearranging the Furniture
Distancing From Self-Injury
Reclaiming Health From Eating Disorders
Guiding Template for Clients With Dangerous Habits
Summary
Personal Exercise
References
Chapter 7: Timeless Influences
Videos, Ornaments, and Aftershave
The Art of Re-Membering
Finding Peace for Lilly
Addressing Early Childhood Issues
Summary
Personal Exercise
References
Chapter 8: Reintroducing School Clients
Making a Campus Appearance
How Schools Respond to Problems
Attempts to Change Behavior
Academic Labels
Notifications No More
Summary
Personal Exercise
References
Chapter 9: Writing Miracle Days With Families
Writing New Miracles With Families
Guiding Ideas for Working With Families
Gaining Control of a Diagnosis
A Blended Family Gets Together
Creating a New Chapter After Loss
Parenting and Couplehood
Reconciliation Forever
Family Sculpting: Managing a Change of Characters
Summary
Personal Exercise
References
Chapter 10: The Path to Less Distress
Gaining Distance From a Diagnosis
Perspective-Shifting Exercise
Externalizing Diagnoses
Ideas and Steps for Externalizing Problems
The Woman I Used to Be
Exceptional Descriptions
Always Seek Exceptions for Direction
Summary
Personal Exercise
References
Chapter 11: Treatment Planning and Group Therapy
Collaborative Approach to Assessment and Transition Planning
Solution Focused Narrative Approach
Changing the Focus of Staff
From Admission to Discharge in One Conversation
Group Therapy for Solution Building
Steps to Take When Beginning a Group
Summary
Personal Exercise
References
Appendix: Guiding Constructs of Solution Focused Narrative Therapy
Index

Citation preview

Solution Focused Narrative Therapy

Linda Metcalf, PhD, LPC-S, LMFT-S, is a professor and director, Graduate Counseling Program, Texas Wesleyan University. She is a licensed professional counselor and licensed marriage and family therapist in Texas and maintains a private practice in the Fort Worth, Texas, area. Dr. Metcalf is a leader in the development and application of solution focused approaches in a wide range of settings and audiences, as well as the practice of marriage and family therapy. She is the author of 10 books for professional and lay audiences, including the ­best-selling Counseling Toward Solutions: A Practical Solution-Focused Program for Working With Students, Teachers, and Parents, 2nd Edition (2008); Marriage and Family Therapy: A Practice-Oriented Approach (Springer Publishing, 2010), and Solution Focused Group Therapy (2007). Dr. Metcalf has served as president and board member of the American Association for Marriage and Family Therapy (AAMFT) as well as president of the Texas Association for Marriage and Family Therapy. Additionally, she is the current president of the Association of Solution Focused Practitioners and has presented and trained extensively throughout the United States and internationally, including Australia, Japan, Norway, Germany, United Kingdom, Thailand, Amsterdam, Singapore, and Canada.

Solution Focused Narrative Therapy Linda Metcalf, PhD, LPC-S, LMFT-S

Copyright © 2017 Springer Publishing Company, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, LLC, or authorization through payment of the appropriate fees to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, [email protected] or on the Web at www.copyright.com. Springer Publishing Company, LLC 11 West 42nd Street New York, NY 10036 www.springerpub.com Acquisitions Editor: Sheri W. Sussman Compositor: diacriTech, Chennai ISBN: 978-0-8261-3176-8 e-book ISBN: 978-0-8261-3177-5 Downloadable Worksheets are available to all readers at springerpub.com/sfntexercises Worksheets: 978-0-8261-3299-4 17 18 19 20 21 / 5 4 3 2 1 The author and the publisher of this Work have made every effort to use sources believed to be reliable to provide information that is accurate and compatible with the standards generally accepted at the time of publication. The author and publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance on, the information contained in this book. The publisher has no responsibility for the persistence or accuracy of URLs for external or third-party Internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Library of Congress Cataloging-in-Publication Data Names: Metcalf, Linda, author. Title: Solution focused narrative therapy / Linda Metcalf. Description: New York, NY : Springer Publishing Company, [2017] | Includes   bibliographical references and index. Identifiers: LCCN 2017000290| ISBN 9780826131768 | ISBN 9780826131775   (e-book) | ISBN 9780826132995 (downloadable worksheets) Subjects: | MESH: Narrative Therapy | Psychotherapy, Brief Classification: LCC RC489.S74 | NLM WM 420.5.N3 | DDC 616.89/165—dc23 LC record available at https://lccn.loc.gov/2017000290 Contact us to receive discount rates on bulk purchases. We can also customize our books to meet your needs. For more information please contact: [email protected] Printed in the United States of America by Gasch Printing.

If you can dream it, you can do it. —Walt Disney

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Contents

Foreword by Elliot Connie, LPC  xi Preface  xv Share Solution Focused Narrative Therapy 1. Meaningful Solutions   1 The Search Is On . . .  1 From Modern to Postmodern: Seeing Clients as Experts  3 Postmodern Models at Work  4 Applying the Blend of Ideas to Valerie’s Case  6 Rebuilding a New Presentation  7 Adding Noteworthy Encouragement  11 The New Brand Sells  12 The Power of Redescription  13 Using Redescription to Create New Presentations  14 Results of the Blend  15 Summary  16 Personal Exercise  17 2. Solution Focused Stories   21 Combining Strengths of Both Models  21 Guiding Constructs of Solution Focused Narrative Therapy  24 Putting the Constructs to Work  28 Summary  29 Personal Exercise  30

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3. Action-Filled Narratives   33 Solution Focused Narrative Therapy: Conversational Ideas  33 What About the Next Session?  56 Summary  59 Personal Exercise  59 4. Triumph Over Trauma   63 Storytelling 101: Finding Resolution to a Plot  64 Seventy-Seven Years: A Timeline to a Preferred Future  66 Composing a New Chapter After Trauma  68 From Trauma to Resolutions: Let the Words of the Client Guide the Way  70 Dear Client: Teach Me How to Talk to You  71 Summary  73 Personal Exercise  73 5. Relationship Presentations   75 Therapists Make Presentations, Too  76 Changing the Rules  78 To Change Someone, Change Yourself  81 Relatable Moments That Build Trust  84 Doing Things Differently With Adolescents  84 Packing Up the Baggage and Reclaiming a Relationship  87 Summary  89 Personal Exercise  89 6. Dangerous Habits   93 Habits Happen as a Method of Coping  94 Gaining Personal Control  96 There’s a Monster in My Head  97 Coping Safely  101

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Assumptions About Clients With Dangerous Habits  101 Substance Abuse Habits  102 Moving Beyond the Roadblocks  105 Rearranging the Furniture  106 Distancing From Self-Injury  108 Reclaiming Health From Eating Disorders  111 Guiding Template for Clients With Dangerous Habits  114 Summary  116 Personal Exercise  117 7. Timeless Influences   121 Videos, Ornaments, and Aftershave  122 The Art of Re-Membering  125 Finding Peace for Lilly  129 Addressing Early Childhood Issues  133 Summary   135 Personal Exercise   135 8. Reintroducing School Clients   137 Making a Campus Appearance   138 How Schools Respond to Problems   139 Attempts to Change Behavior   141 Academic Labels   143 Notifications No More   144 Summary   152 Personal Exercise   153 9. Writing Miracle Days With Families   155 Writing New Miracles With Families   156 Guiding Ideas for Working With Families   157 Gaining Control of a Diagnosis   157

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A Blended Family Gets Together   162 Creating a New Chapter After Loss   162 Parenting and Couplehood   163 Reconciliation Forever   163 Family Sculpting: Managing a Change of Characters   167 Summary   170 Personal Exercise   170 10. The Path to Less Distress   173 Gaining Distance From a Diagnosis   177 Externalizing Diagnoses   179 Ideas and Steps for Externalizing Problems   180 The Woman I Used to Be   181 Exceptional Descriptions   183 Always Seek Exceptions for Direction   183 Summary   186 Personal Exercise   187 11. Treatment Planning and Group Therapy   189 Collaborative Approach to Assessment and Transition  Planning  190 Solution Focused Narrative Approach  192 Changing the Focus of Staff  194 From Admission to Discharge in One Conversation  195 Group Therapy for Solution Building  198 Steps to Take When Beginning a Group  199 Summary  201 Personal Exercise  201 Appendix: Guiding Constructs of Solution Focused Narrative Therapy   203 Index  211

Foreword

First, let me address the elephant in the room: How could I, one of the biggest advocates for practicing the solution focused approach without adding anything else to it, write a foreword for a book like this; one that has at its core the idea that the combination of Solution Focused Brief Therapy and Narrative Therapy would be beneficial. Well, there are two main reasons for my writing this foreword, one simple and one less so. I’ll start by explaining the more complicated point, but in order to do so I have to start by explaining how I met Linda Metcalf and came to learn about her work with these two approaches. It was during my second semester of graduate school. I enrolled in a class with a new professor without any idea of what to expect. By this time I had actually become pretty frustrated with the counseling profession and had all but decided to drop out of school and pursue other interests. My frustration stemmed from the work I was doing at a local agency where I was being mandated to use a very problem-saturated form of therapy in my work. It had the full backing of the powers that be at this agency, who believed this was the only way effective psychotherapy could be done. In fact, I was told that doing anything else would be unethical. These problem focused ways of working never fit with me, and consequently I found the work hard and felt beaten down and overwhelmed by my clients’ problems. I was beaten down by my own ineptitude. I wished there was another way, but I was told there was no other way. Then I met Linda. In that first class, she introduced me to Solution Focused Brief Therapy along with the developers of this approach, Insoo Kim Berg and Steve de Shazer. She explained that their work was about hope, change, and even miracles. I was immediately hooked as I finally realized that there was another way—a more hopeful way—of working with clients; one that fit with the type of clinician (and person) that I xi

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wanted to be. It was as if someone had breathed life back into me, and I wanted to learn as much as I could about this stuff. Perhaps the most remarkable moment for me was when Linda did a live demonstration in class with one of her actual clients. To say I was amazed would be an understatement. As I am writing this foreword, this event happened more than 11 years ago, but it feels like just yesterday. I can remember the family she saw, how they responded to the questions she asked in session, and the amazing change I saw take place right there in the session. I truly was blown away by what I saw— Linda’s remarkable clinical skill. I dedicated myself to not just learning the solution focused approach, but to mastering it. I read every book, watched every video, and attended every training opportunity I could find. In time I had two profound realizations. One was that as I studied and practiced this method, the pure and minimalistic way of working with Solution Focused Brief Therapy was how I wanted to practice going forward. I also realized that this was not what Linda was doing, because she was adding something that, at the time, was unknown to me. It was her own and effectively eloquent way of doing Solution Focused Brief Therapy. And as I talked to her about this, she revealed it was Narrative Therapy that she had been adding into her sessions. That was her secret weapon. If you look beyond the techniques and look beyond the theory, what lies at the heart of Linda’s work is hope. The sort of hope that has impacted her clients and students throughout her career, and I know, as I was once one of them, and seeing that hope changed my life in the most profound ways. Our field needs more approaches that are guided by hope, that focus on a person’s capabilities as opposed to his or her problems. Students need to know that they can work with clients and help create change without focusing on a problem in the way other approaches do. This text provides another way of helping clients to discover their best selves and live a different life, one where a problem is not in control. Linda’s secret weapon is now on full display, but you have to look a bit beyond to see her real work: hope. I started by saying I had two reasons for agreeing to write this foreword. Thus far, I have told you about the harder of the two to explain. I have tried to explain that even though her full approach differs from mine, it has at its core the idea of hope, and witnessing that hope is exactly what triggered me to pursue a greater understanding of the

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solution focused approach itself. I am hoping this book can do the same for readers who may be struggling in the same ways that I was all those years ago. The second, and much more simple reason for me writing this foreword, is that Linda is the one who introduced me to this way of working. It is a great honor and privilege to have played a role, even a small one, in bringing her work into the light. Enjoy the book. Elliott Connie, LPC Coauthor: The Art of Solution Focused Therapy Author: The Solution Focused Marriage

Preface

Maybe it was more than chance that I was given Narrative Means to Therapeutic Ends (White & Epston, 1990) and In Search of Solutions (O’Hanlon & Weiner-Davis, 1989) during the same semester of graduate school in the early 1990s. I had just returned from attending a workshop in Rockville, Maryland, where I had spent a week learning from Jay Haley, a strategic family therapist and my then-hero. A dedicated strategic family therapy junkie, I was sure that the creative, provocative method created by psychiatrist and family therapist Milton Erickson and then refined by Jay Haley was my thing and I was out to master it. Unfortunately, perfecting it was much harder than I thought. In attempting to apply the ideas, I often found myself prepping for hours before a family therapy session, readying myself to deliver the most powerful and brilliant directives—only to find, when the family returned, that things had gotten better. There I sat, in a session with clients whose system had changed over the week, due to who knows what, and not in need of my assistance after all. As I read the two previously mentioned books (moving from one to the other), it took just a few pages of reading from each to go from feeling useless to my clients to recognizing what I had been coming to believe: Clients didn’t need my assistance; they needed me to help them recognize that they could help themselves. Yet they still showed up thinking that I had the answers. Somehow, I had to learn how to work to promote the expertise within them, and not be the expert. So, I discovered new heroes. I followed Steve de Shazer, Insoo Kim Berg, and Bill O’Hanlon around, attending every workshop they held when near and even far away. I even did my PhD dissertation research at Brief Family Therapy Center in Milwaukee. Then I ­followed Michael White and Davis Epston around. They were always so gracious in answering my questions, of which I had many. I fell in love with the xv

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charm of externalizing, letter writing, redescription, and invitations to revise and rewrite stories. Yet I still loved the “Scaling Question,” the “Miracle Question,” and the “What else?” and “What difference will that make?” questions that I learned from Chris Iveson, Harvey Ratner, and Evan George at BRIEF Therapy Practice later on. The struggle was to choose: Which one do I follow? I began noticing in sessions that I would dabble with both models, depending always on the dialogue and language of clients to direct me down whichever path made sense to them. I would think to myself, “That word would be great to externalize,” or “This client seems to see events as occurring constantly—there must be exceptions.” I took notes differently, focusing on language and exceptions instead of problems and even giving my clients copies of my notes afterward. I began to notice that each client seemed to want things to be better and most didn’t mind when I invited them to write their next chapters. When I asked a 50-year-old client if he would like to write “chapter 2,” tears rolled down his face. He looked up at me and asked, “You mean I can do that?” How the sessions went, and how the clients began to talk when I met them, determined which path I went down during therapy: solution focused or narrative. Somehow, that path got easier as it became a blend of both models. I still had concerns, however. Would it be respectful and honorable to both models and their founders to blend them? I wondered and fought the thinking, wrote about the ideas, was shunned by some purists and given encouragement by others—particularly those who embraced the narrative approach! It seemed they truly lived the idea that ideas and lives should evolve into new ways of relating and working. My fascination with both models never waned, and I wondered if they could blend in a way that would give me a framework to use with every client, staying reverent to both models yet utilizing the effectiveness of each. That framework is presented in this book. Eventually, I began to see narrative therapy dialogues as the vehicle for instigating and coloring new descriptions that seemed to help clients see more possibilities ahead of them. I began to refer to those new descriptions as new presentations. My clients liked the idea of taking on new descriptions and presenting themselves differently to others. In fact, just conjuring up new descriptions gave them new ideas for new actions! The language made all the difference in motivating the clients and giving them hope, it seemed. Yet descriptions alone didn’t seem enough to help a client move forward. Solution focused therapy allowed me to put the wheels

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on the new presentation. Using the identified exceptions that emerged in our conversations helped to adjust the tempo and direction of the vehicle. My clients seemed to appreciate the blend, got better quickly, and referred others. Seeing clients react in that way was the most important factor in my continuing to develop the framework, and I have never looked back. Using a blend of solution focused and narrative therapy, I found that the survivors of trauma improved after the first session and were able to make major changes over three to four sessions. Children learned to control their energy, anger, and sadness after a week or two. School teachers were able to look at their students differently and collaborated with me and the students in meetings on campus that colored the students’ new efforts and reputation brightly. Those meetings needed to occur only once and continue to show effectiveness to this day. I was sold. Clients dealing with depression, loss, anxiety, and more came back after the first session, typically telling me how things were better. This book, therefore, is the result of work I have done over 20 years that has evolved into a way of doing psychotherapy and family therapy with a postmodern flavor. After seeing that this approach could be helpful, it became impossible not to think within both models whenever I saw clients. In our first sessions, the clients always seemed to be presenting “gifts” of language to me that showed me which way they wanted to go in therapy. And when they brought into our conversations their family values and beliefs about life and what they dreamed of, new chapters evolved with rich dialogue that allowed them to step out of troubled times and into satisfying possibilities, and to experiment with new actions. Finally, the “miracle day” or “magic wand day” (which evolved from asking the Miracle Question) would arrive—the day when life becomes better. The miracle day became decorated with not only new actions but also recognized beliefs and emotions that supported the desired actions. This seemed to give clients more ideas of how to present themselves as they desired in their miracle day so that interactions changed for their betterment. And the best part? The discoveries, descriptions, presentations, actions, values, and beliefs were all generated by my clients. Therapy became richer yet even briefer. Today, I no longer show up at a session ready to present my intervention as I did in my early days, when I aspired to be a strategic therapist. Instead, I show up, not knowing anything about a new client, to learn of the competencies that are hiding dormant within a person who may or may not have a clue that he or she is already the expert. Although I am still fond of and thankful to the Mental Research

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Institute and legends of strategic therapy, now I get to learn from my clients—through a barrage of questions—how they want things to be, cooperating along the way so that resistance fades and relief appears in the eyes of my clients, no matter what their age or situation. I value the confidence expressed to me by Michael White, who told me more than 20 years ago to use “anything that I have written” in writing my first book, Counseling Toward Solutions. I appreciate his profound influence in how I see and describe people today, as I do that of David Epston in letter writing, certificates, and the idea of copying case notes for clients after each session for their review. My clients are constantly surprised when, at the end of each session, I present them with copied pages of ideas and solutions and tell them that the notes are merely their words and ideas. I treasure the support of Bill O’Hanlon, who wrote the introduction for my first book and told me to shoot for the stars in 1995 with what I thought would work by saying, “There’s plenty of room at the top . . . do it.” I am also indebted to Insoo Kim Berg, Steve de Shazer, and Yvonne Dolan for their wisdom and marvelous books that are so respectful of clients; to Chris Iveson, Harvey Ratner, and Evan George at BRIEF Therapy Practice in London; and to Mark Hayward and Amanda Redstone of The Institute of Narrative Therapy in Rotherham, England. For the past 8 years, the “boys at BRIEF,” as well as Mark and Amanda from the Institute of Narrative Therapy, have taught 25 of my students each summer about both models; I sit each year, listening to them as if I am hearing the jewels of their models for the first time. Learning both models over again each year and watching the music of both models fill pages of ideas in my mind is exhilarating and validating. Elliott Connie, a former student, colleague, exemplary therapist, and dear friend, kept pushing me to write this book. I thank him for his support and amazing contributions to couple therapy. I appreciate his prolific adaptation of the solution focused approach with couples, which he rightfully refers to as solution building. Like the model, he does what works and evolves alongside his clients, providing services that save marriages and families every day. Lastly, I thank you for taking a chance to read a very different kind of therapy book. The framework here is simply my efforts to try and reach clients more often, more respectfully, creatively, efficiently, and constructively with the language of narrative therapy and the actions of solution focused therapy. I hope you enjoy the ride and find some fascination and new energy along the way. Linda Metcalf, PhD, LPC-S, LMFT-S

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Worksheets presented throughout this book are available for download from springerpub.com/sfntexercises

REFERENCES Metcalf, L. (2008) Counseling toward solutions (2nd ed.). San Francisco, CA: Jossey Bass. O’Hanlon, W. H. & Weiner-Davis, M. (1989). In search of solutions: A new direction in psychotherapy. New York, NY: W. W. Norton. White, M. & Epston, E. (1990). Narrative means to therapeutic ends. New York, NY: W. W. Norton.

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CHAPT ER 1 Meaningful Solutions What we think, we become. —Buddha

Valerie, age 45, sought therapy after 20 years of marriage and a recent trend of unhappiness in her life. She and her husband had two children—a daughter, 17, and a son, 13. She began our session by saying she needed to see if she could “find a way back” to her marriage of 20 years. A week earlier, her husband had confided in her that he had been unfaithful to her for 5 years. This news had shaken her to the core, leaving her in a desolate place where she wondered what was true and untrue in her life. Her husband wanted to reconcile with Valerie, but she questioned whether she could do so. While she was unsure if she could go forward in the relationship with him after the affair, she was sure that she needed to talk about her own unhappiness, no matter what happened in the future. She said she was filled with rage over the affair, something that she had never felt in her life. Yet, she was fairly certain the affair was over and believed her husband was sincere in his desire to work things out. nn

THE SEARCH IS ON . . .

Clients like Valerie frequently seek counseling. Engaged in nonstop storytelling and needing to be heard, such clients blurt out to therapists all the wrongdoing that they feel was done to them or that they might have done to others, as if relaying more details will allow the therapist to help them more. Active listening with these clients is important, because the relationship that is built within the first few minutes 1

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will impact the outcome of therapy. After conducting a meta-analysis of 24 well-designed studies, Horvath and Symonds concluded that “the working alliance was a relatively robust variable linking therapy process to outcomes. The relationship and outcomes did not appear to be a function of type of therapy practiced or length of treatment” (as cited in Singer, 2006). However, during the client’s early introduction of problems, many therapists feel a need to jump in and offer aid too quickly, thinking that without a life preserver from the therapist the client would surely drown. The therapist may quickly conjure up what the client must focus on first. While well-intentioned, a too-quick observation on the therapist’s part can lead to therapeutic failure, particularly in sensitive situations such as trauma and abuse. The assumptions made by the therapist about what the client needs to do can easily be off target and prolong resolution. According to Michael White, one of the founders of narrative ­therapy, it is more helpful to take a “not knowing” stance: As therapy becomes less accountable to the everyday developments in persons’ lives, and as it increasingly becomes a context for the reproduction of what is “known” by therapists, it fails to provide opportunities for therapists to think outside of what they might otherwise have thought. (White, 2000, p. 201) More often, as White suggests, the client’s answer may not be the direction the therapist might think that the client needs to go. Therefore, not knowing allows a therapist the luxury of not assuming or prejudging what a client needs to achieve. When the therapist sits back and waits for the client to give the directions, the client is given control over the session and leads the therapist down the path that is most helpful, talking about what he or she is ready to talk about and sharing with the therapist his or her goal. Granted, many clients, when asked about their goal through questions, such as, “What are your best hopes?” may reply with “I don’t know, that’s why I am coming here.” Such answers may at first persuade the therapist that, indeed, the client is helpless and has no clue what to do. However, again, if the therapist is patient and asks the “best hopes” question differently, refusing to step in and offer best hopes, the chances of a brief, efficient, and helpful outcome increase, and the client becomes the expert.

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This chapter describes how to introduce a new model (such as solution focused narrative therapy) to clients that encourages them to look at their “presentation” of the character that appears in the stories that brought them to therapy. Through a blend of solution focused and narrative questions, the therapist seeks new presentations that will lead to new results for the client—without knowing anything about the problem that brought that client to therapy. Later in this chapter we revisit Valerie’s case to learn how she formulates her new solution and new direction. First, however, it is important to explain how this postmodern approach to therapy differs from the modern approach, and the benefits of utilizing it with clients like Valerie. nn

FROM MODERN TO POSTMODERN: SEEING CLIENTS AS EXPERTS

For years, the modern approaches to therapy were sufficient for most clients who desired an understanding of their problems. These approaches proposed that explaining why problems occurred would benefit the client, who would come to understand why such occurrences were happening. Clients listened as modern therapists created ideas and suggestions for making their lives better after insight was recognized. However, the length of the therapy and, often, the distress involved in going backward and getting to the root of the problem slowed the process and delayed the desired outcome. Further, by revisiting negative experiences related to the problem, clients not only became stuck in problem-focused thought, but dependent on the therapist and, in some cases, retraumatized. The postmodern approach gained traction in the 1970s with evidence that it could cut down time in the therapy room by promoting strengths and abilities without digging deeply into the lives and experiences of “wounded” clients. By following whatever the client desired to accomplish in therapy, rather than what the therapist thought the client needed to accomplish, therapy became briefer and clients more empowered. Research done by proponents of the new, postmodern models showed that such approaches are successful and have long-lasting effects. For example, while researching the effectiveness of solution focused therapy, Gingerich and Peterson (2013) conducted a qualitative review of 43 controlled outcome studies on solution focused brief therapy (SFBT) and concluded that SFBT is an effective approach for many different psychosocial conditions with children, adolescents, and adults. Evidence from the studies also indicated that SFBT is especially efficacious for adults with depression.

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Thus, postmodern models developed as an alternative to f­ ocusing on problem-saturated stories and spending time uncovering the reasons for the stories. Instead of doing more to understand or assist a client who is downtrodden by problems, the postmodern approaches tend to dissuade rescue by the therapist based on a strict belief that, even though the client seems to be feeling miserable, he or she is indeed competent and must guide the therapist toward a desired outcome. For instance, narrative therapy focuses on deconstructing the problems that clients bring to therapy and examining how the client’s personal values could be more helpful in constructing new, more productive stories. In contrast, the solution focused approach focuses on getting a “contract” from the client, which is client generated (H. Ratner, personal communication, June 2016). The job of the therapist becomes that of almost coaching the client to realize and then verbalize what he or she wants to accomplish in the contract during the therapy process. When seeking the client’s desired outcome or preferred future, a blend of both models is used to identify (a) what the client wants out of therapy (contract) and (b) what the client values as important in his or her life. Therapists using these approaches realize that when clients are experiencing new actions that are in agreement with their values, the chances of follow-through are better. In the opening case, a modern therapist seeing Valerie as unhappy with her marriage might encourage her to revisit her decision to work things out with her husband, who was unfaithful to her. Another modern therapist might spend time talking about the hurt that Valerie was feeling, reflecting back to her the feelings she was experiencing. There might even be strategizing on how to talk and deal with her children. Some clients may go along with such direction from a therapist, but, if the client’s needs and desires are not being met by the therapist, the chance for follow-through diminishes. In Valerie’s case, when she was given the chance to indicate which way she wanted to go, she chose to rebuild herself rather than to leave her marriage, and to change how she interacted with her children. While not all therapists would agree with her choice, as a postmodern therapist, I embraced her preferred future and took it as our contract for working together. nn

POSTMODERN MODELS AT WORK

The model presented in this book is a blend of two postmodern models, narrative therapy and solution focused therapy. We explore this

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combined approach by looking at some attributes of each model and then seeing what they look like blended together.

Narrative Therapy Developed by Michael White and David Epston, this model ­evaluates discourse, clients’ thoughts and behaviors in the context of their c­ ultures and social environments, in regard to the story they have ­constructed for themselves. This story is regarded as the entry point for bringing about change. White, in his introduction to Narrative Means to Therapeutic Ends, says, I have been interested in how persons organize their lives around specific meanings and how, in so doing, they inadvertently contribute to the “survival” of, as well as the “career” of the problem. And in contrast to some family therapy theorists, rather than considering the problem as being required in any way by persons or by the “system,” I have been interested in the requirements of the problem for its survival and in the effect of those requirements on the lives and relationships of persons. (1990, p. 3) Therapists using this model seek out gaps in the problem-­ focused story (exceptions) and invite the client to understand those gaps in terms of meaning and values in relation to the problem-­ saturated story (M. Hayward, personal communication, June 2016). During this process, clients may find themselves understanding their values for the first time, and how, when their values are not honored in their lives, problems grow and become roadblocks to satisfaction. Clients are then invited to apply their true values to re-author their lives. That understanding and reclaiming of personal values helps the client construct a new, future story in the best possible way. The job of the therapist is to facilitate a discussion so the client can write a new story, using only the client’s chosen characters, plot, and desired outcome, filled with detailed features that exemplify the client’s desired character. This type of exploration will provoke change not only in the client, but in others with whom the client interacts. Thus, those clients who come to therapy seeking to change a spouse, child, work colleague, or friend may begin to see that while their current presentation impacts the responses they receive, a new presentation may change those responses.

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Solution Focused Therapy Initially termed “solution focused brief therapy” due to its brevity, this model focuses on clients creating their own solutions to problems, rather than understanding how their problems come about. The inspiration for the model emerged as Steve de Shazer and his team at the Brief Family Therapy Center in Milwaukee reviewed their therapy sessions, seeking to understand how their work was helpful. They recognized that p ­ ositive results occurred when clients were given the opportunity to reflect on times when they had devised solutions to problems successfully. There was a departure from the problem-solving, problemfocused approach from which this model emerged to an emphasis on solutions and how they worked. The team moved from a focus on identifying the patterns of interaction around the complaint in order to interrupt the problem sequence, much as the MRI [Mental Research Institute] tradition, to a focus on identifying what has been working in order to identify and amplify these solution sequences. (de Shazer, 1982, 1985, as cited in O’Hanlon & Weiner-Davis, 1989, p. 21) The focus on creating solutions occurs through seeking exceptions, or times when the problem occurs less often. Rather than talking about the presenting problem, the therapist guides the client toward seeking out a preferred future. The client is encouraged through questioning to identify a preferred future, noting what the client wants different and in what context. Inquiry focuses on how others will see the client when he or she begins to make changes, and on how others will be affected by the client’s change. After such a rich identification of the preferred future, or goal, the therapist becomes a sort of tour guide, helping the client construct how and when to approach the preferred future, slowly and efficiently, using the identified exceptions. nn

APPLYING THE BLEND OF IDEAS TO VALERIE’S CASE

The postmodern therapist moves into a therapeutic situation quickly, by carefully listening to clients such as Valerie talk for several minutes, then respectfully asking, “What are your best hopes for our time?”— and gently staying persistent until the client gives the directions that are the most helpful to her. The beginning of therapy in the first session

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is crucial to the process and success of therapy. In Valerie’s case, when I asked about her “best hopes” (George, Ratner, & Iveson, 2016) she replied, “I want to rebuild myself.” The next section explores how Valerie’s desired direction took her into “deconstructing” (White, 2011, p. 151) who she was currently portraying, and constructing (solution focused) who she wanted to be as she interacted with the others in her life. nn

REBUILDING A NEW PRESENTATION

With Valerie’s direction to “rebuild herself,” we spent time during that initial session talking about what it would look like someday when she had rebuilt herself. She told me that she would appear stronger, more interesting, and more attentive to her husband, who had told her he had felt disconnected from her over the past 5 years. As Valerie talked and shared more of her story, she admitted that during this period, in which she also felt the disconnection with her husband, she had been overly focused on her daughter, then age 12, who had an eating disorder, and her son, then age 8, who had been acting out at home but not at school. She recognized that she had not been the partner that she wanted to be to her husband. While not taking blame for her husband’s infidelity, she admitted that she had been missing out on the relationship as much as her husband said he had. Although Valerie expressed guilt about what was going on at home, we continued—without dissecting her guilt or wondering about the cause of the issues with her children or husband—to define what rebuilding Valerie would look like. To do that, I was interested in the current, present Valerie as she and others described her. In working with clients in unhappy relationships, it has been my experience that those who come to therapy alone often yearn to fix the other person so things will get better. As a family therapist who thinks systemically, I see a better chance for change in others when the client makes changes. So, in an effort to begin deconstructing the problem and aspects of the client’s current presentation that aren’t working, I often ask permission from my clients to ask questions like the ones I asked Valerie during our first session. David Epston has been known to write letters of invitation to clients that he felt were reluctant to engage in therapy (White & Epston, 1990, p. 84). I have found that invitations to the therapy room keep clients in the expert role and give them a chance to accept the process.

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Invitation: “Would it be alright if I asked you a tough question?” Question: “If your husband and others close to you were here today, how would they have described you over the past 5 years?” It is important to stay respectful of the client during this information gathering, as this process can be difficult. The question is often received with a sigh, and then recognition, as negative traits, habits, descriptions, and actions come flowing out with regret and acknowledgment. While I am not seeking to take my clients to a negative place by creating a list of their shortcomings, I think deconstructing the current presentation helps them to see the part they might play in the problem story. This process also helps them to identify which of their values they have not been acknowledging through actions during the current episode. Therefore, in this part of the session, we construct a long list of how the client has been portraying himself or herself to others. As the client responds, I am able to compose a list of items that the client dictates to me, continuing to ask each time, “What else?” The list serves as a description of the character in the problem story and seems to solidify for clients the realization of whether the actions, consequences, and responses (except for violence) they receive portray who they really are in regard to their values. I learned about writing lists from the practitioners at BRIEF Therapy Practice. They used lists as a means to gather from clients how they viewed change in their preferred future. In this part of therapy, I ­compose many lists. The following is Valerie’s list of descriptions conveying how she felt her husband, children, and others saw her currently: Distant Unhappy Uninterested Cold Depressed Irritable

Disengaged Dismissive Too independent Too focused on the kids Inattentive to husband “Somewhere else,” mentally

After Valerie and I looked over the list together, we discussed whether the traits she was displaying to those she cared for represented who she was and what she stood for. Did they reflect her values about

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relationships? She said she was much more of a quality person than she was presenting to her husband and children. That’s where the word “rebuild” surfaced again, as Valerie stated that it was time to rebuild herself. The realization that comes from seeing these descriptions on paper, in a list (which is given to clients at the end of the session along with another list, described later), seems to lessen blame on others and help clients seek out personal resolution for their unhappiness. When the therapist then asks whether the list reflects their values and beliefs, clients become motivated to reclaim their role in a story with the correct presentation. It is always a joy at this point to ask a question that will generate a new list: “How would you rather people see you instead?” As a result of being asked this question, clients typically sit up, become more assertive and confident, and tell me how they want to project themselves. I simply write down their answers, which often come very fast, almost as if they want to dig out of the story immediately. I continually ask them, “What else?” As I asked Valerie this question, she brought up the fact that she worked in marketing. Narrative therapy suggests that “double listening” (White & Epston, 1990) is a premier opportunity for the therapist to learn about a client from both sides: what’s working and what is not working. A narrative perspective assumes that a person’s life can be viewed as multi-storied (White & Epston, 1990). Expressed more simply, there are many stories that a person can tell about one’s life. The principle behind double-listening is that it opens spaces for the telling of both the trauma story and the response to trauma. This form of enquiry does not necessarily privilege the negative effects of trauma but, rather, approaches a person’s story and history as an opportunity to explore multiple paths. From this perspective, it is possible to trace further within a person’s response(s) to trauma the transformative initiatives, special skills, and values and beliefs that have strengthened their forms of resilience and resistance to traumatic experiences. (Denborough, cited in Marlowe, 2010, p. 43) When I get to know clients in the initial session, I listen closely as they talk and try to learn what they do for a living. I also am curious about what they do well in their profession. These are the layers

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of the story that provide me with what is important to clients. Double listening gives me more l­ anguage to use and more information on their strengths, values, and what is meaningful to them in their lives even when troublesome times interfere. When I asked Valerie how she preferred to present herself, she mentioned that she was good at developing new brands. As we looked at the first list, I asked Valerie, from a marketing perspective, “how such a ‘brand’ would be received in a relationship or anywhere else that she desired?” When Valerie heard the question, she frowned and said, “I wouldn’t want to spend any time with that person!” I then asked her another question: “So, instead of that ‘brand,’ what kind of brand or description would you rather present to relationships?” Her answers became list two: Attractive Interesting Interested Focused Affectionate Smart

Engaged Fun Flexible Reflective Calm Balanced

From that point, the idea of creating a new “brand” made great sense to Valerie. She said, “No wonder I am unhappy with my life . . .  I am not living it the way that I want to live.” She said, “The idea of a brand makes really good sense to me. That is my language, my world.” We continued the rest of the session making a second list and I asked her, “Tell me what it will look like in the near future when you are beginning to achieve this new brand. What actions would you and others notice?” These solution focused questions developed answers that became the foundation for Valerie’s “new brand.” At the end of the session, we went over the second list and I complimented her on the creation of a new brand. I made copies of the two lists and presented them to her before she left. I did not give her any directions, as I trusted that she would choose which list fit within her goal of rebuilding. I then asked Valerie a typical closing question that I use when ending each of my sessions: “What did we do in here, if anything, that might have been helpful to you?” (Metcalf, Thomas, Duncan, Miller, &

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New Presentation

New Actions

Attractive

Take time to look good at home as well as work.

Interesting

Talk about some projects with my husband that are exciting.

Interested

Get into my husband more.

Focused

Set times to spend with my husband and kids away from work—sometimes I keep working when they are there.

Affectionate

Show my husband that I love him when he comes home.

Smart

Take part in conversations, maybe even start them.

Engaged

Initiate some quality time with my family.

Fun

Get back into running again.

Flexible

Change plans, be spontaneous for a change.

Reflective

Take time to be alone and think of what I do have.

Calm

Take a time out before starting an argument with my husband.

Balanced

Divide up my day so that I do things for myself so I am all of these things.

Hubble, 1996, p. 337). She smiled, got tearful, and said “I now have a direction. I should have thought of rebuilding my brand before. That is my language. I realize that how I present myself, like any campaign, gets me positives or negatives.” nn

ADDING NOTEWORTHY ENCOURAGEMENT

After the session, I wrote Valerie a letter, which I see as an extra support or encouragement for clients. Michael White talks about the power of the written word, particularly when the words are that of the client. “Sometimes some of my most interesting thoughts and most important questions occur to me after the end of a session . . . the feedback that I have received suggests that persons do find it helpful to have these questions before their next meeting” (White & Epston, 1990, p. 109). The note that I wrote to Valerie follows. I have combined both the narrative therapy approach of building on the client’s language and meaning and the solution focused approach of noticing exceptions.

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Dear Valerie, The opportunity to rebuild yourself as the woman you want to be seems exciting to you. I can’t help but wonder what the response will be when you are presenting the woman you want to become to others. I look forward to hearing about your experiences as you begin to incorporate your new brand into your life. You are, after all, a master of creating new brands. Linda nn

THE NEW BRAND SELLS

When Valerie returned the next week, she immediately began talking about her “brand.” I asked her a solution focused question, “What’s better since we last met?” and she replied: “My tone is different at home.” “I set some rules for me, boundaries for me.” “I feel more confident and notice that the more confident I am; the more confident Alan is.” “Time with my husband has been better.” “I am focused at work.” “I seem to be better at switching off the rage.” “I have been telling Alan what I want . . . that’s different.” I kept asking Valerie, “What else is different, from your family’s perspective?” As a result of her new presentation, Valerie said her children seemed to notice the change as well. The daughter, according to Valerie, seemed to be showing signs of improvement with her eating disorder. Her son, while still acting out occasionally, found his father disciplining him for the first time in a while. Valerie said she felt more like a team mate, which seemed to do wonders for Valerie and the relationship with her husband. Her son, apparently seeing his parents’ alliance, began to back down from his complaints and upsets more readily. I continued to see Valerie for three more sessions and once with her husband, Alan. She began to consult with herself when she felt down and kept on processing her thinking, and developing a plan prior to talking to Alan. As a result, Alan began to open up to her about things that had bothered him for years. Their sex life improved and a renewed

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commitment replaced distance between the couple. There were still times when “the other person” appeared in Valerie’s mind, but she said on her last visit, “It’s time to put her away, like an old book.” At a 6-month follow up, Valerie was doing well. She and her husband began to take weekend trips, her daughter continued to get better, and her son became more respectful. When contacted, she said, “I like my brand and so does he.”

nn

THE POWER OF REDESCRIPTION

Many clients come to therapy with a “script” or label of themselves that undermines any possibility of progress, and a narrative that ­supports the label. With the fixed mindset, change in thoughts and emotions leading to new actions are difficult, if not impossible, to achieve. For example, if a client comes with a diagnosis of bipolar disorder and seems crippled by the label, I might suggest that bipolar disorder may be just one description, and invite the client to think about additional descriptions that might apply. Clients are intrigued by this suggestion, and the majority are pleased to suggest another description. “Redescription,” as White and Epston called it, and as I demonstrated with the process I took Valerie through, invites clients to describe themselves differently, thereby freeing themselves of labels imposed by others and providing them with a vision of themselves they can feel empowered to embody. Through redescription, a therapist can step into the worldview of the client and walk alongside the client, in order to view a map of the client’s life and learn how the client is storying his or her life. When working with Valerie, I used the powerful ideas behind redescription. In the process of entertaining and responding to these questions, persons derive new and unique redescriptions of themselves and of their relationships (White, 1988). Unique redescription questions can also assist persons in the revision of their relationships with themselves, in the revision of their relationship with others and in the revision of their relationship with problems. (White & Epston, 1990, p. 41)

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I use the technique of redescription to help clients describe how they present themselves in their world, understand how that might have a ripple effect, and proceed to generate a new self-concept and improved relationships beyond the clinical setting. The solution focused therapy and narrative therapy blend allows the therapist to guide the client out of the problem-focused story, using the client’s own language and goal, toward a different vision of himself or herself, gently, and with suggestions such as: “I wonder what it will look like someday when others see you as you wish to be seen.” “I am impressed with the value that you put on relationships and wonder where that value came from. How has that value helped you choose other actions in other situations? How will that value help you now in seeing your own direction?” “How would you imagine it if, just for a week, you presented these values when you interact with your husband or kids?” (M. Hayward & A. Redstone, personal communication, June 2016) “What will others begin to see as you focus on presenting your values as the person you want to be?” “What difference will these actions make for you? For others?” (H. Ratner, personal communication, June 2016) Notice the respectful stance of the therapist in these questions, and the confidence portrayed by using “presuppositional questions” (O’Hanlon & Weiner-Davis, 1989, p. 79). The presuppositional language in the questions, such as, “How will others see you?” and “What difference will the actions make for you?” provide a gentle coaxing of the client to do what works for him or her. There is a marked difference in asking questions this way instead of, “So, do you think others will see you differently?” or “So, do you think there will be a difference when you take these actions?” The last two questions are not nearly as supportive or motivating. The presuppositional l­ anguage questions assume that change will happen, whereas the latter questions do not. nn

USING REDESCRIPTION TO CREATE NEW PRESENTATIONS

Using narrative therapy’s idea that people can recreate who they want to be or even uncover who they really are is invigorating in a session.

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Almost like a blood transfusion, it allows the client to feel alive, heard, respected, and motivated to create and achieve a “presentation” that is more representative of who the client is. The presentation involves how the client interacts with others, goes about his or her day with a new, preferred future as a goal, and presents in a way that represents better who he or she is. Thus, the values and meanings that a client may live out through the new presentation (a sort of vehicle) becomes more satisfying and productive, as it taps into what makes sense to the client. The solution focused approach then provides the wheels for the new presentation, as it rolls into action with action oriented ideas for trying out the presentation over the next few days. The redescription exercise I used with Valerie helped her to see her current presentation that was not working for her, and her relationships, and to develop a new presentation that was more representative of herself. Because it made sense to her in terms of her profession, and since she developed new brands as part of her job, the word “brand” was used repeatedly. To recap, Valerie presented her best hopes, described her current presentation, and rebuilt her new presentation. The redescription, which led to the new presentation or brand, led Valerie to see her part in how her latest story had developed. In most cases, the idea for constructing a list of traits of the current presentation can amount to as many as 20 items, if not more. Each time the therapist asks “What else?” the client seems to go deeper and the discourse is further unveiled. The construction of a second list, describing the client’s new presentation that will enable him or her to carry out the preferred future more efficiently, allows the client to use those values in new actions, which again enables the client to be in control of authoring the new story. Where there is a connection between a client’s values and actions, there is diminished distress. nn

RESULTS OF THE BLEND

When the solution focused model is blended with narrative therapy and the redescription creates new presentation in the second list, clients generate alternative actions of living out their story as a new character. They remain the expert throughout the dialogue and decide how and when to implement the new, alternative way of being with others portrayed on the second list. Cautioned to go slow, typical of solution focused work, clients tend to move quickly, almost with a mental reminder

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of “this is who I wish others to see and I want them to see it soon.” The narrative of a follow-up letter, which is often sent after a session, reminds clients of their words in the session and provides support between sessions. There will be more information on note and letter writing in later chapters. nn

SUMMARY

This chapter explored how Valerie became aware of her problem-­ saturated description and presentation to others, which helped her to see a need for a new presentation that would provide her with a new sense of control over others’ reactions to her. The chapter showed how the narrative approach helped Valerie to reconstruct a new description of herself. Valerie took successful actions using the idea of a new “branding” for herself, similar to the way in which she conducted her advertising business. The next chapter further explains the meld of the two approaches into a new model. Combining two established models, this approach provides ideas for identifying meaning and values (narrative) that guide clients to identify their strengths (solution focused) during the midst of a problem-saturated story. The two models complement each other and work together in the following manner: •

Both models encourage clients to discover exceptions (solution focused) and then identify how those exceptions exemplify their true values (narrative).

•

Both models encourage clients to uncover the images that their problem-saturated actions convey to others (narrative) and provide them with a chance to reinvent new presentations that personify their true self, that may increase their chances of reaching the preferred future (solution focused).

•

The narrative model invites clients to construct a new presentation in a problematic story (narrative) and develop a script for a preferred future (solution focused), with a newly crafted character, instigating new strategies for actions (solution focused), based on exceptions.

To conclude, new story development assists the client and t­ herapist in looking at the map of the client’s life and the gaps in a problematic story, providing hope and uncovering exceptions. The narrative

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therapy model provides a new mirror into which the client may gaze to see which personal values and beliefs can assist him or her in creating a new image, or presentation, and which may be edited out. Solution focused therapy provides the questions that elicit actions that assist the client in choosing a path to resolution. nn

PERSONAL EXERCISE

When I conducted research for my dissertation, I had many questions about what caused change in clients. Was it the brilliant intervention of the therapist, the client’s competencies, or both? I wanted to know if what clients thought led them to change was the same as what therapists thought caused them to change. I chose to do my research at Brief Family Therapy Center in Milwaukee, where Steve de Shazer and Insoo Kim Berg created SFBT. The result of my research was the development of a question that I ask of every client, every group of students I teach, and every group of trainees: “What, if anything, did we do today that might have been helpful to you?” The answers I receive each time are often unpredictable, validating, and provocative! I value very much the answers I receive, because every answer prepares me for my next question or endeavor. In other words, the model presented in this chapter is not useful just for our clients; it can also be useful for us as therapists. The exercise that follows will assist you in seeing yourself through your client’s eyes so that you, too, will be presenting yourself in a manner that works. Think of a recent case where you felt good about the outcome and so did the client. If the client were sitting next to you now, what would the client say you did that might have made a difference? What else? List at least 10 items that you think the client would say you did. 1. _______________________________________________________ 2. _______________________________________________________ 3. _______________________________________________________ 4. _______________________________________________________ 5. _______________________________________________________ 6. _______________________________________________________ 7. _______________________________________________________

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8. _______________________________________________________ 9. _______________________________________________________ 10. _______________________________________________________ What values do you think you embraced as you worked with the client? ______________________________________________________________ ______________________________________________________________ If you were to integrate what worked with the recent client with more clients, just for the next week, what difference would that make for you as a therapist? ______________________________________________________________ ______________________________________________________________ Task: Choose a few clients over the next week and ask them this question at the end of each session: “What did we do in here today that might have made a difference for you?” Enjoy the answers.

REFERENCES de Shazer, S. (1982). Patterns of brief family therapy. New York, NY: Guilford Press. de Shazer, S. (1985). Keys to solution in brief therapy. New York, NY: W. W. Norton. George, E., Ratner, H., & Iveson, C. (2016). BRIEFER: A solution focused practice manual. London, England: BRIEF Therapy Practice. Gingerich, W. J., & Peterson, L. T. (2013). Effectiveness of solutionfocused brief therapy: A systematic qualitative review of controlled outcome studies. Research on Social Work Practice, 23(3), 266–283.

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Hayward, M., & Redstone, A. (2016, June). Texas Wesleyan University Study Abroad: Narrative therapy presentation. BRIEF Therapy Practice, London England. Marlowe, J. (2010). Using a narrative approach in double–listening in research contexts. The International Journal of Narrative Therapy and Community Work, 2010(3), 41–51. Retrieved from www .dulwichcentre.com.au Metcalf, L., Thomas, F. N., Duncan, B. L., Miller, S. D., & Hubble, M. A. (1996). What works in solution-focused brief therapy: A qualitative analysis of client and therapist perceptions. In S. D. Miller, M. A. Hubble, & B. L. Duncan (Eds.), Handbook of solution-focused brief therapy (pp. 335–349). San Francisco, CA: Jossey-Bass. O’Hanlon, W., & Weiner-Davis, M. (1989). In search of solutions: A new direction in psychotherapy. New York, NY: W. W. Norton. Singer, R. (2006). The therapeutic relationship is the most important ingredient in successful therapy. Retrieved from http://www .selfgrowth.com/articles/user/14203 White, M. (1998). The process of questioning: A therapy of literary merit. Adelaide, Australia: Dulwich Centre Publications. White, M. (2000). Reflections on narrative practice: Essays and interviews. Adelaide, Australia: Dulwich Centre Publications. White, M. (2011). Narrative practice: Continuing the conversations. New York, NY: W. W. Norton. White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York, NY: W. W. Norton.

CHAPT ER 2 Solution Focused Stories If everyone is moving forward together, then success takes care of itself. —Henry Ford

In this chapter I discuss some of the basic ideas that I drew upon while blending the solution focused and narrative therapy models. This combined approach seemed to facilitate helpful conversations, filling them with rich dialogue, unique descriptions, and actions. In this way, many ideas that are integral to both are reflected in questions and subsequent conversations. nn

COMBINING STRENGTHS OF BOTH MODELS

The solution focused approach stems from a belief that when clients are given a context where they can recognize their strengths, abilities, and successes, they are able to not only discover their competence, but can carve out a preferred future where the problems that interfere in their lives occur less often. In this process, the therapist sees the client as the expert, and asks questions of the client that stimulate the client’s thinking about his or her future vision. The therapist is, in fact, “responsible for the client’s participation in answering the questions” (C. Iveson, personal communication, 2015). The client is likely to answer questions that pertain to his or her best hopes, being thoughtful and descriptive while answering the questions that are tailor-made by the therapist, who weaves in the client’s language and direction. If a client does not 21

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respond to the questions asked initially, the therapist must reexamine the approach. If resistance occurs, it is believed to be caused by the therapist working on something other than the client’s goal, and it is the therapist who must readjust to what the client wants to achieve to avoid a recurrence of resistance. This is done by the therapist simply asking the client whether or not they are discussing what the client wants to discuss. The sessions will look different for every client, as it is believed that each client has a unique vision of what he or she wants to be different. The sessions keep a focus on where the client is going, rather than where the client has been. This way of working is integral to the solution focused approach, and many of the questions, such as “the Miracle Question,” are used to assist the client in formulating what his or her preferred future will look like. The miracle question can be presented as follows: “Suppose that one night, while you were asleep, there was a miracle and this problem was solved. How would you know? What would be different?” (de Shazer, 1988, p. 5). After the goal of the client is defined by the client through the Miracle Question and the preferred future is richly described, the therapist assists the client in identifying times when small pieces of that preferred future have already happened. Answering the “­exception-seeking” questions “directs the client to search in the present and the past rather than the future for solutions by focusing on those times when clients do not or have not had their problems even though they expected they would” (O’Hanlon & Weiner-Davis, 1989, p. 24). The answers to e­ xception-seeking ­questions help the client build confidence to construct part of the preferred future by referencing past exceptions. The solution focused therapist might also bypass the exception-­ gathering questions (E. Connie, personal communication, 2015), and instead continue to get a clear view of the preferred future instead of pursuing exception gathering. This direction is determined by the conversation and the goal of the client. It is the description of the preferred future that constitutes the intervention. Stating the goal of therapy is so crucial that taking as much time as needed to construct a specific goal is encouraged, even if the presenting problem is not included in the goal. For example, a family may enter therapy because a spouse is concerned about her partner’s drinking habit, which has caused him to lose jobs and be distant at home. When everyone is asked by a solution focused therapist, “What are your best hopes for your family?” the replies may vary considerably. The therapist

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should take note of every best hope and then ask the family to guide him or her through the therapy process by then asking: “So, supposing that these best hopes begin to happen, what would each of you begin to see in your family life that you would appreciate?” The answers probably will be very different. It will be the job of the therapist to assist the family in talking about where to begin, or whether they hear a major commonality in their best hopes. If the issue of the partner’s drinking does not come up, the therapist should not bring it up. When I have worked with such families with similar issues and the best hopes include better communication, more time with each other, less yelling, more involvement, and so forth, the task becomes that of achieving these actions, and drinking will prove incompatible with achieving them. The narrative therapy approach also focuses on the belief that a person’s perception of himself or herself results from many things including the person’s values, the values of others, the present context, or the story that is in place. The context, or story within which the problem exists, influences how the person interacts with others, senses her place in the world, and leads her life. For example, I worked with a couple who sought counseling to improve their communication with each other. The couple had difficulties resolving conflicts that often led to arguments. The wife wanted to learn new strategies to reach her husband who had difficulties listening to her and often left the room during an argument. Her husband told me that he could not listen and had to leave the room during an argument because he had been given a “bipolar and ADHD diagnosis” that prohibited him from focusing. The story he’d constructed around the diagnosis kept him from seeing himself as competent. Given that context, as a therapist, I needed to seek out, along with the client, an alternative story and redescription that would free him from the restraints of the labels he had been given. Here is another example of how discourse can dominate a person’s life. The wife has been given a “victim” label and is not able to see her strengths due to the discourse of victimhood. Instead of seeing herself as a survivor of a challenging situation, she sees herself as helpless and not worthy of a good life or good relationships. Such beliefs foster negative feelings of isolation and sadness. The therapist in that case can assist the client to change the context of how she views herself through r­ edescription and discovering gaps within the problem story of herself as a victim. The therapist then helps the client to begin re-storying, or creating a new chapter, moving past old stories with client consent, that did not contribute to a satisfactory life into one where the client is the author of a better life.

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This redescription seems to help the “helpless client” to consider herself as “able” and the new vision catapults the client into new possibilities for the future. Additionally, the meanings and values identified by the client as important help the therapist in creating questions, using client language that indicates how those meanings and values have played out in old stories that worked. The new, preferred story is then crafted by the client to include the values of the client, which is more likely to match who the client is and wants to be in the future. The blending of the two models, described here, along with their similarities and unique differences, has resulted in a practice that is both meaningful and action oriented. I refer to this new model as solution focused narrative therapy (SFNT). nn

GUIDING CONSTRUCTS OF SOLUTION FOCUSED NARRATIVE THERAPY

To clarify how the blended models work together, I have summarized several commonalities and unique ways of working in SFNT. This provides a practical framework for employing SFNT with clients. Construct 1. Invite clients to see the events in their lives as chapters. Some chapters are successful and others are not as successful. Those successful chapters are “gaps” in the problem story, or exceptions. Therapy should focus on those times, as they can reveal client competencies and presentations of the client that worked. Invite clients to step out of the dilemmas and crises of the current chapter into a new chapter, and develop a new presentation to present to others so that they receive new results. Construct 2. Assist and encourage clients to seek out successful events, and identify the clients’ beliefs and values during those better times. Learn the context that assisted the client at that time, including those persons in the client’s life who supported the successes of the client. Find out what those persons did for the client to support the client’s values that made the difference. Construct 3. Integrate complaints as situations that interfere in a client’s preferred life, rather than diagnosing the client. Align with the client against the complaint, externalizing it. When clients complain about others and how others have wronged them, take an empathetic approach and sensitively wonder which traits they might have presented on that day that did not get them the responses they wanted. Then, help the

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client to recall traits from successful times that could construct a new presentation. NOTE: When working with clients who experienced physical or sexual abuse, it is important to not present the idea that the clients did anything to provoke or cause the abuse. Instead, it is more helpful to empathize and then assist the clients in recognizing what they did deserve in that context, and help prepare them to represent themselves in the future with that belief. Construct 4. Write down all the key words that clients use during the session, and use those words while talking to them. For example, Valerie was interested in marketing and when she described her work in branding, it made perfect sense to her to use the word “brand” for herself. Listen very closely for language and use it in the dialogue. Clients give us “gifts” of language that we can wrap up into questions later. Construct 5. Follow wherever clients want you to go in therapy and refrain from assuming that they are avoiding the real issues. Honor their decision to focus on a goal that they think is important, rather than what you think they should address. This builds trust with clients and helps them feel comfortable. It will expedite success and movement in therapy. Construct 6. Capitalize on successes in clients’ work, hobby, or profession that can metaphorically lead to solutions in other areas when you identify the specific skills associated with their successes. Those times of even the smallest successes can also be the gaps in a problem story that can be expanded and amplified. Construct 7. Through questions, promote the idea to clients that the problem-saturated map they are focusing on is full of “tributaries” of success that are often too small to see from a distance. Your job is to help the client discover them close up. Listen closely for the successes . . .  sometimes they slip by. Listen for phrases such as “The only time it didn’t happen,” or, “It wasn’t as bad last week,” or, “He bullied me twice before I responded” which all represent gaps in a problem story. Construct 8. Promote hope by suggesting that clients “forgot” to be competent, assertive, or responsible during problem-saturated times. This description lessens their tendency to feel like a failure and invites

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them to step back up the stairs of success more easily. Ask clients what it will look like when they are able to remember better strategies next time. Construct 9. Avoid revisiting traumatic events, because there is a risk of re-traumatizing clients when doing so, and that could be harmful. Instead, build on clients’ resiliency, even if they have difficulty recognizing themselves as resilient. Do allow clients to discuss how a trauma has robbed them of a life they desire without going through the details, building a case against the trauma so they may banish the trauma from their everyday living. Construct 10. Instead of praise and compliments, be enamored with client successes, resiliency, and exceptions, and respond by asking, “How did you do that?” Take the stance of honestly being intrigued that clients could be successful in times of distress and challenging circumstances and ask them to tell you how they managed to make it through. Keep in mind that this may be a struggle for some involved in a problem-saturated story. Stay vigilant and keep asking until you get information. Construct 11. Take a not-knowing stance. Gather very little history prior to the session and during the session and avoid asking or even knowing about a diagnosis if possible. This will allow you to see the client as a competent human who is simply stuck in a problem-saturated story, yet present in therapy because he or she wants change. Always begin a session with “What are your best hopes?” The less you know, the fewer assumptions you will make. Construct 12. Hear every goal the client provides you with as one that will make a difference for the client, no matter how unrealistic it may sound. Never respond with, “Is that realistic?” Instead, ask, “What difference would that make?” and keep asking that question until the client provides a goal that is specific and doable in the moment. For example, if a child answers with, “My parents will be back together,” ask, “What difference would that make?” until the child gives a goal that is more generic and workable. The goal will come. Construct 13. See your role as one of keeping track of exceptions, meaning, and values throughout the session. Write them down for clients and give them a copy at the end of the session. The exceptions become part

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of the task to reach the preferred future. The notes keep clients focused between sessions. Construct 14. Write a note and mail it to clients using their language, and state how you look forward to seeing them achieving small changes between therapy sessions. In the note, incorporate exceptions and commend them on their quest to achieve their preferred future. Gently wonder how life will be as they explore new ideas. Construct 15. Use the Scaling Question to measure where clients presently are in their lives in reference to the preferred future and to inquire where they want to be when you meet again in the next session. For children, use your hands, opened very wide to represent a 10 and close together to represent a 1. This visual representation helps clients recognize that perhaps they have not been overtaken by the problem as much as it seems and gives hope. Construct 16. Inquire about descriptions that clients or others have ascribed to themselves and seek new descriptions to create new actions. Ask clients for permission to redescribe a label and provide them with one that might help alter the context. Construct 17. When clients talk about what they do not want in the future, which is all too common, ask: “Instead of that, what would you prefer?” Construct 18. If clients want to talk about the past, listen and then ask, “How is this helpful?” The postmodern approach embraces clients showing us where they want to go. If they want to go down problem-focused lane, we need to follow them for a while, and then inquire about how going down the lane is helpful. Construct 19. Ask the Miracle Question to move clients into the preferred future story and get enough specific actions so that they walk out of the office with a blueprint for new actions. Construct 20. Inquire how clients’ relationships might change in the near future when they begin to present themselves differently. Construct 21. Go slowly. Encourage only small changes so that clients experience success.

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nn

PUTTING THE CONSTRUCTS TO WORK

One might compare a narrative therapist to a screenwriter, taking in ideas from the descriptions of the problem-saturated story provided by the client, then identifying gaps in the story and churning out new lines and character descriptions. This screenwriting involves consultation with the client on the revision of the client’s story in order to make the outcome more satisfactory. Used alone, narrative therapy might move slowly, gathering rich descriptions, mapping the effects of the problem, and creating rich dialogues that are useful in preparing the client for a new presentation. However, it may not propel the client into the future as quickly as the client would like. How, then, can the client move forward, with small steps, strategically, so that success is more likely to happen? That’s where the Miracle Question, exceptions, and Scaling Questions of the solution focused approach come into play. Imagine, for example, asking a client who has developed two lists, like those of Valerie in Chapter 1, to consider that a miracle happens tonight while she sleeps: “When you awake tomorrow, let’s say you have chosen one of the lists that we have constructed and decided you want to present yourself in that way to those persons important to you. What would you be doing slightly differently on that day, on a small scale, that would tell us and others in your life that a miracle had occurred?” “How would you imagine the important people in your life reacting to your new presentation?” “How would knowing that your new presentation affected them in that way make a difference for you?” The last example shows the compatibility of blending the two models. After a client has shared the problem-saturated story, learned the effects of the story on his or her life, and then stepped out of the story into a miracle day, the solution focused model adds the opportunity for the client to configure how he or she will begin taking action and imagine what those effects will be like.The two postmodern models, solution focused therapy and narrative therapy, are similar in theory, guided by client language, and enhance each other as they strive to relieve clients of oppressing problems and provide new solutions and an avenue for better living. The result of blending the two models is like being given a paintbrush and two pallets of paint to try out together and blend to fit a

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client’s goal . . . blending therapies for each unique client with a richness in dialogue and new actions. nn

SUMMARY

Solution focused narrative therapy (SFNT) consists of a conversation that solicits the client’s best hopes, enhancing and flattering the client’s experiences of success in the past through co-discovering exceptions with the client, while promoting a rich dialogue around a preferred future or story that consists of the client’s values. This process becomes visual (narrative) and action oriented (solution focused) as a result. It has been my experience that clients come to therapy because some events or actions of others in their lives have begun to intrude upon their preferred life and they want relief. SFNT concentrates on the preferred future context and the effects the problem story have had on the client’s life. This allows the client to recognize the intrusion of the problem and its effects, and then presents an opportunity to choose to create a new landscape of a preferred future based more strongly on his or her true identity. This coming together of values and client, which often have been distanced by the intrusion of a problem, allows personal satisfaction and confidence to be reclaimed. Thus, the problem becomes less active and less intrusive as clients return to their true identity. The therapist may help clients describe a preferred future and then ask them for specific details on what they will be doing, thinking, and believing about themselves in that preferred future, specifically as they move away from the influence of the problem toward the values that are exhibited in the solution. Since the values are reintroduced in the context of the client’s life, he or she is more prone to embrace the possible changes desired. To do this effectively and efficiently, it is helpful for the client to identify or describe what others would notice as he or she moves away from the problem influence. However, this step is not just about getting others to notice. It is about the client receiving feedback, systemically, as a result of the new interactions and responses, that in turn produce new feelings and results. This seems to stimulate and motivate the client to continue. Without the development of a new presentation and trying out the new presentation with the larger system, many therapies fail because the client is thrust too soon back into his or her life with a new and

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unfamiliar strategy. Old behaviors are recalled by those with whom the client interacts, which may prevent them from seeing the change. It is the new presentation that can make the difference, and the therapist can assist the client by ­suggesting that he or she present the new self slowly, yet skillfully, and with care. nn

PERSONAL EXERCISE

How would those who cherish you describe you on days when you are at your best? Make a list of at least 10 traits and attributes that those persons would use to describe you. 1. ___________________________________________________________ 2. ___________________________________________________________ 3. ___________________________________________________________ 4. ___________________________________________________________ 5. ___________________________________________________________ 6. ___________________________________________________________ 7. ___________________________________________________________ 8. ___________________________________________________________ 9. ___________________________________________________________ 10. ___________________________________________________________ Next, think of some current situations that you might be struggling with. Note them here.

What traits on the list might help you to get through some of the confusion or frustration in one of your current situations of concern? As you build new solutions using your own traits, keep in mind that the best solutions are those that mean something to you. Concentrate on those situations first. The rest will follow.

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REFERENCES de Shazer, S. (1988). Clues: Investigating solution in brief therapy. New York, NY: W. W. Norton. Iveson, C. (2015, June). Texas Wesleyan University London Study Abroad: Solution focused therapy workshop. The Abbey Centre, London, England. O’Hanlon, W. H. & Weiner-Davis, M. (1989). In search of solutions. New York, NY: W. W. Norton.

CHAPT ER 3 Action-Filled Narratives In order to carry a positive action, we must develop here a positive vision. – Dalai Lama

This chapter explains the process of SFNT and offers suggestions for the therapist’s use of conversational questioning. As most therapists know, clients do not follow our scripts or templates, so do not be distressed if at first the client is not especially responsive to the new approach, especially if you have been utilizing a problem-focused approach! If you have, it might be helpful to let the client know that you are going to have a different type of conversation in upcoming sessions. I have outlined suggested steps of the SFNT process in the following text. At the end of the explanation is a note sheet, ready to be reproduced and used in a session. The note sheet can be copied for the client to review after the session, if he or she wishes. This practice of providing each client with copies of the case notes that I write in every session while the client talks, has been well received by my clients and keeps me focused on their language and best hopes as I listen to them. nn

SOLUTION FOCUSED NARRATIVE THERAPY: CONVERSATIONAL IDEAS

SFNT therapy comprises six steps, outlined here and described in the remainder of the chapter: (a) best hopes; (b) mapping the effects of the problem; (c) constructing the preferred story; (d) exception gathering: getting distance from the problem; (e) preparing the presentation of 33

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the preferred future and moving up the scale; and (f) summarizing and inviting clients to watch for success.

Best Hopes The therapist begins the session by introducing himself, learning the names of those attending, and asking the same question of all present: “What are your best hopes for our time?” (George, Ratner, & Iveson, 2016, p. 9) This simple question allows the therapist to efficiently learn from the client what will be better as a result of coming to therapy. Some clients respond to the question with answers like: “I won’t be so sad or depressed.” “We won’t fight so much.” “I will get a job and be engaged in life, not stuck.” “Our daughter won’t be starving herself.” These goals must be restated in terms of what the client will be doing in the near future in order for the therapist to become clear on the destination. That process occurs when the therapist asks: “Instead of being as sad and depressed, what would you be doing that would be better for you?” “Instead of fighting so much, what would you be doing together?” “Instead of being as stuck, what would you be doing to show that you are on your way to getting a job and being more engaged?” “Instead of your daughter starving herself, what would she be doing differently?” (George, Ratner, & Iveson, 2016, p. 13) Note the language: the gradual shift that uses the client’s language and then suggests goal setting in a clear, doable manner. By asking “Instead of being as sad and depressed, what would you be doing . . .?” the therapist is inquiring about what the client’s view of progress would look like when the client isn’t as affected by the problem. The word “as” suggests taking small steps, which is much easier to do than changing everything at once. By asking “Instead of fighting so much, what would

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you be doing together?” the therapist’s query elicits what the couple might do to arrive at an agreement. And finally, when asking “Instead of being as stuck, what would you be doing to show that you are on your way to getting a job and being more engaged?” the language orients therapy toward a direction. Also, in this initial part of the session, since the focus is on best hopes, there are no questions about client history. Most solution focused therapists choose the not knowing stance in an effort to protect themselves from any bias or assumptions. Narrative therapists also honor the idea of not knowing and try to move out of the problem-saturated map as well, digging into the gaps of the problem-focused story in an effort to begin recognizing and amplifying better times. The efficiency of the “best hopes” question ensures that the session focuses on what is most important to the client. When there are multiple people in the room, such as in couples’ therapy or family therapy, it is good to get everyone’s best hopes and then ask for guidance on which best hope to begin talking about. It is important to note that there will always be clients who are sent to therapy by others. Those clients may not have best hopes at first, and may respond with “I don’t know.” It is tempting for some therapists to coach the client along in an effort to get the client through an uncomfortable few moments and to offer some direction. It is important that the therapist not suggest topics or goals, as those would be therapist-generated and this approach demands client-generated strategies. So, consider reconstructing questions for those clients in different ways: “So, if your dad were here, what might his best hopes be for us as we talk today?” “If your probation officer were here right now, what would she suggest that we begin talking about?” By involving a significant other in a client’s life, it is sometimes easier to conceptualize what best hopes might look like. This is not limited to probation officers, ­teachers, parents, or spouses. It could also include pets, deceased persons of importance, and others who are important to the client, such as a best friend. For other clients who simply are stuck with the question and feel at a loss in regard to what their best hopes are, the therapist might look into constructing the question differently, as shown in the following text. It is important to recognize that many clients are not used to being

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asked questions about what they want, and simply need time to think. Allow that time and keep asking the question that seeks the client’s best hopes in a multitude of ways. The following questions may assist clients in identifying best hopes when it proves difficult: “So, if you were to leave here today and think the time we spent was worth it, what would we have talked about that made it worth your time?” “Suppose after our time today you leave and think that you have a new idea or two to try out, what could we have talked about that might provide that opportunity to you?” “What do you hope might occur for you as a result of coming here?” “What do your parents need to see so that you don’t have to come to therapy anymore?” Again, the important part is to sit back and not fill in the best hopes for the client. What makes both solution focused and narrative models efficient is the idea that both are based on client-driven goals. Narrative therapy takes into account that the client’s desired story fits his or her values. The solution focused approach insists that the client builds a preferred future in the session. Both models recognize that when a client’s desired outcome is addressed, the process is efficient and new stories can be written more readily.

Mapping the Effects of the Problem The solution focused approach, followed in its purest form, would not attempt the next step, as it involves an examination of the problem’s effects. So, the narrative approach is integrated in at this point of the process. The solution focused approach tends to stay on the best hopes track, identifying clearly and distinctly what the client wants as a result of coming to therapy, and not moving away from the focus of what the client wants for the sake of staying focused on solutions, not problems. While very helpful in most instances, I have found that sometimes there are clients who simply are not ready to completely focus on the preferred future and solution building. They tend to resist talking about a preferred future and seem to be driven to talk more about the issue that is challenging them. In the book A Brief Guide to Brief Therapy (1993), resistance is explained: “Much of what is often defined as ‘resistance’ can be viewed

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as the direct result of a therapist failing to clarify whether somebody is a customer or not and then trying to ‘sell’ something to a person who is currently not interested in buying anything. Alternatively, the person might possibly be interested in buying something but not what the therapist is currently attempting to sell” (Cade & O’Hanlon, p. 53). I have found that resistance decreases when the client gets to talk about how the problem has intruded into his life. According to Michael White, “By inviting persons to review the effects of the problem in their lives and relationships, relative influence questions assist them to become aware of and to describe their relationship with the problem. This takes them out of a fixed and static world, a world of problems that are intrinsic to persons and relationships and into a world of experience, a world of flux. In this world, persons find new possibilities for affirmative action, new opportunities to act flexibly” (White & Epston, 1990, p. 42). This process is particularly helpful with adolescents, who often feel as if everyone just wants them to change, despite the difficulties they are experiencing. Additionally, in family therapy, when I offer the family members a chance to express how a problematic situation affects each of them, many family members are surprised, shedding new light with their contribution to the story. Just listing the many effects of a problem on a client’s life gives the client a reason to rebel against it, and push it away, gaining distance. I consider taking this stance as a means of cooperating with the client and then aligning with them against their problems. By working this way, there is less blame on a person and more motivation to begin gaining distance from the problem. The conversations that follow become less blaming of the person and more of a collaborative conversation about the effects of the problem on each person in the family. To start mapping the effects using this approach, I may begin this way: “Given the best hopes that you have just stated, I am interested to learn how you came to realize you needed something different instead of the problem that brought you here. Would it be okay if we talked for a few minutes about the effect this problem has been having on your life as a family?” This question is often met with nods of appreciation because the pressure is taken off of the client and placed on the problem, thus, externalizing it. “Externalizing is an approach to therapy that encourages persons to objectify, and at times, to personify, the problems that they experience as oppressive” (White, 1989, p. 5). The SFNT process

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proceeds to gather descriptions of the effects of the problem on the ­client’s life or family’s life. As the therapist begins to hear the various effects, there is an opportunity to name the problem, which is an option in this step. Over the past years, my clients have named the intruding problem a variety of titles such as “the girl in the corner” (referring to an eating disorder) or “a black hole” (referring to depression) or “the bus that won’t stop” (referring to anxiety). Children have provided words for problems such as attention deficit hyperactivity disorder such as “electricity” and “energy.” Whatever name the client gives the problem, it is advantageous for the therapist to accept the name and use it in questions as a means of connecting with the client. Additionally, externalizing reduces pathologizing, which empowers and opens up possibilities. The following statements can be used to begin gathering as many items as possible for the list of effects, and includes ideas for naming the client’s issue: “How should we refer to this issue that you have brought today?” “If you were to name the issue or problem, what name or description would you give it?” “Is it OK for me to ask you some questions around [the named problem]?” “Tell me about the impact of the [depression, anxiety, abuse, trauma] on your life. How has it intruded on your ability to function as you want to?” “What else?” (This question may be asked many times.) If a therapist wishes to be more specific, for example, about the impact of a fighting habit, eating disorder, depression, or conflict, the following questions can be asked. Note how the issues have changed descriptions, at the client’s suggestion, and are used to construct the following questions: “Tell me how the fighting habit has kept your relationship from being what you want it to be with your spouse.” “Tell me how the eating habit has tried to rob you of health.” “Tell me how the sadness is keeping you from getting back into the life you want to live.” “Tell me how the unhappy conversations are keeping you and your spouse from moving forward in your life.”

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Note the optimism and hopefulness that subtly characterize each statement, slightly suggesting that the client is unfairly being held back by the problem and deserves a better future. Every question asked or statement made should contain such subtle hopefulness and present the problem as the intruder and wrongdoer. The presuppositional language usage of “Tell me how . . .” is a way of working in the solution focused model that helps clients to focus more clearly on the effects of the problem instead of asking, “Has the problem affected your life?” which often leads to answers such as, “I guess so.” The use of presuppositional language increases the efficiency of the conversation as it forces the client to see the impact of the issue more clearly. As the client answers, the therapist begins to compose a list, listening for words that indicate the client’s values. The therapist at this point does not reflect or redescribe. Instead, the therapist simply becomes a secretary walking alongside the client, listening as the client uncovers the effects of the problem that the client and others in his system have been stricken with. It is also important to ask which values the problem tried to restrain in a client: “What has the problem taken from you that was the most important to you?” Narrative therapy pays close attention to the values of the client and the meaning behind exceptions. However, during this step, the chore is to get as long a list as possible so that the client recognizes the need to gain distance from the problem. Each time the therapist asks, “How else has this problem interfered with your life?” the chances are that the client will go deeper into his thoughts and recognize still another effect. The longer the list, the better. Additional ideas for questions in this step are: “What else has it affected in terms of other relationships?” “How would others say the problem has affected your occupation?” “What else?” Clients become thoughtful, and in some cases determined to fight back, as the list is constructed. It is common for client reactions to appear as frustration and annoyance toward the problem. By the time this step is completed, the list confirms the clients’ uncomfortable feelings about the problem and the developing annoyance they should feel about the problem’s intrusion. This is when I often see clients more motivated to distance themselves from the problem and move toward change.

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I recall a family referred years ago by a psychiatrist, who said the father had an alcohol problem. The father was in “denial” and refused to talk about the problem to me in an individual session. When I suggested family therapy, the father agreed to come back. Once there, I simply asked the family their best hopes. Answers varied: “We will get along better.” “Mom and Dad won’t fight as much.” “Dad will be able to attend our sports games sometimes.” “Dad will be awake when we leave for school in the morning.” “Mom won’t cry as much.” The father was surprised at the children’s answers, not fully recognizing the impact his drinking problem had been having. As we continued to talk in the SFNT process, the exceptions revealed that there were times when the father was not drinking, and when things went much better for the family. The father entered treatment for alcohol abuse shortly afterwards. Another idea that can be added to this step from the solution focused model is the Scaling Question. Scaling Questions “invite clients to put their observations, impressions and predictions on a scale from 0 to 10, where 0 means no chance of success and 10 means every chance . . .” (Berg & DeJong, 2002, p. 108). In SFNT, the Scaling Question can be used to scale the influence of the problem on the client, on a scale of 1 to 10, with 10 being the most influence. After making a list of effects, the therapist might ask the client to scale the influence of the problem on his or her life. The Scaling Question helps the client put into perspective just how much his or her life is being affected by the problem. The scale is also helpful in diminishing the effects of the problem, as the client decides how much he wishes to lower its effects over a short period of time, in between sessions. In this step, it is important to note that listing the effects of the problem is not done to understand why the problem occurs nor to dissect it. It is done to help clients verbalize the effects of the problem on their lives and begin to become more aware of how the problem is keeping them from the life they desire. Within these conversations, the problem becomes externalized and clients have a chance to see for themselves, as the conversation continues, the benefits of moving away from the problem toward a better way of living.

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I used another variation of this step with Valerie, the client ­introduced in Chapter 1. It involved eliciting descriptions of how the problem affected her presentation to others in her life. When clients come alone to therapy with complaints about how other people treat them, or wanting others to change, I naturally begin thinking in terms of “systems theory” and its premise that individuals function in a system of individuals and any action they take affects others (Bowen, 1966).

Constructing the Preferred Story With the best hopes question resulting in a specific goal, and the effects of a problem identified and scaled, the next step can be to write the preferred story, new chapter, or, as I like to think of it, the “preview” of things to come when the intruding problem is occurring less. The therapist might take the time in this step to assist the client and make a very thorough list of how the client wishes the preferred future to occur (George, Ratner, & Iveson, 2016, p. 37). The Miracle Question is the basis for this step, as it solicits from the client, and client’s family, if present, what the best hopes will look like. The Miracle Question may be asked as follows: “Suppose tonight, while you sleep, a miracle occurs and the problem that has intruded in your life is not affecting you as much. When you awake tomorrow, what will you notice that will tell you a miracle has truly occurred and the problem is having little to no effect on your day?” If the word “miracle” does not seem to fit with the client, the word “tomorrow” (George, Ratner, & Iveson, 2016, p. 37) can be used instead: “Suppose tomorrow, when you awake, you notice that things are better. What will be going on that will tell you things are better?” Additional questions to clarify the day include: “Let’s start with the moment you awake. What will you be thinking about as you wake up and think about your day?” “What would you notice as different as you went through the morning and went to work or school, or interacted with your friends and family, that would tell you the day was different?”

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“What else?” (Ask at least 10 times and gather at least 10 specific actions.) “As you went through the afternoon, what would you notice?” “When the day comes to an end and you look back over it, what do you think will strike you as being the best part?” “Having had this day, how might it affect others in your life?” “How will their reactions make a difference for you?” The questions around the Miracle Question seek to help clients understand their heart’s desire, or true goal that they wish for themselves. The question, “What difference will that make?” is extremely valuable and is repeated whenever the client provides an answer that is vague or slightly unrealistic. I am often asked about what to do with answers that clients give that are not reasonable. My answer is, embrace such answers with curiosity and say: “OK, and what difference would it make to you if your mom were still alive?” “What difference would it make to you if your parents were still together?” “How would it make a difference if you were not in a wheelchair?” By answering clients in this way, their hopes and dreams are respected and, after several more, similar questions, clients often get to a goal that is more realistic. Once I presented a miracle day exercise as a role-play for two individuals in a training session. The instructions were that one person was to ask the questions and the other was to be a client and present a real or fictitious situation to talk about. In this exercise, the questioner was to ask the Miracle Question; then, after the “client” replied the first time, the questioner was only to reply to the client with: “What difference would that make?” Here is what occurred: Questioner: “ Suppose tomorrow, when you awake, you find that a miracle has taken place. What would be going on during that day that would tell you it was truly a miracle day?” Client:  “I will have finished my master’s thesis . . . but that’s too hard!”

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Questioner: “What difference would that make?” Client:

I would not be so isolated and might have time for people.”

Questioner: “And what difference would that make?” The questioner kept asking the same question to each of the client’s responses. Eventually, after asking the question about four more times, the client said: Client:

inishing my thesis would lead to a better F relationship with my mother. . . . I never see her because she lives in another country and I am ashamed that I have not completed it. . . . She was so supportive of my education.”

With this “possible, present goal,” the questioner continued to ask: “What difference would it make to have a better Questioner:  relationship with your mom?” Client:

“I would feel less guilty and slightly happier.”

Questioner: “As a result, what would your mom notice?” Client:

“I would be in contact with her.”

Questioner: “And would your mom appreciate that?” Client:  “Yes, very much. She thinks I am avoiding her and she’s right.” From there, the questioner asked: “So, where could you begin so that your Questioner:  relationship with your mom improves just slightly?” Client:

“I might call her perhaps once per week to begin with.”

It was a long dialogue, but the result defined a direction that was specific and heartfelt. Keep in mind that what makes brief therapies brief is not

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just shortening the process, avoiding talk of the problem, or overlooking details, but getting the client’s heart’s desire involved in the goal setting, and setting doable tasks. Thus, making sure that the client’s goal is truly what the client desires can significantly boost the efficiency of the therapy. It is also very important when asking the Miracle Question to encourage the client to dream, imagine, and have no limits when answering the question and constructing the preview of their preferred story. Following is an example of a dialogue that resulted from asking the Miracle Question. It occurred years ago when the father of one of my clients, Andy, a 16-year-old boy, died suddenly: LM:

“Imagine a miracle occurred overnight while you slept. How would you know this had happened, when you wake in the morning?”

Andy: “My dad would be alive again.” LM:

“I can only imagine how you would appreciate that. What difference would that make?”

Andy: “He got me. He always helped me with my school work. He was a doctor so he was very smart and he understood what I wanted to do in my life in theater.” LM:

“What difference did that make to you?”

Andy: “I could depend on his support.” LM:

“And, what difference did that make for you?”

Andy: “It meant I could be happy in theater and he would want to hear about it and be excited with me.” LM:

“How did that make a difference for you, being happy in theater?”

Andy: “That’s where I am really myself. When that part of my life is good, I am good in other parts too, like school.” LM:

“So, since your dad can’t be with you now, where else might you get some support on your theater work and in being yourself, on a smaller scale?”

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Andy: (A long time passes . . .) “My theater teacher has been very supportive of me since Dad passed away. She’s kind of taken up extra interest in me lately. My aunt, who lives in another state, is also involved in theater herself, so maybe she could be supportive. I guess I could call her. Certain friends are supportive.” See how the question takes the client to a place where you can connect to a wish that is possible? With the question, “What difference would that make?” your client can tell you anything that is meaningful to his or her future and you are able to honor it respectfully, and help the client identify and gather the meanings, then construct a preferred future together that holds the most meaning for the client. When clients choose goals that are important to them, they are likely to achieve them. Additional questions for eliciting ideas on the preferred future: “What will others see you do on that day that would tell them things are different in the new story or chapter?” “What else?” (Gather at least 10 actions.) “What will you be believing about yourself on that day that would make the day special? What else?” As the therapist asks these questions that define the client’s preview of the preferred story or chapter, the therapist listens for words, phrases, descriptions, meaning, and hints of values that are entwined with and influence the client’s future, noting the words used by the client and writing them down. The therapist should write down all phrases, words, and descriptions that the client is using as the client expresses how the preferred future or chapter will appear. At this point, the therapist begins to use the client’s words in the dialogue of therapy. There is a true connection with the client when the therapist begins using the client’s language in the dialogue. In Andy’s case, when asked about how receiving his teacher’s support, calling his aunt, or getting friends’ support could begin helping him, he replied: Andy: “I might get back on track with school work.”

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LM:

“Really? What might I see you do that would tell us both you were back on track?”

Andy: “I need to speak to two of my teachers where I am failing their classes and let them know that I want to make up some missing work.” LM:

“OK. And what else might happen as you receive support from certain others?”

Andy: “There is a play that I would like to try out for. I might just do that.” LM:

“Tell me who would be the most pleased when you consider or even do these two things?”

Andy: “My dad.” Andy and I went on to talk about his dad in later conversations using the ideas in Chapter 7, Timeless Influences. Just from this initial session, he gained enough traction to get his grades to passing and try out for the play. He seemed to engage more with his friends when he became sad about his dad. As his school counselor at the time, I asked if he would like to convey his appreciation of his theater teacher’s support to her directly. Andy and I composed a short note, which he then gave her the next day: Ms. Spencer, Andy and I have been talking about ways for him to get back on track in school during this challenging time. As he and I talked today, he mentioned how much it meant to him that you were supportive of his theater aspirations. Andy and I would like to thank you for such support and wanted to let you know how much it means to him. Sincerely, Linda Metcalf Andy Smith Notes are a powerful tool to use when working with clients whose system can be supportive of the client’s desire for change. Involving the system in this Miracle Question activity promotes the chance that the client’s desired change can continue to occur and even grow into bigger change. There will be more information on note and letter writing in later chapters.

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If the clients are a couple or family, the question should be asked of everyone in the session. What seems important is responding to the descriptions by being very specific with the clients about what the preferred story would look like and mean to them. Family therapists think in circles, meaning interactions cause more interactions and those interactions are maintained by relationships. So, with that in mind, the use of circular questions (Boscolo, Cecchin, Hoffman, & Penn, 1987) is particularly useful for clients who come to therapy with partners or children whom they wish to change. For example, the following dialogue resulted when a client, a young child, responded to the Miracle Question and then circular questions: Child: “Mom would make me breakfast.” LM:

“What difference would that make to you?”

Child: “She would be in the room with me.” LM:

“And what difference would that make?”

Child: “Well, she’s always too busy to sit with me other times, so it would be fun to have her near me. Maybe we could talk.” LM:

“I see. So, this would be something you would really like.”

Child: “Yeah.” LM:

“What would Mom notice about you that would tell her you really liked her making you breakfast?”

Child: “I think she would say I would be nicer and not bother my little brother as much.” LM:

“Hmm. I wonder what that might do for your mom.”

Child: “She would be happy.” By working in this way, the client had a chance to talk about what others would notice about him and what others could do that would make a difference for him. Together, the family members may discover

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things that each of them could begin to do differently that would make a difference to each other. By the time this step is complete, a new, preferred future has been composed and is ready for support from the next step, finding exceptions, which will give the client confidence that he or she can indeed take a step toward the preferred future.

Exception Gathering: Getting Distance From the Problem Once the draft of the preferred future is constructed by the client, the therapist can gently inquire about the times when a small portion of the preferred future has happened in the past. In Andy’s case, for example, when he talked about reaching out to his aunt or friends, I asked him about times when he had reached out to them for other things that he needed. He talked of numerous times that he had called his aunt when his parents were going through a divorce and how helpful she always was to him. He talked of how his friends could always tell when he needed to talk and that there were certain friends who responded better than others. We then noted the names of those friends and what Andy did to reach them in ways that gained him such support. These times, or exceptions, when he was successful in achieving what he wanted are referred to in SFNT as exceptions. Exceptions are defined as follows: •

Times when the problem occurs less

•

Times when the problem does not happen at all

•

Times when a person is able to persevere even when the problem persists

•

Times when the person is able to distance from the problem and continue without its interference

Amanda Redstone has worked with individuals, families, and within agencies using a narrative therapy approach for over 20 years. She writes about how narrative therapy considers the values and meanings that clients have in their lives and incorporates the values and meanings into solutions in therapy. Narrative therapy also takes the story metaphor and links together events in sequence though time (M. Hayward & A. Redstone, personal communication, June 2016). The events themselves are not seen as having meaning; rather, clients give them meaning as they determine a match with their values and interactions with others. Clients do this in many different ways, and often don’t recognize that they are doing so.

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Working in SFNT, clients often bring to the surface the meanings and ­values that led to the circumstance of the exceptions that they discover. When clients begin to understand the difference living out those exceptions or gaps in the problem stories makes, they seem to reconnect to their values and begin to feel satisfied again (M. Hayward & A. Redstone, ­personal communication, June 2016). Redstone suggests that sometimes it is helpful to draw a map of the problem story and place dots on the map indicating times when the problem story was not as dominant. Looking at a large map and the various exceptions or gaps that it can possess is relieving to people and can instigate still other conversations around the exceptions, such as: “How is it you knew to change jobs during the difficult time you describe?” “What does it say about you that in spite of your sadness, you managed to continue to rear your children to be successful adolescents?” “How is it that you came to know that achieving a balance in your life would make a difference?” “How did you discover that perhaps drinking less might cause your children to become closer to you?” Each of these questions gives credit to the client’s competence and emphasizes the values of the client. When the problem-saturated story is dominant, the result is that clients are distanced from their values and have a foggy view of a better story. SFNT helps people step back, have a look at their lives, and make sense of them by seeing how distress developed when they became distanced from their values and beliefs. The model supports the idea that when a client is in touch with his or her *

##

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* *

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* * * * .______________________ * exceptions ## dominant story of concern

*

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values, which are often identified in exceptions to the dominant story, solutions are more easily identified. The previous box shows how a therapist using SFNT might draw a client’s story. The number signs ­represent the dominant story that the client is concerned about and the gaps (exceptions) are represented by asterisks: After drawing such a map, questions applicable to the exceptions can be asked with great curiosity, as follows: “How was it that, even though the time after your father died was difficult, you managed to keep on attending school?” “How was it that you knew it was time to leave home at age 17 and escape the abuse of your stepfather?” “Tell me how you were able to say ‘no’ to the old friends who had such a bad influence on you during that time and make new ones?” “How is it that in spite of the sadness you say has bothered you all of your life, you were able to finish graduate school, get married, have a family, and gain recognition in your work?” (M. Hayward & A. Redstone, personal communication, June 2016) How people think about their lives and then live their lives has to do with how they connect the events of their lives with their values. Assisting clients’ personal agency “is facilitated by encouraging persons to identify those expressions of aspects of lived experience that would have previously gone unstoried and to review the real effects of these expressions in their lives and relationships” (White & Epston, 1990, p. 17). When the therapist begins to understand how the client constructs his or her story, and identifies the values and strengths used by the client, the therapist is able to amplify competence in the client. This is what the exception gathering exercises in this step accomplish. Therefore, the more exceptions are identified, the richer is the story. In this process, there is no hypothesizing by the therapist; in fact, the therapist should do the opposite. It is better for the therapist to position herself as curious about clients’ lives, inquiring with questions that simply examine the exceptions or gaps in the story so thoroughly that the client scaffolds himself up from the problem-saturated story to look out at the landscape of possibilities. Solution focused therapists use the process of discovering exceptions to help the client realize that there have been less problematic times in the past and that the client himself has been more successful than he realizes. The SFNT finds the information uncovered in discovering exceptions to be empowering and validating of client ­ competence.

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Therefore, gathering information about times when the client’s context was less problematic is the backbone to solution building. ­ Upon ­ examination of exceptions, meaningful strategies that have made the client’s life better are brought to the forefront and become the building blocks of solutions. While not all problem-free times can be reconstructed p ­ erfectly, such identification holds clues to clients’ values and how clients might begin to construct their lives differently and achieve their best hopes. Because finding exceptions validates and builds confidence, gathering them in abundance is very helpful. To identify exceptions, the therapist inquires about times when some of the listings of the preferred future already occurred on a small scale. The following questions solicit exceptions from a couple who wants to improve their communication and have a discussion without raising their voices: “Take me back to times when you and your partner were having such a conversation on a small scale.” “How did you know to do that? Where were you? What was different on that day?” “What else was going on that assisted you in responding that way?” (You should get at least five exceptions.) When working with couples or families, gathering exceptions can be challenging. A parent of a teen might say, “Well, sure, when he gets what he wants he’s nicer to me.” To this statement, a familiar question rises to our rescue: “So, I wonder, does it make a difference to him when he gets what he wants?” To which the teen may respond: “It means my mother is finally giving me a little time or reward. Usually all she does is yell at me.” This can be continued more efficiently with the following questions: LM:

“So, what does that do for you to get a reward or a little time?”

From here, the dialogue switches to a conversation that becomes more heartfelt and strays away from the extrinsic reward of “getting what he wants.”

Preparing the Presentation of the Preferred Future and Moving Up the Scale Think back to the last time you had a day when you were at your best. What were you doing on that day that told others things were a bit

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different that day and you were at your best? What else would they say? As a result of having a day when you were at your best, what was different for you later? When Valerie described how she had presented herself to her ­husband prior to deciding to rebuild herself, she described a person that she was not pleased with. While her presentation did not directly cause her husband to be unfaithful, it also did not contribute to the relationship in a positive way. Again, systems theory comes into play here, and from her description prior to the rebuilding, we discovered that even her children were reacting to the current presentation. Many clients come to therapy unhappy with the way they have been treated by significant others in their lives. They seem to hope that, by telling therapists how difficult things are with their significant others, they may be given ideas for changing them. Unfortunately, there are no ideas for directly changing people. However, there are ways of widening the scope of the current presentation so that the client begins to notice what might be changed on his or her part to evoke a different response from someone else. So, if the current “presentation” is not working to get clients what they feel they deserve, then the subtle suggestion of trying out a different approach linked to the preferred future may be in order. While developing this model, one of the most helpful discoveries I made was noticing the change in clients’ demeanor when I ask about how their presentation came across to others either when the problem was affecting them or when they stepped out of the problem story into a preferred future. The reference to experiment is important, as inviting the client to try out a new chapter experimentally takes pressure off of the outcome and suggests that it is simply an experiment. . . . If it works, great; if not, it was, after all, an experiment. The experiment is often presented as an idea and I then mention, “Just until I see you again, let’s see how the experiment unfolds.” The presentation in this part of the session should be composed of rich descriptions—so rich and specific that the client visualizes his new character responding, acting, and interacting with persons involved in his life. The questions may be asked like this: “What would others notice about you for the next few days that would send them the message that you were [client’s answer to best hopes] ______________?” “How would others come to realize that you were not allowing the problem’s influence to rob you on that day?”

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“What beliefs would you have about yourself on that day that would keep these actions on track?” (You should get at least five beliefs.) This imagined, constructed presentation prepares the client for more visible steps to take with others so that success is more likely. By spending time enriching the character presentation, the preferred future has a better chance of manifesting. The presentation contains descriptions that can also be written down in a list. They become tools the client can use as resources for reaching the preferred future. By the time this conversation is over, the client has had the chance to identify what he wants to achieve in the preferred future, see how that attempt has been stifled by the problem story, articulate what he is trying to reclaim in his life, notice the exceptions to the problem, and develop a new presentation that incorporates it all. The template on the next few pages outlines this process. It should never be “applied” to a client; rather, it can be used by the therapist to gently guide the client into a new preferred future with actions to take and beliefs that motivate.

Summarizing and Inviting Clients to Watch for Success Evan George (personal communication, June 2016) suggests that after you read back the items to the client, you say something that empowers the client to recognize his own competency. A question in that regard might be, “What are your thoughts on what you told me during our time today?” Then, de Shazer’s Formula First Session Task is a brilliant way of ending a session after summarizing what the client has provided during the session: “Between now and the next time we meet, I would like you to observe, so that you can describe to me next time, what happens in your life that you want to continue to have happen” (de Shazer, 1985, p. 137). As the session ends, I like to ask the client about his or her view of how the session went. It is information for me to use next time and a respectful way to stay collaborative with the client in building narrative solutions. The session then ends, and I ask the client if he or she wishes to meet again. It is not assumed that there needs to be another session. It is the client’s prerogative. What follows is a worksheet that the therapist can use in ­implementing the ideas described in this chapter. All entries are client generated, so it is suggested that the therapist ask the client whether the entries are correct when writing them down.

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Action-Filled Narrative Summary Client Name:



Date:

1. Best Hopes:

2. Mapping the Effects of the Problem/Current Presentation Scale:___________ Key Words: 1.    2. 3. 4. 5. 6. 7. 8. 9. 10. 3. Description of the Preferred Future 1. 2. 3. 4.

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5. 6. 7. 8. 9. 10. 4. Exception Gathering 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 5. New Presentation Ideas:

6. Summary Preferred Scale by Next Session:___________

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nn

WHAT ABOUT THE NEXT SESSION?

In the first session, the therapist proactively elicits a goal from the ­client that is doable, action oriented, and specific. The effects of the issue are gently approached and the preferred future is richly composed by the client. The session may include a Scaling Question to measure the magnitude of the problem on the client’s life and then, later, a Scaling Question that refers to the desired, preferred future. After this first rich and provocative session, what’s next? At the beginning of every subsequent session, I ask: “What has gone better?” Most of the time, if I followed the client closely in the first session, and listened to what the client said he or she desires in the preferred future, making sure I asked “What else will be different?” at least six or seven times, the client will return and respond to my question by telling me that things are better. Clients are often surprised by this question as it gives them little time to focus on anything else . . . then we get right down to business. Sometimes it takes me asking the question again, in a different manner: “Since we talked last, what has gone slightly better?” “What would your family, spouse, children, boss, or coworkers say that they notice is different about you?” “If I went through a recent day with you when things seemed better for you, what might you say was making that difference?’ Most clients will eventually share something that has gone better. Others are full of answers and are excited to describe what has been different since we talked. With those who readily give me answers, such a conversation might go like this: Client: “I think I am happier.” LM:

“And since you are happier, what have you been doing to lead you to feeling happier? What difference has that made for you?”

Client: “Our son has made progress in school and has gotten into his homework without us nagging him.” I might then say to the son: “How have you done that? If I watched you on that day when you got into your homework, what might I have seen you do? What were you thinking about? What was different that

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day?” And, to the parents: “And since he has done that, what difference has that made for you?” The importance of being deeply curious about how things have transpired in a successful manner brings to light for clients the steps and strategies they have taken to accomplish change. The answers practically create a “preferred continuing future” as the descriptions come to life and verify the changes the clients have made. Often this creates a moment for clients who did not realize that they had done anything different. There will always be clients who just don’t think that anything has changed. My advice with those clients? Don’t believe them. Life has too many variables, situations, and contexts where things cannot stay the same. Since things don’t stay the same, it stands to reason that from week to week, something has gone differently. It is the driven therapist who believes completely in the client that maintains a stance that something has gone better and seeks to find it. The next case illustrates this stance! A young woman in her early thirties came to therapy after she was scorned by her coworkers for reporting a fellow employee for sexual harassment. After stating her best hopes, mapping the effect that the current situation at work was having on her life, composing the preferred future, and discovering some strategies that she used when dealing with other challenging times, she seemed optimistic as she left the session. She appeared confident that she could handle the stressful time. She returned for session two, and I asked her, “What’s better?” She said, “Absolutely nothing.” Here is an excerpt from the dialogue that ensued: LM:

“So, if I were to have watched you or others would have watched you last week, what might we have noticed that would tell us things were slightly better for you?”

Client: “Not sure. Hardly anyone talks to me at work.” LM:

“Hardly anyone? So, of the few who do talk to you, what might they say was slightly different?”

Client: “Well, there was one person who hasn’t said anything to me until last week. He came up and asked how I was.”

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LM:

“Really? I wonder what might have been going on with you that might have encouraged him to say something to you.”

Client: “Maybe I looked a little happier. I met someone last week, and he and I have been going out and talking each day.” LM:

“You met someone? How has that made a difference for you?”

Client: “It gets me out of the house, and the way he talks to me makes me feel really great about myself. He knows what’s happening at work and he’s very supportive.” LM:

“OK. And, how has having his support and getting out of the house made a difference?”

Client: “I am not isolating myself as much. I even started working out. Come to think of it, at work I am not keeping to myself as much as I was before.” LM:

“And, how is that making a difference?”

Client: “Well, it was really more than that one person who talked to me. There were several. It seems like people are looking at me differently.” LM:

“And, I wonder what they might say you are doing that makes them look at you differently.”

Client: “I’m not avoiding people. I am eating lunch in the lounge.” As we continued to talk, we came up with a list of about nine items, which I wrote down for her. At the end of the session she smiled and said, “Well, this is strange. I thought I was going to come in here today and not have anything to report, and was feeling bad about it. Now, I don’t feel bad at all. More has been going better than I realized.”

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So, in response to my question, “What’s better?” a client who responded “Absolutely nothing” actually did experience things that were better. She had allowed the problem story to hover over some better times and had almost dismissed the fact that she had experienced several new things. Such is the magic behind seeking gaps in the problem story. It is so uplifting, and the reason I keep on asking, “And what difference did that make?” and “What else was slightly better?” The client continued to do well, especially with her coworkers, most of whom eventually came forward to support her at work. Her former presentation at work had been to isolate herself in her office. Her new outside interests had given her a boost of confidence that showed at work, and she presented herself differently to others, and thus provoked different responses. Her ability to raise the flag against sexual harassment and continue to work toward building confidence and representing herself in the manner that matched her values made all the difference to her as she coped. nn

SUMMARY

When we assist clients in noticing times when they are at their best, holding sacred their values and, thus, developing their personal agency, we give them a gift. Noting what is important to clients, how they survive, and how they manage, and screening alongside them the times when things are better, we change a map of trauma into a map of hope by adding events of worth. When clients have a connection to what they want, by experiencing it and then wanting more of it in their future, they are able to move forward. nn

PERSONAL EXERCISE

In this chapter we explored assisting clients to generate ideas on when they will be their best. We discussed presentations that might or might not bring clients what they want from a relationship. As therapists, knowing how we present ourselves to our clients is valuable. Evan George (personal communication, June 2016) has pointed out that “how we think about our clients comes across to our clients.” It is a huge responsibility for us as therapists to examine our affect and our mannerisms toward clients, and to create a context where clients can work effectively with their competencies. The following exercise may help to identify traits, values, and actions that help you present your best self to your clients, particularly clients that are challenging!

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Suppose, tomorrow morning, as you awake and think of the day ahead, you prepare to be at your best. What might you do or think about as you prepare for your day?

 What would you be thinking about as you traveled to your session that would begin to help you set the stage for being your best?

 Once you arrived and greeted your first client, what would the client notice about you that would tell him or her you were at your best?

 What else would you be doing during the session so that the client got the hint that you thought favorably of him?

 How would you end the session in a manner that would indicate you were still at your best? How would the client know at the end of the session that you were thinking favorably about him?

 As you leave your workplace later, think about how being at your best on that day influenced your work as a therapist. How did the client react to your being at your best in the session?



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As a result of this exercise, how might you conceptualize your own competency as a therapist? Enjoy the reactions.



REFERENCES Berg, I., & DeJong, P. (2002). Interviewing for solutions. Pacific Grove, CA: Brooks/Cole. Boscolo, L., Cecchin, G. F., Hoffman, L., & Penn, P. (1987). Milan systemic family therapy: Conversations in theory and practice. New York, NY: Basic Books. Bowen, M. (1966). The use of family theory in clinical practice. Comprehensive Psychiatry, 7(5), 345–374. Cade, B., & O’Hanlon, W. (1993). A brief guide to brief therapy. New York, NY: W. W. Norton. de Shazer, S. (1985). Keys to solution in brief therapy. New York, NY: W. W. Norton. George, E. (2016, June). Texas Wesleyan University Study Abroad: Solution focused therapy workshop. BRIEF Therapy Practice, London, England. George, E., Ratner, H., & Iveson, C. (2016). BRIEFER: A solution focused practice manual. London, England: BRIEF Therapy Practice. Hayward, M., & Redstone, A. (2016, June). Texas Wesleyan University Study Abroad: Narrative therapy presentation. BRIEF Therapy Practice, London, England. Storm, C. L. (2011). Milan systemic family therapy. In L. Metcalf (Ed.), Marriage and family therapy: A practice oriented approach. New York, NY: Springer Publishing. White, M. (1989). Selected papers. Adelaide, Australia: Dulwich Centre Publications. White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York, NY: W. W. Norton.

CHAPT ER 4 Triumph Over Trauma What lies behind you and what lies in front of you, pales in comparison to what lies inside of you. —Ralph Waldo Emerson

Of all the clients I have worked with, those whose lives have been ­violated by violence or sexual abuse have been the bravest clients. No matter what age, those special clients come to therapy with a stigma that seems to have been attached to their very being, causing them uncertainty in how to shake the effects of the trauma that was put upon them. To some therapists, they are seen as victims, overcome by violence in a way that will take years to resolve. When viewed in that manner, therapy is slow and evolving, sometimes recapturing in dialogue the abuse in an effort to desensitize the victim and confront the abuser from far away. For the first years of my practice, when such “survivors” came to therapy, I, too, wondered how to address their huge challenges in a way that would bring relief. As clients and I began our time together during those days and I heard words such as “victim,” I would invite clients to consider another way of describing who they were . . . as a survivor. That invitation was rarely turned down and they typically looked up at me as if I had called out their name differently. I never referred to a client as a victim again. For clients who have experienced trauma, the stories they bring to therapy tell us about the characters they have become as a result of the event that occurred to them. Narrative therapy is often referred to as the 63

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storied therapy, seeing the lives of clients as stories on a map. Clients typically go through their lives and create stories on their own, using their own initiative. Left to themselves, a client in such a story might glance back at his or her life, smile at the achievements, and see all that he or she has accomplished. While life for most people is typically seen as an accumulated string of such accomplishments, the happy stories dwindle in impact when a traumatic event occurs. Suddenly the life that had been well managed feels out of control. With these concerns I was curious about whether there might be a way to work with clients bothered by trauma that rebuilt their confidence in their ability to survive by tapping into their strengths through acknowledgments and offering to them the opportunity to write the next chapter. Obviously these clients were interested in a preferred future. They wanted change, or they would not have been attending therapy. They wanted to return to experiencing the meaningful parts of their lives because they had experienced them before. They wanted to be able to function in a manner that resembled the people they had been before the event attached to them each day. Twenty-five years ago, in New Orleans, a solution focused t­ herapy conference presented an alternative way of working with clients who were dealing with trauma. These were the early years of the model and its applications were being explored with all types of clients. I will never forget Yvonne Dolan talking about her work with sexual abuse survivors and saying to all of us who attended: “Asking clients to go back into the abuse and describe the details is, in itself, abusive” (­personal communication, Y. Dolan, 1991b). She described effective sessions where clients reclaimed their strength and bravery, and were able to move forward with relief. Clients were listened to and then they talked about what they wanted in their lives. Dolan’s work, along with narrative therapy’s externalizing of the problem ideas, equipped me with new ways of reaching clients so that the relationship with the intruding problem was changed. nn

STORYTELLING 101: FINDING RESOLUTION TO A PLOT

After learning from Dolan the importance of not going back into details of trauma, and fascinated by the narrative therapy model of new descriptions and the importance of honoring values in clients, I decided to check into how stories were written, particularly novels, and found some direction. After all, weren’t clients coming for new chapters?

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I then researched structures of novels and combined some ideas from narrative therapy and solution focused therapy into an exercise that I explain later. The structure of stories that I researched included three acts and two plots (Hill, n.d.). Steps that represent how the practice is adapted for clients who have experienced trauma are set in italics: Act I: The main character is content in his or her life. Plot 1: An event occurs to throw everything in the main character’s world off balance. The event is named by the client. Act II: The main character takes an emotional journey with challenges to overcoming the event that occurred. Unfortunate circumstances, hurt, and challenges affect the main character. The client describes how the trauma has affected his or her life. Plot 2: There is a new direction, usually when a “hero” or “heroine” appears, the situation turns around, and a goal becomes reachable. The hero or heroine draws upon his or her strengths and uses the lessons he or she has learned to bring the story to a conclusion. The client has an opportunity to describe a preferred future and begins to “step into a new chapter” using his or her own strengths and abilities. Additionally, the conversation may describe the exceptions, or times when the client was able to achieve some of the preferred future descriptions. Act III: In this act, the main character is able to succeed and become what he or she wants to be. There is resolution and the main character triumphs over the challenge. The client chooses small tasks on his or her own in an experimental manner, so that he or she may try out his or her preferred future. The description of the character in Act I lent itself well to narrative therapy components that focused on the values and meanings that

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clients have for their lives and the events in their lives. Just like Plot 1 in the novel, many clients describe the values that were lost to the trauma with the language they use to describe themselves currently. In this segment, the client externalizes the trauma by naming it. In Act II, the clients talk about how the trauma has become bigger than they are, leaving them without a direction to begin moving forward in their lives. That description, which I heard often, gave me the idea of externalizing the trauma and asking clients to name it. Plot 2 seemed to be a perfect fit with the solution focused model as it aligned with the use of the Miracle Question to identify a preferred future, and action-oriented questions to drive the work forward. The Scaling Questions were also helpful as clients described the effects of the trauma experience on their lives and, later, to describe how the experience was shrinking. In Chapter 2, we looked at a diagram with asterisks and number signs illustrating how problem-saturated stories, told by our clients, can be referred to as the map of their lives. Years ago, when working with a survivor of sexual assault, I thought of presenting to the client a timeline, rather than a map, to not only show the event and when it occurred, but to illustrate the many years ahead of the client that could be lived with less of a traumatic influence as time went on. When the timeline proved successful as a method of showing how distancing from the experience could open up possibilities for a preferred future, I combined all of the ideas in this section into an exercise that I will discuss in the next section, illustrated by a case. nn

SEVENTY-SEVEN YEARS: A TIMELINE TO A PREFERRED FUTURE

Leanne, age 13, came to counseling with her mother after confiding in her mother that her cousin had sexually abused her several times when she was 9 years old. Leanne told me that she had tried to rid her mind of the incidents, not understanding why they occurred, but was still torn with dealing with them frequently. The previous week at her middle school, a school counselor gave a guidance lesson on sexual abuse. The counselor described situations, possible signs, and actions that adults or even people close in age to the students might partake in that were inappropriate and wrong. Leanne told me that, sitting in the classroom that day, she seemed to go back in time and re-experience what occurred at age 9. She realized then that what had happened to her was sexual abuse. She left the class in tears, told the school counselor what she remembered, and the school counselor called Leanne’s mother, who came to school immediately. Her mother called me for an appointment.

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When Leanne came to the first session, she was emotionally drained and kept a blanket on her lap, holding it close throughout our session. She had spoken to the police over the weekend, and her cousin had been arrested. I learned that Leanne’s mom had believed her daughter immediately when Leanne told her about the abuse and offered to support her in any way possible. While I did not ask about details, I did listen to the basic information that Leanne’s mother provided and then asked both Mom and Leanne what their best hopes were. Leanne said she wanted help in dealing with the situation. She wanted peace. Her mother said she wanted her daughter to be able to cope with whatever came next in regard to the arrest, possible conversations with prosecutors, and so forth. After a few minutes of dialogue, Leanne asked to talk to me alone. When clients come to therapy with such trauma, it has been my experience as a solution focused narrative therapist that seeking and listening to my client’s direction is the most important thing I can do as a therapist. To this day, I do not know what Leanne’s cousin physically did to her, nor did I ever ask. I was more interested in what Leanne needed than what I thought she should do. Yvonne Dolan, author of Resolving Sexual Abuse (1991a), talks about alternative therapies for sexual abuse resolution. She says: Having a victim of sexual abuse tell and retell the tale of her victimization for the sole therapeutic purpose of desensitization is like removing a bullet slowly and painfully, one tiny millimeter of metal at a time, reopening the wound each time. This form of desensitization is not always dependable; even in the cases where it does succeed over time, it is often an inefficient and unnecessarily painful method of treatment that prolongs the client’s suffering and revictimizes her over and over again. (Dolan, 1991a, p. 29) Therefore, instead of inquiring about the abuse, I followed Leanne’s lead by asking and then listening to her best hopes, which were to get help dealing with the situation at hand. Needing a more specific goal to be the most helpful, I asked Leanne what that might look like in the near future when she was dealing with the situation and achieving peace. Leanne clarified that she would be able to get back to doing what she had been doing before she recalled everything so clearly. She was not

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sleeping well, and when she did sleep, she had nightmares about the event. She was isolating herself in her room and not associating with friends at school. At that point, I began a conversation using the ideas that follow next, which combine solution focused therapy and narrative therapy together, creating a story structure. nn

COMPOSING A NEW CHAPTER AFTER TRAUMA 1. Listen to the story, if the client insists. Do not ask about events as it could be traumatizing. Make sure the abuse is no ­longer occurring. Acknowledge survivorship. It is important in this step to not suggest victimhood. Instead, ask the client what her best hopes are. While the client has been harmed, ­suggesting survivorship over victimhood increases hope and validates that the client indeed did survive the abuse; this is a powerful redescription. 2. Draw a timeline for the client, gathering vital information in the process. If possible, use a large piece of paper, or draw on a white board and take a photo of the diagram when finished and give it to the client. On the left end of the timeline, write the birthdate of the client. At the right end of the timeline, write down the typical age that people in the client’s family live to be—their longevity. Place a mark on the timeline when the incident occurred. Ask the client what he or she wants to call the incident. Write the client’s name for the trauma above the mark.

incident _______________x__________________________________________ Birth date Life span

3. Ask how the incident has kept or is keeping him or her from living his or her life. Ask how the incident has trapped him or her. Write down his or her answers under the “incident.” Gather as many effects of the problem as possible. This is a crucial part of the exercise, as it enables the client to vent about

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the abuse and to map the effects of the problem on her life. You should get at least 20 effects. Ask the client to indicate how big the ­problem has been, on a scale of 1 to 10, with 10 being the ­biggest. Subtract the client’s current age from the ­number at the right of the timeline. Suggest that she or he has _____ years to keep ­stepping away from the story, writing a ­preferred future. 4. Moving forward on the timeline, ask the client to describe her preferred future, the way she wants things to be as she begins to step out of the incident into a new chapter or story. Ask her to describe what others will see her doing that will tell them she is the author of the new chapter. Write the client’s ­descriptions of her preferred future down under the timeline on the right side, past the situation mark. In this part of the exercise, gather as many descriptions of the new actions as possible. Ask her to name the new chapter and write it above the area with the descriptions. 5. Read back the descriptions of the effects of the incident, slowly and clearly, to the client. Then suggest: “As you think of the effects of ‘the incident’ that I just read and begin ­stepping out of the story that was written for you, here are the things you said you wanted to achieve in the new chapter.” Then, read the descriptions of the preferred future, slowly. Make a copy of the timeline and give to the client. 6. This last step has two options: (a) Ask the client for very small actions that she can begin doing to move down the scale so that she is in charge, not the event. Ask what others will see her doing just over the next few days that will tell them, too, that she is moving down the scale to be in charge. (b) Present the timeline copy to the client and let her know that you look forward to hearing next time how she took small actions to overcome the event. Give her full control over what to do with the timeline. As Leanne and I went through these steps, I learned that her grandmother had lived to the age of 90 years, which gave Leanne 77 years to step out of the story of abuse into a new one. She told me approximately 25 effects of the abuse, which she named “sexual abuse,” because, in her

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words, “that’s what it was.” She scaled the effects of the abuse on her life at a 9. Some items on her list were: I don’t trust males. I keep myself shut away from people. I don’t do as well in school as I could. I cut myself in the past when I thought about it. As she composed her new chapter, she named it: “The Best Chapter of All,” and listed items, such as: I will meet someone I trust and get married. I won’t get pregnant in high school. I may become a police officer. I will spend more time with my family. I will sleep very well each night. I gave Leanne a copy of the timeline and told her that I was impressed with her descriptions of “The Best Chapter of All.” I told her I looked forward to hearing how she stood up to the “sexual abuse” effects over the next week. When Leanne’s mother came into the session, the first words from Leanne to her mother were: “Mom, I have 77 years,” with a smile. Mom did not understand what Leanne was referring to, so, with Leanne’s permission, I explained the timeline. When Leanne returned the following week she was back in school, and when I asked “What’s better?” she reported that she had slept well every night since our session. I asked her where she was on the scale and she reported “a 5.” I asked her mother what she had noticed about Leanne and she said that Leanne had been spending more time with her family, getting caught up on school, and doing a few activities with her friends. I saw Leanne two more times for this issue, each time beginning the session with, “What’s better?” Eventually, at the end of the fourth session, she said “I’m good.” nn

FROM TRAUMA TO RESOLUTIONS: LET THE WORDS OF THE CLIENT GUIDE THE WAY

Stories get constructed through experiences of life. In this chapter we have discussed how clients who experience trauma can write new stories so that their values are honored as they distance themselves from the event. The model described in this book can be of assistance to any

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client going through any trauma. The basics of following the clients’ language, stepping into their worldview to connect with them, and then assisting them in rewriting a new story so that they can begin to function again can be universally applied to any situation. I talked once with Anna, a 4-year-old girl who was very f­ rightened about riding in a car after being in an automobile accident with her grandmother. She was so terrified about riding in a car that she would scream if her parents put her in her car seat. This went on for several months. Meeting Anna, I pulled out some drawing paper and sat with her on the floor. I learned about her “being afraid.” I asked her to indicate the scale of “being afraid” by extending my arms out wide and then closing them together, asking: “When you ride in the car, how big is the fear? Is it this big, or, this big?” Anna pulled her arms out wide. Then, in our conversation, I asked about times when the fear was smaller. It took some time, but Anna was able to describe several times when the fear was smaller, such as when the car was stopped, or when her mom sang to her as they drove down the street. At that time, she put her hands together to show me how small it was. When her mom learned of her daughter’s exceptions (times when the fear was smaller), it led the mom to identify other times when her husband had reassured Anna while putting her in her car seat that she was “safe.” She said the word “safe” seemed to connect with her daughter. I asked Anna what “safe” meant and she said: “I’m okay.” We talked at length about how both Mom and Dad keep Anna safe each day. Anna was alert and attentive as her mom illustrated the various things she did each day, including how she fastened Anna’s seat belt. Mom also talked about how stopping was a “safe” activity. I encouraged Anna’s mom to continue doing what was working as much as possible. When they left that day, I heard her grab Anna’s hand as they went down the stairs and say, “This is how I keep you safe going down the stairs.” Although we had scheduled a second appointment, Anna’s mom called and said it wasn’t necessary, as Anna was doing well in the car. nn

DEAR CLIENT: TEACH ME HOW TO TALK TO YOU

Kim and Trey came to therapy after Kim had delivered a stillborn child. Completely engrossed in sadness after their loss, the couple presented

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themselves to therapy not knowing how to cope. Kim was a lab assistant at a local university and Trey worked at a bank. Trey was very concerned about Kim, as she had begun isolating herself at work, staying at home, and refusing to be around her family. I asked the couple what their best hopes were and Kim quickly said, “I don’t know what I can hope for at all. For now, I just don’t know what to say to people and they don’t know what to say to me. When they do talk, they say, ‘It’s probably for the best.’ That makes me angry. Our son was perfect in every way. Our doctor told us that he was.” I noticed as the couple talked that they referred to the child as “the baby we lost.” At one point, I found myself rather speechless, not knowing how to address the couple about their child. I took a leap of faith and asked: “I am wondering how to talk to you about your baby. Can you share with me how you would like to talk about him?” Kim looked up and said, “His name was Ben.” I then asked about Ben: “Tell me, what did Ben look like, and how much did he weigh? I am interested in whatever you would like to tell me.” Through tears and smiles, Kim described her baby boy and brought out pictures of him, dressed in a yellow suit. The pictures showed Kim and Trey holding Ben. They told me that they had provided an official funeral for him. They went on to tell me who he looked like in the ­family . . . hair color, weight. Although this was a very sad conversation, I noticed that the couple seemed a bit uplifted talking about their child. After a while, I told the couple that I appreciated them “teaching me how to talk about Ben.” I then wondered out loud if it might be helpful for others to be taught as well. For a few minutes, the couple was quiet. Then Kim began to talk about possibly going to a couple of close friends at work who seemed to be supportive and telling them more about Ben, as she had in the session. She said that talking about him in the session made her feel better, as if he really did exist. When the couple returned the next week, both seemed slightly better and Kim volunteered her experiences of talking with coworkers about Ben, even bringing out pictures to show them. She said many of the coworkers cried when they saw Ben’s pictures, but they thanked Kim for showing the pictures to them. Kim said she was isolating herself less at work and had gotten back to enjoying her job. That was our last session. A year and a half later, Kim gave birth to a baby girl. When in doubt about how to reach clients dealing with difficult situations and trauma, do not feel as if you need to race to the rescue, as tempting as it

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may be. When a client can come up with his or her own resolution, there is a better chance of following through and finding relief. Leanne described her preferred future in such detail that, upon later review, she was able to identify ideas of her own to implement slowly, which she did. Kim taught me how to talk about her son when she brought out pictures. Other ways of using language to reach those who experience loss or have difficulties with dangerous habits are described in later chapters. When we help our clients to talk about what is valuable and meaningful to them, we build the conversation from the event that is of concern to a place where they want to go to recover their true selves. And once they are connected again with their true selves, their comfort and confidence are restored and trauma is distanced. nn

SUMMARY

What if, in therapy, when people want to get back to where they once were, where their values, beliefs, and identity are comfortable and satisfactory, we simply assist them in finding out how to get back through identifying exceptions as clues to the path back? When Kim brought out the baby pictures, that was an exception. From there, she showed me that talking about her son brought her some relief.What if, in finding their way back through identifying exceptions, clients discover how this process affects their lives and the lives of others, and they achieve distance from the problem? When Kim went back to work changed, with the intention of sharing more details of her experience with her coworkers, they rallied around her and she in turn continued to evolve. nn

PERSONAL EXERCISE

In this chapter we discussed several ways of talking to clients who have experienced trauma and related challenges. Chances are, you have experienced difficulties at one time, yet pulled yourself together to continue in your life. How did you do that? The following exercise is designed to help you develop insight into your own coping strategies, so you can see how the therapy performs. Think back to a time when you went through a difficult challenge. What were the effects of that challenge on your life?

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How would you describe the way you got through the challenge?

What would others say you did that brought you through the challenge?

What else?

Perhaps you have a current challenge. Glancing over your answers to this exercise, what might you utilize for a few days to stand up to the challenge so that you experience life as you desire?

REFERENCES Dolan, Y. (1991a). Resolving sexual abuse. New York, NY: W. W. Norton. Dolan, Y. (1991b). Solution Focused Therapy Conference. New Orleans, Louisiana. George, E., Ratner, H., (2016, June). Texas Wesleyan University Study Abroad: Solution focused therapy workshop. BRIEF Therapy Practice, London, England. Hayward, M. & Redstone, A. (2016, June). Texas Wesleyan University Study Abroad: Narrative therapy workshop. BRIEF Therapy Practice, London, England. Hill, P. (n.d.). Conflict and character within story structure. In Learn the elements of a novel. Retrieved from http://www.musik-therapie.at/ PederHill/Structure&Plot.htm

CHAPT ER 5 Relationship Presentations How people treat you is their karma; how you react is yours. – Wayne Dyer

When Deb, age 58, came to therapy, she was concerned about her relationship with her husband, whom she described as distant and volatile. She, like a lot of clients, seemed to start the session before I had a chance to set the tone by telling me about all of his horrible traits. She must have thought that the more she told me about him, the more advice she would get on how to change him! She obviously needed to be heard, so I listened to her story and descriptions and then asked: “So what are your best hopes for our time?” The following dialogue emerged: Deb:

“I just need to know how to respond better. He is a jerk.”

LM:

“What difference will it begin to make when you know how to respond better?”

Deb:

“I will feel a lot better about myself, more confident.”

LM:

“And, what difference will that make when you feel better about yourself and are more confident?”

Deb:

“I may stand up for myself.”

LM:

“What do you hope he notices when you stand up for yourself?” 75

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Deb:

“That I am to be respected and appreciated.”

LM:

“How will you show him that you are to be respected and appreciated when you stand up for yourself?”

Deb:

“I probably won’t yell and curse like I did before. I would stay as calm as possible and state my case and my needs.”

LM:

“Would that be different from what you have presented to him before?”

Deb:

“Yes. It would be a lot like I already am at my job as a manager. I have to do that with employees every day.”

LM:

“And, have those employees been with you a while?”

Deb:

“Most of them have been with me for 10 years.”

LM:

“If I lined up your employees in our room here, and asked them to share how you come across at work, what might they say?”

Deb:

“That I am fair, understanding, inquisitive about what they think we should do in certain situations. I ask their opinions often.”

When you think of relationships and how they work best, it seems that what Deb was describing of her actions in her workplace could ­easily be ideas to use at home. Once she continued to specifically describe exactly what she wanted her husband to see, and borrowed some ideas from her strategies at work, Deb left with a new presentation. nn

THERAPISTS MAKE PRESENTATIONS, TOO

Go back to the last time when you were working with a client and, after you left the session, you admitted that the session didn’t go as well as you wished. Perhaps you “weren’t on your game” that day. On the way home, you think of the questions you asked and feel rather confident that you did a good job at asking them but, still, you wish the session would have gone differently. What if, on the way home, you put yourself into your client’s shoes and reflect how you, the therapist, came across? Perhaps you might begin seeing that, possibly, you pushed too hard or didn’t allow the client to clearly

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express the goal he or she wanted. Instead, you pushed to work on a goal you thought the client needed. You meant to be helpful, after all, and the client did seem distressed and needy. Your intentions were good, but little progress was made. If you are a solution focused therapist, chances are that you would be furious with yourself. You listened to your goal and not the client’s. If you are a narrative therapist, you might wonder, “How was it that I was unable to connect to my client . . . what did I miss?” All of these revelations are fine, but rather useless. Instead, it is much more helpful for you to ask yourself: “What did I do that might have been slightly helpful?” “What have I done before that seemed to work better with clients such as ____?” “What would the client say I might have attended more to during our session?” “What might I do differently next time to get a different result?” Those answers will probably be very different. And then you might ask: “What will I need to do to create that presentation of myself in the session?” See how clear the direction becomes and how humbling it is when you are the one stating how you came across, rather than having someone tell you? While in no way am I suggesting that it is important for us to criticize our efforts, I am suggesting that systemically, when we want a different response from an interaction, it is up to us to present our response in a different way. In other words, it is easier to own your part in the relationship and recognize what works and what does not work with this approach. The same goes for the relationships that our clients are invested in and that they come to therapy to discuss. The solution focused narrative therapy (SFNT) model spends as much time as it takes to craft questions around the preferred future until both therapist and client know what the desired outcome is. The narrative part of the model encourages the therapist to spend time deconstructing the storyline in the first session to understand the relationship that the client has with the problem, by seeking the effects. Once that is accomplished, the narrative therapist will assist the client in defining how the client has presented himself or herself in the past that might have affected the responses the client received from others. From there, a client-defined

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new presentation becomes the way that the client’s new character tries out parts of the preferred future with those important to him or her. Working with the client, the solution focused narrative therapist takes the information on the client’s destination and enriches it with specific details about what others will see in the new presentation— one that will more efficiently assist the client in gaining what he or she desires in the preferred future. From there, the client will determine what steps to take to achieve that presentation. Then, the client gathers action-­oriented steps from exceptions that have been identified in the sessions to move f­orward with tasks. Once the client has a preferred future and a new presentation in mind to guide action on small parts of the preferred future, relationally, things have a better chance of changing. nn

CHANGING THE RULES

Many clients who are in unhappy relationships have no idea why they make the same mistakes again and again. For example, some women who grew up in alcoholic homes tend to pick partners to fix, similar to the way they tried to fix and take care of their alcoholic parent. The women are overly helpful and self-sacrificing, all to no end, and often succumb to abuse. This chapter gives the practitioner ways to help both male and female clients reflect on their actions and the reactions that occur in their relationships as a result. In the case of Marsha, described next, I struggled to find a way into her worldview so that her resistance to change could be reduced. After listening to her story, I decided we would compose a list defining the rules she was currently following and would need to follow to maintain the status quo she desired. The exercise is based on this statement: “If I stay, what are the rules I must go by?” My clients seem to find the exercise to be helpful in identifying what they must keep doing or agree to do in the future to keep the peace or status quo in a destructive relationship. It is important to mention here that when dealing with dangerous relationships, as therapists, we must put aside our model and pay attention to the safety of our clients. Therefore, safety plans and community resources should always be provided to clients dealing with violence. If, however, our clients are not willing to budge, and instead choose to stay in a relationship for their own reasons, the exercise provides a new way for them to view their current plan. Among many rules that I have heard from clients using this exercise, some examples are:

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“I must ignore the verbal abuse and not say anything back, even if my children hear him.” “I guess I must clean up after his drinking.” “Keep the second job to pay the bills.” For many clients, the list can grow to 20-plus answers and become an eye-opening experience, which then encourages the client to reexamine her actions. Marsha, age 38, with two children, had been married for 10 years to her husband, Dale. Marsha’s family owned a successful car dealership where Dale had become employed after marrying Marsha, who also worked at the dealership part time, but did her work at the family’s home. Marsha described her desperation over Dale’s recent “manic spending and traveling” for work, particularly in Las Vegas, where he had gambled away much of the financial assets that Marsha had put away for the children’s college fund. She was concerned about Dale’s spending habits and, fearing the possibility of bankruptcy, had told him to stop, but he ignored her. She thought his drinking was increasing, too, as her father had told her that Dale drank at lunch and other salesmen were complaining. There were women at work who Marsha suspected Dale had been sexually harassing. She knew that one had accompanied Dale on a recent business trip, yet Dale denied it. With two young children, she often found herself borrowing money from her father to pay bills and not telling Dale, to keep from embarrassing him. She was at her wits’ end and unsure of what to do. Nevertheless, Marsha was sure that she was not going to leave Dale, even though things were getting worse each day. Clients like Marsha present to therapy with complicated and difficult situations, which may at times include violence and emotional abuse. Therapists may pose the idea to these clients that staying in such a challenging situation jeopardizes their health and even their life. As counselors, it is our duty to suggest that clients explore outside resources to assist them if their life or the lives of others are in danger. Yet, there are clients who simply do not want to leave. In an effort to move the session forward, after listening to Marsha (she was very determined to tell me all kinds of details and frustrations) I asked Marsha what her best hopes were. Marsha responded that she wanted Dale to change. He needed to stop drinking, stop spending, and stop cheating on her. I then asked what he would be doing instead and she said, “He would be the husband he was in the beginning, where he listened to me and we respected each other.” In keeping with the postmodern approach presented here as SFNT, I have found it helpful to pay attention to the worldview of such clients

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who are stuck in a tragic relationship but then possibly explore the ­client’s current presentation, which is often eye-opening to the ­client. With that in mind, I asked Marsha the following question: “So, in the beginning of your marriage, what would Dale and others have noticed about how you were in the relationship?” Marsha sat back and became tearful. She told me she was strong in the beginning, and took pride in herself. She made sure she always dressed nice for Dale and arranged time for dates with him. She gave him lots of her time and he reciprocated. Over the years when she had their children, she had gained an enormous amount of weight and doted more on the children than on Dale. As a result, once she realized that she had changed, she began to do more to “get him back.” It seemed that the more she tried, the more he distanced himself. So, Marsha’s current presentation to Dale was, in her words, “­ desperation.” Even though we talked about the exceptions, times when the marriage was working, Marsha had reason after reason why she could not lose weight, or stop focusing on the children. She was stuck. Seeing that Marsha had resistance to making any changes, I decided to cooperate with my client by inquiring about the “rules of the relationship” that Marsha and Dale had developed. Whenever I ask this question, clients look surprised. However, I explain that as people in relationships, we develop rules or guiding activities that keep the relationship on a certain track. At that point, Marsha began to understand what I was talking about and told me the following: 1. I guess I will need to keep cleaning up after him and monitoring the money. 2. I may have to keep ignoring the infidelity. He won’t admit to anything and I want my children to have their father at home at least sometimes. 3. I guess I will need to keep monitoring the household bills to make sure they get paid. 4. I can’t bring up the spending or drinking because he gets mad and then leaves for a few days. . . . plus 21 more rules.

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By the time we finished, I had two pages of rules that Marsha ­recognized had developed between her and Dale. She looked at me when I gave her a copy and said: “You must think I am crazy to follow these like I do.” I did not respond to that statement, but instead said to her: “Over the next week until I see you again, I would like you to consider reclaiming the strong woman you were when you were first married to Dale and choose which of these rules you are willing to follow. Think, too, about who you were when you first presented yourself to him in the past.” When Marsha returned the following week, she reported that she had experienced another very difficult and embarrassing situation with Dale that week. She handed me the list of rules that she had dictated to me, and showed me where she had marked through 19 of them. She was no longer willing to follow the rules, and had filed for divorce. I am a marriage counselor, not a divorce counselor, and though it is always difficult when clients choose to leave their marriages, I trust that my clients are doing what they need to do, and after a few months, the divorce was final. After the divorce I continued seeing Marsha, along with her two children. Then, I found in my office the strong woman who was beginning to respect herself. As a result of Marsha reclaiming herself and changing her presentation, Dale was now working elsewhere and beginning to appear slightly more responsible in seeing his children and providing for them, per court order. Marsha joined a gym and began to lose weight and reclaim who she wanted to become, again. Asking clients what the rules of their relationship are brings to the surface the client’s actions and presentations that are keeping the relationship in unhappy and challenging states. Once identified, clients have the option of choosing to keep the relationship on the same path or redirect it to a new one. Most opt for a new one. Then, we jump into a preferred future conversation and talk about how their new, more desirable presentations might appear different to the significant other. nn

TO CHANGE SOMEONE, CHANGE YOURSELF

I often work with talented, aspiring supervisees pursuing licensure as professional counselors or marriage and family therapists in the state of Texas. At one of these sessions, a supervisee brought up the following case for discussion among his group supervision colleagues. The client was a 32-year-old man, who described his childhood and adolescent years as full of disappointment in his mother and abuse by the men she married. He stated that his mother’s husbands drank and abused both her and her son. Although she was now separated from her third husband, the son was

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furious at having to constantly take care of his mother when she was abused by her spouse. The son wanted to confront his mother and tell her how she had ruined his life and that she needed help in choosing partners. My supervisee was unsure how healthy it would be for this client to confront his mother and was concerned that the “enmeshment” and “enabling behaviors” he suspected would continue unless the client began to do something different. He was perplexed about how to help the young man and was interested in how his colleagues would respond to the case. Most of the colleagues said that they did not think that having the son confront the mother would work. I agreed. We opted instead for the supervisee to use the “best hopes” question to move onto a path to a preferred future for the client—who was present—not the mother, who was not. In cases like this, one person has come to therapy to work on a relationship, which often means that person wants to change the other person. For both the therapist and the client, the best hopes question, again, is a rescue tactic. The sample dialogue that follows shows how the interaction with my supervisee’s client could evolve. It is based on my work with similar clients who wanted to either confront or change another person: LM:

“So, what are your best hopes for our time?”

Client: “To find a way to get my mother to listen to me. She has terrible taste in partners. They abuse her and me.” LM:

“And what difference would that make for you if she were to listen to you?”

Client: “She would be safe.” LM:

“And what difference would that make for you when she was safe?”

Client: “I could begin living my own life.” LM:

“Right now, if I asked your mom to describe how you come across to her, while well meaning, in an effort to keep her safe, what might she say?”

Client: “Probably that I hover over her, trying to convince her to stay away from those men. I probably appear to have no life at all. I don’t trust her. I worry about her. I probably look pathetic, like she’s all I’ve got.”

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LM:

“How would you rather she see you?”

Client: “Like I had a life.” LM:

“If you left my office and, just for today, began to show her from a distance, that you had a life, what might she see?”

Client: “I would plan a vacation. I haven’t had one in 10 years. I would probably make some friends and go out. I would focus on work, which I recently took off from to sort things out for my mother when she moved. I would have a life.” See how this client can move from wanting to change his mother to creating new possibilities for himself just by asking the same question, “What difference would that make for you?” (George, Iveson, & Ratner, 2009). Most of us have motives behind our actions, yet, too often, we only see one way to achieve them. The question reaches our core values and conjures up the reason that we want things to be different; usually, we want things different not just for the other person, but for ourselves. Once a therapist learns what an action means to a client, the therapist can take it to another level, where the client works toward achieving the personal change rather than changing others. This helps clients to achieve what is important to them, but in another way. Imagine, in this case, what the mother might do if her son took a vacation during the time of her separation. Imagine what she might do if he called her less often while on vacation. She might begin to deal with the situation she put herself in and perhaps do something different as well. We can only imagine, but the chances are, she will do something different. Her role would shift from one that she knows to a role that is uncomfortable. It is a good example of the “ripple effect,” a tenet of the solution focused approach: Solution focused therapists argue that if one small positive improvement or change can be achieved in what was otherwise a repetitive stuck pattern, then many other positive changes can occur through the “ripple effect.” (de Shazer, 1985, cited in Yasmin & Rhodes, 1995, p. 9)

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nn

RELATABLE MOMENTS THAT BUILD TRUST

Adults aren’t the only humans who pursue better relationships. The ­following conversation describes a dialogue that I had with an 8-yearold boy named Eric, who was upset about his parents’ divorce. The boy had become very disrespectful to his father, who had received custody of him. LM:

“So, if you had a wish that we could talk about, what might it be?”

Eric:

“That Mom and Dad would live in the same house again.”

LM:

“OK, that makes sense. And, I wonder, what difference would that make to you?”

Eric:

“I would feel like I have a family again.”

LM:

“And what difference would that make to you?”

Eric:

“I don’t know . . . I guess I would feel happier again.”

LM:

“I see. I know that your parents don’t live together now, but are there times, now, when you feel a little happy?”

Eric:

“Yes, when I play with my dog at my mom’s house.”

LM:

“Got it. When else?”

We gathered about 10 other exceptions, or times when Eric felt slightly happier, and wrote them on a large sheet of paper. Using the same steps presented in previous dialogues in this book, the conversation allowed the child to express his wish even though it was not attainable, yet I was eventually able to honor the needs behind his wish. By asking the same question again and again, we eventually got to a place where we could begin talking about other times when he felt happier, providing clues to the father. nn

DOING THINGS DIFFERENTLY WITH ADOLESCENTS

And then there are the adolescents, my favorite clients, with whom creativity in constructing a dialogue to mend a relationship requires

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a slightly different approach, yet the same theory—that is, finding a way to cooperate first! Such was the case with Tiara, age 13, and her mother. When they arrived for the first session, Tiara refused to get out of the car. Her mother came into the clinic and asked for assistance. While I could not help the mother to get Tiara out of the car, I did suggest that she let Tiara know that she would only need to come in for 10 minutes to check things out. Grudgingly, Tiara came into the clinic, earphones on and iPod playing as she swayed to the music and flopped into a chair. Apparently this was how Tiara had been reacting to every request of her mother’s, with defiance and abandon. I learned that her parents divorced in the past year and her school performance and behavior had gone downhill. No amount of encouragement, consequences, or rewards had made a difference for Tiara. My hunch was that Tiara was gearing up for the session to hear more of the same things she had heard from her mother. I wanted to do something different, so instead of asking the best hopes question, I asked another sort of question after the two clients settled into their chairs in the therapy room: LM:

“Mom, tell me what you love about your daughter. I would like to know everything about her.”

Mom: “Well . . . she’s beautiful and smart and, honestly, since I made this appointment, things have gone better.” (At this point, Tiara glances over at her mom, puzzled.) LM:

“Really? Such as what?”

Mom: “She’s been helping me with her younger brother, with watching him while I work a second job in the evening, and not complaining that I can’t take her places like we used to.” LM:

“Wow. Tiara, that is quite amazing. How did you know to do that?”

By this point, Tiara had taken out the earphones and begun to l­isten to the conversation. We were 10 minutes into the session. At first she said nothing but then she responded: Tiara: “Because my mom has a sucky life. My father cheated on her and left her to take care of us. She works two jobs for us. I guess it’s the least I can do.” (Mom begins to cry.)

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LM:

“It sounds like you are pretty understanding of what your mom’s going through. Tell me about your mom.”

Tiara: “She is a strong woman. When she found out my dad was cheating on her she didn’t put up with it. Now, even though he has a girlfriend, who I don’t like, Mom keeps it together, even when Dad is rude to her.” (Mom is fascinated by Tiara’s replies, and grabs her hand.) The session continued, and by the time it ended, 40 minutes later, Tiara and her mom had talked about their best hopes for each other and their immediate family, which included Tiara getting back on track with school in the fall. I learned from Tiara that there were two Tiaras: a “good Tiara” and a “bad Tiara,” who had apparently appeared only in the last few months of the school year when she began associating with a new crowd at school. When I asked which one she felt did her justice, she said the good Tiara, but she wasn’t so sure if people at school would ever be open to that. I asked her: “What would they begin to see if you did introduce them to the good Tiara?” She described a very different girl. We continued to work for three more sessions. When she returned to school in the fall, I was able to ease her return by talking to her teachers, with Tiara at my side on the school campus, reintroducing Tiara to the teachers she would have that semester. That seemed to help her transition back into the role of “good Tiara” and helped the teachers to see her differently as well. It is important to mention that in cases involving school failure, behavioral issues, or other situations, meeting with key members of the system involved (teachers, administrators, and more) is crucial to the child’s or adolescent’s success. A therapist can assist a school client to construct new strategies and presentations that are more representative of who he or she wants to be, but if the system is not informed of the intention, the chances for long-lasting change drastically decrease. Why? The answer lies again in the ripple effect, which addresses how our new interactions cause changes in old interactions. If Tiara’s teachers expected the “bad Tiara” to return to school, they would be seeing her with the same lens that led to her being labeled in the spring. But, if they were “reintroduced” (Metcalf, 2008) to the student, face to face in a very short meeting, and learned that the student desired to show them

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a new side of themselves, there would be a much greater chance that the student would be able to rebuild the relationships with the teachers. This is a key element of success when working with clients who are dealing with school problems. nn

PACKING UP THE BAGGAGE AND RECLAIMING A RELATIONSHIP

This final case described in this chapter represents a culmination of my work as a solution focused narrative therapist. It stretches the limits of the SFNT model when a client shows emotional needs in a session and the therapist has a chance to honor them. It also provides an example of how writing down the words of the client and reciting them back during the session can amplify a change in a relationship. Lonna and Gary were 2 weeks away from finalizing their divorce when they called to schedule an appointment for marriage counseling. Two weeks before the call, and a year after the divorce papers had been filed, Gary had asked Lonna to lunch and suggested that they try to make their marriage work. Lonna was in shock. Their marriage of 20 years had been challenging. They had two adolescents with special needs, and Gary’s parents had been emotionally abusive to both him and Lonna over that time. Because of the arguments and secrecy that had characterized their marriage, described by both partners, there was a fear that reconciliation might not be attainable. They were very afraid that the old patterns would set in and lead them back to divorce. Yet, there was a connection between them and they came to therapy every week for 4 months. We went through the same SFNT ideas presented earlier in this book, and during the third month, Gary, who had been living separately for a year, was pondering returning to the family home. He had made big strides in controlling his anger with his wife, and Lonna had made amends for some activities that he had been unhappy with as well. In essence, the couple had almost achieved what their preferred future described. They had initially scaled their relationship at a “2” and were now scaling it at an “8.” Trust, intimacy, and respect had returned. Yet, Gary could not work up the nerve to return to the home. At this point, Lonna felt hopeless that the marriage could work, and Gary could not come up with reasons why he could not return home. As a result, Lonna began to distance herself from Gary. They seemed to be at an impasse. The holiday season was now under way. Gary took the children to visit his parents out of state while Lonna stayed at home. During the visit, Gary felt marginalized once again by his parents, who also criticized his children’s behavior. He quickly left their house with the

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children and returned home. Upon return to counseling the ­following week, the couple appeared sad. When I asked, “What are your best hopes for our time?” Gary began to cry quietly and said, “I just don’t know. We have achieved everything I had wanted as a couple, and I still can’t move home. Then I visit my parents and I come back like this. They ­simply cannot see the man I am today or the family I have as worthwhile. It is almost like I must be validated by them for my ­decision to reconcile with Lonna in their eyes or I don’t move. I feel lost. My sister is the only one who has ever achieved anything, in their eyes.” As Gary talked, his words, “the man I am today,” kept ­resonating with me. I recalled language I had read in Michael White’s article, “Saying Hullo Again . . .” (1988), which described the use of narrative therapy in clients dealing with grief and loss. In the article, a section on adult self-abuse relays questions that help clients deal with important adults in their life who do not approve of them and instead, reject them: Further questions are then helpful in assisting these persons to revise their relationship with themselves. These questions encourage the person to speculate about how they might have been experienced, as they are now, by the child/adolescent that they were. (White, 1988, pp. 34–35) Gary had talked about being rejected by his parents in the past. While he was successful and motivated to reconcile, the baggage of his childhood was keeping him from feeling confident about his ability to move forward. I decided to step into Gary’s worldview and talk about his current emotional dilemma. His wife was in the room when I asked a key question. Here is how the dialogue unfolded: LM:

“Tell me, what is it that you know, but your parents do not realize, about the man you have become, and your family?”

Here are Gary’s answers, which he gave in front of his wife: “I have assisted my children in becoming who they are. I do understand our kids’ needs.” “I am someone who needed their support as an adult, just as much as my sister, and even though I didn’t get it, I still made it. I am successful.”

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“I am someone whose wife is a team player. She always did her best to do a lot of the ‘dirty work’ of parenting. She always went beyond, to get her family what it needed.” “I am someone who thinks that how Lonna does things is just fine, even though it’s not my mother’s way.” “I am someone who has succeeded in his field and contributed to the world.” “I am a good dad.” “That I see my marriage as just as important as my parents see theirs. I am married to someone who values family time and does all she can to make it work and I love her.” “I am someone who wanted something different and has the values to show it.” At this point in the session, Lonna was smiling and crying at the same time and Gary was sitting up taller in his seat. I copied the notes—which I titled, with Gary’s help, “The Man That Gary Is”—and gave them to Gary. At the follow-up session 2 weeks later, the couple announced that Gary had terminated his apartment lease and had moved home with his family. nn

SUMMARY

Words, recognition, preferred stories, values, and meaning are all wrapped up in what the SFNT model aims to provide to clients who are dealing with relational concerns. The clues to using the ideas of the model come from listening very closely to our clients for their language and values and being innately curious about who our clients are, what they want, and how they have traveled down similar paths. These cues, if honored, can assist the therapist in starting conversations that lead to reuniting clients with their values, thus, returning them to a more satisfying life. When Gary told me what he wished his family saw, he was providing me a list of his values. When Lonna heard the values, she recognized that she was an integral part of Gary’s preferred future and that he recognized her for her values. nn

PERSONAL EXERCISE

How do your values guide you in relationships? Mark Hayward and Amanda Redstone (personal communication, June 2016) have men­tioned that life goes off track when problems cause us to lose a

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connection with our values. Therefore, conversations that reunite us with our values, identified in preferred future dialogue, are enriching to us and influence our relationships. Consider the following thought-­ provoking questions. Think back to a recent encounter with someone who might have been challenging, yet, you were able to work through the encounter (then or later) and felt good about the outcome. What thoughts or values guided you through your responses? (List at least five!)

What did the other person notice about you in the process? What was your presentation? (List at least five!) As a result, how satisfied were you with your response? What difference did that make?

Keep these answers close to you, as they are guiding strategies for relationships.

REFERENCES de Shazer, S. (1985). Keys to solution in brief therapy. New York, NY: W. W. Norton. George, E., Iveson, C., & Ratner, H. (2009, June). Texas Wesleyan University Study Abroad: Solution focused therapy workshop. Brief Therapy Practice, London, England.

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Hayward, M., & Redstone, A. (2016, June). Texas Wesleyan University Study Abroad: Narrative therapy presentation. BRIEF Therapy Practice, London, England. Metcalf, L. (2008). Counseling toward solutions. New York, NY: Wiley. White, M. (1988, Spring). Saying hullo again: The incorporation of the lost relationship in the resolution of grief. Dulwich Centre Newsletter, 7–11. Yasmin, A., & Rhodes, J. (1995). Solution focused thinking in schools. London, England: BT Press.

CHAPT ER 6 Dangerous Habits Nothing is as dangerous as an idea when it is the only one you have. —Emile Chartier

Is it a disease or a habit, a diagnosis or a label? These questions about dangerous habits such as substance abuse, self-harm, and eating disorders have been researched and reviewed by many therapists and medical professionals who work with clients dealing with such challenges. How the therapist approaches these client concerns charts the course for therapy. Pathological labeling of clients for substance abuse, self-harm, obsessive–compulsive disorders (OCDs), and eating disorders does little to render success over the disease. The medical model views such challenges as addictions: Addiction is defined as a disease by most medical associations, including the American Medical Association and the American Society of Addiction Medicine. Like diabetes, cancer and heart disease, addiction is caused by a combination of behavioral, environmental and biological factors. Genetic risks factors account for about half of the likelihood that an individual will develop addiction.  (National Center on Addiction and Substance Abuse, n.d.) Although a diagnosis often sheds light when explained to clients, it also can disable them. Clients may feel that since they have a “­disease,” they 93

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are held hostage by the prognosis statement given in many treatment centers of “once an addict, always an addict.” While this chapter in no way intends to ignore the physical and emotional effects of dangerous habits, it aims to show how using redescription provided by narrative therapy offers a new way for t­ herapists to work with clients whose lives have been threatened by these habits. nn

HABITS HAPPEN AS A METHOD OF COPING

The idea of a dangerous habit suggests two things: first, that a client is dabbling in an activity that is harmful yet habitual; and second, that a habit can be managed through interventions. Coping with danger­ous habits can then be seen as the task of a client to reclaim his or her values, needs, and preferred future. The mere difference between suggesting to a client that his or her life is being intruded upon by habit rather than disease provides the first opportunity of seeing possibilities for overcoming the intrusion. Marie is a licensed professional counselor who works with young adult men on probation for drug possession and drug abuse. She noticed that whenever her clients were confronted by program staff about their substance abuse or relapse, and forced to think that they would be perpetual addicts or alcoholics forever, they appeared defeated, hopeless, and unmotivated. While the program pushed the ideas that addiction was a lifelong disease in an effort to educate and impress upon the young men the risks involved if they continued to use, the majority of them continued to relapse anyway. Whenever Marie talked with them after a drug test came back positive, she noticed how hopeless they appeared. Several would even say, “Well, it’s a disease, so what do you expect from me?” According to the National Institute on Drug Abuse (NIDA), “Like other chronic diseases, addiction can be managed successfully. Treatment enables people to counteract addiction’s powerful disruptive effects on the brain and behavior and to regain control of their lives. The chronic nature of the disease means that relapsing to drug abuse is not only possible but also likely, with symptom recurrence rates similar to those for other well-characterized chronic medical illnesses—such as diabetes, hypertension, and asthma—that also have both physiological and behavioral components (NIDA, 2012). Frustrated, Marie attended a group supervision meeting that I run for interns working on licensure as a professional counselor or marriage and family therapist one morning and expressed her concern over her

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clients, who seemed unmotivated and helpless. On that day, the group and I were discussing a narrative question that seemed to help clients recognize the impact of a traumatic event, difficult childhood, or a problem such as substance abuse on their lives. “Who would you be today if the situation that brought you here had never entered your life?” The question was constructed and influenced by the work of Combs and Freedman (1996). Like the Miracle Question, which provides a glimpse of a future without the issue’s intrusion, the question allows the client to contemplate how things could have been without the influence of the dangerous habit. Marie was intrigued and took the question back to her group that week. When she returned a week later, she reported the reactions of her group members: “That morning they were all sitting back in their chairs when I checked in with them that week, mostly looking down at the floor. Each one of them looked completely hopeless. I told them that I had a new question for them that day that I wanted them to think about: ‘Who would Marie be today if the problem(s) that brought you here had never happened at all?’” To her surprise, all the group members looked up at her, sat up in their chairs, and started describing who they would have been in a manner that reflected an energy she had not seen before. She asked every one of the group members to tell everyone more about who he or she would have been. “What would you be doing if not being affected by the problem? How would those important people in your life see you differently? What difference would it make to you for others to see you differently?” Marie wrote each of the group members’ responses on a whiteboard, and found that many of the responses were similar: “I would have a better job.” “I would have my family back.” “I would be in school.” “I would have money.” “I wouldn’t worry about the police every day.” “I would be able to relax. . . .”

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There were more than 25 answers. Then she asked them, “What if these could become your goals?” They were very quiet and some said that goals like that could never happen. Then slowly, they started talking about very, very small steps they could take to begin to move closer to their bigger goal. She asked the scaling question to all of them to see how close they were to the goals they had described. The answers she reported were surprising to everyone, as none were below a 3. They then talked about moving very slowly up the scale just for the next week, which led them to talk more about small steps they could take. She had never seen them so excited and motivated. And the motivation continued, because every week, instead of talking about what had happened, they talked about what they were doing to reach their true goals. nn

GAINING PERSONAL CONTROL

This chapter explores ways to talk with clients of all ages whose lives have been intruded upon by dangerous habits such as substance abuse, eating disorders, self-harm, and OCD. The ideas are applicable to any activity that “intrudes” upon the satisfaction of a client’s life. In the cases that follow, the pathological labels were never mentioned by the therapist, yet in most cases, both clients and therapists had been informed of the diagnosis. Some clients came to therapy with a diagnosis yet left with a new description that seemed to fit better and offered them hope. Each of those clients taught me how, with encouragement, a new definition of what was happening to them could take them much farther away from the habit than being confronted and labeled as having a disease or diagnosis. It is important to note that many traditional medical model treatments do work, especially for motivated and engaged clients who are determined to get their lives back. Programs such as Alcoholics Anonymous, Narcotics Anonymous, and problem-focused treatment centers are very helpful to many, many people. But for others who have gone from treatment setting to treatment setting without relief, the suggestion of externalizing a problem as a dangerous habit brings a sigh of relief and new insight into their competence to gain control of the habit. Additionally, since the ideas conveyed here include mapping the effect of the problem on the client’s life, clients who engage in the conversation often react with more responsibility, ready to defend their lives and desires from the intruding problem

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by doing things differently. And they can do all of that without admitting that they are diseased or forever an addict. In the cases presented in this chapter, externalizing the problem is utilized heavily, as it gives a client who is feeling overwhelmed and controlled by the problem the opportunity to stand back and examine not only the effects the problem has on his or her life, but the opportunities that await once the problem habit is less intrusive.

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THERE’S A MONSTER IN MY HEAD

Olive, age 10, came to counseling with her mother, who was concerned that Olive had developed numerous rituals at home that seemed odd and bothersome to both Olive and her family. For instance, Olive would go to each door in the house every morning and evening, open the door, make a hand gesture over it, and close it twice. She could not drink from a water fountain at school before looking at the ceiling. She would comb her hair at least 15 times each morning and night and brush her teeth five times per day for exactly 4 minutes. She insisted on doing all of the laundry in the home and folding the laundry to make sure all the labels were lined up and looked “perfect.” When friends came over—which was not often, as Olive thought they were too messy—she followed them around to straighten up things that they might have touched or moved. According to her mother, Olive had always been a neat child, and at age 2, she would straighten her dolls constantly as she played with them, lining them up in a perfect row. In school, Olive said that she made all As and was constantly erasing her papers so that things she wrote down were, in her words, “perfect.” She said when she read a book, if she missed a word while reading out loud, she would have to start completely over from the beginning of the book. Olive and her mother were concerned about these behaviors, and how they were affecting Olive’s home and school life. Troubled by the “rituals” that her mom described, Olive appeared overwhelmed and overburdened by the constant need to do tasks that interfered with enjoying her life as a 10-year-old. Although we never discussed OCD, Olive certainly exhibited many symptoms. I listened closely to both of them and then moved forward in the session with the following question, to gain traction toward creating a preferred future. I asked them both: “So, what are your best hopes for our time?” Mom: “Olive told me last week that she felt like she had a monster in her head and wanted it to stop. She said she was so tired of the monster because it kept her from

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having any fun, doing more crafts, and she couldn’t do the activities she wanted to do. She couldn’t watch a favorite show on television without making sure things were perfect before she sat down. She was tired of it constantly making her do things. She found her actions annoying to herself, as they were to all of us, but she just couldn’t stop.” Olive: “I just want it to stop so I can have more time to do the fun things I want to do. I don’t mind it if it keeps me tying my shoes like this . . . (pointing to her laces) but I would like to stop doing all of the other things, like closing the doors all of the time.” As the session continued, the goal of being able to do more fun things, and have more time away from the “monster” so that she could relax, became a goal that Olive identified and was delighted with. In an effort to talk about the effects of the monster in her head, the conversation continued: LM:

“So, tell me, what is the monster in your head keeping you from doing?”

Olive reported that it kept her from doing crafts, which she loved, playing outside with friends, being on time, finishing a book, and about 10 other effects. I wrote down each of Olive’s answers; then I read back the list I had composed and asked Olive: “Suppose I sprinkled fairy dust over your house tonight so that when you awoke tomorrow, the monster in your head would not be there. What would be going on when you first wake up that would tell you things were better?” Olive described in detail how she would be doing crafts much more often, would watch her favorite superhero mermaid show, have a few friends over, get a drink from the drinking fountain at school without looking at the ceiling three times, read an entire chapter in a book without stopping, and, in her words, “not be doing the hand thing” (referring to the hand gestures she performed when closing the doors in her house). I was curious about her superhero show that day, so I asked what she liked about it, hoping to find some familiar language to use in our conversation. I learned that the mermaids on the show had super

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powers. I wondered out loud if she might be interested in pretending that she had super powers like the mermaids. She smiled, laughed, and said “Sure.” She continued to tell me that on that day, too, she would only brush her hair four times and brush her teeth for 3 minutes, not 4. Doing these things, she said, would give her more time. At this point, I gave Olive some drawing paper and asked her to draw the monster in her head. Then, I asked her to indicate, on a scale of 1 to 10, where the monster was when we started talking that day, with 10 meaning the monster was completely taking over and a 1 meaning she was in charge. Olive said the monster in her head was an 8, and that this was how she felt most days. I asked her to write down on the paper what she had told me the monster made her do when it was in control. Then, on another paper, I asked her to draw the day that was ­sprinkled with fairy dust and write down what she could do using her super powers, just for the next few days. She wrote all over the second paper, not worrying at all about neatness or perfection, even ­misspelling a word or two, which I didn’t dare correct! She seemed driven to get everything down on the paper quickly. Her mother said that she had never seen Olive express herself so freely on paper without erasing or making sure everything looked perfect. I asked Olive if she would like to take the paper home and she said that she would. She said she wanted to put it on the doorway that led to the garage so that she could read it each day before school. I asked her what she might do just for that evening, to begin shrinking the monster. She talked about not w ­ orrying too much about the labels on the pillows when she arranged them that night and how that would mean she would be able to watch her ­superhero show twice. She also wanted to stop doing the “hand thing.” In a week, Olive and her mother returned. When I asked, “What’s gone better?” Olive’s mother said that Olive had stopped the hand gestures. Her mother also said that Olive had been walking into the house after school and throwing her things in the closet quickly instead of arranging them carefully, so she could go outside and play. Olive was beaming as she told me she had stopped erasing her school papers constantly. She said she limited herself to two erasures. She had only looked at the ceiling before getting a drink at the water fountain once that week. She confirmed that she had followed through with each of her ideas to shrink the monster, which she said was now a 5 on the scale. I continued to see Olive two more times with her mother and on occasion, her father, who confirmed that Olive had “gotten in charge of” the monster in her head. Olive took delight in telling me her triumphs

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This Certifies That:

Olive Brown Has successfully shrunken the monster in her head. She has performed this task by bravely refusing to close doors, brushing her hair only five times, not starting over when reading books, and making many other great changes. As a result, she has developed super powers to keep the monster in her head away so she can have much more fun doing crafts, playing with friends, and watching her super hero show. Signed, Olive Brown Linda Metcalf over the monster in her head and, above all, the things she was now able to do since the monster was smaller. At the last session, Olive and I composed a certificate to complete during the session. I made a copy of the certificate and gave the original to Olive, who was thrilled and said she was going to frame it. A follow-up call with her parents 6 months later revealed that Olive was continuing to put the monster in her head aside so she could do more enjoyable activities. She had drastically cut down her need to do things perfectly and was performing the rituals to a level that seemed, to them, normal. Her mother remarked: “You know, my husband and I are type A personalities and work all of the time. Since Olive has been backing off her rituals, we have been trying to relax as well. I think that helps to keep Olive on track as well. She is doing great. She has friends over all of the time and seems very happy. Even the teachers have noticed a change.” In Chapter 4, which focused on trauma, we saw how mapping the effects of a problem on a person’s life could motivate the client to take action against the intrusive problem. In the same way, clients who

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­ resent with situations such as Olive’s can be helped to take action. p Whether it be anxiety, depression, anger, negativity, or a monster in one’s head, making a list of the effects seems to encourage clients to recognize their unhappiness that such effects are occurring and, as a result, stand up to the problem and reclaim their lives. nn

COPING SAFELY

It has been my experience that most dangerous habits are coping mechanisms for clients. The habits provide some sort of relief to the client who is dealing with challenging situations. When a problem-focused therapist confronts a client’s coping “solution,” the client sometimes becomes resistant. What is a client to turn to? I encourage my supervisees, when working with such clients, to “rise above the story” and ask: “How does this habit help you?” Nearly always, the client is surprised by the question, often responding, “I don’t think it does, it’s just what I do. I know I need to stop but I don’t want to.” Then, we move into the best hopes question and therapy begins. In answering the best hopes question, most clients will talk about something other than the habit from which they are seeking to recover. With this mindset, the therapist presents a conversation to the client focusing primarily on what the client wishes would be better in his or her life. Whatever the preferred future develops into, as the conversation continues, the chances are that achieving that preferred future will necessitate a change with regard to the dangerous habit. Again, systems theory comes into play, suggesting that more of the same interactions and activities will result in the same outcome. A different outcome, as described in the client’s new chapter, or preferred future, will require a change of interaction and activity to achieve the preferred future. In the next sections, I provide questions to use when working with clients who are dealing with dangerous habits. Using this approach, clients become more invested in the process and take responsibility for distancing themselves from the habit and reclaiming their lives. nn

ASSUMPTIONS ABOUT CLIENTS WITH DANGEROUS HABITS

The solution focused narrative therapist takes on a different assumption and stance about clients bothered by dangerous habits such as substance abuse, self-harm, OCD, or eating disorders than a problem-­ focused therapist would. Denial of a dangerous habit is a huge hurdle in

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t­reatment and is approached in problem-focused treatment programs by ­insisting that the client recognize that he or she has an addiction or disease. Clients are pushed to recognize that they will always have an addiction or disease. When they become resistant, they are deemed uncooperative, in denial, and unmotivated. Both the therapist and the client reach an impasse. This is especially the case for clients who are placed in treatment centers by family members. They are, in essence, being persuaded to work on someone else’s goal, not their own. The assumption of a therapist using solution focused narrative therapy (SFNT) is that the client’s attempt to cope with situations in his or her life has led to habits and activities that have become dangerous to the client’s well-being and possibly others in his or her life. The therapist therefore does not confront the client, but rather seeks best hopes from the client regarding what the client wants to better in his or her life. It is the hope of the therapist that by working with the client to achieve what the client wants, he or she will see a need to (a) give up the habit and (b) feel empowered to create a preferred future. nn

SUBSTANCE ABUSE HABITS

Treatment and relapse prevention for clients dealing with substance abuse has taken many forms in problem-focused therapy, without substantial positive results: In the past, traditional treatment methods for drug addiction and alcoholism have been characteristically intense and confrontational. They are designed to break down a client’s denial, defenses, and/or resistance to his or her addictive disorders, as they are perceived by the provider. Admissions criteria to substance abuse treatment programs usually require abstinence from all illicit substances. Potential clients are expected to have some awareness of the problems caused by substance abuse and be motivated to receive treatment.  (Sciacca, 1007, p. 41) As for relapse, which is often considered part of the recovery process, the outcome studies do not show high percentages of remission, particularly when traditional methods are used: In a meta-analysis of alcoholism treatment outcome studies, average short-term abstinence rates were 21%

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for untreated individuals in waiting-list, no-treatment or placebo conditions, compared to 43% for treated individuals. Similarly, Weisner, Matzger, and Kaskutas (2003) found that treated alcohol-dependent individuals had higher 1-year ­nonproblem use outcomes (40% versus 23%) than did untreated individuals. Overall, these studies suggest that, especially among individuals who recognize their alcohol problems, treated individuals achieve higher remission rates than do untreated individuals . . . More social resources, especially supportive relation­ ships with family members and friends, are associated with both treated and untreated remission. More reliance on approach coping and less on avoidance coping also is linked to a higher likelihood of remission. In addition, compared to individuals who remit with help, those who remit without help tend to have more supportive family relationships and to rely less on avoidance coping. (Moos & Moos, 2006, pp. 212–213) Solution focused therapy (SFT) has provided therapists with new tools for working with clients who are dealing with substance abuse. The following is a summary of research findings that have shown the effectiveness of the solution focused approach over the problem-­focused approach. Researchers have tested the effectiveness of SFT with substance abusers (Smock, Trepper, Wetchler, McCollum, Ray, & Pierce, 2008). The study concluded [that] clients receiving SFT had significantly improved scores on the Beck Depression Inventory and Outcome Questionnaire. While there was clinically significant data in the SFT group, the comparison group did not improve on either measure significantly. Next, de Shazer and Isebaert discussed the effectiveness of SFT as an approach to treat alcoholism. In this study, the researchers found that 84% of their participants from inpatient therapy, and 81% from outpatient therapy, had established sobriety for at least four years and counting (2004). These two research studies provide insight into the effectiveness of solutionfocused therapy with both substance abusers and problematic drinkers. (Wallace, 2016, p. 13)

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Rane Wallace is a licensed professional counselor and licensed chemical dependency counselor who works with clients trying to gain control over their substance abuse habits while they are on probation. He writes in the following passage about the helpfulness of providing a context where the client feels empowered versus confronted: framing questions in a solution oriented way helps empower the client to become more goal-oriented. Instead of using the word “if,” therapists use the word “when.” By altering the wording of questions, therapists empower clients (Taylor, 2005). For example, a solution focused therapist working with a justice-involved individual may say, “When you complete probation,” instead of “if you ever complete probation.” (Wallace, 2016, p. 13) The presuppositional language, addressed earlier in the book, provides a way of questioning that elicits answers, since the questions suggest there are answers. The client directs the session toward the goal that is most important to him or her, as these questions are answered, and identifies what will be occurring when the dangerous habit is no longer interfering in his or her life. The therapist follows the client’s lead. If substance abuse is what the client wants to address, the therapist presents a suggestion to the client that they refer to the substance abuse issue as a dangerous habit. If the client is open to a redescription of the issue, the therapist continues the conversation using language suggested by the client to represent the substance abuse issue. The focus, as suggested, is to create the preferred future, so richly described and irresistible that the client must achieve it. It should be noted that some clients have difficulty acknowledging that the habit is interfering in their lives, although their significant others may insist that it is. It is important at that point to move back into the best hopes question in an effort to rejoin the client and learn what the client wants to make better. This will, again, lessen resistance. As the client continues to talk about what he or she wants for the preferred future, the therapist can also encourage the client to describe the new ways in which he or she will live life. It is often at this point that clients may include the goal of stopping the substance abuse. Again, the key is to gain a solid, specific goal and preferred future that the client longs to achieve. “What will you be doing on that day when things are better and [the goal] is occurring?”

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“What will others notice and say is different about you and their interactions with you?” “What else will be different?” (To be asked at least 15 times!) The answers provided in these questions are composed as a list, which can then be copied and provided to the client at the end of the session. The list will give the client a direction toward actions in his or her preferred future. There is a powerful impact when a therapist takes time to read back the list to the client, slowly and carefully, reminding the client consistently that the words are the client’s. Once the therapist finishes reading the list, he or she simply hands the copy to the client and compliments the client on knowing what is best. The therapist might ask for the client’s ideas on what to try out, or leave it to the client to decide later. The idea of making lists, which has been mentioned throughout this book, came from George, Iveson, and Ratner (2009) at Brief Therapy Practice in 2009 and continues to be part of every session I have with clients. On many occasions, clients will admit that in between sessions, they go over the list. Children and adolescents often post the lists in places where they can readily see them, as Olive did in the earlier case example. Adults often keep the lists on their person, in their wallet, or in their purse. The construction of the lists serves as a respectful and bountiful intervention.

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MOVING BEYOND THE ROADBLOCKS

No matter where the dialogue goes, the substance abuse, an integral part of the client’s life, tends to surface on its own during the conversation as a roadblock to something the client wants to achieve. This is especially true if family therapy is utilized and the best hopes of each family member are verbalized. Family members who are the most affected by the dangerous habit often describe a preferred future as full of activities that can only be achieved without the substance abuse habit. Thus, the helpfulness of family therapy cannot be ignored. The Miracle Question, which propels the description of the preferred future, invites such descriptions of a preferred future from everyone involved. The narrative component then invites everyone in the family to describe how each of them will take authorship in contributing to a new family chapter. This gentle suggestion is often quite helpful to the person bothered by the dangerous habit, as it seems to suggest that authoring a new chapter will include a new script.

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Of course, there will always be times when clients ask for educational information; under the scope of the solution focused ­ approach, the therapist should provide the resources requested. The therapist can also ask, during a point where the client feels confused over substance abuse issues, if resources would be helpful. However, it is important to not push resources onto a client who has come to therapy to work on other concerns. The postmodern approach consistently suggests that the client is the expert and the solution builder. The following case illustrates questions that have been helpful in working with clients bothered by a variety of substance abuse issues. nn

REARRANGING THE FURNITURE

Mario, age 45, came to an Employer Assistance Program (EAP) appointment after he failed a drug test that was given to him by his employer. He told me that he had worked for the same company for 25 years, and had smoked marijuana just as long. According to Mario, his habit never pushed him into other drugs. He simply loved marijuana and it helped him relax after work from his stressful job as a line manager. Like a lot of clients, he said that he never smoked at work and had always received exemplary annual reviews. Thus, his employer wanted to keep him on staff but also demanded that he be drug free, according to their new policies. Since his boss had talked to him, Mario said he had not smoked. After Mario shared this information, per his referral, we continued: LM:

“So, what are your best hopes for our time?”

Mario: “I need to keep my job. I am not happy about giving up weed. I love weed and the way it helps me relax. I’ve done it so long, and it hasn’t caused any problems anywhere else . . . but, I guess to keep my job, I have to address it.” LM:

“So, it sounds like you know what you want. So, besides the chance of losing your job, what have been the other effects of the habit in your life?”

Mario: “Well, my wife worries and gets upset at me sometimes. We actually used to smoke together but she stopped when we had grandchildren. We have one grandchild who lives close by now and my wife doesn’t like it when I smoke because the baby might smell it.”

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LM:

“What else?”

Mario: “Last year my doctor told me that he didn’t like the way my lungs sounded in my annual physical for work.” LM:

“So, would it be okay if we talked about this activity that you engage in when smoking marijuana as a sort of ‘dangerous habit’?”

Mario: “Yeah, that’s okay.” At this point, Mario and I scaled just how big an influence the ­ arijuana habit was in his life, on a scale of 1 to 10, with 10 being the m biggest. I was surprised to hear that he put the habit at a 6. According to him, he did not smoke every day, just several times per week. He never smoked when his grandson was present. He never smoked at work, nor before he drove somewhere. When I asked him how he managed to do those things, he said he wouldn’t do anything to jeopardize his grandson’s visits, his job, or his own safety. He truly had values that guided him into setting boundaries for himself. I made a note about those revealed values and planned on complimenting him about his values and inquiring later where he got them and how they had assisted him in other areas of his life. He had kept a job for 25 years and that was another value. He must have felt a loyalty to do what was required of him at work. He also put limitations on his use of marijuana, which appeared as exceptions to the habit. I continued in our conversation and then asked him what he did on those nights when he didn’t engage in the habit to relax and he said he would sit outside on the porch and play his guitar. We then talked about a preferred future without marijuana but with new strategies to relax. After he described the preferred future, I inquired how he had quit other habits in his life. I soon learned that one of his habits was physically raging at other drivers (he rode a motorcycle). He said he would get pulled over occasionally by police for his ranting at other drivers at stoplights. He said to quit that habit he had to take the back roads home, which he still did to this day. He not only found it pleasant to drive on quieter streets, he also stayed out of trouble. When I asked him what difference driving on quieter streets made, he said it just removed him from temptations. Again, he was able to set limits so that he was abiding by boundaries. At this point, we talked about what values he possessed that encouraged him to make decisions when really needed, such as taking a quiet street. He talked at length

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about his upbringing, the model he wanted to be for his kids and now his grandchildren. He said he got those values from a father who was a hard worker, who had two jobs so his mother did not have to work outside the home. That work ethic had served him well over the years. He seemed surprised to realize that the ethic had gone farther than that. It had stopped him from taking chances so that his livelihood and his safety, along with the safety of others, would not be affected. At the end of our session, I had constructed lists of effects, the ­preferred future, exceptions, and his values. I asked him where he might like to be on the scale when he returns. He said “a 5.” When he returned the following week, I learned that he had again refrained from s­ moking ­marijuana successfully. When I inquired how he managed that, he said he had left the session last time, and realized he had to do some ­rearranging at home. He went home and moved the recliner that he had always smoked in to another room in the house and threw away the pipe he often used when he smoked. He remained drug free at a 6-month follow-up session. He continued to bring up the word “values” and talk about how he never realized that even though he smoked marijuana, he had values that kept him from smoking it in certain situations. He said if he could make decisions like that and stick to them, he could stick to being clean. nn

DISTANCING FROM SELF-INJURY

Whether it is self-injury or an eating disorder, which we will address later, clients bothered by these dangerous habits are often using the habits as coping mechanisms for living their lives. Since these habits are coping mechanisms, the habits are not easily surrendered. These cases are challenging. The Mayo Clinic recognizes that, There’s no one best way to treat self-injuring behavior, but the first step is to tell someone so you can get help. Treatment is based on your specific issues and any related mental health conditions you might have, such as depression. Treating self-injury behavior can take time, hard work and your own desire to recover. (Mayo Clinic Staff, 2016) Working with clients affected by self-injury means developing a working relationship where resistance is lowered. To do this, the SFNT approach is helpful as it allows the therapist to step into the worldview of the client and learn how the habit helps him or her, externalizing the habit in the process. By avoiding confrontation and instead taking

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a ­curious stance, the therapist is more likely to join with the client and gain trust. Julie, age 15, had been to four treatment centers during the period of a year for self-injury and suicide attempts. The daughter of a prominent s­ urgeon and a congressman, she revealed on several occasions how she disliked the way her parents argued. She struggled with depression and had engaged constantly in risky behaviors. She would cut often, and her parents would always take her to the emergency room for stitches and treatment. She had compiled books full of “new coping mechanisms” that were given to her by therapists in her inpatient stays. Yet, she continued to cut. During our first appointment, I asked her, “How does cutting help you?” Julie replied that it settled her down, helped her to relax, and took away the sadness that she often felt. She said she was depressed. When I asked her what her best hopes were, she said “to feel less depressed.” She had broken up with a boyfriend about a year ago. One therapist in one of the treatment centers where she had stayed told her she was suffering from posttraumatic stress disorder (PTSD), which stuck with Julie. She could then justify her cutting, she said, since she had found out that PTSD is incurable. What was interesting about Julie was that by the time she came with her family to the first session, she had not cut for 2 months. She had been in the fourth treatment center for the past 2 months and had been watched constantly. She was now on several medications for depression and anxiety. Her arms had healed up, yet her parents were terrified that she might begin cutting at any moment. In situations like this, where family dynamics play such an important role, I invite everyone to attend. During that first session, we began the conversation much the same as I suggest in the template at the end of this chapter. We discussed the family members’ best hopes. Here are the responses: Mom: “That Julie would be safe.” Dad:

“That Julie would be safe and we could have peace at home, particularly between Julie and me.”

Julie: “That I wouldn’t be so depressed.” With so many best hopes, and a somber context, full of ­hopelessness, I thanked the family and asked them the Miracle Question, which

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involved asking them to describe a day where the family and Julie functioned much better. The rest of the session involved everyone answering the Miracle Question. The answers were, Mom: “I would be able to go to work and not worry. I am quite behind in my work and would be caught up. Our family life would be calmer on that day. We would eat breakfast together instead of Julie staying in her room away from us.” Dad:

“Julie and I could have a conversation that wouldn’t get heated. I could ask her about her plans for that day. She might get up out of bed for a change, and maybe do things with her brother.”

Julie: “I would be happier. I might go out with friends.” We continued to talk about what else would be better for the session until we got a visual picture of the preferred future. I also inquired of Julie what had made the difference for her to cut less over the past 2 months. She said the last treatment center had constantly watched her and she was away from the family conflict at home. We talked about what difference that made and she said: “I felt peaceful, like I didn’t have to tune anything out anymore.” This information was informative to her parents who were surprised at the impact their arguing had on Julie. At one point, Julie said her mom once told her that she and her father were considering divorce because of Julie’s negative behaviors. At that point, her mom became tearful and apologized to Julie, saying what went on between the parents was her (Julie’s mother’s) fault. She also disclosed to Julie that she and Julie’s father were starting marriage counseling. At the end of the session, I asked the family whether what we discussed in that session might have been helpful. They responded: Mom: “I think we learned a lot about how our (marital) relationship impacted Julie. I never realized it was so hard for her.” Dad:

“I feel like a weight has been taken off of my shoulders. You have given us a good day to imagine, and honestly, I feel much freer than I have in a while.”

Julie: “I think they listened to me.”

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Over the next few weeks, the family dynamics got better and I  ­continued to work with Julie individually, as well. Julie was able to find other, healthier avenues to relieve stress and achieve peace rather than through self-injury. Each of the healthier avenues were activities that she had engaged in before; thus, the exceptions to times when she self-injured. I saw Julie for more than a year, at first once a week then once a month. The self-injury went away, yet she still had difficulty getting her life back on track. As her parents got marriage counseling, however, Julie began to act more like a typical adolescent and began associating with friends and going back to school. This case illustrates a very important systemic factor: that an individual who copes through dangerous habits should always be viewed through a lens that considers how the interactions in her life with significant others might have created the need for the habit. Unless the system is involved in expressing best hopes and a preferred future, ­simply seeing a client individually will slow down progress and lessen a chance for long-lasting change. Of course, there will always be clients whose families opt not to participate. Those clients can also be helped with SFNT; however, the therapist will need to focus more on how the client can manage the preferred future in a context where others might not support it. Identifying others in the client’s life who might offer some support helps the client to feel less alone in pursuit of a better life. nn

RECLAIMING HEALTH FROM EATING DISORDERS

Eating disorders are often referred to as diseases or illnesses by ­problem-focused treatment centers. The medical model often conceptualizes the disorder as occurring from the following contexts: •

Dysfunctional family dynamic

•

Professions and careers that promote being thin and weight loss, such as ballet and modeling

•

Aesthetically oriented sports, where an emphasis is placed on maintaining a lean body for enhanced performance. Examples include rowing, diving, ballet, gymnastics, wrestling, long distance running

•

Family and childhood traumas: childhood sexual abuse, severe trauma

•

Cultural or peer pressure among friends and coworkers (National Eating Disorders, n.d.)

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Among the many treatment options for clients affected by ­eating disorders are family therapy, group therapy, and individual counseling, which may include work with a nutritionist. While traditional treatment may be helpful to many, the fact that most of the treatments involve changing eating habits so the client becomes healthier is often met with resistance. There is a true need for the client bothered by an eating disorder to have control over his or her consumption of food. Imagine, then, what occurs when a treatment center controls the amount of food that the client is supposed to eat at each meal. When working with clients bothered by eating disorders, I make it mandatory for the client to see a physician regularly during therapy. Eating disorders are very dangerous habits and medical monitoring is essential. While a therapist may not suggest calling an eating disorder by its diagnostic name (e.g., bulimia, anorexia, or binge-eating disorder; see www.nationaleatingdisorders.com), the manner in which the habit is addressed is similar to that discussed so far in this chapter regarding other dangerous habits. In Solution Focused Group Therapy (Metcalf, 1998) I wrote about a client named Deena, who was a binge eater. She had gained about 30 pounds and was concerned about her health. She had attended a treatment ­center for eating disorders and did well in the structured environment. However, once she returned home, she returned to temptations, and her eating disorder habit returned. Here is a segment of the dialogue that occurred in a group setting that she attended in aftercare: LM:

“Apparently, it (the habit) must bring you satisfaction. Does anything else come close to what it does for you?”

Deena: “No, just other sweets, maybe listening to music, sometimes or walking with my dog. The trouble is, if I’m in the house, I’m too tempted.” LM:

“I have an idea. Please tell me if I am off base after I share it with you. You said that you eat ice cream about five times per day, right?”

Deena: “Yes.”

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LM:

“How much would you suggest cutting down on or changing your eating habits so that you would feel just a slight improvement?”

Deena: “Maybe eat it just four times a day.” (Metcalf, 1998, p. 72) The preceding dialogue represents giving back control to the client, who has had control threatened by her former treatment, where abstinence was expected. Again, consider that dangerous habits may be the person’s only identified coping mechanism. To ask the person to abstain completely is understandable to the therapist but frightening to the client. The SFNT approach suggests that going slowly is important to achieving long-lasting change, and maintaining change means utilizing the values of the client. In this case, giving control to Deena seemed helpful as did going slow. If I were to continue with Deena’s dialogue here, we would learn that she valued being able to cope with feeling insecure and having some control. She felt a lot of pressure to measure up to her brothers and sisters who were all very successful. As we continued to work together, we considered her values of doing something important with her life as we talked, and thought of a preferred future where her values were still prominent, but she was also valuing her health. At the end of one ­session, I asked Deena to be on watch during the next week for times when she was tempted to eat ice cream but took control over it. I asked her to notice closely where she was and what she was doing. I also asked her to notice when she was eating healthy. Deena was one of the first group members to terminate as a group member after a few months. During our group times, we discussed effects of the dangerous habit, preferred futures, and exceptions. When asked what she found most helpful in gaining control of her habit, Deena said she “. . . appreciated the fact that she was never told to quit bingeing” (Metcalf, 1998, p. 73). Through the group conversations, she said that she learned how the habit had kept her from feeling good about herself, as she felt shameful each time she indulged. She said she had always wanted more in her life than what her siblings wanted and constructing her future made her realize that she needed to go back to school and get training. She also noticed when she had things to do actively, she binged less. She began structuring her free time with enjoyable activities and applied to graduate school.

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GUIDING TEMPLATE FOR CLIENTS WITH DANGEROUS HABITS

The following box offers a template of questions that may be useful when beginning conversations with clients who are dealing with dangerous habits. The questions are suggestions, and should be used in ­collaboration with the client’s direction.

Ideas for Helping Clients Deal With Dangerous Habits • “What are your best hopes for our time?” • “So, someday when your best hopes are occurring, what will

that look like?” • “How shall we talk about the ‘habit’ that is keeping you from

your best hopes?” • “What have been the effects of the habit on your life?”

(Compile a list: “Effects of the Habit.”) • “Tell me times when you have been able to resist the

habit and it did not affect you as much.” (Compile a list: “Exceptions.”) • “What will you get to do when the habit is not a concern for

you?” • “Who will notice first when the habit is gone and you are in

control? What will they notice that will show that you are in control?” • “On a scale of 1 to 10, with 10 meaning you are in control of

the habit and 1 meaning the habit is in control of you, where were you when you arrived here today?” • “Let’s say tonight, while you sleep, a miracle occurs and the

habit that has been intruding in your life disappears. When you awake tomorrow, what will you notice that will tell you things are very different? What will you be doing during those times that will be different? What will others notice? Will those significant others be pleased?” (Compile a list, “The Preferred Future.”)

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At this point in the conversation, the therapist might read back the lists that have been compiled by the therapist to the client. After ­reading the lists, the therapist can make copies of the work and hand it to the ­client, saying something like: “Here are your words and ideas on how you want things to be and how you have achieved them before. As you go through the next week, watch for times when you might try out just a few of the items on the Preferred Future list. Watch closely, too, for how others react to you when you try them out. Think of this activity as an experiment.” When the client returns, ask: “What’s gone better since I have seen you?” “What else is better?” “On the scale we discussed last time, you said you were at a ___. Where would you say you are today?” “How did you do that?” “What were you thinking about that helped you to do that?” “What were you believing about yourself that helped you to be on top of the habit?” “Who has noticed things being different?” “As a result of their noticing, what else has gone better for you?” Again, the therapist begins to compile a list of successful actions that the client has taken, along with new thoughts and beliefs about himself. Again, the lists are copied and given to the client. Future sessions can continue at the client’s discretion at this point and each time thereafter, putting the client again in control of the conversations and whether to meet again. For the second and future sessions, the ­following questions are useful: “Tell me what has gone slightly better since we last met.” “What is it like for you to see yourself doing these things?” “Who has noticed these changes?” “What is it like for you to know that others are noticing you do things differently?” “What does being able to do things differently tell you about yourself?”

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These questions were crafted with the influence of Mark Hayward (personal communication, June 2016). His influence is depicted in the second, fourth, and fifth questions of the previous list, as each of the questions search for meaning and values, a prominent component of narrative therapy. The solution focused method is dominant in the first and second questions, which are more action oriented. The blend of the two models here provides a rich experience for the client, who gets to identify not only what has worked, but also the influence he has had on others as a result of new actions. It is important to note that when asking, “What’s better?” in the second and subsequent sessions, that some clients may not be able to recall, at first, if anything has changed. Do not give up. It is nearly impossible for change not to occur, with all of the influences and interactions that people have each day. The fact that a first session has occurred will cause a client to think differently and then probably do something different, even if it is very small. So patience is of the essence here. Continue to inquire about small things that might have changed and, definitely, ask about what others might have noticed. If things have gotten worse, in the client’s view, ask when the worst day was. Then, any day after that or before that is an exception. nn

SUMMARY

Creating empowering conversations with clients who are dealing with dangerous habits is rewarding for both therapist and client. These conversations, through cooperation with the client’s worldview and redescription application, seem to relieve the anxiety and fear of change that are so present in these clients. Giving back control to a client who feels out of control due to the habit reduces resistance and allows the client to see his world as more than a world tarnished by a disease. Calling an issue a habit, rather than a disease or addiction, also provides hope. This is not to negate that these habits are serious, nor will they simply disappear. Instead, it is simply another way of conversing about dangerous habits that seems to open up possibilities to clients who can’t see any way out. By working this way, it has been my experience that clients are more open to composing a preferred future where they are the author who is habit free.

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PERSONAL EXERCISE

Think of a habit, routine, or any concern that currently might keep you from living the way you wish. It can be anything, such as being too sedentary at night, overspending, or not doing something you desire to do, such as exercise. Then imagine the following: Suppose tomorrow when you awake, the habit that keeps you from living your life the way you want disappears. 1. What would your morning, afternoon, and evening look like that would tell you and others who are important in your life that you have put the habit out of your life?

2. What else?

3. What else?

4. What else?

5. What difference would putting the habit out of your life, just that day, make to you?

6. What difference would it make to others in your life?

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Enjoy the description of your habit-free day. And, tomorrow, try out just one or two very small ideas that you came up with when you answered, “What else?”

REFERENCES Combs, G., & Freedman, J. (1996). Narrative therapy: The social construction of preferred realities. New York, NY: W. W. Norton. de Shazer, S. & Isebaert, L. (2004). The Bruges model: A solutionfocused approach to problem drinking. Journal of Family Psychotherapy, 14(4), 43–52. George, E., Iveson, C., & Ratner, H. (2009, June). Texas Wesleyan University Study Abroad: Solution focused therapy workshop. Brief Therapy Practice, London, England. Mayo Clinic Staff. (2016). Self-injury/cutting. By permission of Mayo Foundation for Medical Education and Research. All rights reserved. http://www.mayoclinic.org/diseases-conditions/ self-injury/diagnosis-treatment/treatment/txc-20165488 Metcalf, L. (1998). Solution focused group therapy: Ideas for groups in private practice, schools, agencies, and treatment programs. New York, NY: Free Press. Moos, R., & Moos, B. (2006). Rates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction, 101(2), 212–222. doi:10.1111/j.1360-0443.2006.01310.x National Center on Addiction and Substance Abuse. (n.d.) Addiction as a disease: The disease model of addiction. Retrieved from http:// www.­centeronaddiction.org/what-addiction/addiction-disease National Eating Disorders. (n.d). Retrieved from http://www .nationaleatingdisorders.com National Institute of Drug Addiction. (2012). How effective is drug addiction treatment? In Principles of drug addiction treatment: A research-based guide (3rd ed., p. 11). Bethesda, MD: Author. Retrieved from https://www.drugabuse.gov/publications/ principles-drug-addiction-treatment-researchbased-guidethird-edition/frequently-asked-questions/-how-effective-drugaddiction-treatment

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Sciacca, K. 1997. Removing barriers: dual diagnosis and motivational interviewing. Professional Counselor, 12(1), 41–46. Reprinted with permission from Health Communications, publisher of Counselor (formerly Professional Counselor), www.counselormagazine.com. All rights reserved. Smock, S. A., Trepper, T. S., Wetchler, J. L., McCollum, E. E., Ray, R., & Pierce, K. (2008). Solution-focused group therapy for level 1 substance abusers. Journal of Marital and Family Therapy, 34, 107–120. Taylor, L. (2005). A thumbnail map for solution-focused brief therapy. Journal of Family Psychotherapy, 16(1–2), 27–33. doi:10.1300/ J085v16n01_07 Wallace, R. (2016). The avenues for change by taking the road less travelled in treatment. Texas Probation, IV(3), 10–15. Retrieved from http://www.txprobation.com/wp-content/uploads/TPA-2016Summer-Journal.pdf Weisner, C., Matzger, H., & Kaskutas, L. (2003). How important is treatment? One-year outcomes of treated and untreated alcoholdependent individuals. Addiction, 98(7), 901–911.

CHAPT ER 7 Timeless Influences The boundaries which divide Life from Death are at best shadowy and vague. Who shall say where the one ends, and where the other begins? – Edgar Allan Poe

Chances are that most of us have lost someone in our lives who meant a lot to us. That person left indelible memories on our lives that are still with us today. At times we might smile and think, “Wow, he would have loved this painting,” or, “I still remember how much she liked that recipe.” These memories bring us warmth. They are evidence of a person having been in our life and influencing us as a person in a timeless fashion. But how did you influence these people? If they could speak, what would they say you did that made the difference to them? And, what difference did your influence have on their life? These ideas are the cornerstone of this chapter, which is heavily influenced by Michael White’s seminal article, “Saying Hullo Again: The Incorporation of the Lost Relationship in the Resolution of Grief” (1988). In the article, White suggests to us that while the physical being of a person whom we have lost is not present, his or her influence on our lives is timeless. We are different having known that person, and that person is different from having known us. According to White, until we come to grips with the fact that no one we have known is completely lost, but remains ever present in his or her impact on our lives, grief cannot be resolved and relief cannot be attained. Additionally, the idea that 121

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we influenced another’s life is a comfort to us and helps us overcome the restlessness of grief. nn

VIDEOS, ORNAMENTS, AND AFTERSHAVE

When Ann, age 52, came to counselling, it was 4 months after her husband, Bill, had died of pancreatic cancer. Ann had been encouraged to “go see someone” because she could not get back into her life’s routine. She had taken off work to be with Bill a few months before he died, to be his caretaker. She told me that Bill had been in a lot of pain toward the end and to her, his passing was a relief to both of them. Yet, her grief seemed to encompass every move she made after he died. Her children had told her they were concerned because all she seemed to do was watch the video that Bill had recorded for his family, several times per day. I could tell that Ann needed to talk about her husband as we began the first session, but I also noticed that she was guarded. She told me her family told her that she was dwelling on Bill too much and that it was time to let him go. This brought tears to Ann’s eyes as she lamented that she wasn’t ready to let go. Guided by White’s article, I suggested that she did not have to let go. In fact, I suggested that she say hello again to Bill. He was, I said, a huge part of her life and to let him go too soon did not seem right. She immediately relaxed, sat back in her chair, and smiled slightly. I then asked her to tell me about Bill. I wanted to know who he was, what he was like, and what she loved about him. For the next 20 minutes, I learned a lot about Bill and about Ann. Apparently, the couple was a match in so many respects. They liked the same things, loved to travel, and adored Christmas. Ann’s best hopes were to “try and get back into life again.” It was after Thanksgiving at the time I was seeing Ann. When I asked her about what it might look like someday when she was getting back into life on a small scale, she said, “Well, Christmas is coming. If I were back into life, I would be looking forward to that. Right now, I am not.” At this point, she said that she and Bill both adored Christmas. I began asking Ann some questions around the holiday since that seemed to be important to her. It occurred to me as she talked that if she could get engaged in the holiday, it might mean she was getting back into life and keeping the influence of Bill with her. Here is our dialogue: LM:

“If you were to look through Bill’s eyes today, wherever he is, what would he say he appreciated about you during Christmas?”

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Ann: “That I hung lots of decorations. We always went shopping for an ornament at the Hallmark store . . .  you know, the ones with the year on them.” LM:

“What else would he be appreciating about you during Christmas?”

Ann: “That I loved buying gifts for the kids and grandkids. That I made Christmas kerchiefs for the dogs and cookies for the neighbours. I really got into it. I just can’t do that this year, though. The kids said it wouldn’t be right. That makes me sad.” LM:

“And what would Bill appreciate you doing, even though the kids have other ideas for this year?”

Ann: “He would want me to decorate.” LM:

“What comes to mind for you, when you think about the things he loved watching you do and appreciated you doing?”

Ann: “I think about how I used to be.” LM:

“And, what does that bring alive again for you?”

Ann: “Christmas and the season it is meant to be. I think of how I love doing those things I just talked about.” LM:

“Then, I would like you to think of this, as we end our time today: That whenever you do things that Bill appreciated in you and loved watching you do, you bring him alive once again and honor his influence.” (Based on White, 1988).

Close to the end of the session, she looked up at me and said, “I have to tell you something that no one knows about. I smell his aftershave at least four times a day. I watch his video secretly when my children are at college. Is this OK to do? I am trying to move on and I wonder if this is keeping me stuck.”

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We then had the following conversation: LM:

“How does it help you to smell his aftershave and watch the videos?”

Ann: “I feel close to him.” LM:

“And when you feel close to him, what difference does that make?”

Ann: “I have peace. It’s like he’s still there.” LM:

“Then, smell the aftershave as much as you like, and watch the video as often as you need to. It sounds like a lovely way to remember Bill and feel close to him.”

Again, Ann seemed relieved and very grateful. White (1988) talks of how well-intentioned people, in an effort to help those who struggle with loss, sometimes push them forward too quickly. When I replied to Ann’s concerns that others thought she should move forward and say goodbye to Bill with the idea of saying hello to him, not only did she seem grateful, she left my office smiling. This has been the case with most people who I talk to, who feel not only grief but pressure to move on in their lives. It seems more respectful to suggest that they should not move forward until they are ready. This seems to empower those who feel out of control and lessens the additional burden imposed on them by others and “the pressure.” When Ann returned a week later, I asked her what had been better. She happily told me about the Christmas ornament that she bought the day after we met. She said she went to the same store that she and Bill always shopped at for the ornament. She also told me that she had begun decorating the house for Christmas, which was a surprise to her children. They later thanked her for doing it. She told me that she had watched the video six times the day after she left my office but not as much over the days that followed. She still smelled the aftershave at least twice a day. I encouraged her to continue doing whatever seemed to bring her close to Bill. I continued to see Ann for several more weeks. The holidays went by; in January, she came to one of the last sessions and told me that she had been thinking more about what Bill had appreciated in her and wanted for her. One of the things he appreciated was that she was very smart, but disliked the fact that she did not have a college degree. He had

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always encouraged her to finish college so that she could get a job that he thought she deserved. She had put it off all of those years and focused on her children and Bill. Since she had been off of work for almost 6 months now, and was in jeopardy of losing her job, she decided to resign from her job. She told me that she had contacted a local university and asked about admission and enrolling in classes. She planned to live off of Bill’s life insurance for a while as she attended school that semester. I saw Ann one more time after that session. She reported that while she still smelled the aftershave at least once per day, she had put the videos in storage for now. She had started spring classes, was enjoying the new social contacts she was making, and, in her words, had gotten back into life, with Bill “at my side.” White’s (1988) work with clients dealing with loss is incorporated into the SFNT model and the way that I work with clients dealing with grief and loss. The approach takes the narrative therapy work that focuses on the influences of those who have passed on and the solution focused use of the Scaling Question. By normalizing a client’s sadness, clients are allowed a relaxed atmosphere in a session that celebrates the one who has departed. Then, gathering exceptions from times when the grief is not as great, such as Ann’s smelling the aftershave clients find a direction that seems to help. It has been a true joy to work with such clients and see the relief in their faces as we talk. nn

THE ART OF RE-MEMBERING

For a moment, as you read this section, think of someone you have lost in your life, or have not had contact with in a while, that truly ­influenced you and contributed to your personhood. As you recall that person, answer the following questions to yourself: “What did that person contribute to my life? What else?” (Think of at least five things.) “What have I been able to do as the result of knowing this person and being impacted by him or her?” “What would this person say that I contributed to his or her life?” “Who did the person become or what did he or she do, as a result of knowing me?” These questions are hybrid questions, combining the narrative and solution focused approach into SFNT, and credit is given for their development to Amanda Redstone and Mark Hayward of the Institute

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for Narrative Therapy, who were also influenced by Michael White. The search for meaning and values in a person is the narrative portion and the action-oriented questions of doing and being impacted constitute the solution focused portion. Together, the blend of the two models make for a rich conversation that leads to a suggestion of the following questions: “When you think of how ____ contributed to your life, tell me about the current membership of people in your life. Who would you say, of those you associate with currently, has a slightly similar influence on you, like ____did? Who else?” “What might be the result, if you invited more of those likeminded people into your life, or even looked for such people, as a way of re-membering or repopulating your friendship group?” “What difference might that make to you?” “What might others notice as you repopulated your group?” “Who might you currently know that you could choose to get closer to or add to your group that could contribute some of what ____ did?” “How have you gotten close to others like ___before?” “How would you begin to do this, just until we meet again?” When people re-member their relationships, they typically identify members that enhance their identity and connect with their values. According to Hayward and Redstone (2016), it is the times when we are disconnected from our identity and values that problems are free to enter into our lives and disrupt our lives. For example, when people evaluate how negative relationships affect them, they have the chance to downgrade those relationships and protest them by distancing themselves. As therapists, we can see our job as reconnecting our clients with their values, which brings relief to them in the form of solutions and ­direction. Clients can then learn to re-member their club of life with those persons who enhance their identity and values as a person. The following template (Ideas for Assisting Clients in Re-Membering Conversations) was contributed by Angela Emerson, a PhD student at Texas Wesleyan University. Notice the richness of the questions as they draw out clients’ values as well as the values they find themselves attracted to. Such discovery of one’s preferences of people can be a gift to clients who find themselves in relationships with significant others or family

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Ideas for Assisting Clients in Re-Membering Conversations Therapists are likely to have an opportunity to engage in ­re-membering conversations with clients when: •

Clients mention an important person from their past in a positive light.

•

Clients are talking about a particular skill or knowledge or value that they are utilizing while addressing a problematic situation in their life.

•

Clients come to therapy with a relatively negative conclusion about their identity.

•

Clients speak as if their personal descriptions sum up everything about them.

The re-membering conversation can then be used as an antidote: Step 1. Identify a significant person, real or imaginary. •

“Who else would be the least surprised to hear you say this?”

•

“Who else would know that you stand for this?”

•

“Who else might share this way of thinking?”

•

“Who might agree that these values are important?”

•

“Has there been someone in your life who might have validated these beliefs that you have?”

Step 2. Identify how this person contributed to the client’s life. •

“What did this person bring to your life?”

•

“What did he or she see in you that others might have missed?” (continued)

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•

“What did he or she value in you that wasn’t valued by others?”

•

“Can you tell me a story about your connection with this person?”

Step 3. Discuss what the person contributed to the client’s identity. •

“How did this person’s actions make a difference in how you understood yourself and your life?”

•

“How did he or she make you think and feel about yourself?”

•

“How did he or she contribute to your sense of who you were and what you stood for?”

•

“What did he or she help you get clearer about?”

Step 4. Discuss what the client might have contributed to the ­person’s life. •

“What do you think it meant to him or her to be connected to you?”

•

“Did you receive what he or she had to offer or did you let it bounce off you?”

•

“Did you honor what he or she had to give you or did you dishonor it?”

•

“How might his or her life be different on account of knowing you?”

Step 5. Talk about how the client contributed to the person’s identity. •

“How do you imagine that your valuing of what this person had to offer affected his or her own commitment to these things?” (continued)

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•

“How might his or her connection with you have influenced what this person thought about himself or herself?”

Step 6. Help the client to bring the storyline up to date and discuss the path onward. •

“In which ways might you see aspects of your life as some kind of testimony to this person or to the purposes or values you shared with him or her?”

•

“In which ways is this person still able to be present in your work and life?”

•

“In which ways might this person’s influence now be extending from you and into other people’s lives?”

Source: Angela Emerson (2016, based on personal communication with M. Hayward & A. Redstone, June 2016).

members who bring them down and rob them of their identity. By conjuring up descriptions of those who have enhanced his or her life and making a plan to re-member this life club, the client again leaves with a plan. nn

FINDING PEACE FOR LILLY

Meredith, age 42, came to counseling at the urgent request of her husband, Phil, who called to make the appointment for her. I learned that the couple had married 6 months earlier, and that Meredith became pregnant 3 months later. Two weeks ago, she miscarried. The couple were told the baby had a medical defect and would not have been able to live outside the womb. Meredith was devastated. A teacher at an elementary school, she could barely face anyone at school and has taken leave for the rest of the term. She doesn’t want to answer any questions from anyone. She said she knew that the baby would not have survived, and that it was for the best, but she feels overwhelmed with grief. When clients like Meredith come to therapy having experienced a devastating event, they often have a need to tell someone details about what has occurred and seek direction. It seems helpful, therefore, to listen to what they have to say as long as it does not upset them further,

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and then gently guide them into a conversation about their goal for the session. With Meredith, when I asked what her best hopes were, she said it was “to find peace.” Here is how the dialogue went: LM:

“How will you know when you are beginning to find peace?”

Meredith: “I will be able to leave my house. Right now I don’t want to go anywhere or do anything.” LM:

“What else?”

Meredith:  “I might smile again and think about going back to work. I might know how to talk to people about the baby.” LM:

“How would doing these actions begin to bring you peace?”

The last question is a derivative of “what difference would that make to you?” I was interested in how the activities she ­suggested would make enough of an impact to cause her to take an action. Meredith:  “It would mean that I had come to grips with the fact that we had lost our child. It would mean that I admitted that I was pregnant with our baby and wasn’t trying to run away as if it had never happened.” LM:

“And how would that help?”

Meredith:  “It would mean that I could talk about her with others and not be ashamed that I had lost her. I could think about her even though she did not survive.” Meredith’s answer taught me how she and her husband were talking about their child. With that hint from her answer, I continued: LM:

“How do you and your husband talk about the baby?”

Meredith: “We called her Lilly.”

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LM:

“Pretty name. Tell me, how did being pregnant with Lilly influence you?”

Meredith:  “I was so happy. It meant that even though I married late, I could still have a child. I am around children all day long so the thought of having my own was amazing.” LM:

“Bear with me for a moment as I ask you this; ‘If we could have looked through Lilly’s eyes as she was with you, what would she have seen in you and your husband?’”

Meredith:  (Smiling broadly.) “That we loved her from the moment she was conceived. That we would have done all we could to have been good parents to her. That I was very careful with what I did. I read to her! I love to read to my elementary students, so I read her books!” LM:

“What else?”

Meredith:  “That we would have shared her with our families and friends and they would get to know her too.” LM:

“When you think of how she influenced you, and how you might have influenced her life, ever so slightly, while she was with you until recently, what comes to mind?”

Meredith:  “That I did all I could to have a healthy baby. That I am different because I was pregnant with her. I value the little ones more now when I do get out, even though I feel sad. Talking about her this way somehow makes her seem real.” LM:

“When you think of those people in your life who have lent support to you during this time, who would you suggest getting close to in an effort to help you the most?”

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Meredith:  “My sister-in-law. She lost her first baby due to miscarriage. Also, I have a neighbor who has been very kind. She doesn’t ask a lot of questions, she just listens and smiles at me. She invited me to lunch last week at a café not too far from home.” LM:  “Do you think these people would be surprised at how they have been helpful to you?” Meredith: “Probably.” LM:

“I wonder what they see in you and appreciate about you that encourages them to be in your life.”

Meredith:  “I don’t know. I guess with my sister-in-law, I am always there for her. We enjoy each other and can talk openly. With my neighbor, I am unsure.” Talking to Meredith on that day with questions derived from White (1988) was something I had not tried before, as miscarriage is such a sensitive topic. But when Meredith began talking about the baby as Lilly, she opened the door to a dialogue that seemed to e­ xtinguish her anxiety and gave me a chance to discuss the baby openly with her. She had wanted to do this with others but did not know how to accomplish it. She also had put aside others in her life who had made comments that she did not appreciate. By including people who could begin to assist her in her current story, she left with a direction. When Meredith returned the next week, and I asked her what was better, she said, “I seem to have found some peace.” I asked what had occurred during the week that seemed to help her in finding peace and she said: “Somehow, just being able to talk about Lilly here, as if she was a person, helped. I went home that day and told my husband we needed to create a scrapbook for her. Together, we put all sorts of things in the scrapbook from items we had bought and each of us wrote a letter to her. It made her real. I also started sleeping better at night. I am still very sad, but I am able to leave the house. I called my neighbor yesterday and asked her to lunch. I asked her if I could talk about Lilly with her. We both cried the entire time at lunch but . . . I did it. Somehow I felt like a parent, not a person who had a miscarriage.”

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Meredith came once more and then called to say that she thought she could manage. When White (1988) wrote about the importance of seeing those who have passed away as influences rather than being physically present, he gave therapists and clients a gift that empowers each of them to view loss differently. To talk about Lilly so openly seemed to fulfill a fantasy, of sorts, by a mother who wanted that experience, yet felt denied. The following template is a suggestion for working with clients who have experienced loss. I am indebted to Michael White for his willingness and permission to allow me to use his words with my s­ olution focused additions.

Ideas for Assisting Clients With Grief and Loss • “Tell me about___________. What difference did he/she make

in your life? What did you love about him/her? What did she/he teach you? What else?” • “If we looked through _____’s eyes what would ___say he/

she appreciated about you?” • “What difference will it make for you someday when you

begin appreciating those traits in yourself? What might you begin doing today, just on a small scale, that _____might appreciate as well?” • “What do you think _____’s reaction would be to see you

appreciate those qualities in yourself?” • “I want you to keep in mind, that each time you do those

small actions that _____appreciated, you bring alive the things that _____loved about you, and you honor _____’ s life.” A copy of the notes taken in the session are made for the client at the close of the session. nn

ADDRESSING EARLY CHILDHOOD ISSUES

The previous section addressed ways to assist clients who have lost significant others in their lives. Fiinding ways to compartmentalize the occurrences in the lives of our clients so that the outcome leads them to a healthier life is always paramount in therapy. That said, many clients

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bring childhood memories and challenges to therapy in the hope of ­finding meaning in their current life and diminishing the negative impact of unfortunate situations during childhood. Often adult clients come to therapy telling us that all or most of their problems are the result of a bad childhood. The following template, influenced by Michael White, suggests questions that may be particularly helpful with these clients. These questions are also helpful with children and adolescents whose parents, grandparents, guardians, or teachers do not see competence in them and relay negative reactions that are emotionally hurtful.

Ideas for Assisting Adults, Children, or Adolescents of Emotional Abuse and Neglect • “As you think back to the times in your life when you did not

get what you needed from your parent or guardian, tell me what he/she should have noticed about you.” • “What did others notice about you that _____ did not notice?” • “As you think of the qualities you possessed in the past that

went unnoticed by _____, how do you explain your ability to ______________ currently?” The last question can be asked many ways. It is helpful to get to know the young person as much as possible prior to asking this question. Learn the person’s hobbies, interests, skills, values, and exceptions, or times when things go better for him or her. This question will then amplify the person’s competence and help him or her to experience confidence. More questions are: “How is it that even though you have had challenges, you still want more out of your life today?” “What do you know about yourself that gives you that confidence?” “What might begin to happen for you when you begin to show others the qualities that they missed?” “When they change their minds about you, even on a small scale, what difference will that make for you?” “How might you begin doing this on a very small scale?” I have found it important to mention to young people when ­working this way that the adults in their lives may not be able to see

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their new actions easily. This is when together, the young person and I ­compose a letter to those adults of question: Dear Aunt Kay, Kenny and I have talked today about some changes he wants to make. He shared with me how he wants to rebuild his reputation. He has come up with a plan to show you some new actions and will begin trying them out when he leaves our session today. Please watch for what Kenny does that tells you that he is getting back on track to being the person he wants you to see. Signed, Linda and Kenny nn

SUMMARY

In the past, working with clients dealing with grief and loss might have involved going through the steps of grief with such clients. While such normalizing of emotions is helpful to many clients, it still leaves them at times feeling lost, without direction. Through the narrative work of Michael White and the re-membering work as conveyed by Redstone and Hayward, along with action-oriented language from the solution focused approach, this chapter presented ideas that take an SFNT approach that is empathetic and sensitive, yet action oriented. The ideas presented here acknowledge those who have died yet resurrect them in terms of their influence, providing the client with something to hold onto going forward. Knowing that one is different from having known the person who has departed provides a comfort that is unbelievably simple, yet powerful. Additionally, looking back on one’s childhood for those persons who admired and cherished them provides them with some nurturing thoughts that empower them. The following exercise takes both topics into play and provides a reflection on times that were the most helpful, supportive, and enriching. nn

PERSONAL EXERCISE

Think of a person who you miss in your life and answer the following questions: What was it like being around _______, whom you loved? Who was he or she?

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How did this person’s actions make a difference in how you understood ­yourself and your life?

How did being around him or her make you think and feel about yourself?

How did he or she contribute to your sense of who you have become?

What do you think it meant to him or her to be connected to you?

How might his or her life be different on account of knowing you?

Over the next few days, do something that the person would appreciate in you. Know that when you do, that person just got closer to you and his or her influence grew again. If the person is still living, consider writing him or her a note.

REFERENCES Hayward, M., & Redstone, A. (2016, June). Texas Wesleyan University Study Abroad: Narrative therapy presentation. BRIEF Therapy Practice, London, England. White, M. (1988, Spring). Saying hullo again: The incorporation of the lost relationship in the resolution of grief. Dulwich Centre Newsletter, 7–11.

CHAPT ER 8 Reintroducing School Clients There are two ways of spreading light: to be the candle or the mirror that reflects it. – Edith Wharton

When a child with school-related issues (referred to in this chapter as the school client) presents to therapy with behaviors at school that deny the child privileges, label him or her a challenging student, or decrease academic success, parents are often concerned about how the school will respond when the child attempts to change. The stigma of misbehavior and poor academic success can be hard to shake once the school staff has concerns or is frustrated with the school client. This is true even when the school client has good intentions of changing. Eventually, without receiving recognition of what they are attempting to do, many well-intentioned school clients give up. When met by skeptical teachers, even the best-intentioned school clients often revert to old behaviors. As a former school counselor and current consultant to schools, I know the importance of assisting school staff to see, anew, the school client who wants to make changes. This chapter addresses how to help the school client compose goals and assist the school staff in this transition. Entering the school “system” takes some maneuvering on the therapist’s part to be successful. This chapter provides some information on common school-related issues, programs, and processes.

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nn

MAKING A CAMPUS APPEARANCE

Whenever I work with a school client with a school problem in my ­practice, I always meet with the school client and parents in my private practice office first and the next session is held on the school client’s home campus. My reason in making this trip to school on behalf of my school client comes back to systems theory. Think about it like this: A school client may come up with best hopes to be successful in school or change his or her reputation and behavior, and identify times when school has gone better, developing tasks from the exceptions. Armed with this information and motivation, the student may go back to school with the intention of doing better. But if teachers are not provided with information about the plan, the school client will likely encounter the same context that helped to create the problem in the first place. Well-intentioned teachers do not purposely cause the relapse in such clients; they simply interact with the student in the same way they did before, when the student was problematic. Teachers tend to recall what they previously knew about the student; that is, the challenges he or she presented. Unless the teachers have new knowledge of what the school client intends to do differently, they may look at him or her with the same knowledge and problem-focused lens. When the therapist visits with the teachers, administrators, and counselor on campus, alongside the student, who is always in the meeting, an opportunity arises to share what the school client intends to do differently and to reintroduce the school client (Metcalf, 2010, p. 5). Reintroduction is a word I adopted to describe the action of introducing the student who has had prior mishaps with behavior or academic work and now has a plan to improve. When I meet with staff, I actually say, “I want to reintroduce Kyle to you. He has made some new goals and has some new strategies to try out as he goes back to your classes so that things go better for him. Would you just watch out for what he tries to do differently?” When I first used this approach, I would ask the teachers to watch for the changes a student made and then let the student know that they noticed. I don’t do that anymore. Teachers are stretched as it is, with too many responsibilities. They forget that a student is doing well in the midst of a lesson plan or activity. They are simply happy that things are running smoothly. So, to lessen disappointment for the student, who might

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be waiting to hear a compliment, I just ask the teachers to watch. And then the conversation in the meeting with teachers continues: “Kyle, can you let your teachers know what you intend to try out as you get back on track? . . . Are there some things that your teachers might do to help you with this?” At this point, most school clients are rather subdued, as they begin to see their teachers with a different lens, as helpers toward their goals. This change in relationship between school client and teachers will reinforce the intentions of the school client to make changes. It is important to note that not all meetings on campuses run smoothly! Occasionally, I encounter teachers who are so frustrated with a student that they may not be open to engaging in watching for differences. When that happens, it is best to acknowledge the frustration and pose the exercise of watching for improvement as an experiment. I have also said to such frustrated teachers that, “My hope is that by Kyle trying out some new strategies, your classroom works better for you as well.” This seems to appease the frustrated teacher, as it offers a reward for the teacher who is willing to try out the experiment. Over the past 10 years, I have kept data on the teacher meetings with students described in this chapter. On a recent calculation of my cases, where I went to school with my school client, there was a 97% success rate in the school client’s reengagement in school, giving up negative behaviors, becoming respectful to school staff, and improving grades. This chapter will share some information on how schools currently approach behavioral and academic challenges for students so that the visiting therapist understands the language. I am also providing steps that I have developed and used during the on-campus conversation with teachers, parents, and student present. The conversation is composed of the solution focused and narrative approaches that have been presented throughout this book and shows how stepping into the worldview of the school client and school staff in the process reduces resistance and encourages collaboration. nn

HOW SCHOOLS RESPOND TO PROBLEMS

I recall as a middle school teacher in the 1970s, when corporal punishment was acceptable, a principal who would paddle students (only boys) who misbehaved or were disrespectful. Once the

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punishment was completed, the principal would shake the student’s hand and ask him to sit down and talk. By the time the student left the principal’s office, he and the principal were friendly with each other and the student had probably forgotten that he had received a punishment. Some people would have said back then that it was the punishment that kept the young person on track afterward. I think it was the relationship that was built after the punishment that did it. While I never condoned corporal punishment, I was pleased even then to see how the relationships that occurred after punishment always ­ encouraged school ­ clients to become more engaged and improve. As a new teacher in my own classrooms during the ’70s, my classroom management strategies took a dramatic shift when I encountered disrespectful students. I tried my best to adhere to the advised practice of presenting stern looks, not smiling, and confronting students about performance. I failed miserably. After my first year as a middle school teacher, which was very unpleasant, I vowed to go back to school in the fall with a different approach. That approach was quite different from that of my colleagues, who would “never smile at students until Christmas.” When I had a misbehaving student, we talked outside the classroom briefly about what I needed to do to help and what the student needed to do. I made sure my lesson plans were lively and interesting and took it as my responsibility for my students to do well. I got to know them as people and attended their sports games. I complimented them on their clothes and their music. And, there was some great music in the ’70s! I admit being a bit unorthodox in my thinking, but during that year and every other year that I taught, I left school each day satisfied, and with no referrals to the principal’s office. As a clinician going into a school system to advocate for and support a school client, it is important to recognize that most schools are problem-focused when it comes to problem solving. Teachers and staff seek to try and understand the reasons behind behaviors and use behavioral techniques such as rewards and consequences. Teachers are taught during their education to assess problems and create curricula to promote success. They are not mental health workers. Teachers may say that they take a positive approach when talking to parents, but that usually means that they begin a conversation with a compliment and then focus on the problem. Schools may have different strategies for implementing consequences that include time

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outs, denying recess, denying participation in activities, in-school ­suspension, alternative school placement, and expulsion. It will be helpful for a clinician who is going to a certain school to support a school client to learn what the school policies are. Policies are usually found on the school website. nn

ATTEMPTS TO CHANGE BEHAVIOR

In many schools today, in regard to behavior problems, there is ­something referred to as a “zero tolerance” approach to behavior that therapists should know about: Zero tolerance, as it is currently used, focuses only on turning consequences into mandatory punishments. It completely ignores values and rules. For example, look at what happens when a student brings a weapon to school. Zero tolerance becomes the excuse for throwing away a range of alternative consequences and enforcing only the toughest possible punishment. The student is either given a lengthy suspension or expelled. Recent research has shown that not only are these punishments highly ineffective, but they are also major factors in creating the school-to-prison pipeline. Zero tolerance has morphed into a deceitful attempt at social engineering. (Curwin, 2015) While the intentions of schools that impose zero tolerance is to create safe schools, the ideas often lack any deep understanding of the individual student’s behavior. While it is understandable to pursue a student who brings a gun to school as a serious threat, a 6-year-old boy in the same school who kisses a girl on the cheek may be “charged” with sexual harassment. Instead of learning that the 6-year-old’s family members are affectionate and show each other they care with a kiss on the cheek, the policy is followed and the child is shamed. As an educator, I try and help school staff think outside the box when I encounter rigidity, understanding their purposes and then asking how well the strategies are working. I typically get answers that don’t support the strategies used and frustration about a lack of alternatives to try. Fortunately, today, many school districts are stepping away from zero tolerance policies and pushing relationship building in schools.

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The Social Emotional Learning (SEL) ­movement is g ­ aining traction in many schools, p ­ romoting social and emotional health in classrooms, between students, and in t­eacher-student ­interactions. The following excerpt from the Collaborative for Academic, Social, and Emotional Learning website explains how SEL works: Our emotions and relationships affect how and what we learn and how we use what we learn in work, family, and community contexts. On the one hand, emotions can enable us to generate an active interest in learning and sustain our engagement in it. On the other hand, unmanaged stress and poor regulation of impulses interfere with attention and memory and contribute to behaviors disruptive to learning. Moreover, learning is an intrinsically social and interactive process: it takes place in collaboration with one’s teachers, in the company of one’s peers, and with the support of one’s family. Hence, the abilities to recognize and manage emotions and establish and maintain positive relationships impact both preparation for learning and the ability to benefit from learning opportunities. Because safe, nurturing, well-managed learning environments are essential to the mastery of SEL skills, they too are essential to children’s school and life success. SEL skills and the supportive learning environments in which they are taught contribute to the resiliency of all children—those without identified risks and those at-risk for or already exhibiting emotional or behavioral problems and in need of additional supports. (www.casel.org/faqs) The social emotional learning concepts mirror what narrative therapy suggests, that when students are pursuing a task that has meaning and are feeling valued and supported through relationships, they thrive. In contrast, when school staff pursues well intentioned strategies that do not suggest that the school client is a valuable part of the community, but rather is tarnished due to bad behavior, the chances of eradicating problem behaviors decrease. This is particularly true of adolescents who tend to rebel when punished repeatedly. They may be sentenced to alternative school placement for 6 weeks where they thrive and bring up their grades. A therapist ­working

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with such a student might ask, “What was different in that context?” This question may provide ideas for the home campus when the ­conference, led by the therapist, occurs.

nn

ACADEMIC LABELS

For academic issues, schools often seek diagnostic testing by a school psychologist or diagnostician to learn the problems that are hindering a student’s success. Sometimes the testing may explain both emotional behaviors and academic results. Most often, the results are presented to parents and teachers with emphasis on the student’s deficits. Diagnosticians and school psychologists attempt to start off the conversation in a positive way, but the recommendations typically apply traditional approaches that conjure diagnoses and center around the student’s deficits. The parents may bring to a school meeting a diagnosis that has been provided to them by a diagnostician, school psychologist, or ­psychiatrist. Sometimes, the traditional strategies outlined by school personnel to fix the behavior problem don’t fit the child. When that happens and the child does not comply, the school may decide the issues are deeper than they can manage. Thus, the student is referred to counseling outside of the school. By the time the school client meets a therapist, the school client has probably burned some bridges at school in regard to behaviors and may be experiencing school failure. Because of this, when a therapist decides to go to school and meet school staff, sending a template letter in advance can be helpful. The Exception Observations sheet on the next page includes a sample letter and is adapted for the purpose of guiding a therapist through a conversation with a student, teachers, and parents. The sheet was developed by the author (Metcalf, 2008) for Response to Intervention (RTI) meetings, using a solution focused approach. It paves the way for a solution focused narrative conversation and helps teachers to be aware of what will be discussed. Prior to the meeting, it is a good idea to get a parent and student to sign the sheet and then give the sheet to the school counselor or school administrator to ­distribute to every teacher the student has during the school day. The next case provides an overview of how the process can work.

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Exception Observations Dear Teacher, I would like to invite you to a conversation for on in room at o’clock. Your presence is requested because you are an important member in the student’s academic life. As the student’s therapist, I want to learn from you what works slightly with the student. The meeting will not last longer than 30 minutes. Prior to the meeting, please notice times when this student is slightly successful in your classroom. Note the kinds of lessons, activities, behavioral interventions, motivational strategies, or other methods that help the student to be slightly more successful. Please list these times when the student is more successful in the following list. Please list at least five of these “exceptions” to the following problem, and bring the list to the meeting. Thank you. Therapist signature

Parent signature

Student signature

Exceptions: 1. 2. 3. 4. 5. Source: Metcalf, 2010, p. 72.

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NOTIFICATIONS NO MORE

Logan, age 11, came to counseling with his parents after getting a referral for behavior at his intermediate school. According to his parents, Logan had been

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a successful student up until the last 4 months, when they began to receive ­consistent negative notifications about his academic work on the online school site where they could check his daily progress. When I asked about the time prior to the last 2 months and inquired what had made the difference in his success at that time, I learned that he had changed teachers at the beginning of the semester. Apparently, the school had changed Logan’s classes to accommodate a problem that he had encountered with another student who had bullied him. While Logan was not blamed for the problem, the issue had left several teachers skeptical of him. Unfortunately, even though he was trying to get back on track, he was not succeeding. He would get up to 10 notifications each week, mostly about incomplete or missing work. When I met with Logan and his family during the first session, I asked everyone about their best hopes and not about the school concerns. Logan’s mother had already relayed too many details on the initial phone call. I wanted to hear what the family and Logan wanted to accomplish. I asked about the family’s best hopes. Logan said he wanted to stop the notifications from happening so he could have his privileges at home back and more free time. Logan’s parents wanted Logan to not be as angry when he came home from school each day. They said that when he was angry, he lashed out at his younger sister and had an ­“attitude.” I asked them, “What will be happening instead?” I then heard that Logan’s parents would see Logan successful in school so he could engage in after school activities. They also wanted to be able to enjoy their evenings with Logan and his sister, without worry about grades or notifications or Logan being so angry. Logan said he would be able to go outside after school, get back onto his baseball team, and skateboard. I asked to talk with Logan alone and asked him the Miracle Question: LM:

“So, let’s suppose that you go home tonight and while you sleep a miracle happens. You wake up tomorrow morning and think, ‘Hey, I don’t mind going to school today.’ Tell me what will be different as you arrive at school.”

Logan: “I will go to school and if I don’t understand something, I will ask the teacher. I used to just give up and put my head down.” LM:

“So what will be different on that day so that you ask for help?”

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Logan: “I will just have to do it.” LM:

“If I were to watch you on that day, just doing it, which classes would I see you doing that?”

Logan: “Hopefully all of them. I usually do that in the morning classes.” LM:

“What’s different in the morning classes?”

Logan: “Well, I think that the teachers like me and I sit away from kids that talk too much. I asked to move a few weeks ago and that’s helped a lot.” LM:

“Wow. That was a great move on your part. What is it that those teachers see that you wish the other teachers would see?”

Logan: “That I can do the work. I just get stressed sometimes when I get stuck. Then I take the stress home and things don’t go well. My sister comes up to me and I yell at her. Then my mom yells at me. It’s bad.” LM:

“So, on this day, instead of the stress coming home, what would be better?”

Logan: “I should just throw the stress behind me and focus.” LM:

“And, how would you do that?”

Logan: “Well, if I could sit in better places in my classes in the afternoon, away from some kids and maybe near some girls, that would be good. The girls work harder than some of the other kids do.” LM:

“So, what would your sister and parents notice about you on this miracle day that would tell them things were better?”

Logan: “I would come home not angry and stressed. I would play with my sister. Then Mom would be happy and if Mom is happy, everybody is happy.” Logan had a great plan but I was concerned about the afternoon classes. I asked Logan’s mother to call the school counselor to get permission to schedule a conversation with me and Logan’s

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teachers. I connected with the school counselor after getting the ­mother’s ­permission and sent her the document, The Exception Observations. I asked both parents and Logan to sign the document, scanned it, and e-mailed it to the school counselor. I met with Logan’s teachers the following week. I asked that Logan wait outside in the reception area of the school conference room until I got to know the teachers. I do this routinely until I know how the conversation goes in regard to the teachers’ expectations and listen to their answers to the Exception Observations sheet. I began the conversation by thanking them for their time and asking them what their best hopes were for Logan. A detailed Solution Focused Team, Parent, and Student Meeting template follows this case description. That template served as my guide for the meeting. Two of Logan’s teachers who taught Logan’s morning classes responded that Logan did well in their classes as long as he sat by himself and they checked on his work occasionally during class even if he did not ask for help. I asked them, on a scale of 1 to 10, with 10 the highest, where Logan was and they both said he was at a “7.” One of the afternoon teachers said that she knew Logan had potential but wasn’t applying himself well in her class. She gave him a “4.” She saw him play around in class and have difficulty in focusing. Given new information from her colleagues in the morning, she said that she was willing to move him to a different place and check on him more often. The last teacher had nothing to say about Logan except negative remarks. He did not think that he, as a teacher, needed to do anything different. He rated Logan at a “4” and said it was all up to Logan. At this point I brought Logan into the meeting and explained to him that we were talking about how he was currently doing in his classes. I asked him where he thought the teachers scaled him on the 1 to 10 scale. Logan said he thought they all probably scaled him at a 7. At this point, the morning teachers confirmed that they had indeed given him a 7 and shared with him things that they noticed helped him. He agreed with their observations. One of the afternoon teachers said she wanted to move him to a different place and asked Logan where he would like to sit. He told her and she also asked if it would help if she asked him if he understood the work more often. Logan said it would help because when he doesn’t understand he sometimes gives up. The last afternoon teacher said little during this time and I noticed that Logan was not willing to say a lot to him. We ended the ­conversation with strategies that the morning and afternoon teacher described, plus a few more with Logan’s help.

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Over the next 2 weeks, Logan received only one notification. He seemed happier after school and that carried over into his home life. On a 2-week follow up after the school meeting, I asked Logan what was going better. He immediately smiled at me and said, “Well, on a scale of 1 to 10, I am at an 8.” And, as for the fourth afternoon teacher who seemed a bit cautious about trying anything new . . . I received an e-mail thanking me for ideas on how to help Logan. That was quite a surprise. The last template included in this section is about Exception Findings. Many schools today seek data to help them assess their

Solution Focused Team, Parent, and Student Meeting Date: Student:

 Grade:

Primary teacher:

 Team:

Attendees:

1. Identify hopes: The leader opens by expressing appreciation to those attending the meeting, then starts the conversation: “What are your best hopes for our meeting today?” (It is common for attendees to answer by saying what they do not want. Help those who respond in this way to develop a more workable goal by asking, “What do you want to happen instead?”)

On a scale of 1 to 10, with 1 meaning not successful and 10 meaning completely successful, where is the student? Parent:

 Student:

  Teachers (take average score): (continued)

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2. Set goals: The leader thanks everyone for their responses and asks everyone, “What will the student be doing in the classroom over the next 3 weeks so that the score increases and our concern decreases?”

3. Identify exceptions: The leader asks about the exceptions that everyone present was asked to document: “Looking at your Exceptions Observation sheet, when is this happening or when has it happened slightly already?”

To Parent/Student: “When have things been better in other classrooms, grades, or situations at school or even outside of school?”

4. Develop strategies: The leader asks the student, teachers, parent, and staff members who are present to decide which exceptions can be used and adapted in the classroom and at home for the next few weeks. Classroom strategies: (teachers and student)

(continued)

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Curriculum addition based on exceptions:

Home strategies:

5. Scaling progress: The leader restates the scores from the beginning of the conversation and asks the participants what rating they hope the student will achieve by the next meeting. Parent:

 Student:

 Teachers:

Summary: The teacher asks the parent and student, “What was helpful for you today in this conversation?”

Next meeting date:

 Time:

Source: Adapted from Metcalf, 2010, pp. 73–74.

strategies with students. There is a movement in the United States referred to as Response to Intervention, or RTI. An explanation about RTI from the National Center on Learning Disabilities (n.d.) follows: The RTI process begins with high-quality instruction and universal screening of all children in the general education classroom. Struggling learners are provided with interventions at increasing levels of intensity to accelerate their rate of learning. These services may be provided by a variety of personnel, including general education teachers, special educators, and specialists. Progress is closely monitored to

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assess both the learning rate and level of performance of individual students. Educational decisions about the intensity and duration of interventions are based on individual student response to instruction. (www.rtinetwork.org/learn/what/ whatisrti) The Exception Findings sheet can be used by school staff as a c­ ollaborative way to engage students and teachers to discuss the student’s successes. It can also be used as data for future RTI meetings should students like Logan be referred for future concerns.

Exception Findings Date: Student:

  Grade:

The documentation on this page is only for exceptions—times, situations, or activities when the student begins to be more ­ ­successful in the classroom. Week 1 Exceptions: List activities, situations, assignments: 1. 2. 3. 4. 5. Weekly score:

 Student:

  Teacher:

Week 2 Exceptions: List activities, situations, or assignments: 1. 2. (continued)

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3. 4. 5. Weekly score:

 Student:

 Teacher:

Week 3 Exceptions: List activities, situations, or assignments: 1. 2. 3. 4. 5. Weekly score:

 Student:

 Teacher:

Source: Metcalf, 2010, p. 75.

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SUMMARY

This chapter has provided ideas for therapists who are presented with school-related issues by parents and their children. Taking a new approach, focusing on strengths and exceptions, and re-describing diagnoses increases the chance of reintroducing a school client to school staff who have categorized the student in a certain limited or negative manner. The value of a therapist entering the school system as a consultant desiring to learn from the school client’s teachers is sensitive, yet extremely valuable in relation to the school client having a chance to try out new strategies. It has been my experience that parents are very pleased when I have offered to go to the school client’s campus and learn the context, which provides me with more information on how to direct future sessions, if necessary. Fortunately for the school client, additional sessions are usually not needed when this approach is taken, since staff relationships with the school client change, which in turn ­creates motivation for the change to continue.

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PERSONAL EXERCISE

Think back to when you were in school, and try to recall a teacher who made a difference to you. Chances are that the teacher wasn’t someone who gave you less work, but did something to inspire you and get you excited about what you were learning. What did the teacher do that worked?

How did you respond to the teacher as a result of his/her teaching strategies?

How are you still affected by such people today in your work or relationships?

What is it about these interactions that mean the most to you?

What else? (Times 10.)                These observations about how you learn best, get motivated, and feel inspired are probably still valuable to you today. The next time you seem a bit off track with a project, a client, or any professional interest, recall what worked before. It might give you the push you need.

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REFERENCES Curwin, R. (2015). The real meaning of zero tolerance. Retrieved from http://www.edutopia.org/blog/real-meaning-of-zero-tolerance -richard-curwin Metcalf, L. (2010). The field guide to counseling toward solutions: The solution focused school. New York, NY: Jossey-Bass. National Center on Learning Disabilities. (n.d.). What is RTI? Retrieved from http://www.rtinetwork.org/learn/what/whatisrti

CHAPT ER 9 Writing Miracle Days with Families There are only two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle. — Albert Einstein

The young woman came to the family therapy office in tattered clothing, with handkerchief in hand, and sat down and started crying before she even spoke. When she finally composed herself, she began to tell her tale to the professional opposite her. She spoke about her mother, who had passed away several years ago, and continued on, sadly, about how her father had remarried in desperation . . . On this day, the young woman, Cinderella, came to therapy as a last resort, looking for relief from the chaotic life she was living. According to the notes taken by the family therapist in the individual session, Cinderella presented to therapy with symptoms of insomnia, depressed mood, a poor appetite, a need to isolate, and tearfulness. (Metcalf, 2011, p. 1) When a therapist sees an individual such as Cinderella, and listens to her tale, the therapist has but one glance into the context that plays such an important role in the life of the client. Behaviors, interactions, thoughts, and strategies all come from the context of relationships and the environment in which we live. An individual therapist using solution focused narrative therapy (SFNT) could certainly work with Cinderella, seeking her best hopes and encouraging her to design her preferred future. The therapist could have a conversation with her about her strengths and abilities to cope so far, discovering, alongside 155

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Cinderella, her exceptions to the story. There would be times when the therapist would come to understand the values that Cinderella holds for marriage, closeness in family life, and independence. These successes would contribute much to the process of therapy. Cinderella would then leave the session and go back to the same system that helped to create the chaos in her life. With her strengths in hand and a supportive therapist, she would probably move forward in her life and make changes that she would be proud of. It might be a struggle, as the family picture she presented to the therapist was chaotic. Yet, she could certainly make some changes in spite of the system she lived in. Yet, what if the therapist invited Cinderella’s stepmother and two stepsisters to join the next session? What if during that conversation, the therapist saw how jealous the stepsisters were of Cinderella, who they saw as more attractive, and learned of their desire to be close to her as a sister? The therapist might observe that the stepsisters failed miserably to communicate by their crass actions. What if, upon more conversation, the stepmother talked during the session about her deceased husband, Cinderella’s father, in a somber manner, relaying her grief for his loss and the desire to become close to Cinderella? Well, we would have a very different fairy tale if the last paragraph actually happened, wouldn’t we? To go a step further, what if, upon assisting the family to choose a preferred future, the therapist watched the development of new actions that each family member could initiate? How might such new actions, by everyone including Cinderella, help lift Cinderella’s depression, insomnia, isolation, and more? This is the kind of outcome that family therapy seeks to achieve in SFNT. By working with the system, new best hopes and preferred future storying might lead to more cooperation, collaboration, and success. nn

WRITING NEW MIRACLES WITH FAMILIES

Using the solution focused narrative approach while working with families like Cinderella’s allows the therapist to see the family as one functioning in a current chapter, with many more chapters to come. It is almost like seeing family development before one’s eyes, with each new development requiring different roles from family members. Using SFNT, the problem that the family may bring to therapy can be externalized, relieving a family member of blame and helping the family seek new interactions that reduce the chance of the problematic family member continuing to be blamed for the problem.

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GUIDING IDEAS FOR WORKING WITH FAMILIES

SFNT considers the following ideas of both the narrative and solution focused models when beginning to work with a new family:

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•

Families are systems and their interactions result in certain behaviors; therefore, a change in interactions will result in new behaviors.

•

Gathering the best hopes from every family member can provide direction, or goal, for a conversation in therapy.

•

By inviting the family to describe the problem externally, a family member can be released from blame and join the other family members in building a preferred future.

•

Acknowledging the effect of the problem on the family system can provide motivation to the family members to stand up to the problem and reclaim the desired family context.

•

Discovering exceptions in family life and among family members provides encouragement and strategies to use once again.

•

Scaling problems from 1 to 10, with 10 meaning the family is in control and 1 meaning the problem is in control, provides a way to measure distress and success.

•

The suggestion of writing a new chapter as a family, where each family member has a chance to describe his or her wishes, encourages each member to alter his or her own character to fit the chapter.

GAINING CONTROL OF A DIAGNOSIS

I met Devon, age 14, and his parents several years ago during the summer. When the family came to the first appointment and checked in, I could not find them in the reception area. The receptionist said they had gone outside and were sitting on a bench. It was summer in Texas, and a record heat wave was going on. I went outside to find them and brought them inside to the therapy room. I soon learned from Devon’s mother that Devon felt embarrassed to go into the building and wait in the reception area because of his skin disease.

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She continued to tell me that Devon had been diagnosed with a skin disease that was so rare that he was a frequent patient at the Mayo Clinic, where he would often be observed by 13 doctors at once. Internally, Devon was perfectly healthy, but his skin disease would flare up chronically, and when it did, Devon would wear heavy jackets to school and keep his head down whenever he socialized. Devon’s parents were concerned because he was entering high school in the fall and they feared that he would have a difficult time adjusting to high school and being social. Devon was an only child and the parents felt it was very important that he make friends. With this information presented to me immediately upon settling into the session, I listened, as they seemed anxious to tell me lots of information, and then I asked the family their best hopes: LM:

“So, what are your best hopes for our time?”

Dad:

“I want Devon to stop being worried all of the time about his neck. He seems overwhelmed by it and seems to not want to go anywhere with us. He spends a lot of time at home playing video games. I want him to see that he is a normal kid, be confident, and level out a little bit on his worry.”

Mom: “I want the same thing so that Devon won’t let the disease take him over so much. He gets angry and while we try to talk to him, talking doesn’t do the trick. He wants to talk at night, and we do, but the next day it’s the same story. He needs some things to do so that when he gets angry he knows how to cope.” Honestly, the answers I received to my best hopes question were many and quite varied, so I continued to ask the parents how they would know when Devon was doing better. Mom: “He would do things with his friends and not let this problem, this disease, keep him from being an average kid.” At this point, Devon was still quiet and did not respond to my best hopes question. Since mom began to refer to the skin disease as

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a problem, I took the opportunity to externalize it and take a different approach when resuming my talk with Devon: LM:

“So, is this how your family talks about it? As a disease, or a problem?”

Devon: “Yeah.” LM:

“Would it be OK if we referred to it today differently as we talk?”

Dad:

“Sure. Devon, how do you want to talk about it?”

Devon took a lot of time thinking about his answer. His parents tried to encourage him but eventually sat back and silence took over for a few minutes. Finally, Devon spoke: Devon: “It would be a very long word . . . a very long group of words . . . a sentence.” LM:

“So, tell me and I will write it down. I will be your secretary.”

Devon: “The most hated thing in the world.” Mom and Dad were surprised by the description that Devon provided. I began to ask Devon how the “most hated thing in the world” had been affecting him and his family. He told me he wore heavy jackets at school, kept his head down in the hallways, and only spoke to a few friends. I asked his parents about the effects of the “most hated thing in the world” and they agreed that it kept him from doing the things he loved to, such as going outside with friends. I learned that on certain days the skin disease flared up and Devon was devastated. Then, the skin disease would fade. Devon also said that he tended to talk a lot at night, before bed, and he thought that doing so made his parents tired, which he felt bad about. But then he said something else. He said that he didn’t talk about it every night. Then his Dad agreed that they did not talk each night like they used to. Instead, they talked a few times a month at the most. This mention of exceptions prompted me to move into identifying exceptions. I asked Devon how he managed to not talk about the most

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hated thing in the world as often as he used to. I also asked about how often “the most hated thing in the world” bothered him during the day: Devon: “It bothers me the most at school when I get there first thing in the morning because I have to walk through a crowd of kids I don’t always know. Once I get to my advisory class, I am fine. Then, it bothers me mostly in the hallways between classes, and at lunch.” Now, a typical middle school day is about 7 hours long. Adding up the time in between classes and lunch, I came up with about 50 ­minutes a day. I asked Devon to verify that it was only 50 minutes a day that “the most hated thing in the world” bothered him. He smiled and said: Devon: “Yeah, I guess so. I hadn’t thought of it like that at all.” Mom: “That’s a very interesting way to look at this.” LM:

“How is it that you have been able to manage keeping it to 50 minutes a day?”

Devon: “Well, most of the time I am with my friends and they know that . . . this thing . . . is no big deal.” LM:

“How is it that they know”

Devon: “I’ve told them.” Again, the story changes and the exceptions multiply. By this time, Devon’s parents were sitting back in their seats calmly and listening to a side of Devon’s life that they had not heard before. As the session ended, I made a copy of the notes I had taken on “the most hated thing in the world,” complete with its name, its effects, the exceptions, and an idea: LM:

“Devon, I would like to invite you to watch for times over the next few days when ‘the most hated thing in the world’ occurs less. Mom and Dad, would you also mind watching how Devon continues to be in control of ‘the most hated thing in the world’ just until I see you all again?”

I asked the family for their feedback on how the session went and the parents said that they felt hopeful for the first time in a long time

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that Devon was going to be okay. They said they had not realized that Devon had things under some control. I was fortunate that day, in that I had three psychology students observe the family and serve as a reflecting team. This meant they came into the therapy room and talked with me while Devon and his family listened to them compliment Devon and his family. Once finished, I spoke with Devon and his family briefly. They enjoyed the chance to listen to the students very much. Later that afternoon, the students and I wrote Devon a letter and I mailed it the next day: Dear Devon, It was great to meet you and your family today. We are quite impressed by your ability to share with friends that “the most hated thing in the world” is really something manageable. We were also impressed to learn that you are on top of it for 6 hours out of 7 every day at school. We can’t wait to hear how else you maintain your control over “the most hated thing in the world.” See you soon. Linda, Douglas, Maria, and Susan When Devon and his parents returned the next week, I found all three of them in the reception area inside the clinic. Devon had gone to an amusement park that week with his cousins and his dad. According to his dad, Devon held his head high instead of looking down and had fun with his cousins. I asked Devon how he managed to do what his dad described. He said that after the first session, he realized that maybe it wasn’t as bad as he’d thought, especially since it was only 50 minutes a day. He said, “hearing the compliments from the team gave me confidence.” He said that while his neck did bother him at the amusement park, he just decided to talk to his cousins and not worry about it. Then, he said, he soon forgot all about it. I saw Devon once more and the family decided that they would call if needed. Devon started high school successfully. A year later, his Mom called to tell me that Devon went swimming for the first time, with his shirt off. This case showed how the SFNT approach took Devon out of the problematic role and placed “the most hated thing in the world” in his place by externalizing it, freeing Devon up to step back and recognize that the problem did not bother him constantly. The parents, once given the chance to see their son as in control of the problem, opted to sit back physically in the session and, at home, change from seeing their son as

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problematic to seeing a son who had more control over the ­problem than they realized. Returning to the second session, the parents were much more relaxed and told me that they were doing more things together as a couple since they felt that Devon seemed to have things under control. The new thoughts and actions of the parents left Devon to continue his life as a 14-year-old, and since he was not the focus of his parent’s ­concerns, he relaxed, as well. nn

A BLENDED FAMILY GETS TOGETHER

In cases where a blended family has best hopes of joining together and getting along together, SFNT can be helpful in gathering best hopes from everyone who has been brought together. The new parents may hope to help their children adapt to a new family life where everyone is respected for their differences yet involved in the family activities. The children may ask about fairness and wanting time with their biological parents. Questions might be: “Suppose a miracle happens tonight while everyone sleeps. When you wake up tomorrow morning, what will be happening that will tell you a miracle really happened?” “How will each family member be acting toward each other?” “How will that be helpful to others?” “Who will benefit the most?” “As a result of the benefit, what might an evening together look like?”

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CREATING A NEW CHAPTER AFTER LOSS

A family may come to therapy for help due to the loss of a family member, such as a child, parent, or grandparent who lived with them. Questions might be: “What are your best hopes as you write a new chapter together and remember____?” “What will be going on in the new chapter that will show your best hopes? Who will be doing what?” “If we looked through the eyes of _____as you move forward writing the chapter, what would he/she see you each do that would have brought her/him joy?”

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“What are some small steps that you can begin to take together to begin writing the chapter?” nn

PARENTING AND COUPLEHOOD

Finally, a couple may, after having their first child, find themselves lost as a couple and focusing only on the baby for conversation. They have become distanced from each other and have little to say to each other at night. Perhaps the therapist might inquire about how the c­ouple met (Connie, 2012, p. 9). The therapist might continue the conversation about the things the couple did early in their relationship that amplified the attraction. Questions such as: “What would be different on a miracle day when you returned to being the couple you were before?” “What else?” “What would your partner do that would tell you that it was truly a miracle day and you were a couple again?” “As a result of ___doing that, what might you do?” Then, turning to the other partner, “As a result of _____acting that way, how might you react?” These questions seek the preferred future that holds new descriptions for the couple and gives each partner an opportunity to share what truly would make a difference. Here are some more questions ­surrounding how the miracle might appear: “So on this day, as you revisit the times you had as a couple early in your marriage, what will you notice your wife doing during the evening when you have time together, that would remind you of the days of courtship?” Since the questions draw on client exceptions and imagining a preferred future within the miracle question, a therapist need only to ask the questions—which become the intervention. nn

RECONCILIATION FOREVER

Laura called and made an appointment for couples therapy. She said that she and her husband, Ben, had separated 6 months earlier. She reported that after another recurring argument that involved Ben screaming at her, which upset

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their two young children terribly, Laura took the children and moved into an apartment. The next day, she filed a restraining order against Ben. I sat in the first session that day with another therapist, Elliott Connie. The couple argued for much of the session before we even began. After asking the couple their best hopes, the therapist was able to finally get an idea of what the couple wanted and needed from the session. The couple initially said they wanted to see if they could reconcile, but Ben was skeptical. Here is the dialogue that occurred: Ben:

“I would like to know if she is sincere in wanting to reconcile. She says she is, but how can I believe her? I never thought she would leave me. It has been very hard to not see my kids for the last 6 months, just occasionally, and it is her fault. Although, I do realize that I have a temper.”

EC:

“So, Laura, what are your best hopes?”

Laura: “I want to reconcile. I know that living away from him is not in our kids’ best interest. I just could not take the arguing and screaming anymore. I love him and since I have left, I have made changes. He just doesn’t see them. I miss him. We had a good marriage in the past, before the arguments started getting so bad.” EC:

“So, take me back to when the two of you met.”

Laura: “We met in college. We were best friends. We did so much together and were a team in everything we did.” Ben:

“We were affectionate to each other. We rarely argued. We had similar goals. I was in school and she was just starting college. We didn’t have a lot of money, but we had lots of good times.”

EC:

“So, let’s say a miracle happens tonight while you are both asleep, and let’s imagine that you are together, as you sleep, in the house with your children. You wake up tomorrow and things are better, as if a miracle had occurred. It reminds you of when you were first a

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couple, when you first got together. What would be different on that day?” Laura: “We would both get up before the kids and have breakfast together. Then, we would talk about the day ahead and who was going to do what with the kids, like a team. I am finishing up college right now and have a job possibility that would really help us. He might ask me about my class. Then, when the day ended, we would do something just with us, like sit in the back yard and talk.” EC:

“And, Ben, as your wife describes this day and how she would approach it, what might you do as a result?”

Ben:

“I would be affectionate to her before we got up and had that breakfast! I would look forward to the evening with her, knowing that I would have her attention, not just the kids. I might call her from work during the day just to say hello and ask her what she’s doing.”

EC:

“And, Laura, in this scenario with Ben being affectionate, calling you midday, and spending time with you in the evening, what might that do for you?”

Laura: “I might feel important. I might be more affectionate back, and want to talk to him more, and not be afraid he would blow up at me. I have been going to a counselor for the last few months and have gotten stronger and more independent over the last 6 months.” Ben:

“I would like to see you more independent. You were very independent when I met you and I liked it a lot.”

The therapist worked with Ben and Laura for 40 minutes and together, the couple came up with other things that they would be doing on the miracle day. The therapist got very specific with each answer, asking how Ben thought he would respond and asking Laura how she might respond. Elliott Connie, author of Solution Building With Couples (2012), makes sure that the questions are balanced between each person and builds on the answer each person gives. He is interested in how each

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partner might respond and appreciate the other as each tried something different. This serves to motivate one partner when he or she hears what the other partner is likely to do as a result of a new action. Many couples are surprised by the questions and the answers, which often lead to a rich description and outcomes pictured in the preferred future. The session with Laura and Ben was conducted before a group of student therapists. Ben was actually surprised that Laura had agreed to do the session with observers and was skeptical that she would follow through with it. He had assumed she would be too shy and not confident enough to follow through. He was mistaken. Ten minutes before ending the session, the students gave feedback to the couple and the therapist. Here are the summarized observations from the students: •

This couple had a great beginning to their marriage. If they can be teammates again, and active together like they once were before they had kids, we think they can make this work.

•

We are impressed with the way Laura has taken it on herself to work on her follow up and independence. She seems to have learned a lot, taking the children to an apartment and caring for them alone. She seems sincere to want to reconcile.

•

Ben seems to have been really hurt when Laura left, and as a result he seems to have come to grips with the anger. We are impressed with his being cautious so he is not hurt again and with how he connected what he does at work to cope with his anger to how he could cope at home.

•

Their children are lucky. Their parents obviously love them and want to give them a good life. It seems that the parents are realizing that being good parents means being a good couple first.

The couple was stunned by the remarks of the students. When the students left, and the session was ending, I asked the couple a closing question: “What happened in here today, if anything, that might have been helpful to you?” Ben said, “I realized as the students were talking that she actually did follow through and did this in front of all those people. She has become more confident than I thought she was.” He looked at her in the most respectful way—one that I don’t think she had seen in a very long time. His remark caused her to move closer to him, smile,

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and grab his hand. A month later, I learned that Laura and the kids had moved back into their former home with Ben. It is now 2 years later as I write this manuscript and I just got another e-mail from Laura about how they keep celebrating their new marriage as best friends. nn

FAMILY SCULPTING: MANAGING A CHANGE OF CHARACTERS

So far, this chapter has focused on working with families as an efficient method of creating long lasting change in individuals and in the systemic interactions of a family. The cases presented in this chapter have all been seen in private practice, yet in many agencies today therapists are incorporating family therapy into treatment plans. The following contribution of Shannon Semersky, a Marriage and Family Therapist Associate, demonstrates the applicability of Virginia Satir’s (1983) family sculpting within a solution focused framework. Sculpting is a tool for making an external picture or “sculpt” of an internal process such as a feeling, experience, or perception. It uses body postures and spacing as a demonstration of relationship patterns of communication, power, closeness, and distance. The individual representing his/her interpretation of an event becomes the artist (sculptor), and asks the other group members to assume a specific body position and expression that reflect his/her perception. This allows the individual to remove himself/herself from the picture to gain a more objective view, and opens the possibility for new awareness. (Satir Centre of Australia for the Family, n.d.) Shannon sees the families of her adolescent clients as a way to help the families systemically change so that the adolescent has support to accomplish goals. She uses a solution focused and narrative approach when doing a family sculpting exercise. Here is a summary of how she does the exercise.

Solution Focused Family Sculpting by Samantha Semersky, LAMFT Family sculpting was developed by Virginia Satir and looks at the visual representation of how an individual experiences his or her

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family. As a group therapist, so much work can be done through using feedback from other families observing one another’s family sculpture and relating through their own shared experiences or emotion. The exercise I am going to describe can be done in a multitude of different settings such as a family session, a multifamily group, or group therapy with no family members actually present. I have mostly done this exercise in a multifamily group setting with adolescents and their families and found the added group dynamics to be extremely powerful. I start by explaining what sculpting is and how a sculptor using clay is able to mold the clay into any form he or she desires. The clay does not move itself unless manipulated by the sculptor to do so. Therefore, family members are told that they should not move or position themselves differently than how they were positioned by the sculptor, which is usually the adolescent client. I give them an example with myself as the sculptor. I ask members of the group to ­represent fictitious family members and then I assign them a position or motion to show them what can be done. I might have someone on the floor, someone facing away from other members, someone w ­ alking, someone closer to the other members, or someone further away. I also position myself as the identified client in the way I see myself in the family. I prefer to say “action” like a director to start the members in doing whatever motion they were instructed to do. I then stop, then sculpt, and invite the members to share their interpretation of what I have sculpted as a client. I then share with them possible intentions I had behind sculpting the fictitious family members the way I did. The instruction I give to the families next is to sculpt how each member sees every other member of the family currently. It’s a pretty simple instruction. Less direction allows for more creativity in the process. I typically ask the identified client to go first and then each family member who is present takes a turn in placing family members as he or she sees them in the family. I allow for time to process and discuss what is observed about the sculpt. If done in a multifamily setting, I ask the audience what they noticed or how they might suspect each member feels in the position they were placed. Oftentimes audience members elicit

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meaning that I myself did not consider when conceptualizing my own clients! After each family member has sculpted, I then instruct the identified client to start the solution focused part. I say something like: “In five years if things went really well for this family, sculpt what it would look like.” This part of the activity is for generating the client’s preferred family future. This is what elicits action and instills hope in a vulnerable moment where a family might have just come face to face with the extent of their disconnection. Traditional family sculpting does not facilitate this part of the experience and often can bring attention to a problem and then neglect to suggest the idea of a solution. Oftentimes the family sculpts can be very difficult to process and observe. The experience forces members to confront difficult perceptions and can at times lead to defensiveness or blame. The preferred future sculpt directs attention away from defensiveness and blame and instead toward action and solution building. I love processing how each family member feels about the sculpted preferred future and facilitating discussion around what each member might need to do to get to his or her place in the preferred sculpt. I have found oftentimes the identified client, particularly an adolescent client, will prefer to use surrogates for their family members instead of the family members present in the session. One particular client stated that she wanted to make sure her mother saw everything rather than getting caught up in the position the client was giving her. Another client explained that she felt uncomfortable giving direction to her parents and felt more comfortable letting the actual sculpt nonverbally speak for her. The beauty of this technique is that it says so much without a word being spoken. It can feel much easier for an adolescent to nonverbally express his or her point of view this way rather than previous verbal attempts that led to an argument or defensiveness. The results of working in this way has been rewarding to me as a therapist and to my clients. I always use this exercise for every adolescent I see in the agency.

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nn

SUMMARY

Working with families can be helpful for promoting long lasting change in individuals, as it provides the therapist with a glance at the system in which the problematic behavior emerged. This chapter offered ideas on how the SFNT can be useful when working with families who have identified a struggling or disruptive family member, or who feel hopeless about a situation. The chapter also showed how using the SFNT approach helps couples reconnect with the times when they met and felt attractive to each other, thus reintroducing a lens through which even the most distressed couples are able to view who they were and who they could be. nn

PERSONAL EXERCISE

It is always easier to think, “If he/she would only change, I would be happier.” Changing others is something we do not have control over. However, we do have control over what we do. Perhaps if you are wishing for another person to change, consider what you might be doing if he or she did change. Get a clear picture of things you might do or be able to do if that person changed. Then, think of something very small from that vision, and do it independently. It might take pressure off of your partner, and give you new insight into what you are capable of! Think of a current relationship that you value yet are not completely satisfied with. If you could change the person in that relationship, what would you change?

 As a result of the person changing, what might you be able to do differently? List several things.

 What difference would it make for you to be doing those things?



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What would doing those things bring out in you, as a person?

 What might others notice about you as you begin doing those things on a very small scale?

 When might you begin to value and believe in yourself?

 Over the next week, try doing something on a very small scale that can bring out in you what you value and believe about yourself.

REFERENCES Connie, E. (2012). Solution building in couples therapy. New York, NY: Springer Publishing. Metcalf, L. (2011). Marriage and family therapy: A practice oriented approach. New York, NY: Springer Publishing. Satir, V. (1983). Conjoint family therapy. Palo Alto, CA: Science and Behavior Books. Satir Centre of Australia for the Family. (n.d.). Group therapy methods. www.satiraustralia.com/groups.asp

CHAPT ER 10 The Path to Less Distress If you are distressed by anything external, the pain is not due to the thing itself, but to your estimate of it; and this you have the power to revoke at any moment. — Marcus Aurelius, Meditations

Charlie, age 12, was brought to counseling by his father and mother who were ­concerned about Charlie’s anxiety. The anxiety tended to occur every Sunday night and, according to the parents, caused Charlie to be upset and restless. When the family settled into their seats in the first therapy session, I noticed how Charlie sat in between his parents, who sat very close to him, almost in a protective mode. After greeting each of them, I asked the family what their best hopes were. Dad:

“We are concerned about his anxiety. I have major depressive disorder and anxiety disorder and I have probably given it to him. I take medication for it and I want to make sure that Charlie doesn’t end up letting the major depressive disorder and anxiety disorder take over his life like it has mine.”

Mom: “I would like Charlie to be less anxious. He tends to get anxious on Sunday night, after a busy weekend. He gets so antsy and just can’t settle down.” Dad:

“Right. That’s when I talk to him about his feelings, his anxiety and ask if he feels depressed. I take a lot of 173

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time making sure that we have time to talk when this happens. I explain to him what anxiety and depression is and why that is probably the reason he is upset.” As the parents talked, I noticed Charlie looking down and unhappy. Occasionally he would flash a smile when he talked about sports. I was interested in what Charlie wanted from our time. I asked Charlie what his best hopes were. Charlie:  “I want to get control of my major depressive disorder and anxiety disorder. It comes on every Sunday night. It kinda makes me jittery in the evening and I think I need to get it under control. I may need medication.” I was concerned about the possible transference of Dad’s diagnosis onto Charlie, so I asked the parents if I could take a few minutes to talk with Charlie alone. Here is how the conversation with Charlie went: LM:  “So, the ‘anxiety’ that bothers you on Sunday nights. . . . Any other time that it bothers you?” Charlie:  “It’s mostly Sunday nights when I get jittery. Sometimes it happens during the week after dinner when my homework is done and I don’t have a lot to do.” LM:  “So, would you like to talk about it as ‘anxiety’ or something else?” Charlie: “OK. I don’t know what else to call it, though.” LM:  “Well, tell me what happens when ‘it’ takes over on Sunday night.” “Well, if I have had a busy weekend where I played Charlie:  baseball and soccer games all day on Saturday, Sunday comes along and with nothing to do, I just get jittery.” LM: “Would it be OK then if we called it ‘jittery’?” Charlie: “Yeah, that’s fine.”

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LM:  “So, when this ‘jittery’ comes along, what happens?” Charlie:  “I am laying on the couch with nothing to do and I start thinking a lot about going back to school the next day. I like school. I have fun there. I just can’t settle down. It’s a weird feeling.” LM:  “When you look back to last week, tell me times when the jittery showed up.” Charlie: “Actually, it wasn’t there much last week at all.” LM: “Really? How did you keep it away?” Charlie:  “I had tournaments on the weekend, so Mom and I practiced every night during the week. I love practicing basketball with my mom.” LM:  “Ah, and how is that different than the days when ‘jittery’ takes over?” Charlie:  “I use up all of my energy, I guess. I have a lot of energy.” LM:  “Hmmm. So, would it be possible that jittery comes along when you have extra energy?” Charlie: (smiling) “Yeah.” LM:  “If you were to think about how you kept the extra energy away last week, with practicing with Mom and being in tournaments, I wonder what you would suggest doing to keep it away this week, just until I see you again.” Charlie:  “Well, Mom really likes playing basketball with me in the driveway. Maybe when the extra energy comes along, we could do that.” I asked Charlie’s parents to step back into the session at this point and gave Charlie a break. I did this to maintain respect for the parental hierarchy, which I did not want to undermine by talking in front of Charlie as if he weren’t there. I told the parents, with Charlie’s permission,

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that we talked about his anxiety as “extra energy,” instead of anxiety and ­depression, and then I explained to the parents that I asked Charlie about a new description in an effort to not label Charlie, and instead, to give him power over the jittery feeling he had. I told them that instead of anxiety, Charlie’s responses sounded like extra energy. I told them that Charlie had smiled and agreed with me on that new description. Mom immediately sat up, looked at me and then her husband, and said: Mom: “Thank you! I have told my husband to stop planting his diagnoses in Charlie’s head.” Dad:

“I was just trying to help him know what was wrong with him.”

LM:

“And, I sense that you meant well. What I did with Charlie was suggest a different way to think about things. And, when we talked, I learned that the extra energy only occurs on days when he is bored, particularly after a busy weekend. He actually came up with some things to do to keep the extra energy away.”

Dad:

“What?”

LM:

“Let’s let Charlie tell you both.”

I went to get Charlie and brought him back into the session. Charlie shared with his parents that he had “extra energy” that made him jittery sometimes. His demeanor was drastically different as he told his parents about the extra energy. He smiled, was animated, and began talking like a normal 12-year-old. He enthusiastically told his parents that he thinks he just gets bored after he has a lot to do and the extra energy has to come out somehow. He told his mom that he thinks he needs to play basketball with her when the extra energy comes along. His mom was quick to agree that she would be more than happy to do that. His dad became very quiet. Two weeks later on the follow-up session, Charlie reported that he got extra energy only a couple of times and that when it came along, he and Mom played basketball until it was gone. The dad, who brought him to the session that day, reported that for the last 2 weeks he did not see Charlie laying on the couch on Sunday nights being anxious. He said he was quite surprised that Charlie could “shake the extra energy off” like he did. He said that the experience of bringing Charlie to my

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office was very different from other therapy sessions he had been to. He then made an individual appointment for himself. nn

GAINING DISTANCE FROM A DIAGNOSIS

With clients who come to therapy and present with diagnoses, it is very important to remain respectful of their attempts to understand why they are experiencing distress. While diagnoses are helpful to clients in certain contexts, such as getting services that they need to obtain better mental health, more often it has been my experience that the diagnosis cripples the clients mentally, creating a barrier to improvement and diminishing hope. In Charlie’s case, I asked him if it would be okay to rename the anxiety. This is a common practice that I take, getting permission from a client to describe the distress he or she is experiencing differently. Language is a very powerful tool that therapists have when working with clients who have been given a diagnosis, and how they linguistically style their questions and responses has a major impact on how clients view themselves. In fact, it can make the difference between a client being hopeless and hopeful. The hopeful client is more likely to make changes when the door to a preferred future opens. The redescription of client problems or diagnoses that I keep ­referring to throughout this book is not just for clients. It is for therapists, as well. As I mentioned in earlier chapters, I prefer to know very little about my clients as they begin therapy. This keeps me objective and hopeful. If, however, I find a client that is truly married to a diagnosis and is having difficulty getting past the label, I sometimes resort to redescribing the client to myself before the next session, in an effort to stay on the forward moving track and create possibilities for the client. From my experience as a supervisor, I have talked with many a supervisee who dreaded seeing a particular client coming in for therapy. Haven’t we all had those clients? In those cases, especially, taking time to ask the supervisees to describe how they saw the client, currently, and then asking them to redescribe the client as a means of approaching the next session changed their mindset enough to not only get them through the next session, but to help them create different questions and be more helpful to the client.

Perspective-Shifting Exercise The following exercise is one that I use when I consult with a school district and for agency therapists who are trying to shift from a problem-focused approach to an SFNT approach. It is best to use a flip chart or white board

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to do this exercise. The questions refer to the columns on a chart that I draw (see the accompanying figure) and reflect how I process the exercise. The answers are actual answers that I have received from participants. 1. Tell me some negative labels that you sometimes use to define clients. Write these labels under the Current Negative Description column. 2. Tell me some of your typical reactions to clients with these descriptions. Write these reactions under the Current Reaction column. 3. Now let’s look at each one of the negative descriptions and the reactions column. Which of these reactions to the ­negative descriptions work well for a long period of time? (At this point, I begin crossing out reactions that don’t work. Typically, most of the answers get crossed out!) 4. Since the reactions aren’t working, let’s consider ­redescribing the negative descriptions into more possibility oriented descriptions. Write down the new descriptions in the New Description column. 5. Now, with these new descriptions, let’s think about new actions that you might take in working with this “newly described” client. Write down the answers in the New Action column. Current Negative Description Current Reaction

New Description

New Action

Attention Deficit Disorder

energy

seek exceptions

frustration/refer give consequence

Unmotivated

give up

for focusing

not motivated yet

seek interests build relationship

Oppositional Defiant Disorder

shout back/refer

assertive

ask opinion

Depressive Disorder

ignore, give up

sad

seek exceptions

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Most participants are very surprised at the differences in ­interventions that occur just from the redescription of a client (see Chapter 8). This is particularly helpful in problem-focused schools, agencies, hospitals, and treatment centers for participants to see how options emerge with just a change in language. In no way does the redescription negate the diagnosis. Instead, it simply offers another, more helpful way to define a client. I have found that when I offer redescription to a client, it has been helpful to say: “The diagnosis is one way to define yourself. Would it be okay if we came up with another way to describe the concern?” nn

EXTERNALIZING DIAGNOSES

When working with clients such as Charlie and other clients in this book where diagnoses tend to discolor otherwise healthy lives, e­ xternalizing allows a client to step back and envision a diagnosis as separate from himself or herself. In most cases, this method is welcomed, particularly by children and adolescents whose parents have identified them as “the problem.” While using alternative language around a diagnosis does not invalidate the diagnosis, it does seem to change the mindset of the client from being trapped by a diagnosis to being hopeful about moving forward in life. Externalizing problems changes our relationship with the ­problem. By creating a conversation around a problem or problematic situation and mapping the effects of the problem on a person’s life, the client has a chance to: •

Find strategies that “teach” the problem that the client can be in control.

•

Create a competition between problem and person for control.

•

Scale the impact of the problem and develop a plan to move up the scale.

•

Scheme ideas that will keep the problem at a distance.

•

Lessen the amount of time spent with the problem.

•

Imagine a life without a problem’s influence and come up with strategies that empower the client over the problem. (Influenced by Hayward & Redstone, 2016)

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Some suggested steps to take when ­ externalizing problems or diagnoses follow—these may be helpful for clients dealing with a variety of issues that have intruded into their lives. The steps and ­questions have been developed from those described by Michael White (1989). nn

IDEAS AND STEPS FOR EXTERNALIZING PROBLEMS

Externalizing a problem or diagnosis allows clients to separate themselves from the dominant stories that have shaped their lives and relationships. By externalizing problems, clients have a way to describe the effects of the problem, thereby building their resistance to the problem, and then come up with strategies to stand up to the problem and distance themselves from the problem with new strategies. It is helpful to begin by asking about the client’s best hopes. As the client talks, listen for words that reference a problem, diagnosis, or situation that sounds as if “it” has intruded in the client’s life. Listen for words like “the problem,” or “my depression,” or “she has ADHD,” or “he gets anxiety.” Even simple language such as “it just seems to take her over” offers an opportunity to externalize. Once a language has been established in the conversation referring to a problem, follow these guidelines: 1. Separate the Problem From the Client Ask the client to name the problem or suggest a way of talking about it. Since you have been listening to the client, mention words that have been used several times as possible names. For children or adolescents, ask them to draw it. 2. Map the Influence of the Problem Ask how the problem causes the client problems. Inquire how the problem has “robbed, trapped, kept the client stuck, taken away freedom, intruded,” and so forth, on the client’s life. Inquire what others might say the problem has done. Make a long list. The longer the list, the more resistance to the ­problem’s intrusion may begin to occur. 3. Scale the Effects of the Problem Present a scale of 1 to 10 to the client and explain that a 1 means the problem has the biggest effect, completely ­controlling the client, and a 10 means the client is in control.

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4. Seek Exceptions Look for times when the client has slightly more control over the problem. Get a list of at least 10 incidences where the client has had some control over resisting the problem. Get as many details as possible so that a visual picture emerges in the ­conversation for the client. If the session includes family members, ask them for exceptions. For example, if the client says, “when I am walking my dog,” ask, “What is it about walking your dog that helps?” The specific descriptions will grow into tasks. 5. Ask the Client to Create Some “Strategies” to Stand Up to the Problem Read back over the exceptions, asking the client to listen to his or her words as you read them and consider using whatever exceptions seem reasonable until the next session. Ask if the client would like you to make a list of these ideas. 6. Copy and Present the Lists to the Client Make a copy of all lists and present them to the client as “your ideas.” 7. Follow Up at the Next Session At the beginning of the next session, ask, “What’s gone ­better?” Ask how the client managed to do the things that have gone better. Ask what others have noticed and would say have gone better. Then ask, “Where are you on the scale today?” From that answer, inquire how the client managed to move up or stay the same. If the client slid backward, ask what he or she had done before that prevented going backward. nn

THE WOMAN I USED TO BE

Mara, age 41, presented herself as depressed and frustrated with her husband and her life. When I asked what her best hopes were, she said that she wanted to be the woman she used to be. She then immediately said she had lost energy and felt as if there was a perpetual cloud of depression over her life. This led us to discuss who she used to be. I learned that the woman Mara used to be was: •

Super strong, able to make decisions

•

Financially okay and secure

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•

Engaged in super fun activities

•

Had no fear of losing anything

•

Saw every day as a new day where she believed in herself

This rich description described Mara’s values of independence and self-confidence. I learned that she had inherited those values from her father, as a young girl. As Mark Hayward and Amanda Redstone (personal communication, June 2016) have pointed out, when clients are distanced from their values by problems, the clients experience distress. In an attempt to honor Mara’s desire to return to the woman she was before, I wanted to learn more about what that would look like for Mara. So, using her language, I asked the Miracle Question like this: “Suppose tonight, while you sleep, a miracle happens. When you awake, you are ‘the woman you used to be’ in your current life. What would be different on that day?” Her reply: “I would be secure and confident. I would show my character as a happy person in general. I would be assertive. I would go to work and pursue new products. I would be independent. I wouldn’t be so despondent when a product I am selling doesn’t sell. I would be cooking again, in a creative way for my family. I would be affectionate to my husband.” We continued to get a list of almost 20 items, with each item ­becoming more thoughtful and emotional as we continued. When I asked Mara the Scaling Question, referring to where she currently was in regard to creating the miracle she described, she scaled herself at a “3.” I asked where she might like to be when we met next, after she began to reclaim herself as the “woman she used to be.” She said she would like to be at least a “4.” At that point, I simply went over the miracle day, made a copy of the notes, and presented them to Mara. When she returned the following week, she scaled herself at a “5.” She said she had begun paying attention to what she needed physically. She found a yoga class that she enjoyed. She had begun talking to her husband “softer” than usual, and he noticed. We spent a little time on what “softer” looked like to her and to her husband. She also said she thought she had become more approachable. I asked what that looked like.

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She said she wasn’t as anxious or impatient, trying to get everything done at once. When I asked how her husband reacted to her, she said he was responding to her by being open to taking some big steps in their life such as buying a house, which before he had been against. I continued asking “what else?” had been different and Mara continued to describe several other actions. Each time she described a new action, I asked more specifically about what that action meant to her, and how others were reacting to it. Asking these specific questions seems to (a) validate and (b) provide some insight as to the power of their new actions. Over the next few weeks, Mara continued moving up the scale, contacting old friends and becoming more social. One friend, who had been rude to her in the past, was rude again when Mara called her, yet Mara was able to stay confident and tell the friend that perhaps it was time to part ways for a while. We continued over the next few weeks to talk about creating “positive outcomes,” which were Mara’s words. By the last session, Mara said she had become “super comfortable with herself, calmer, internally better, able to go with the flow, shake off rejections, and structure her day to accomplish many tasks for her business.” At this point, I invited Mara to keep a list of what she continued to accomplish, since this was a value for her that held meaning in terms of who she was becoming. She liked the idea of the list, saying it reminded her of what she did well. By the time we terminated, after five sessions, Mara had made it to an “8” and her relationship with her husband had greatly improved. She described herself as respectable and “smooth thinking.” She was able to routinely verbalize what she was thinking, unfriend nosy n ­ eighbors, and regroup with people who shared her interests. nn

EXCEPTIONAL DESCRIPTIONS

In each of the cases in this chapter, a preferred future is described through the Miracle Question, problems are externalized and described using narrative therapy, and new tasks to integrate the preferred future are developed from exceptions. This is the blend of narrative and solution focused therapy as it can be used to work with clients dealing with a variety of diagnoses. nn

ALWAYS SEEK EXCEPTIONS FOR DIRECTION

In the case of Angelica, age 14, it was the identification of continuous exceptions that gave her and her family tools to step out of a diagnosis that was affecting

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everyone in the family. Angelica’s parents were informed by her p­ sychiatrist that their daughter was afflicted by early-onset schizotypal personality disorder. They were told that their daughter would continue to become debilitated and symptoms would worsen with time. Angelica was started on a medication regimen. The family was then referred to family therapy by the psychiatrist to learn how to cope with Angelica’s behavior. When I met Angelica and her family the first time, I saw that Angelica had pulled out all of her eyebrows and had grown her bangs out to completely cover her face. She clutched a statue of Jesus, wrapped in a towel, while she sat on the floor in my office, among her three siblings, who I noticed tried to keep their distance from Angelica. The mother and father, when asked what their best hopes were, described a very chaotic life and a desire to gain some control so that the “other children” could grow up in a somewhat normal environment. One of the challenges was that Angelica lit candles each night and lined them along her bed, placing bibles next to the candles. Angelica told her mother that the candles kept her safe. The parents were worried about Angelica’s bed catching fire so they often kept vigil near her bed at night, causing them fatigue. Additionally, the family could not go anywhere without Angelica carrying the statue of Jesus with her, which embarrassed the other siblings and kept Angelica from actively participating in anything. During the first session, since the family wanted to try and achieve some sort of normalcy, I did not recognize Angelica as the identified patient nor acknowledge her hair and the statue that she held on to. Instead, I asked about all of the children, including Angelica, and was curious about their interests and ideas for the future. I also wanted a clear picture of what a “normal” life for the family might look like. There were many ideas shared about vacations and sports, which the family seemed to enjoy talking about. I also asked Angelica what she hoped for, but she did not respond. However, we continued on, constructing a preferred future. I wished the family well after the first session, inviting them to find one item on the list we constructed to try out over the next week. When the family returned the following week, so did the statue and some additional guardian angel pins that Angelica had randomly placed on her shirt. I asked the family what had gone better since I had seen them and they talked about going ice skating the past week. The father said that even Angelica tried to skate. I looked at Angelica and said, “Wow. How did you do that?” She again said very little, but acknowledged that she had enjoyed it a little, even though she had to

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leave her statue in the car for 2 hours. I said to her, “I’ll bet that was hard. How did you do that?” She said she was afraid she would drop the statue on the ice and break it. I commended her on being so cautious with the statue. We continued the session by talking about what else had been different. I learned that the parents were beginning to set some small rules for Angelica’s behaviors. For example, when she got into shouting rages when she could not indulge in odd behaviors such as lighting candles, the parents had stayed calm and maintained a consistent boundary. At times, the boundary setting lasted for hours, but the parents took turns. This, they said, kept the other children from getting too upset and too involved in trying to help Angelica. While one parent kept watch, the other parent played with the other children outside. Over the next few months, more behaviors surfaced with Angelica, who was now beginning to appear as a rebellious teen. On one occasion, the mother reported that on the way home from a session, Angelica became so outraged that the mother stopped the car and called for police help. When the police arrived and talked to Angelica, who had been hitting her mother, the police told Angelica that if she continued, they would take her to juvenile detention. Angelica seemed to listen on that day and, afterwards, began to regress from the raging. Upon return to therapy the following week, I asked the mother, “What difference do you think calling the police might have made?” The mother replied that she had become aware that while Angelica was diagnosed with a bad disorder, it was still important to be her mother and to set boundaries and maintain consistency for her benefit. She saw doing this as essential from that point, if her family was to survive. The parents began setting stricter boundaries and I kept seeing Angelica and her parents for a period of several years, once a month. Angelica still took several medications and was able to begin functioning well enough to attend a private alternative high school for teens with challenges. Eventually, the family terminated therapy when things seemed to be more under control. About 10 years later, I received a phone call from Angelica, who was then 24 years old. I recognized her voice immediately. She had called to tell me that she was selling candles with her mother in a pyramid marketing business. She wanted to know if I would like to join. I shared that I could not, due to a code of ethics that kept me from engaging in business with a client. She understood and then said the following: “That’s okay, Dr. Metcalf. I understand. And hey, I wanted you to know that I got married. My husband and I just bought a house. I also

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work as a pet groomer at a pet store and I love my job. I don’t take any more medications. I guess I just wanted you to know.” While I will probably never take my pet to be groomed by Angelica, I was quite pleased to hear from her and hear the elation in her voice about working with her mother and achieving a life on her own. It has been clients like Angelica that have shown me that diagnoses, while intended to explain a problem, do not necessarily guarantee a certain outcome for an individual. nn

SUMMARY

Anger, depression, and anxiety that cause distress are sometimes hard for clients to manage and gain control over. Deconstructing the problem to find out why such reactions are occurring does not lead to solutions; rather, it provides more reasons to suggest that a normal life is i­mpossible. This chapter attempted to show how identifying the effects of such descriptions slow down the progress of the person’s triumph over the problem. There is a special moment in a therapy session when a therapist suggests that the client “stand up for himself against the anger.” Another client may feel more normal as a therapist invites him to redescribe depression as “sadness.” The new thoughts and beliefs about oneself that develop through SFNT can be priceless, prompting clients to raise their expectations for their futures and begin identifying actions to get there. Mark Hayward and Amanda Redstone (personal communication, June 2016) have noted that linking problematic events with times where clients distanced themselves from their values causes distress. In so many cases where clients bring in situations, concerns, or problems, I notice how they have been distanced from who they want to be. Take Mara, who, once married, became someone else, and moved away from her values of independence by quitting her job and trying to adapt to married life. Or Charlie, who, with his parents’ influence, began to see himself as anxious rather than recognize that he simply functioned better when busy and active. Or Angelica, whose diagnosis influenced her family until her mother recognized that Angelica did have times when she paid attention to authority and saw those times as keys to helping her daughter. Most of the clients in this book who were affected by situational issues, trauma, grief, or loss were distanced from their values when those situations arose. Naturally, the clients reacted and became uncomfortable in their new roles. This emphasizes the importance of listening to clients’ preferred futures and embracing their words, which give hints to values, no matter how impossible their preferred futures may

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seem. Honoring a person’s values and seeing those values as freeways to solution building is the road to the most helpful therapy. nn

PERSONAL EXERCISE

Think of a current client that you are working with who is causing you some concern. Perhaps the client is not able to verbalize a goal clear enough for you to pursue with the client. Maybe you leave each session thinking, “I hope he or she doesn’t reschedule!” For a moment, think of how you are describing the client. Be honest. Then, think of how you have approached the client using that description. How ­effective would the client say the therapy has been?

Now, with a great deal of imagination, come up with a new description of the client. With that description of the client, how will you greet the client the next time you meet?

How will you do things slightly differently, given the new conversation?

As you try out this exercise on a real client, watch for how the s­ ession goes differently. When the session ends, look back on what you did differently and recognize how your flexibility as a therapist might have helped you, too, escape the clutches of a diagnosis.

REFERENCES Hayward, M., & Redstone, A. (2016, June). Texas Wesleyan University Study Abroad: Narrative therapy presentation. BRIEF Therapy Practice, London, England. White, M. (1989). The externalizing of the problem and the re-authoring of lives and relationships. In M. White (Ed.), Selected papers (pp. 5–28). Adelaide, Australia: Dulwich Centre Publications.

CHAPT ER 11 Treatment Planning and Group Therapy Growth is never by mere chance; it is the result of forces working together. —James Cash Penney

I once consulted with a group of staff members at a residential ­treatment center for children. The staff were interested in improving their program and thought the solution focused approach might be helpful to them. I drove to the facility early on the first morning and arrived about 30 minutes before my appointment. I noticed some children playing soccer in a field next to the center. I remember watching them and thinking how typically they were playing and reacting to each other. There were the usual squeals and punches that children exhibit, but for the most part, they were reacting well and normally to each other and to the adults who were standing around. As I was watching, the director walked up to me. I greeted him and told him how much I was enjoying watching the soccer match. I told him how well the kids were doing and how great the adults were interacting with them. He looked at me and said, “But you don’t know what’s wrong with them yet, do you?” He was correct. Yet, I did not really want to know what was wrong with them. Instead of wondering why the kids were in treatment, my inclination was to observe how they were functioning well, without the prejudice of diagnoses. Why diminish the possibility of a preferred future by tarnishing it with diagnoses? I wondered later how the clients might have reacted to me if I, as their therapist, had been guided only by 189

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my initial impressions, rather than their documented reasons for being in residential treatment. nn

COLLABORATIVE APPROACH TO ASSESSMENT AND TRANSITION PLANNING

This chapter provides ideas for how agencies, schools, treatment centers, and groups can adopt solution focused narrative therapy (SFNT). My work in applying this method began more than 25 years ago when I was asked to compose a solution focused treatment handbook for the staff at a residential treatment center in Texas that worked with adolescents and adults. To begin the process of writing the handbook, I asked the psychiatrists, psychologists, nurses, therapists, and administrators what they hoped to achieve by creating the handbook. In other words, “What were their best hopes?” They replied that they needed •

Assistance in helping patients to set reasonable, obtainable goals for treatment

•

Help in getting a commitment from each patient to engage in treatment

•

Ideas for how to design treatment for each individual patient so that patients could function better and cooperate while in treatment

It was quite a request. Many of the clients in the treatment center were there by court order and it was hoped that by changing their behavior they could avoid jail time. Some of the clients were adolescents sent by their families, who were ready to give up on them. The families tended to show up to therapy only occasionally and did not commit to being part of the treatment strategy. Some wanted to just drop off the problematic children and pick them up when they were “fixed.” Employee assistance programs asked that employees who were admitted for treatment be rehabilitated as quickly as possible so they could return to their jobs. It seemed that everyone wanted a quick fix, a recipe for success, and a plan to impose on the patients that would solve their issues. The staff members were steeped in a medical model of thinking and acting toward their patients. To move into a solution focused narrative model of treatment, constructs and guiding ideas of the staff needed to change. My challenge was how to do that in a respectful manner,

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building on the staff competencies. Here is how the problem-focused approach directed their treatment of patients: •

The patient was assessed as needing help or entering treatment to solve a problem. Tests and diagnoses were given to determine how treatment was to be designed.

•

The patient was seen as having a disorder and as not competent to solve his or her own problem.

•

The treatment team determined the goals for treatment and the patient was told what he or she needed to do to be discharged. These goals were based on medical information and symptomology and strategies decided upon using practices that had helped other patients.

•

The patient was required to attend all assigned activities, groups, therapy settings, and outside resources while in treatment and to participate. If the patient refused to attend, he was deemed uncooperative and was confronted or denied privileges.

•

Discharge planning began after the patient made progress. The treatment team determined what the patient should do for aftercare.

In this setting, the treatment staff determined what was best for the patient. While they were experts in each of their areas, the staff, following the problem-focused approach, failed to get patient input. They viewed a patient who was uncooperative as resistant, instead of as a patient whose goal was not being addressed. If a patient relapsed shortly after discharge and returned to treatment, he or she was described as “not willing to work on the real problem,” leaving staff to conclude, “no wonder he is back.” Therapist and author David Waters partnered with Edith Lawrence to promote an approach to clinical social work that draws on qualities of the clients, such as courage and hope. Waters makes a strong case for a move away from the medical model of treatment: The concept of competence provides a conceptual replacement for the medical model. It is based on a systematic search for the strengths and resources that people bring to life but often do not recognize or use fully. Beginning with the idea that

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most symptoms represent adaptive attempts gone awry, a competence approach develops the healthy urges that reside within symptoms and helps clients organize around those instead of around the problems themselves. (Waters & Lawrence, 1993, p. xvi) This client-centered approach gives agency to people who have presented in therapy and, in keeping with solution focused techniques, orients their work toward a nonproblematic future. nn

SOLUTION FOCUSED NARRATIVE APPROACH

The SFNT approach developed in the residential treatment center shifted the focus of treatment. We called this approach the Exceptions Program: •

The client was viewed by staff as needing a break from the problem that had interrupted his or her life. The client was not viewed as broken, and instead was seen as temporarily off track due to problem intrusion. A diagnosis might be given to the client, but the client’s goals took precedence in the treatment planning.

•

The client was seen as someone who had been able to function on his or her own in the past, but had lost sight of his competencies due to problem interference. The staff’s job was to assist the client in rediscovering his or her competencies through exception finding.

•

The treatment team always discussed the client’s concerns with the client (and family members when applicable, and chosen by the client) present, and together the team and client strategized how to create a context in treatment that was conducive to change for the client’s goals.

•

Treatment team meetings always began with the question, “What’s going slightly better for____?” This dialogue focused on exception discoveries, where the staff discussed times when the client was not allowing the problem to take over. The focus was on exceptions, and the staff adjusted its interactions, strategies, and activities so that the exceptions, now referred to as strategies, could reoccur.

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•

Discharge planning began with the intake conversation. The person doing the intake took time to learn what the client wanted for his future and described what the client hoped for and needed from treatment to be discharged successfully. From that point, the process involved collaborative planning between the client and the staff. Therapeutic activities were suggested and offered to the client. It was the client who ultimately agreed to the plan of treatment.

Note the change of language from “patient” to “client.” This illustrates how a client is given some control over goal setting and treatment. The actual process for the client can also be redescribed as “recovery,” or “transition” planning, or however the staff and client wish to describe the process. The manual that the staff received, entitled Exceptions (Metcalf, 1992), was designed to provide what the staff wanted, with one big difference—it was client directed. It addressed the staff requests as follows: •

Assistance in helping patients to set reasonable, obtainable goals for treatment Upon entry into the treatment program, a client began “termination talk,” which described how the client, her family, her employer, or school would know when she was ready to leave. What would be signs of success? What actions would begin happening to suggest success? These became goals for treatment.

•

Help in getting a commitment from each client to engage in treatment Clients were asked what it would take for them to be more engaged in treatment. What could psychiatrists, psychologists, therapists, technicians, and dieticians be doing that would be helpful in engaging them? What would the client need from the providers? If the clients did not know when initially asked, they were given time and asked to continue to think about what the treatment center could do to engage them. Then, clients were also asked about situations in their lives when they felt engaged in processes or projects, and those “exceptions” became part of treatment.

•

Ideas for how to design treatment for each individual patient so that patients could function better and cooperate while in treatment

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After the first few days in the treatment center, clients were asked which activities, therapies, or resources might be the best for them. The treatment center had an array of services on offer. The staff would make suggestions and explain the usefulness of each choice, such as individual therapy, family therapy, and group therapy, to the client. The client was also invited to choose from occupational therapy, art therapy, Alcoholics Anonymous meetings, and experiential exercises such as ropes courses, journal writing, and more. At the end of the conversation, a treatment plan was constructed. nn

CHANGING THE FOCUS OF STAFF

The staff engaged in intensive training for a week, learning the solution focused ideas and narrative therapy ideas that have been explained throughout this book. Like many therapists who experience a paradigm shift, it was difficult for them at first to let go of their expertise, thinking that they knew best, and to resist the urge to tell clients what to do. The solution focused narrative approach would, in fact, prompt the staff to sit back at times, refrain from teaching and directing clients, and instead ask the client what needed to happen next in order to reach the goal the client had set. In the case of a client who had gotten off track and required some redirection from the staff, the client would be asked to describe what he or she could do differently next time; again, placing the client in control. In weekly meetings, the consultant who did the training reviewed cases and coached the staff on the application of the solution focused narrative approach. After a few months, the consultant met every other week; finally, when competency seemed to be reached and the staff felt they had a solid grasp on the model, the consultant visited only when needed to offer additional coaching. The difference between the two approaches led to a comprehensive change in the treatment center protocol, as clients gave input into the treatment planning that would help them achieve the goals they set. Daily conversations changed, from diagnostic and problem-­saturated conversations to exception description conversations. The head nurse and lead therapist were given the job of maintaining the competency-based conversation in treatment team meetings and shift changes that occurred each day. Instead of staff telling each other what happened with a client who they needed to watch out for, different conversations emerged that focused on what clients did better. The next few pages highlight forms that assisted the staff in integrating the approach.

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nn

FROM ADMISSION TO DISCHARGE IN ONE CONVERSATION

The Exceptions program manual was composed of several guiding forms. Included here is a revised Admission Interview from Solution Focused Group Therapy (Metcalf, 1998, pp. 55–56).

Program Entry Interview 1. Tell me how you will know when treatment has been successeful here. I am interested in your ideas. (If the client says that therapy was someone else’s idea, ask: “What would that person he or she hopes will be different for you once treatment is complete?”)

2. Tell me times in the past when the problem did not affect you as much as it does now. What went on then that helped you to be in control of the problem? What else did you do then that made things different? What did others do?

3. When you have completed our program, what do you hope you will be doing differently that will assure you and your close ­significant others that you are ready to leave? (Ask the client for specific overt behaviors. If the client says, “I will be less angry,” ask, “Instead of being angry, what will you be doing instead?”)

(continued)

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4. How might other people at home or work or in other important relationships know that your life is on track?

5. When you think of your answers so far, how would you state your personal goals for treatment at this facility?

6. On a scale of 1 to 10, with 10 meaning highly likely, and 1 meaning not possible, where would you rate your current ­likelihood of achieving your goal?

7. Considering the number you just gave me, which of the following activities do you think would begin to be the most helpful in achieving the goal you have described? _____Multifamily therapy _____Chemical recovery group _____Experiential (ROPES) group _____Anger control group _____Dangerous habits group

_____Relationship group _____Women’s issues _____Men’s issues _____Survivor’s group _____Parenting skills

The interviewer then suggests to the client the following groups as a starting point for the program and asks for the c­lient’s consent: _____AM process group _____Individual therapy

_____PM process group _____Family therapy

________________________________________________ Client Signature

Interviewer Signature

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As the Exceptions Program continued, it became clear that the way progress notes were written had a huge impact on aspects of the client’s treatment. The notes that were taken each day in groups, therapy, and various activities needed to have a SFNT approach. The Progress Notes format, shown in the following chart, seemed to help the staff focus on exceptions rather than problems and be able to report their findings in treatment team meetings. Finally, getting staff to stay focused on exceptions and competency in their clients also meant that staff evaluations and assignments needed to take on the same approach. When staff were evaluated or their assignments reviewed, the focus was typically on what the staff did well. It would become routine to share comments such as Great work with Jonathan, Harry. You seem to be quite good at getting him engaged in the multifamily group so that he expresses what he hopes to experience at home with his family. Tell me how you learned to do that.

Progress Notes Name of Client:______________ 

Date:____________

Goal of Client:_____________________________________________ Therapy/Activity/Group Type:______________________________ __________________________________________________________ Exceptions: 1. 2. 3. 4. 5. Scale: 1–10 Where is the client today in relation to achieving his or her goal according to the client?_______ Source: Metcalf,1992, p. 27

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Once staff is focused on exceptions and redescriptions, individuals and families in groups begin to experience a very different group dynamic. Instead of being confronted, they are complimented. Instead of being given an agenda or paper assignments, they are asked for their best hopes for the group session. I recall a group of young women who were sexual abuse survivors. As we talked about goals, one woman spoke of feeling safe from a stalking ex-boyfriend who had assaulted her. As the group connected over a few sessions and members began talking about their preferred futures, Shana began talking of her dreams of being a flight attendant. She had always had those dreams, she revealed, but due to the various relationships she had in the past that were controlling, she never dared to inquire about the career. As I asked her what a career as a flight attendant would do for her, she replied “I would finally have some real freedom.” After attending two more sessions, Shana did not show up for group one evening until the end of the hour. The group members were a bit frustrated with her tardiness until they heard her reason. “I am late because I am coming from an interview for an airline training course to be a flight attendant. And, I passed it! I start training this weekend. This is the last time I will be here.” The solution focused approach to narrative therapy has shown to provide an entryway into what is most important to clients. When the client is in a group, the motivation and excitement becomes contagious. Questions throughout this book reflect a curiosity from the interviewer toward a recipient, always seeking the recipient’s insight on how and when he or she does something b ­ etter rather than t­ elling the client what to do. This insight, which is discovered by the client through the conversations suggested in this book, is more valuable than any praise. It is a validation of what the ­client already knows how to do, yet may not recognize, and is reinforced with the suggestion that if the client did it once, he or she can do it again.

nn

GROUP THERAPY FOR SOLUTION BUILDING

Leading a solution focused narrative group lessens unproductive storytelling and consistently supports the client’s goals. There are ­

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several assumptions that a group leader might need to adhere to when leading such groups:

nn

•

People are competent and are experts on their own lives.

•

Change is inevitable—watch for it in the session and outside the session.

•

Exceptions to problems always exist.

•

Specific goals are always better attainable.

STEPS TO TAKE WHEN BEGINNING A GROUP

My favorite groups are process groups such as AM and PM process groups in treatment centers. They do not have a theme and they typically focus on whatever the clients want to focus on that day. In the AM process group, the focus is on what the clients want to achieve that day and, in the PM process group, how the day progressed. The group typically involves clients with a variety of issues. The process groups differ from specific topic groups in that the group members simply process whatever is facing them that day. The members set the agenda. In specific topic groups, the subject and focus of the group is on a certain situation that, most often, is the choice of the therapist. Consider the following helpful steps. 1. Set the pace of the group by asking each member what his or her best hopes are. If a client was sent by a family member, employer, or probation officer, and does not have best hopes of his own, ask the client what the person who sent him to the group wants him to achieve. Consider writing everyone’s best hopes on a white board for all to see. From the very beginning, when clients say what they do not want, immediately ask: “What do you want instead?” Note: For some groups, particularly specific topic groups, the listing of best hopes provides a starting point as the group continues. Ask those groups, “Which topic shall we talk about today?” while looking at the list. This way the group begins talking about what is important to them. In process groups, also look at the list and ask the group members to select a

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topic for the group on that day. The group leader can even ask if the group thinks a particular person might need their attention that day and, if so, what might the group hope the discussion is about. 2. Ask about the effects of the problem. The best hopes have stated what the clients want better. It is helpful at this point to find out how the best hopes will be helpful. One way to spur motivation is to talk about the effects of the problem that the client wants to solve. Make a list on the white board of everyone’s effects. 3. Set goals with the group. Say: “Someday, when the problem that brought you here is gone or much less bothersome, what will be different?” Make sure to change the language of goals of what clients do not want to what they do want instead. Write these on the white board. If clients have difficulty setting goals, ask the Miracle Question too or ask what the clients think family members, teachers, probation officers, and other contacts will begin to see when the problem is not happening. 4. Inquire about exceptions. This is the exciting part of a group, where group members can identify times when a problem did not affect them as much, and group members can add instances when they saw their fellow group members doing better, as well. Write down the exceptions on the white board, or take notes and copy for the group members later. 5. End the group with feedback and tasks. At the end of the group, ask group members to compliment those group members who seemed to be the most helpful to them that day. Also ask for compliments to group members who displayed a behavior that was helpful. Then, ask the group members for tasks that they will try out until the group meets again, based on the exceptions that were discussed. 6. Scale the group. This last step is helpful to the group leader in that it provides information on what went well. Ask the group to scale the

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process and outcome of the group from 1 to 10, with 10 being the highest. Make sure to ask what prompted them to scale the group as they did. Ask what could be done differently next time, if anything. Group therapy, when conducted in this way, moves its members toward change more quickly than problem-focused groups. Since the group does not spend a lot of time going back into the causes and situations that precipitated the dilemma in the first place, there is more constructive time spent in building a preferred future, only with new assistants! For this reason, groups formed outside an agency setting might find that the group enrollment is “rolling” or has new group members added often. When this occurs, let the group members explain to the new member how the group is conducted. nn

SUMMARY

How we accept clients into “treatment” or groups sets the tone for the therapeutic process. When we allow clients to help us choose what treatment modality or topic to discuss, as presented throughout this book, the result is a motivated client and a more efficient therapy. When treatment center staff engage in a process that is based on clients’ perceptions of what would be helpful, on occasions when the staff see a need to suggest an additional intervention, the client is more likely to agree. nn

PERSONAL EXERCISE

Most of us are involved with groups. Whether it is through our employment, sports teams, classes, family gatherings, or other interactive activities, our involvement affects the group. Think of a current “group” that you are engaged in and would like to be more involved in and think about the following questions: 1. How would you scale your participation in the group on a scale of 1 to 10?

2. What would others in the group say you do that they appreciate? Where would they scale you?

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3. What would others in the group say they wished you would do more of?

4. What could you do to raise your score?

5. What difference could that make for you, if you moved up the scale?

We are all social beings. We tend to thrive in the presence of others, especially when we get back from others what we hoped for. Yet, we often play a part in what we get back. I hope this exercise provides you with a look at your role in groups so that you can create a context in your life with others that is fulfilling for you and exceptional for them.

REFERENCES Metcalf, L. (1992). Exceptions. Fort Worth, TX: Metcalf Publications. Metcalf, L. (1998). Solution focused group therapy. New York, NY: Free Press. Waters, D., & Lawrence, E. (1993). Competence, courage, and change: An approach to family therapy. New York, NY: W. W. Norton.

A p p en d ix Guiding Constructs of Solution Focused Narrative Therapy

Narrative Therapy Constructs

Solution Focused Therapy Constructs

Reauthoring and creating new chapters allows the client to flourish with new descriptions that are meaningful and exemplify his or her values. Unique outcomes are gaps in the problem story and should be explored.

Eternalizing problems assists a client in taking back his or her life and standing up to an interfering issue.

Solution Focused Narrative Therapy Constructsa 1. Invite clients to see the events in their lives as chapters. Enrich the chapter with descriptions of new presentations that project client values.

Exceptions are times when the problem occurs less.

2. Assist and encourage clients to seek out successful events, and identify the clients’ beliefs and values during those better times. 3. Integrate complaints as situations that interfere in a client’s preferred life, rather than diagnosing the client.

(continued)

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(continued) Narrative Therapy Constructs

Solution Focused Therapy Constructs

Solution Focused Narrative Therapy Constructsa

Language connects the therapist and client and provides the therapist with direction and an opportunity to externalize the problem.

4. Write down all the key words that clients use during the session, and use those words while talking to them.

The direction of the Building a preferred client is always future with a client honored. The encourages him or her therapist then to focus on details that seeks out meaning enrich the conversation, and values that which itself becomes an the preferred intervention. direction holds for the client.

5. Follow wherever clients want you to go in therapy and refrain from assuming that they are avoiding the real issues.

There are always unique outcomes and gaps in the problem story that assist the client in sensing that the problem is not all encompassing and instills hope.

Exceptions to times 6. Capitalize on successes when the problem in clients’ work, hobby, does not occur in other or profession that can situations builds a sense metaphorically lead to of competency and solutions in other areas provides solutions for when you identify the client to identify with the specific skills as tools for the current associated with their issue. successes.

New descriptions to explain actions gives confidence and encouragement.

Exceptions serve to help the client see that the problem does not occur constantly. This allows the client to realize competency. The therapist asks, “How is it you did that in that situation?”

7. Through questions, promote the idea to clients that the problem-saturated map they are focusing on is full of “tributaries” of success that are often too small to see from a distance. (continued)

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Going too deeply into the problem story may recreate traumatic labels and descriptions, and allow the problem to overwhelm the client’s efforts to reclaim the person he or she wishes to be.

Normalizing is important so the client feels competent and empowered.

8. Promote hope by suggesting that clients “forgot” to be competent, assertive, or responsible during problem-saturated times.

It is not necessary to know about the trauma to move into a preferred future. In fact, it is more productive to encourage clients to create a future where they are in control, not the event.

9. Avoid revisiting traumatic events, because there is a risk of retraumatizing clients when doing so, and that could be harmful.

A therapeutic stance of 10. Instead of praise astonishment goes far in and compliments, be establishing respect and enamored with client empowerment for a client successes, resiliency, struggling to deal with and exceptions and an issue. It inspires hope respond by asking, and ability in the client. “How did you do that?” Not knowing is more 11. Take a not-knowing helpful for both therapist stance. and client as the therapist brings a new lens to the session and sees the client as the client, not a diagnosis, freeing the therapist to remain without prejudice. (continued)

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(continued) Narrative Therapy Constructs

Solution Focused Therapy Constructs

Solution Focused Narrative Therapy Constructsa

The client’s language provides words to use in helping him or her feel heard and respected. It also provides meaning and describes what is important to the client.

Always honoring every goal keeps the client feeling respected. Whatever the goal, it is the client’s miracle, which is honored. If it seems impossible, asking “What difference would that make?” repeatedly will typically result in a goal that can be addressed currently.

12. Hear every goal the client provides you with as one that will make a difference for the client, no matter how unrealistic it may sound.

Keeping a tab on success, abilities, and exceptions for the client to review and recognize is helpful in creating a session with promise.

13. See your role as one of keeping track of exceptions, meaning, and values throughout the session.

The written word to a client, summarizing a session with statements from the therapist that ponder “how the client will stand up to the issue so that his or her life is reclaimed,” is invigorating for a client to keep between sessions and promotes progress.

14. Write a note and mail it to clients using their language, and state how you look forward to seeing them achieve small changes between therapy sessions.

(continued)

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How clients or others describe themselves gives them insight into how current actions or descriptions affect others. By creating new descriptions, clients leave with a new perception of themselves and a plan on how to present their authentic selves, which are most often based on values and meaning.

Solution Focused Therapy Constructs

Solution Focused Narrative Therapy Constructsa

Measuring the current status of the problem provides hope, as clients may recognize that they are not completely taken over by the problem; this allows them to consider taking small steps to move up the scale.

15. Use the Scaling Question to measure where clients presently are in their lives in reference to the preferred future and to inquire where they want to be when you meet again in the next session.

Asking “What will others see you do over the next week or so that will tell them things are better?” gives clients another way of thinking about how they might show progress to those significant others in their lives, and makes the goal more specific.

16. Inquire about descriptions that clients or others have ascribed to themselves and seek new descriptions to create new actions.

Asking what a client prefers rather than what he or she does not desire provides more specific statements that can help the client to take more specific actions toward solutions.

17. When clients talk about what they do not want in the future, which is all too common, ask: “Instead of that, what would you prefer?” (continued)

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(continued) Narrative Therapy Constructs

Solution Focused Therapy Constructs

Solution Focused Narrative Therapy Constructsa

The client leads The client leads the session. 18. If clients want to talk the session. If However, the solution about the past, listen the client insists focused approach may and then ask, “How is on talking about encourage a therapist to this helpful?” the problem, the ask how such revisiting therapist might is helpful and then ask the client to carefully promote map the effects of seeking a preferred the past issue on future without dissecting the client’s life in the past or inquiring an effort to then about it. invite the client to step out of the control of the issue into a new future. The Miracle Question assists 19. Ask the Miracle the client in identifying Question to move what will be happening clients into the when the problem is preferred future solved or better. The story and get enough therapist takes time to specific actions so that get specific ideas so that they walk out of the the client recognizes office with a blueprint not only what he will for new actions. do differently, but what others would see as well. Asking how changes will affect relationships encourages clients to further identify how such changes will impact others and then come back to impact the client. This provides motivation for change.

20. Inquire how clients’ relationships might change in the near future when they begin to present themselves differently

(continued)

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Going slowly encourages 21. Go slowly. Encourage clients to feel comfortable only small changes so as they make changes, that clients experience and not rush. This takes success. pressure off of a client who designates just how much change to pursue. See Chapter 2 for a more detailed discussion of each of these constructs.

a

Index

action-filled narratives best hopes, 34–36 clients to watch for success, 53 constructing preferred story, 41–56 exception gathering, 48–51 mapping problem’s effects, 36–41 moving up the scale, 51–53 preparing presentation of preferred future, 51–53, 56–59 rich and provocative session, 56 addiction, definition of, 93, 94 ADHD diagnosis, 23 anxiety, 174, 176 art of re-membering, 125–129 bipolar, 23 Brief Guide to Brief Therapy, A, 36 change behavior, 141–143 changing the focus of staff, 194 childhood baggage, 87–89 circular questions, 47 client-centered approach, 192 clients as experts, 3–4 competence approach, 191–192 constructs, of solution focused narrative therapy, 24–27 coping with dangerous habits, 94–96 couplehood, parenting and, 163

dangerous habits addiction and, 93 assumption about clients, 101–102 coping mechanism, 94–96, 101 dealing with clients, 114–116 definition of, 94 eating disorders, 111–113 family therapy, 105 gaining personal control, 96–97 “monster in one’s head,” 97–101 rearranging furniture, 106–108 self-injury, distancing from, 108–111 substance abuse, 102–105 depression, 176 distress anxiety and, 174, 176 diagnosis, 177–179 externalizing problems, 179–181 woman, 181–183 eating disorders, 111–113 employee assistance programs, 190 encouragement for clients, 11 Exception Findings, 148, 151 Exception Observations, 143, 144, 147 Exceptions Program, 192–194 Admission Interview, 195 Progress Notes, 197 extra energy, 175, 176

211

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family sculpting, solution focused, 167–169 Formula First Session Task, 53 group therapy, 198–201 Miracle Question, 41, 42, 44, 47, 95, 105 modern approaches to therapy, 3–4 “monster in one’s head,” 97–101 narrative therapy model, 5, 21–24, 36, 39, 48 National Institute on Drug Abuse (NIDA), 94 NIDA. See National Institute on Drug Abuse noteworthy encouragement, 11 “not knowing” stance, 2 parenting and couplehood, 163 postmodern models, 3–4, 28 narrative therapy, 5 solution focused brief therapy, 6 power of redescription, 13–14 presuppositional language questions, 14, 39 problem-focused approach, 6, 177, 191 reconciliation forever, 163–167 redescription to create new presentations, 15 power of, 13–14 reintroducing school clients academic labels, 143 behavior problems, 141–143 making a campus appearance, 138–139 notifications, 144–151 overview of, 137 school’s response to problems, 139–140 relationship presentations adolescents, dealing with, 84–86 building trust, 84

chance of changing, 78–83 childhood baggage, 87–89 rebuilding, 7–11 therapist role in, 76–78 using redescription, 15 re-membering conversations with clients, 127–129 “to find peace,” 129–133 videos, ornaments and aftershave, 122–125 Resolving Sexual Abuse (Yvonne), 67 Response to Intervention (RTI), 143, 150–151 SAMHSA. See Substance Abuse and Mental Health Services Administration Schizotypal Personality Disorder, 184 SEL. See social emotional learning self-injury, distancing from, 108–111 sexual abuse, 63 effects of, 69 resolution, 67 trauma, 67 victimization, 67 SFBT. See solution focused brief therapy SFT. See solution focused therapy social emotional learning (SEL), 142 Solution Building With Couples (Connie), 165 solution focused approach, 36, 139 solution focused brief therapy (SFBT), 3, 6, 21–24 solution focused family sculpting, 167–169 Solution Focused Group Therapy (Metcalf), 112 Solution Focused Team, Parent, and Student Meeting template, 147, 148 solution focused therapy (SFT), 103 treatment handbook, 190 storied therapy. See narrative therapy

I n d e x    2 1 3

Substance Abuse and Mental Health Services Administration (SAMHSA), 102 substance abuse habits, 102–105 systems theory, 41, 52 timeless influences early childhood issues, 133–135 overview of, 121 transition planning, 190–192 trauma effects of, 63 experienced, 65 incident, 68, 69 narrative therapy components, 65 to resolutions, 70–71 of sexual abuse, 67

victimization, of sexual abuse, 67 working with families, guiding ideas for, 156 blended family getting together, 162 control of diagnosis, 157–162 family sculpting, solution focused, 167–169 new chapter after loss, creating, 162–163 parenting and couplehood, 163 reconciliation forever, 163–167 zero tolerance approach, 141