As parents, we foist our dreams and aspirations on our children, push them to be more that we could ever be. But do we have the courage and honesty to look within ourselves and ask whether our parenting is driven by our own needs or those of our children? Just as importantly, are we able to accept them and respect them for who they are?

All You Need Is Love will convince you that parenting is not just about bringing up children; it is about empowering ourselves to be better human beings. It is not about teaching but about learning from our children. This is a book of strategies, tools, reflections and anecdotes for twenty-first century parenting. It will help you connect to the immense wealth of wisdom that is already present in you.

Child & adolescent psychologist and family therapist Dr Shelja Sen highlights this through her five anchors of parenting – Connect (create the foundation of parenting); Coach (build the necessary skills in children through an understanding of their unique wiring and temperament); Care (nurture ourselves for a more wholesome life); Community (build caring ecosystems for children to thrive in) and Commit (sustain the courage and compassion).

• Watch Shelja Sen’s TED Talk on How to Speak to Your Children
• Watch her  Video on 5 Cs of Parenting
• Buy All You Need is Love at Amazon

Imagine: No Child Left Invisible
Building emotionally safe spaces for inclusive spaces and creative learning

Why do we send our children to school? How can learning be meaningful? And most importantly, how can we build schools worthy of our children?

From the time children are little, we start making stories about them. Schools are like factories where these stories are manufactured all the time. Some children at the top of the hierarchy enjoy rich, diverse and colorful stories which are told and retold. However, there are many who spend most of their lives in school, clutching on to single, thin narratives of ‘failure’: ‘can do better’ and ‘not up to the mark’, ‘not reaching potential’ – every ‘not’ restricting and making their narratives thinner, limited, with lesser scope for possibilities. These are the children who are forgotten, who are invisible and who are seen as never being good enough.

At the core of this book is a deep faith that learning is about the magical relationship the teacher builds with each child; it is about building emotionally safe, inclusive spaces for creative learning. That is the heart, the lifeblood, the bare bones of learning.

Imagine is a call to action for teachers, parents, counselors, therapists, activists, thought leaders and other change agents in our society. A game changer that will force us to reflect, rethink, redesign schools that our children truly deserve.

 Watch her talk about her new book, Imagine: No Child Left Invisible as she answers pertinent questions.

Buy Imagine at Amazon

It is with great sadness that we share the news of the death of one of our trainers, Martin Oswin.

Martin was the first to deliver the course that had been created by Greg Vinnicombe and myself, and was the first to test whether the structure and content would work in the hands of someone else. In the event , Martin demonstrated that the integrity of the course was not only replicable, but also allowed others to colour the course with their own individual flair and style. This, in turn, gave us the confidence to recruit further hand-picked trainers – Naomi, Stephan, Suzi, Tara and Kidge.

Successful completion of our course requires students to present five sources of evidence of learning, two being a Practice Log and a Case Study. Practice Logs and Case Studies are usually accounts of how SF Practice has been used in conversations with service users. I still recall an occasion when Martin contacted me to say that one of his students was a manager and could she use her use of SF in meetings in the Practice Log and as a Case Study. We checked our assessment criteria and could see no reason why not.

The celebration of Martin’s life was attended by about 500 people. In the midst of the gathering I chanced to meet the manager who had written the Case Study, Anne. Unbeknownst to me, Anne’s use of SF as a manager had led to extraordinary changes in her service. Also, unbeknownst to me Martin, as the unsung hero he was, had continued to provide massive support to make this possible. When I asked Anne if she could say more about what had been achieved, she shared the following.

“Martin has been such a big part of our life in the service as a previous colleague, friend and later trainer and mentor. The service developments started a number of years ago when I met up with Martin and he was speaking about the exciting course he was on and how it had the potential to change the way we provide mental health care – Solution Focused Therapy. I had known Martin for some years and worked in some complex situations with him, and his ability to meet people at their level and acknowledge and empower them by his caring, fun and at times pure whacky personality was always dynamic and infectious, so if he thought this was going to work I was intrigued to know more. I spoke with Martin on and off over the years and then we came back and revisited solution focused therapy in a more strategic way.

I enrolled on the solution focused therapy certificate course with a desire to use SFT in team and service development which I have found to be a powerful tool and has instigated a number of positive changes in our locality. My portfolio was made up of transformation workshops in Primary care, Learning disability and Secondary Mental Health care through SFT which I would have only achieved through Martin’s mentoring and guidance. Most take a handful of clinical cases to describe how they can use SFT in practice. With Martin’s encouragement I took a series of community service development workshops affecting many staff – I could only have done this with Martin there saying “you can do it and make it work”.

In the service we had been planning a transformation of how we manage and lead community services. We were keen for management structures to work across pathways that service users access for their care, and also ensure a coordinated approach to provision. We wanted to break down barriers between teams so that service users did not experience multiple referrals and team criteria but felt they were on a pathway of recovery that was right for them, and to achieve this we needed to have more coordination. I had a vision of everyone who accessed the service through our Crisis pathways and entry points to services having a united response and that this should be empowering for service users and carers, not prescriptive by staff. This would be a cultural transformation of practice rather than changing teams and staffing as we see in most service transformations.

As I met and talked through with Martin we viewed how solution focused therapy could be our tool to ensure compassion, empowerment and coordination. After months of negotiation and planning Martin drew up a training programme for staff working in the crisis pathway so that service users met in acute hospitals, through Police intervention, Crisis House, Crisis Cafes, Primary Care workers and Crisis Resolution Home Treatment teams all experienced a SFT approach. This was completed by a raft of training days for staff with follow up days and supervision, whilst Martin supported me to maintain momentum from the senior management team to ensure ongoing progress.

Martin was a dear friend who I had planned to work more with, but sadly that will not be now. He brought SFT to my work and I am keen to ensure this lives on as I see the benefits for our service users, carers and staff.”

Anne
Martin’s wife has asked that stories of Martin can be shared with her so that she can share them with Martin’s young sons as they get older. I very much appreciate this opportunity to share one of many stories that can keep the memory of Martin alive and keep Martin as an on-going source of inspiration. If you would like to contact Anne to ask more about what has been achieved and how this was done please contact me on John@johnwheeler.co.uk and I will put you in touch.

John Wheeler
Head of Centre. Solution Focused Trainers.
http://www.johnwheeler.co.uk/

by Erin Sepe

I frequently reflect on my therapy sessions. I ask myself what went well and what I’d like to improve. Recently, it occurred to me that I had not been scaling very much. I find scaling to be a useful tool when a client is walking around in vagueness. I hear clients state things like, “I’d like to find myself again.” “I’d like to be more relaxed.”, “I want freedom” “I want to be happy” “I want better relationships” or “I want to be more confident”. I find these statements are vague and they need definition. When I assume I know what the client means or what she wants, it feels like I am putting myself in the therapy driver seat. What I really strive for is to be the passenger reading the map.

There are many paths on the solution-focused therapy map. I want the client to tell me, with specificity, where are we headed, what’s the destination. Once they begin to define what they mean by: “relaxed”, “freedom”, “confidence” and “happy”, then I can better assist them in navigating the path to getting there.

How do I know the “right” scaling question? I don’t want to drive the bus so I ask for clarity, to narrow down the location. I need to control my impulse to want to drive, “fix” or “give advice”. Solution-focused therapy is a method combined with training, instinct that is strengthened by practice and experience, and art. I cannot assume that I have ever been where this client wants to go however with practice I become skilled in maneuvering. A scale can be a good approach to test a path. Particularly, when a client is vague and they haven’t really identified their ultimate destination.

Scaling can be productive when the client has been driving around aimlessly. When she begins to identify what type of path is appealing, some of the tangible things she wants on the path to her destination then I can formulate a scale. “I want better relationships”, hmmm, okay on a scale of 0-10, ten being I am perfectly content with the relationships I and zero being as far away from that as possible what number would you say you are right now.

Now I have a scale, based on the client’s language and I zoom in on getting closer to the destination. I begin to “work the scale” by asking, “What is it that defines that number?” What is needed to increase that number? What do you already have that keeps that number from being lower? When the client answers these questions it allows me to offer “turns”. Left, right, forward, maybe we need to backup. Further, I gain insight that may signal other paths to explore up ahead.

There are likely several scaling questions a clinician can ask that would be “correct”. My definition of “correct” is whether or not the navigation was helpful to the client. Have we made progress in identifying signs along our way that confirm measurable progress? Did it get them closer to knowing where they ultimately want to go?

Richard Kahn, Ph.D., MS, RD

The Miracle Question (MQ) is an important tool in SFBT. Some practitioners, like me, have trouble asking the MQ. Help came from Cami Boyer, a psychotherapist. She offered a MQ workshop at the 2017 Solution-Focused Brief Therapy Conference in Santa Fe. Boyer likened using the MQ to bread baking. Bread baking is recipe-free when you understand the principles that underlie recipes.  The essential recipe for the MQ, she proposed based on work with Teri Pichot, is a question that helps clients imagine their preferred future. About a dozen perplexed SBFT colleagues responded with MQ problems that turned into solutions with Boyer’s help.

One challenge the MQ presents is the amount of skill and time needed to prepare the client and the therapist.^1,2   In a separate workshop, family therapist Brandon Eddy, PhD, confirmed the time challenges. He needs two sessions to ask the MQ with families with children on the autism spectrum. He uses the time for assessment and for the parents to establish goals.

In the nutrition program for low-income families, where I work, appointments last about 20 minutes with paperwork. We see most families every two or three months. Another colleague noted, with general agreement, that with some people of faith, the word miracle pulls in other feelings and ideas that create other pitfalls when asking the MQ.

Solutions soon appeared. One participant recalled that the MQ arose when Insoo Kim Berg responded to her patient’s saying, “Maybe only a miracle would help.”¹ Berg and colleagues followed up with what became the MQ. From this perspective, the MQ itself was co-constructed, not invented. Another session participant said that asking for Best Hopes helps elicit a preferred future. From this perspective, the MQ is means rather than an iron clad end.

A stricter view of the MQ structure comes from the influential practitioners at The Center for Solution-Focused Practice in the UK. Their firmer view of MQ shows up in their adaptation called the Tomorrow Question (TQ).³ Here’s the TQ: “Suppose you achieved your hopes overnight, what would you be doing different tomorrow?”  The Centre team maintains that  (1) the time element, specifically night and tomorrow, the same ingredients in the MQ, and, (2) the pairing of the problem to the solution, together, like flint against steel, ignite the preferred future and are key to the MQ formula.

The broader view is taken by Pamela King, LFMT. She adapted the MQ for questions that spark a preferred future in children in Tools for Effective Therapy with Families and Children.⁴ One is the magic question: “Let’s pretend you have magical powers to make the future exactly how you want it to be. What will be happening in your just right future?” She also adapted a crystal ball question from Erikson and de Shazer. There is one ball for past successes, one for current encouraging signs and one for the preferred future. She has a three part wish game: “You have three wishes. What can you do to start the magic in yourself?” King also lists the Magic Wand Technique invented by Selekman for the child to cognitively immature to manage the MQ.⁵ Selekman zaps children with his magic wand to generate a preferred future. In my experience, the wand requires less build up and is less fraught than using the word ‘miracle.’ I declare my pen is a magic wand and tell the client I will wave it over their head 3 times to help elicit the child’s preferred future or solution.  When I see the clients smile or some other body language tip-off, I know I can proceed. Other times, I sharpen a new pencil, perform the magic and give child or adult the ‘wand’ as a take home gift for future magic making. Perhaps, very little build up is needed with children who still live with magic.

Fort adults, the MQ requires some build up even when the time is short. Yvonne Dolan gave me some suggestions to help manage the known challenges of the MQ.⁶ Even with limits, she suggests that goal setting and scaling questions can prepare the patient for the MQ. The patient’s expressed goal is the steel against the problem-talk flint. Scaling creates the opportunity for some kind of refinement of the goal. At this point, Dolan suggests that we can ask something along the lines of, “Let’s suppose that sometime during the night tonight something wonderful happens, a sort of miracle, and when you awaken you are a 10.  How would you discover this?” 

Here’s a case vignette of using a magic wand during a first session in private practice.

The health goal was to have their 6 year old daughter restart weight gain and vertical growth after one year of no growth. Ceasing to grow taller for a 6 year old is most likely a grave sign of protein-energy malnutrition usually due to family stress or extreme poverty. A gastrointestinal evaluation was planned by the pediatrician to rule out any digestive disorder.

Prior to the first session, I asked for a 3-day diet history, the foods eaten in a three day period, and a list of Mary’s strengths related to eating. That prep might have led to the pre-session change. Mary, not her real name, had begun to eat more. Her diet history revealed insufficient protein and calories. After we reviewed diet changes that met the family’s lifestyle, I asked how mealtimes went. The parents reported common parenting errors in feeding children: electronics at the table, bribing, force feeding and mealtime chaos. Prior to my SFBT training, I would dig into the past. I took advice offered by McFarland and stuck with present strengths.⁷ If mealtimes changed, other things would change in the family system.

I gave the parents the basics on Mary’s nutritional needs based on Mary’s preferences and standard guidance on how to establish calm family meals. Some of these established tips matched Mary’s already present eating strengths written down on the pre-session list. She ate better, for example, when both parents ate with her on weekends or at extended family events. More expert-family pairs were discovered so I could confirm some practices rather than introduce new ideas.  On the other hand, weekday meals were unproductive. Mary ate little at rushed breakfasts on schooldays. Mom’s profession often forced her to work past dinner time. There was little family life at the table during the work week. While we adults spoke about scheduling possibilities, Mary either sat on the couch or danced around the office.

When Mary next sat down between her parents, a good omen, I hoped she would have a good breakfast solution. In this case, there was little build up other than some short conversation about mealtime and breakfast. Declaring my pen a magic wand, I asked her to close her eyes and told her that I would wave the wand over her head three times. She would then tell me what would be a good breakfast for her. Out came the perfect dietary prescription of high protein and calorie breakfast. She then asked to woken up by her mother calmly. I could never invent that tip quickly! The discovery process would take forever. Mom and Mary embraced.  Mom agreed to wake up that much earlier to support Mary’s wish.  We agreed to meet 6 weeks later in order to see what was working.

Three weeks into the gap, I received an email. A pediatric weigh-in visit revealed a 1.5lb increase which eliminated the need for a GI evaluation. Dad, the primary caregiver, added that Mary is now a member in good standing in the clean plate club with no fussing. Mary’s weight continued to increase by the second appointment. Score one for the Magic Wand. We had a second meeting that included a further weight increase. Case closed!

1. de Shazer S, Dolan Y, Korman H, Trepper T, McCollum E, Berg IK. More Than Miracles: State of the Art of Solution-Focused Brief Therapy. Oxon, UK: Routledge; 2012.
2. Stith S, Miller M, Boyle J, Swinton J, Ratcliffe G, McCollum E. Making a Difference in Making Miracles: Common Roadblocks to Miracle Question Effectiveness. Journal of marital and family therapy. 2012;38(2):380-393.
3. Brief Therapy Practice. How Brief is Brief? https://www.brief.org.uk/resources/faq/how-brief-is-brief. Accessed December, 2017.
4. King PK. Tools for Effective Therapy with Families and Children. New York and London: Routledge; 2017.
5. Selekman M. Solution-Focused Brief Therapy With Children. New York: Guilford Press; 1997.
6. Dolan Y. MIracle Question. 2018.
7. McFarland B. Brief Therapy and Eating Disorders. Jossey-Bass; 1995.

Richard Kahn, Ph.D., MS, RD

Richard Kahn, PhD, RD, is a nutrition therapist specializing in the needs of both typically developing and atypically developing infants and young children. Nutrition therapy is a counseling approach that places nutrition for children in the context of family life. He is the father of two, as well as a cook at an organic restaurant, specialty-food-store owner and manager at Fairway Market, a leading food retailer in New York City.  He serves on the board of the New York Zero to Three, a nonprofit advocacy group that works to promote the optimal development of young children, their families, and their communities in the New York region. We were fortunate to have him be a part of our online certificate course. Thank you Richie for your wonderful contribution! He can be reached at:

RichardKahnNutrition.com | Facebook page is RichardKahnNutrition

Wynn Calder – 6/19/18

In the spring of 2017, as a mid-career graduate student in counseling psychology at Framingham State University, I took Dr. Anne Lutz’s course, Solution-Focused Fundamentals and Practice. In thinking about what I might do for my final project, a light bulb went off: Solution Focused questions could improve my sustainability assessment interview process. They could build on the content-oriented questions of my Sustainability Assessment Questionnaire (SAQ) and help foster a more strength-based narrative.

As an educational consultant and former teacher, I have spent a lot of time thinking about how schools work and how they change. Institutions are collections of people and they present many of the same challenges as individuals when it comes to figuring out what they want to become, what’s making them stay the same, and how I to help them change. I attempt to help K12 schools (mainly private and independent) become more sustainable in their teaching and operations. My primary service has two parts: a sustainability assessment followed by a collaborative process to develop a long-term sustainability plan. This article suggests that Solution Focused questions can enhance an institutional assessment process, just as they have been shown to be effective in the therapeutic realm.

A comprehensive definition of sustainability in education, given in the questionnaire introduction, reads: “The concept of sustainability – which, at a minimum, addresses how humans can live on the planet over time in a manner that protects cultural and biological diversity, recognizes and appreciates ecological limits, offers just and accountable governments and economies for all, and draws on the human capacity for adaptive learning and innovation – offers a tremendous challenge for education. It requires educational institutions to rethink their missions and to re-structure their courses, research priorities, community outreach, and campus operations. By preparing students – and the whole campus community – to be more adept decision makers in the increasingly complex, dynamic, and uncertain future that we all face, integrating sustainability into all of the major activities of educational institutions also presents a tremendous opportunity.”

When I conduct a sustainability assessment, I typically visit a school campus for one to two days and interview both individuals (like teachers and staff members) and groups (like committees and student groups) using the SAQ as my guide. The questionnaire is divided into five sections: Curriculum; Campus Operations; Community Service; Student Engagement; and Administration, Mission & Policy.

It includes questions such as:

• Indicate the extent to which sustainability is a focus woven into traditional disciplinary education in science, math, English, history, the arts, etc.?
• What do you see when you walk around campus that tells you this is an institution committed to sustainability?
• To what extent are student groups on campus directly involved in sustainability initiatives?
• Please describe the key factors that support the advancement of environmental and sustainability issues on your campus?
• What factors do you think account for resistance to or lack of responsiveness to these concerns?
• What “next steps” do you feel ought to be taken?

Based on what I’d learned in Professor Lutz’s course, I generated a set of SFT questions to supplement the SAQ and organized them into four groups:
1- questions for a faculty or staff member with a positive orientation toward sustainability;
2- questions for a faculty or staff member with a negative orientation toward sustainability;
3- questions for a student environmental or sustainability group; and
4- questions for an environmental or sustainability committee.

Here are some examples:

Faculty/staff member with positive orientation:
• What are your best hopes for this conversation?
• How can I be most helpful for you today so that this conversation is worthwhile?
• What are your best hopes for this school in sustainability over the next several years?
• How do you see yourself playing a part in that vision?
• On a scale of 1-10, how empowered do you feel you are to contribute to that vision?
• What makes it not lower?
• What would it take to raise it by one or two points?
• On a scale of 1-10, where 10 is that you’re fully satisfied with your contribution to sustainability at ________, and 1 is the opposite, how would you rate yourself?
• What makes it not lower?
• What would it take to raise it by one or two points?
• What have you tried to do that has been most helpful for the school?
• What else have you tried?

Analyzing a recent success (Example: An advisor to the student environmental group is helping them articulate their goals and successfully work toward them):
• Looking at your recent success, how was it different from other efforts you’ve made to enhance sustainability at ________?
• How else?
• How did you do it? How else did you do it? (Let’s list these things so you can make use of them going forward.)
• On a scale of 1-10, where 10 is you are confident you could do this again and 1 is the opposite, where would you say you are now?

Analyzing a recent setback (Example: A teacher is attempting to get her history department colleagues to start mapping sustainability content that is relevant to history, and to consider ways of incorporating key issues into the existing curriculum):

• How did you cope with what this setback? What did you learn from it?
• Where do you get your resolve to move forward?
• What do you think you would do differently next time?
• What else would you do instead? (Let’s list these things so you and I can make use of them going forward.)
• On a scale of 1-10, where 10 is you are very confident in your ability, as a history teacher, to reach your goals and 1 is the opposite, where would you rate things now?

Faculty/staff member with negative orientation:
• What aspects of sustainability are most appealing to you?
• If you were tasked with trying to improve the school in those ways, how would you go about doing that?
• Etc.

Student Environmental or Sustainability Group:
• What are your best hopes for this group?
• What does it look like to be successful and effective?
• What have you tried to do that has been most helpful for other students? For the school?
• What else have you tried?
• Who are the most important people in the school for enabling you to achieve success in environmental or sustainability action? Who else?
• What do you most appreciate about them? How are they helpful to you?
• On a scale of 1-10, where 10 is that you’re making the most use of these important people, and 1 is the opposite, where would you rank the group?
• How can you engage these individuals in your future efforts?

Environmental or sustainability committee:
• On a scale of 1-10, where 10 is that you’re fully satisfied with the progress of this committee, and 1 is the opposite, how would you rate yourselves?
• Etc.

In addition to supporting individual and group strengths in the context of school sustainability, the SFT questions help uncover the personal, motivational and relational dimensions of taking action and trying to affect change. In retrospect, the Sustainability Assessment Questionnaire has been overly focused on “what” someone accomplished rather than “how” they did it, or “how” they handled a setback. In other words, understanding the power of motivation, patience, resourcefulness, and creativity, in this context, can be illuminating for thinking about what might be tried next, or how to proceed differently to get different results.

In reviewing the SAQ for this exercise, I discovered that it already includes some SFT-oriented questions. But the supplemental questions above illustrate a level of strengths-based inquiry that I had not considered. Since last spring, my interview process has been enhanced in a couple of ways. In addition to providing new insights into how to improve sustainability at schools, I’ve noticed that the SFT questions help people become more animated and interested in discussing these issues. Perhaps that is because they’re asked to delve deeper and to shine a light on their strengths and successes.

Wynn Calder

We were thrilled to have Wynn join us for our online certificate course in 2017 and are excited to share his article for our Summer 2018 Inspirations Newsletter. William (Wynn) Calder directs Sustainable Schools, LLC, which helps schools and colleges improve their teaching and practice of sustainability. He is also currently pursuing an MA in counseling psychology. See www.sustainschools.org. Wynn can be reached at wynn@sustainschools.org.

A Simple Graph Which Answers The Question:

“Why has my life ALWAYS been terrible?”

Seth Bernstein, Ph.D.

Corvallis, Oregon

A common perception of clients who are experiencing major depression is that their lives have always been terrible. They are not speaking metaphorically. They are being literal. They only have memories of the times in their lives when they were feeling the way they are feeling now – depressed. How can a person answer the Miracle Question, how can they think about their Preferred Future when they have no access to an affective state that is positive? They can’t.

For over thirty years I have used the graph illustrated above to help my depressed clients understand the relationship between affect and memory. The explanation takes about five minutes and in my experience, the insight it provides emotionally opens clients to thinking about a future that contains accomplishments, meaning, and positive feelings.

I first became aware of the concept of “state-specific memory” in the 1970’s when I had an interest in para-psychology. At the time, Charles Tart was one of the foremost researchers in the field. The term he used, “state-specific memory,” has evolved since that time and is now called “state-dependent memory” or “state-specific learning.” Wikipedia defines it as “the phenomenon through which memory retrieval is most efficient when an individual is in the same state of consciousness as they were when the memory was formed.” I would suggest that those who are interested in exploring the research on state-dependent memory, which dates from 1937, start with the Wikipedia summary.

In talking with clients about this subject, it isn’t necessary to cite the research. They will trust you when you say, “there is a lot of research to support what I am about to show you.” Some clients, however, will be interested in the research. So, be prepared to provide them with directions on how to find it.

I have found that giving a handout with the graph above to a sitting client is not as effective as having the client stand up and walk over to my white board where I draw the graph as I explain it. The process is more dynamic. The physicality of changing from a sitting position to a standing position and literally moving across the room creates an unconscious metaphor for changing perspective and changing bodily sensations, both of which, currently, are rigid and stuck.

Here is my explanation:

It is not surprising that you feel hopeless. You think back on your life and all you see is blackness. When you look forward, all you can imagine is continued blackness. Why wouldn’t you – or anyone for that matter – if all they could remember when they looked back were the times they were depressed. It is logical to assume that your life, looking forward, will just be more of the same.

 There is a considerable body of research which explains why people who are significantly depressed can only remember the times in their lives when they were depressed. This body of research is called ‘state-dependent’ memory.’ Let me show you how it works. <I create the diagram, above, as I talk.>

You see this wavy line? It’s a person’s mood going up and down. We all have good days and bad days. We have times when we are feeling positive about things and times that when we feel doubtful or pessimistic. When our highs and lows fall between these two lines, our memory functions effectively. When we are feeling up, we can still remember the times in our lives when we were feeling down. When our mood is in the low part of the wavy line, we can still remember the times we were feeling positive about ourselves and our lives. Also, we are able to anticipate that there will be future times in our lives when things will be looking and we will be feeling brighter.

However, when our mood drops below this black line or goes above this pink line (that’s called mania), our memory does not function effectively. When we are down, ALL we can remember is the times we were feeling down. That’s literally all our brain allows us to remember. See the tops of these inverted mountains? That’s where we live and have ALWAYS lived.  We can ONLY remember the lows.

So, it is no wonder that people whose mood drops below this line cannot see a future for themselves that has any potential for being better. It all looks bleak, both looking back and looking ahead.

Does that make sense to you?

Generally, my clients answer this question in the affirmative and what follows is a slow opening up to memories and affects that had been previously locked out by state-dependent memory. I believe the mechanism which does this unlocking is hope. Where there had only been pain and fear, my explanation helps my clients reorganize their conceptualization of their experience. In so doing, a door is opened. This is very much in line with Freud’s explanation of how interpretation works.

In describing the transition from locked memory to unlocked, my colleague Yvonne Dolan observes that “I routinely watch for signs of physical relaxation in order to decide what to offer the client next. Specifically these signs usually include  a slight slowing of breathing and  settling further into the chair, body movements or fidgeting slowing down, accompanied by  some head nods, followed by  what Milton Erickson and Ernie Rossi used  to call an ” expectant look,” in which  the client at least briefly makes some eye contact with the therapist or otherwise appears to be comfortably waiting for the therapist to say something. Rossi viewed these signs as a signal of the client’s readiness to be invited into a therapeutic trance. With the SF approach, I have learned to view these “yes set” responses as a sign that the client is now feeling safe and calm enough to consider a SF question.”

Colleagues, I would suggest you try using this graph and this explanation. See for yourselves whether they unlock your clients’ potential to imagine a future for themselves that includes positive experiences, accomplishments, and pleasure. As we know from our training and experience in Solution-Focused Therapy, until clients can imagine a real future for themselves, the rest of what therapy has to offer will not be of much use.

Erin Sepe

Several years ago I was substituting, for a day, in a kindergarten classroom when the school practiced a “code red” drill. I found myself, with 20 five-years-olds, huddled under the desk, lights off, shades drawn, and classroom door locked. Part of the drill includes the principal walking down the halls and checking that the classroom doors are locked. When she got to our classroom, we could hear the doorknob move. I noticed a five-year-old girl, crouched near me, crying. She said something like, “Is that the bad guy?” she may have even used the word “shooter.” I tried to reassure her, comfort her, by saying, “No, that is the principal checking that we are practicing the right safety.” Immediately, another little girl said, “For when it really happens.”

My children are now fourteen and twelve. They are in middle school, and they have never known a world without school shootings and terrorist attacks. After the recent horror in Florida where a former student returned to his high school and killed seventeen, wounded, some critically, another twenty and shook to the core hundreds of thousands of on-lookers, I wonder how we use Solution Focused Therapy to aid in what we have not been able to control.

A colleague and friend said her nineteen-year-old son commented, “I’m numb. It just happens, and there’s nothing you can do about it”. He’s not alone. What do we do as clinicians when we cannot assure a positive outcome or a remedy? My kids made it through elementary school and when these gut-wrenching atrocities occur, I think, “We’re almost there” my daughter has four years of high school left and my son six. The reality is though that this happens on college campuses, concerts, and shopping malls. How do we counsel the uncontrollable? After all, if it is in the back of our minds as parents, it’s at least on our children’s minds when “code red lockdown” is unexpectedly announced over the intercom. We all see the images, and when we begin to push it out of the forefronts of our minds, we are ambushed again.

Talking about the frequency, intensity and unpredictability of the problem can reinforce feeling prey and fearful. I appreciate that Solution-Focused Therapy can offer something else. As counselors, we can turn the focus from the problem by focusing on questions. Asking, “What helps to deal with, manage or cope” with regard to our clients’ feelings surrounding these shootings. Scaling “How well are you coping on a scale of 0-10” can be helpful, recognizing that “10” may not be something attainable by one individual. Maybe it’s a matter of a “good enough” coping number. Maybe a “7” is the best an individual can manage. Asking clients, “Who helps them get a good enough number,” “What do you do that helps to move you up the scale when you are lower?” Scaling “Where were you on the scale just before the tragedy occurred?”, “What was it like when you were higher on the scale?” and “What small thing would help to return to that number?” Also helpful is asking “How come” the number on their current scale is not lower.

Additionally, asking clients how a “VIP,” a mother, father, teacher, sibling or other VIP would rate the client’s ability to cope is a way to bring the perspective of others and introduce information that the client had not given consideration. Often clients or their VIP’s gain knowledge that is helpful in moving toward solutions. Exploring VIP’s and what a client values about their VIP’s helps the client recall the support and care she has received from them. Finally, asking clients, “What do you think it would mean for your VIP to see you moving up the scale toward your goal?” allows a client to consider the impact their success has on the people they find important.

If ever and until we have a solution to school shootings and terrorist attacks, focusing on how we cope with the possibility that it could happen again might be better than focusing on the unpredictable and vast nature of the problem.

Anne Bodmer Lutz, B.S.N. M.D.

What does “person-centered care” mean? The use of this terminology is frequent, but the concept is vague. “Person-centered care” (PCC) has been recognized as one of the critical elements needed for the redesign of our nation’s health care system (IOM, 2001). The Institute of Medicine (2001) defined PCC as “care that is respectful and responsive to individual patient preferences, needs, values, and ensuring the patient values guide all clinical decisions”. Stephanie Morgan, and Linda Yoder have defined PCC “as a holistic (bio-psychosocial-spiritual) approach to delivering care that is respectful and individualized, allowing negotiation of care, and offering choice through a therapeutic relationship where persons are empowered to be involved in health decision at whatever level is desired by that individual who is receiving the care.” (Morgan and Yoder, 2011).

The Solution-Focused approach is one of the most pragmatic ways to implement PCC when having conversations with clients. How does the solution-focused approach fit into PCC? How do you know when you are utilizing a “Solution-Focused PCC” approach? Who is the person in PCC? How might clinicians implement “Solution-Focused PCC”? Here are a few examples illustratng how assessing important relationships in a client’s life broadens “who” the person is and fosters additional possibilities to develop solutions based on each client’s unique social context.
All people live in relationships. Relationships are not only crucial for survival but essential resources that help people solve their problems. Problems are solved in one of two ways, either the problem is solved, or the individual and those most important to them no longer view the behaviors or difficulties as problematic. I think about the many youths who I don’t see who may be considered as having a substance use disorder. What is the reason I don’t see them? Certainly, access is one challenge, but also whether or not this youth and the social context they live in view this as a problem. Perhaps the youth is using substances with their parents, and it is viewed as normal. Perhaps, the parents do not view it as a problem unless their grades have declined. The context may change when the youth is discovered to be selling drugs at school; thus now the school views it as problematic. Or they are caught drinking while driving and legal entities “mandate” them to treatment.

Mapping out a client’s context is critical in understanding and assisting them in building solutions from the multiple perspectives of those most important in their life. I propose the idea of developing a “VIP map,” much like you weave a beautiful quilt that has differing colors, textures, fabrics, and designs. I define VIPs as the relationships that are most important in a client’s life. VIPS are used when negotiating goals as well as when evaluating treatment progress. For example, asking what are would your client say are their VIP’s “best hopes” for them, and incorporating VIPs when asking scaling questions such as: How confident they are that you will remain sober from 1-10? How satisfied from 1-10 would they say things are between you? How confident are they from 1-10 that you can remain safe?

Inquiring about a client’s VIPs early on and throughout the conversation broadens “who” the client is and integrates the social context within the dialog, fostering additional possibilities and hope for solutions. I invite you to consider six categories of VIPs: Classic, Vulnerable, Hidden, Spirit, Pets, and Future VIPs. Categorizing VIPs in this way has been a helpful way for me to organize and map a client’s social context.

“Classic VIPs” are those relationships that we typically think of when considering important people in our life. They may be spouses, children, friends, co-workers, grandparents, aunts, uncles, teachers, community supports, clergy, people who have died – whoever the client identifies. It is important not to assume who these relationships are, but instead, ask clients.

“Classic VIP Questions”
1. Who are the most important people in your life?
2. Who else? Who else?
3. What do you most appreciate about them?
4. What else? What else?

When practicing these questions with trainees, they are often surprised by the intimacy and vulnerability that may arise. Frequently, they feel a heightened sense of gratitude and appreciation for those important in their life. These questions can help activate relational resources when clients are experiencing thoughts of suicide. It is often important people and relationships in an individual’s life that stop them from acting on these thoughts contributing to a “resilience assessment” when evaluating safety concerns.

“Hidden VIPs” are those relationships that clients may want out of their life, yet are still important for them in that they may be critical in determining decisions in a client’s life. They may be DCF workers, Probation officers, therapists, psychiatrists, judges, or family members. Hidden VIPs are important to consider for “mandated” or “externally motivated” clients. As a child psychiatrist, there are very few youths who want to come and see me. Most of my clients are “externally motivated” with the goal of not having to see me again. Asking them who would decide when they no longer need to see me often uncovers important relationships in their life. I remember an adolescent girl who I was treating in a residential facility for substance use. When I asked her about her “Classic VIPs,” she could not identify anyone. She had been living on the streets selling and using drugs to survive as both her parents had died. This VIP map was very challenging to develop. When thinking more about her situation, I reflected that someone cared enough about her to get her into treatment, even if she did not think of this as “caring.” It was a teacher at her school. This discovery led to more questions about what she thought the teacher appreciated about her and what her teacher knew about her that she would be successful in her life.

“Hidden VIPs” Questions
1. Who was “worried” or “concerned” about you that they thought coming here would be helpful for you?
2. Whose idea was it for you to come here?
3. What are they saying you need to do so you don’t need to come here anymore or can go back to home, to the school they want, etc.?

Pet VIPs (Very important pets). In my work with children and families, I have increasingly been inspired by how important pets are in people’s lives. They are often a source of comfort, companionship, and reason for living. I discovered this by accident. In my private office, I would sometimes bring my dogs to work when I needed to get paper-work done. Because of this, I had a dog bed hidden in the corner with a small dog toy. I was amazed to discover how often both youth and parents asked whether I would bring a dog to the session. I acknowledged that my dogs are not therapy dogs, but I do enjoy bringing them when not seeing clients. This began a conversation about animals in their life. Do they have pets? Are they important in their life? What do they most appreciate about them? What difference have they made in their life? These relationships are often very beneficial. They may also be painful such as when clients divulge a beloved animal they lost.

It also led me to consider asking them if it would be helpful for them to bring their animal to the session, much like I would invite them to bring other important human family members. I have found clients very honest about whether it would be helpful. Some have said, no – it would just cause them worry about their animal destroying my office or distracting them from what they needed. Others have said it would be very helpful. This has led to the delightful discovery of including some of my client’s pets in sessions. I have met multiple dogs, cats, birds, and even a hedgehog. One particular client brings his dog to every visit. He acknowledges that it is his loving dog that is his reason for living and gives him the motivation to come to his appointments. His dog even knows when the 50 minutes are ending and will jump off the couch and politely wait for his weekly treat!

“Pet VIP Questions”
1. Do you have pets?
2. Are they helpful for you?
3. How are they helpful for you? How else?
4. What do you most appreciate about them?
5. What else? What else?
6. What do your pets most appreciate about you? What else?

“Vulnerable VIPS” are those relationships in a person’s life who are in need of support, special care, protection, and help. One of my prior workshop participants, Erin Sepe, came up with this name and I give her all the credit! Often these people are reasons and motivation for clients to move forward in their life. Another workshop participant who works with boys in detention created a group in which she had the boys identify vulnerable VIPs in their life. She then had them write a letter to them expressing their best hopes for them and what they most appreciate about them. This also helped them develop empathy and normalized their experiences with the others.

“Vulnerable VIP Questions”
1. Whose wellbeing do you feel responsible for?
2. Who relies on you for help and support?
3. Who depends on you?
4. What would they say you have done to help and support them?
5. What would they say they appreciate about you? What else?

“Spiritual VIPs” can be considered a client’s spiritual beliefs and may also include relationships people have lost. Loss is a natural part of life, and I have found this concept a helpful way to strengthen and expand resources when mapping a client’s VIPs. Spiritual VIPs are unique for every client, and can assist them in talking about beliefs around the meaning of their life, connection with others, and provide them with a sense of peace and purpose. Spiritual VIPs often help clients cope in very challenging circumstances. When I ask clients how they have coped and endured incredible loss, they often talk about their faith in God and how this has provided them the strength and endurance to carry on. This can foster hope by exploring in more detail how God has been helpful for them, how else, what they appreciate about God and what God appreciates about them. It can also provide opportunities to compliment them on their faith and how they have nurtured and developed this strength in their own life.

Spiritual VIPs may also include relationships clients have lost. Exploring losses through Spiritual VIPs can further deepen how their loved ones remain in their heart. I had a client who lost her mother, father, and her primary guardian was unable to care for her because of active substance abuse. When I asked her whether there had been important people in her life who she lost, she spoke about her grandmother. I began asking her what she appreciated about her grandmother and what her grandmother would appreciate about her. I asked her what her grandmother would say she is most proud of about her. This opened up a conversation about this loss in a tolerable way and helped her talk about all the ways her grandmother remains in her heart. Rather than feel only the loss and separation, it helped her realize how her grandmother carries on within her heart. I think of the quote by William Shakespeare: “Give sorrow words; the grief that does not speak knits up the o-er wrought heart and bids it break.”

“Spiritual VIP” Questions
1. Many people have lost important relationships in their life. Is this something you have coped with?
2. What did you most appreciate about them? What else?
3. Are there small ways in which you have kept them in your heart?
4. How have you kept them in your heart? How else?
5. Has it been helpful for you?
6. How has it been helpful for you?
7. What would they say they most appreciate about you? What else?
8. What would they say they are most proud of supposing they were with us in the room as we are talking? What else?
9. What would their best hopes be for you? What else?

“Future VIPs” are relationships clients hope to develop in the future. This again came from a prior workshop participant! It can be helpful to explore best hopes for relationships in the future and what clients would be “doing” when they are in satisfying relationships. How would they know these relationships were satisfying for them? Has there ever been even a little bit of these future VIP qualities in their current relationships? On a scale from 1-10, how confident are they that will be able to find their future VIP? How satisfied are they from 1-10 with their current VIPS? What is a good enough number? What keeps the number from being lower? How would they discover when it goes up by one point?

“Future VIP” Questions
1. What are your best hopes for a satisfying relationship?
2. What do you know that you need/want in a relationship?
3. What else?
4. What are “green flags” that would tell you this relationship is what you hope for? What else?
5. Are there aspects of your “future VIP” happening even a little bit now in your relationships?
I hope this article helps you to see the beauty, complexity, and challenge of broadening “who” the client is in PCC. I invite you to try some of these questions and co-create a beautiful tapestry that is helpful for your clients and enriching for the privileged work we all do.

References:
Crossing the Quality Chasm. (2001). doi:10.17226/10027
Morgan, S., & Yoder, L. H. (2011). A Concept Analysis of Person-Centered Care. Journal of Holistic Nursing, 30(1), 6-15. doi:10.1177/0898010111412189

“BUT NOW IT’S COOL TO SEE THAT

MY PARENTS ARE PROUD OF ME!:”

A SPARKLING MOMENT INTERVIEW

 James G. McCullagh

            In the spring of 2017 one of the assignments at the end of the semester in Dr. Anne Lutz’s Solution-Focused Fundamentals course

Anne Bodmer Lutz, B.S.N., M.D.

Human beings are unique in two ways – we are tool-bearing and talkative. This ability to talk provides us with opportunities to communicate with others. Some conversations enhance possibility, while others diminish it. When possibility is enhanced, we have self-agency – a sense that we can take the necessary actions to address what concerns or troubles us – to accomplish our hopes, ambitions, and dreams. How can we help people transform their stories and create a conversational space that enhances hope and possibilities? Solution-Focused brief therapy (SFBT) can be thought of like a new language requiring fluency and skills different from the native problem-solving language we are all fluent in.

SFBT is a future-focused, goal-directed approach to brief therapy. The developers meticulously observed hundreds of therapy sessions, carefully noting which questions proved to be most consistently linked to clients’ subsequent reports of progress. These questions were then incorporated into the solution-focused approach. (More Than Miracles, de Shazer et al.).

Let’s get started on the Top Ten Solution-Focused Translations!

#10: The Indirect Compliment: How did you do it?

Let’s look at this lovely question. How conveys “in what manner? By what means?” Notice the question is not “Did you do it?” but instead “HOW” did you do it. Did (observe it is past tense), conveys they have done it already. Noticing with clients what they have already done enhances a sense of self-efficacy because they have already accomplished it. The second verb “to do” (to accomplish, perform and execute) conveys past success. How are problems (or as I like to translate “challenges”) solved? It requires action or the verb “to do.” Most of us are less fluent in the use of the indirect compliment, which is in the form of a question, and have greater ease when providing “direct compliments” such as “Wow” or “Congratulations.” Listening for opportunities to compliment clients based on their complaints (and who doesn’t love to complain) with indirect compliments is a powerful question to enhance self-efficacy and hope. What the heck – try asking the indirect compliment with your patients, colleagues, children, loved ones. I assure you no harm will be done!

#9: What are your best hopes?

This is the solution-focused translation of the chief complaint (What brought you here). The question is not “do you have hopes?, But rather “What” are your best hopes. It is hopeful, future-directed and creates a narrative which communicates to clients their competence and hopes to live a more satisfying life on their behalf.

#8: What else? How else? Who else?(Three for the price of one)

Effective solution-building requires getting as many details as possible about prior successes. These questions leave no potential strength uncovered and are the metaphorical “language shovels” that dig for the details of success. What else are you good at? How else did you do it? How else was it helpful? Who else is most important to you?

#7: Who are the most important people in your life and what do you most appreciate about them?

All people live in relationships. Relationships are not only crucial for survival but also essential resources that help people solve their problems. Problems are solved in one of two ways. Either the problem is solved, or the client and those most important to them no longer view the behaviors as problematic. For “challenges” to be considered solved, the client’s system must be in agreement that there are no significant problems. What better way to learn who is important to your client than to ask.

#6: What do you know?

What do you know conveys that clients have knowledge, understanding and a recognition of what is important in their life. Asking clients what they know about marijuana, medications, their diagnosis attests to their competence. One of my favorites is to ask parents “What do you know about your child that tells you they will succeed in life?” It has continually amazed me that parents are always able to answer this question no matter how dire the situation appears.

#5: Have you ever had to cope with trauma, domestic violence, hurricanes, homelessness, mudslides, poverty, loss, death, etc. ?

Incorporating the one-word “cope” within the question demonstrates that your client has coped. If they say yes, my next question is “How have you coped?” When clients are sitting in front of you talking, they have indeed coped. Remember that cope is one letter away from hope.

#4: You must have a good reason?

Asking clients their good reasons for behaviors that appear harmful (i.e.) self-harm, drug use, staying in a domestically violent relationship, to name a few, reveals how clients engage in these behaviors because in some ways they are useful and beneficial for them. The question does not condone the behavior but instead helps to understand the client’s motivation to do what they are doing. This can help lead the conversation towards alternatives.

#3: Was it different for you?

Noticing positive differences, also known as exceptions, are times when an expected problem could have occurred but didn’t. Positive differences often go unnoticed by clients. Meticulously paying attention to these differences often discovers past successes.

#2: On a scale from 1-10, where ten is you are satisfied, and things are good enough, and one is the opposite, where would you say you are?

Scaling questions can minimize language confusion that often occurs within conversations. They are quick, easily adaptable and client-centered. Solution-Focused scaling questions are constructed in such a way that the 10 highlights a positive direction of where the clients want to move forward (i.e.) confidence in ability, satisfaction with relationships, ability to keep safe, or helpfulness of medications. Asking what keeps the number from being lower (and what else) often uncovers further undiscovered strengths and past successes. It is one of many potential amplifying questions used to “work the scale” and often leads to more possibilities to compliment and bring to light more past successes.

#1: What are you good at and enjoy?

This question affords your client an opportunity to talk about parts of their life going well and communicates they are more than their presenting problem. These strengths are essential resources that would otherwise often be undiscovered within the conversation and are critical resources that can often assist them in solving their problem. Investigating details by asking how they learned the skills; what else they are good at and how else they learned these skills recognizes a client’s expertise and mastery expanding the narrative of their accomplishments and abilities.

De Shazer, Steve, et al. More than Miracles: the State of the Art of Solution-Focused Brief Therapy. London, Routledge, 2012.

Franklin, Cynthia, et al. Solution-Focused Brief Therapy: a Handbook of Evidence-Based Practice. New York, Oxford University Press, 2012.

Lutz, Anne Bodmer. Learning Solution-Focused Therapy: an Illustrated Guide. Arlington, VA, American Psychiatric Publishing, a Division of American Psychiatric Association, 2014.