Quick Doing What Works in Brief Therapy

A Strategic Solution Focused Approach
2. Auflage 2008
ISBN: 978-0-08-055732-8
Verlag: Elsevier Science & Techn.
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 336 Seiten

This book is both a set of procedures for the therapist and a philosophy- one that is shared with clients and one that guides the work of the therapist. This second edition continues its excellence in offering clinicians a guide to doing what works in brief therapy- for whom, and when and how to use it. Psychotherapy that follows these guidelines validates the client's most important concerns - and it often turns out to be surprisingly brief. Author, Ellen Quick integrates strategic and solution focused therapy and includes guidelines for tailoring technique and interventions to client characteristics and preferences. With clinically rich examples throughout, this book offers applications for couples, including indications for individual or conjoint sessions.
NEW TO THIS EDITION:
* Chapter summaries highlighting key points
* Presents ways of eliciting what clients most want to remember
* Describes the 'Doing What Works Group,' including outcome research findings and all materials needed to run the group
* Addresses the relationship among the positive psychology movement and this approach and the potential for collaboration
* Emphasizes an acceptance-based stance and how acceptance commonly leads to change
* Proposes that 'doing what works and changing what doesn't' can provide a transtheoretical perspective for therapists of any orientation

Ellen K. Quick, Ph.D., earned her undergraduate degree from Wellesley College and her doctorate in clinical psychology from the University of Pittsburgh. She has practiced psychology for over twenty years, specializing in brief psychotherapy. Since 1981, Dr. Quick has worked at Kaiser Permanente in San Diego, California.

Autoren/Hrsg.

Quick, Ellen K.

Inhaltsverzeichnis

1;Front Cover;1
2;Doing What Works in Brief Therapy;4
3;Copyright Page;5
4;Table of Contents;6
5;PREFACE;16
6;Chapter 1 The Model and Its Origins;22
6.1;ADDITIONAL PERSPECTIVES;23
6.2;THE MODEL;23
6.3;BRIEF STRATEGIC THERAPY: THE MRI APPROACH;24
6.4;SOLUTION FOCUSED THERAPY: THE BFTC APPROACH;28
6.5;COMBINING MODELS;30
6.6;THE STRATEGIC SOLUTION FOCUSED MODEL;31
6.7;SUMMARY OF CHAPTER 1;35
7;Chapter 2 Clarifying the Problem: What's the Trouble?;36
7.1;PRIORITIZING PROBLEMS;37
7.2;“WHO, WHAT, WHEN, AND WHERE?”;38
7.3;IN WHAT WAY IS THIS A PROBLEM?;40
7.4;TO WHOM IS THIS A PROBLEM?;41
7.5;WHY NOW?;43
7.6;TRANSLATING VAGUE CONSTRUCTS TO CLEAR COMPLAINTS;44
7.7;WHEN THE PROBLEM IS THE PAST;45
7.8;A DIFFERENT PROBLEM EVERY TIME;46
7.9;PROBLEM CLARIFICATION AS INTERVENTION;47
7.10;CELESTE: “MY MOTHER WAS VERY SICK MENTALLY”;49
7.11;HOW IS THERAPY SUPPOSED TO HELP? THE WORST AND BEST MESSAGES;52
7.12;SUMMARY OF CHAPTER 2;54
8;Chapter 3 Amplifying the Solution: Variations on the Miracle Question;56
8.1;THE MIRACLE QUESTION;57
8.2;DAVID: “I WOULDN’T HATE GOING TO WORK”;60
8.3;IDENTIFYING AND AMPLIFYING EXCEPTIONS;67
8.4;SCALING QUESTIONS;68
8.5;VARIATIONS ON THE MIRACLE QUESTION;70
8.6;MIRACLE QUESTIONING AS PROBLEM CLARIFICATION;72
8.7;MIRACLE QUESTIONING AS INTERVENTION;75
8.8;THE FUTURE CREATES THE PRESENT;78
8.9;SUMMARY OF CHAPTER 3;79
9;Chapter 4 Evaluating Attempted Solutions: If It Doesn’t Work, Do Something Different;80
9.1;ELICITING ATTEMPTED SOLUTIONS;81
9.1.1;“What Else?”;82
9.1.2;Being Specific;83
9.1.3;When “Nothing” Has Been Tried;83
9.1.4;Did It Work?;84
9.2;CONCEPTUALIZING PATTERN INTERRUPTION;84
9.2.1;Disrupting Solutions;85
9.2.2;Reversing Solutions;86
9.3;CHANGE SLOWLY;87
9.4;DEPRESSION: WHEN “CHEER UP” DOESN’T WORK;88
9.4.1;Depression After a Loss;88
9.4.2;Depression “Without Reason”;89
9.5;ANXIETY: WHEN “CALM DOWN” DOESN’T WORK;90
9.5.1;Interrupting Avoidance;91
9.5.2;Reversing “Concealing”;91
9.5.3;Interrupting “Perfectionism”;92
9.6;INTERRUPTING UNSUCCESSFUL ATTEMPTED SOLUTIONS IN RELATIONSHIPS;92
9.6.1;Reframing;93
9.6.2;Interrupting Ineffective Communication;93
9.6.3;“You Don’t Have to Like It”;94
9.6.4;Interrupting Promises of Change;94
9.6.5;Interrupting “Please Stay”;95
9.6.6;Interrupting “You Must Decide”;96
9.7;PARENTS AND CHILDREN: REVERSING WHAT DOESN’T WORK;97
9.7.1;Problems with Children;97
9.7.2;Problems with Parents;98
9.8;ATTEMPTED SOLUTIONS TO EATING PROBLEMS;98
9.9;SEXUAL SOLUTIONS: INTERRUPTING “FORCED AROUSAL”;99
9.10;RECOGNIZING INDIVIDUALIZED ATTEMPTED SOLUTIONS;100
9.11;SUMMARY OF CHAPTER 4;100
10;Chapter 5 Designing the Intervention: Validation, Compliment, and Suggestion;102
10.1;THE THREE-PART INTERVENTION;103
10.2;THE “BREAK”;104
10.3;VALIDATING;105
10.4;COMPLIMENTING;107
10.5;DESIGNING SUGGESTIONS FOR CUSTOMERS, COMPLAINANTS, AND VISITORS;109
10.6;WHAT MESSAGE WILL HELP MOST TODAY?;111
10.7;INTRODUCING THE COUNTERINTUITIVE;112
10.8;SUGGESTIONS, SPECIFIC AND “GENERIC”;114
10.8.1;Specific Suggestions;114
10.8.2;Generic Suggestions;115
10.9;COUNTERINTUITIVE APPROACHES: EMPATHY, NOT MANIPULATION;117
10.10;SUMMARY OF CHAPTER 5;118
11;Chapter 6 You can Take It With You: What Do You Want to Remember?;120
11.1;USEFUL FOR THERAPISTS AND FOR CLIENTS;121
11.2;THERAPIST INFLUENCE ON TAKE-HOME POINTS;123
11.3;COMMON THEMES;123
11.3.1;Recognizing Progress, Coping, and Insight;123
11.3.2;Therapeutic Relationship Variables;124
11.3.3;Images, Metaphors, and Didactic Information;125
11.3.4;Plans for Action;126
11.3.5;Changes for Relationships;127
11.3.6;Acceptance;128
11.3.7;Acceptance and Action Simultaneously;128
11.3.8;Take-Home Messages Over a Course of Therapy;128
11.4;SUMMARY OF CHAPTER 6;132
12;Chapter 7 Therapist Decisions: Clarifying, Amplifying, or Interrupting;134
12.1;GENERAL GUIDELINES;135
12.1.1;Speak So the Client Will Hear;135
12.1.2;Do What Works;136
12.1.3;Other “Rules”;136
12.1.4;Straightforward Approaches First;137
12.1.5;If It Doesn’t Work, Do Something Different;137
12.1.6;Breaking the Rules;139
12.2;WHEN PROBLEM CLARIFICATION DOESN’T CLARIFY;139
12.3;“WHEN MIRACLE QUESTIONS DON’T CREATE MIRACLES”;140
12.3.1;When the Miracle Is the Unsuccessful Attempted Solution;141
12.3.2;Shifting from Amplifying to Interrupting;142
12.4;WHEN ACCEPTANCE AND DOING SOMETHING DIFFERENT DON’T HELP;144
12.4.1;Back to Specific Techniques;144
12.4.2;Return to Clarification of Problems and Expectations;146
12.5;SHIFTING STANCES AS THERAPY PROGRESSES;147
12.5.1;Amplifying What Works and Interrupting What Doesn’t;147
12.6;SUMMARY OF CHAPTER 7;150
13;Chapter 8 Practical Considerations: Using the Model in Behavioral Health Care;152
13.1;MEDICATION AND THE MODEL;152
13.2;A MODEL THAT “WORKS” IN MANAGED CARE;154
13.3;INTERMITTENT CARE: “THE FAMILY PRACTICE MODEL”;155
13.4;HOW MANY SESSIONS? “NOT ONE MORE THAN NECESSARY”;156
13.5;SPACING SESSIONS;157
13.6;FOLLOW-UP SESSIONS;158
13.7;“TERMINATION” IN INTERMITTENT CARE;159
13.8;PRACTICAL CONSIDERATIONS;160
13.9;SINGLE-SESSION THERAPY;162
13.10;CAVEATS IN BRIEF THERAPY;163
13.11;SUMMARY OF CHAPTER 8;165
14;Chapter 9 Couples: Problems and Solutions;166
14.1;STARTING WITH THE COUPLE TOGETHER;167
14.2;CLARIFYING THE PROBLEM(S);167
14.3;ELABORATING THE SOLUTION(S);169
14.4;THREE-PART INTERVENTIONS FOR COUPLES;170
14.5;JILL AND NICK: “COMMUNICATION IS A PROBLEM”;172
14.6;FOLLOW-UP: TOGETHER OR SEPARATELY?;174
14.6.1;Follow-Up Together;174
14.6.2;Individual Follow-Up;177
14.6.3;Individual Sessions in Difficult Situations;178
14.7;THERAPIST CONCERNS;179
14.8;STARTING WITH ONE PERSON;180
14.9;VALUES AND A MARRIAGE FRIENDLY STANCE;183
14.10;SUMMARY OF CHAPTER 9;185
15;Chapter 10 Doing What Works Group Therapy;186
15.1;GROUP FORMAT;188
15.2;RESEARCH ON THE GROUP;193
15.3;THE INGREDIENTS OF CHANGE;194
15.4;CASE EXAMPLE;196
15.5;SUMMARY OF CHAPTER 10;198
15.6;APPENDIX: DOING WHAT WORKS GROUP VISUALIZATIONS;199
15.6.1;Visualization 1: Group Helped You in Just the Way You Hoped;199
15.6.2;Visualization 2: Crystal Ball;201
15.6.3;Visualization 3: Miracle Question;202
15.6.4;Visualization 4: Act Two;204
15.6.5;Visualization 5: One Year Reunion;206
16;Chapter 11 Positive Psychology and the Strategic Solution Focused Model;208
16.1;SOME POSITIVE PSYCHOLOGY PRINCIPLES AND TECHNIQUES;210
16.2;USING POSITIVE PSYCHOLOGY TOOLS IN STRATEGIC SOLUTION FOCUSED THERAPY;212
16.3;A TECHNOLOGY FOR POSITIVE PSYCHOLOGY;213
16.4;CASE EXAMPLES;215
16.4.1;Jamie;215
16.4.2;Marla;216
16.4.3;Byron;217
16.4.4;Miguel;218
16.5;SOME CONCERNS ABOUT THE POSITIVE PSYCHOLOGY MOVEMENT – AND SOME POSSIBLE SOLUTIONS;219
16.6;SUMMARY OF CHAPTER 11;220
17;Chapter 12 Acceptance and Change and the Model;222
17.1;THE ACCEPTANCE CHANGE CYCLE IN MULTIPLE APPROACHES;222
17.2;ACCEPTANCE IN THE STRATEGIC SOLUTION FOCUSED APPROACH;225
17.3;CLARIFYING AND “DECONSTRUCTING” DIFFICULT PROBLEMS;225
17.4;COPING QUESTIONS;226
17.5;AMPLIFYING THE COPING RESPONSE;227
17.6;INTERRUPTING UNSUCCESSFUL COPING SOLUTIONS;229
17.7;COPING WITH INDECISION;231
17.8;USING THERAPIST IMPOTENCE: “I CAN’T MAKE IT ALL GO AWAY”;232
17.9;THE ACCEPTANCE/CHANGE CYCLE IN THERAPY;234
17.10;SUMMARY OF CHAPTER 12;237
18;Chapter 13 Doing What Works as a Transtheoretical Approach;238
18.1;COMMON FACTORS AND THE MODEL;239
18.2;A DOING WHAT WORKS PHILOSOPHY WITH TECHNIQUES FROM OTHER MODELS;240
18.2.1;The Research on “What Works”;240
18.2.2;Master Therapists Combine Techniques and Improvise;241
18.3;A UNIFYING FRAMEWORK;242
18.4;A FEW BASIC PRINCIPLES;243
18.5;SUMMARY OF CHAPTER 13;245
19;Chapter 14 Case Examples: Intermittent Care;246
19.1;HARRIET: “I GUESS I COME WHEN I NEED YOU”;246
19.2;GAIL: “RAGE ATTACKS FOREVER”;247
19.3;JEFFREY AND CLAUDIA: SEX DRIVE DIFFERENCES;250
20;Chapter 15 Excerpts: Single-Session Therapy;254
20.1;MARY’S MIRACLE;254
20.2;LIZ: “I BLOW UP AT HIM”;264
21;Chapter 16 Case Examples and Excerpts: Brief Therapy;274
21.1;MEGAN: “PROBLEMS WITH MY FATHER”;274
21.2;AL: THE WORDS AND THE MUSIC;281
21.3;GLORIA: THE INCONSISTENT OVEREATER;287
22;Chapter 17 Case Example: Crisis Intervention;298
22.1;CRAIG: “IT WAS JUST TIME TO END IT”;298
23;Chapter 18 Case Examples: Doing What Works With Longstanding Patterns;306
23.1;BETSY: DEPRESSION AND “LOSING IT”;306
23.2;LEANNE: “I THINK I’VE ALWAYS BEEN A LIAR”;312
23.3;DISCUSSION;318
24;REFERENCES;320
25;INDEX;328

Leseproben

Preface Doing What Works in Brief Therapy: A Strategic Solution Focused Approach, Second Edition, is a description of strategic solution focused therapy and how the model has evolved since the publication of the first edition in 1996. As in the original version, this book covers the development, theory, and techniques of the model and provides clinical examples, with sufficient detail for the reader to apply the principles in his or her own practice. This second edition adds chapters on eliciting what clients want to remember from their therapy and on using the strategic solution focused approach with groups. It describes how the positive psychology movement and acceptance-based approaches interface with the model, and it looks at recent developments in behavioral health care. Finally, “doing what works and changing what doesn’t” is considered as a transtheoretical perspective. Summaries have been added at the conclusion of each chapter to outline key points for the reader. The primary audience for this second edition, as for the first one, is the practicing psychotherapist. Those practitioners already familiar with brief strategic therapy and/or solution focused therapy will recognize how the current model applies, integrates, and extends the models. Therapists of very different orientations will appreciate the discussion of issues that emerge in therapy of all kinds. Balancing client needs for change and acceptance/stability, speaking the client’s language, and dealing with uncertainty and life dilemmas are universal therapist concerns addressed in this book. For beginning therapists, most often graduate students in psychology, social work, nursing, and medicine, this is a guidebook. It not only discusses procedures but also describes just how to use them, with numerous and specific clinical examples. Behavioral health care administrators and planners will be interested in seeing how brevity is frequently a natural consequence of using a strategic solution focused approach. Rigid adherence to specific protocols is not required for efficiency; on the contrary, flexible construction of interventions for individual situations produces maximum efficiency and relevance. Finally, psychotherapy researchers and social scientists interested in the debate about whether common factors or specific interventions are the “active ingredient” in treatment will be interested in the discussion of how the principles of this approach provide a transtheoretical perspective. The book begins by introducing the model. The theory and techniques of the two parent models, Mental Research Institute (MRI) brief strategic therapy and Brief Family Therapy Center (BFTC) solution focused therapy, are reviewed in Chapter 1. The current approach combines brief strategic therapy’s emphasis on clarification of problems with solution focused therapy’s emphasis on amplification of solutions. It further integrates solution focused therapy’s emphasis on doing what works with strategic therapy’s focus on changing what does not. The chapter addresses some issues encountered when combining models in systemic therapy and outlines the current approach. Chapter 2 discusses problem clarification, a first and important step in strategic solution focused therapy. The essential idea is that understanding exactly what happened that is problematic, and how something is a problem, will lead to increased precision in the treatment. The author further describes how problem clarification can itself become an intervention, leading to significant normalization and reframing. Amplification of solution scenarios is the focus in Chapter 3. This chapter reviews how to use de Shazer’s “miracle question” to transform goals to specific solutions, some of which may already be present. Variations on the miracle question that involve “specific miracles,” “multiple miracles,” deliberate avoidance of the word “miracle,” and coping solutions are discussed. Chapter 4 concentrates on attempted solutions: identifying them and evaluating their efficacy. Commonsense “first-order” attempted solutions that frequently do not work well enough are reviewed, and some “second-order” alternatives are considered. There is discussion of a variety of “restraint from change” messages. In Chapter 5, the focus is on planning and delivering feedback to clients. This chapter describes how to develop a “three part intervention” that includes validation, compliment, and suggestion components. The suggestions emphasize amplification of emerging solutions that work and interruption of those that do not. Chapter 6 describes ways of asking clients what they most want to remember from their therapy. There is discussion of some common themes that emerge, including recognition of progress, relationship variables, and acceptance. Chapter 7 addresses the question of when to emphasize which component of the model. The author proposes some guidelines about initial selection and subsequent shifts of focus. Doing the most straightforward thing first, the therapist attempts to find procedures that “work”; when they do not, the therapist “does something different.” Recent developments in behavioral health care are the focus of Chapter 8. The author points out that while “brevity” is not the primary aim of this approach, it can result from precise clarification of problems and solutions. There is discussion of single session therapy, brief treatment, and intermittent care, with consideration of ways of discussing benefit limitations with clients. This chapter also addresses how medication can be considered an attempted solution, sometimes successful and sometimes unsuccessful. Working with couples from a strategic solution focused perspective is the subject of Chapter 9. This chapter presents a format for an initial conjoint session that elicits separate problem descriptions and miracle scenarios from each partner. Indications for conjoint versus individual follow-up are suggested, and ways of dealing with animosity, secrets, and infidelity are discussed. This chapter addresses ways of honoring client preferences and simultaneously taking a “marriage friendly” default position. There is discussion of acceptance and change in relationships. Chapter 10 describes the Doing What Works Group. It covers how to conduct strategic solution focused therapy in a group setting and summarizes some quantitative and qualitative research on the group. The visualizations and forms used in the group are included in the chapter. The interface between the positive psychology movement and the strategic solution focused model is the topic of Chapter 11. Similarities between the approaches are covered, and the potential for collaboration is addressed. Chapter 12 discusses acceptance-based approaches and the acceptance (stability)/change cycle. This chapter describes how the acceptance of ambivalence and discomfort becomes an important part of coping with difficult situations – and how it often leads to change. Chapter 13 looks at the question of whether common factors or empirically validated treatments are the “active ingredient” in effective treatment – and the position that second-order change may be the unifying factor. The strategic solution focused approach is conceptualized as a transtheoretical perspective that can guide therapists of any orientation. Chapters 14 through 18 present case examples. In Chapter 14, the examples come from intermittent care: a woman with a “difficult husband,” before and after his death, a woman with longstanding “rage,” and a couple, before and after marriage. Chapter 15 presents two single session therapy excerpts that illustrate different components of the model. Chapter 16 consists of three excerpts from brief therapy, where “problems with my father,” a lack of self-discipline, and overeating are the presenting concerns. The client described in Chapter 17 is in crisis, with serious suicidal ideation, and the clients in Chapter 18 struggle with longstanding patterns. As all the chapters emphasize, the critical elements in strategic solution focused therapy operate at two levels simultaneously. Working with the client, the therapist attempts to clarify the problem and to facilitate the client’s doing what works and changing what does not. At the same time, the therapist selects techniques tailored to each situation, shifting to something different in response to problems or obstacles as they arise. Clarifying problems, doing what works, and changing what does not: that is the recurring theme throughout this book. The ideas presented here are not original. I have been influenced by the thinking of Milton Erickson and am grateful for the opportunity I had to receive training from him in the 1970s. I have been strongly influenced by the important work done at MRI by Gregory Bateson, Don Jackson, Richard Fisch, John Weakland, and Paul Watzlawick. I am particularly grateful to Richard Fisch for the many ideas he shared with me, in the context of telephone case consultation over the course of several years. The thinking and writing of Steve de Shazer and Insoo Kim Berg at BFTC have also been central in the development of the ideas described...