Institute for Solution Focused Therapy and Framingham State University

Date: 7/17/17 – 7/21/17

Course Overview:

The Solution-Focused Summer Intensive provides a rigorous 5- day certificate program in Solution-Focused Fundamentals and Practice. Yvonne Dolan and Anne Lutz, invite you to visit Framingham State University,  just 25 miles from Boston.  This intensive will provide the fundamentals of the solution-focused approach, and applications of this approach. The workshop will be taught using a combination of didactics, role-plays, ample video examples, exercises and case discussions. There will be plenty of opportunities to network, build relationships and have a forum to exchange and collaborate on ideas.

Monday: Engagement 7/17/2017

At the heart of all therapy lies the human relationship. The therapeutic alliance with our clients is the base from which all therapy begins. Building an alliance is a critical skill to learn in caring for others. Knowing how to navigate the complexities and nuances of establishing a therapeutic alliance, especially in the initial encounter, is arguably one of the most important skills to master. The development and maintenance of the therapeutic relationship is a primary curative component of therapy, providing the context in which specific techniques exert their influence. Today we will focus on Activating Resources: how to uncover, amplify and diagnose strengths, resources, and positive attributes in a client’s life that are critical for a positive therapeutic outcome, while also strengthening the therapeutic alliance.

1. Introduction to Solution-Focused Practices

As clinicians in the helping profession, we are in a privileged position to engage clients in conversations that create hope and  possibilities. The solution-focused treatment approach is in accord the positive psychology movement that emphasizes well-being and optimal functioning instead of pathology and etiology. “Rather than looking for what’s wrong and how to fix it, we tend to look for what is right and how to use it” (Berg). This course will teach the basic tenets of the solution-focused approach, the core skills and techniques required and most critically, the “how-tos” of practicing this approach. 

2. Commencing with Competencies/ Activating Resources

Today  we will focus on how to uncover, amplify, and diagnose strengths, resources and positive attributes in a client’s life that are critical for a positive therapeutic outcome. We will being with “problem-free talk” – an opportunity for clients to talk about parts of their life that are going well. Compliments are another tool used frequently and throughout the solution-focused interview. We will learn about both direct and indirect compliments. We will end this week by diagnosing the strengths in a client’s social context using VIPs. VIPs are the social context in which clients develop their solutions.

3. Positive Differences (Exceptions)

Positive differences, also known as exceptions, are those times when the expected problem could have occurred but did not occur, or was less severe. Positive differences are times when clients are doing things differently than usual and these differences are helpful for them in solving their problems. Solutions are often built from formerly unrecognized differences. These require close attention and meticulous listening on the part of the clinician, as often they go unnoticed by the client. We will continue to work on growing our “third ear” for any possible successes, exceptions or positive differences. In addition, we will learn how to amplify these positive differences through the use of a specific line of questioning.

4. Development of the “Yes-Set”

The Yes-set is a set of solution-focused skills that involve creating a conversation in which both the clinician and patient say yes and agree on as many aspects of the conversation as possible.The yes-set is a metaphor for the client’s acceptance of the intervention message or any therapeutic suggestion. We will learn about general yes-set skills, content yes-set skills and how to develop an emotional yes-set.

5.Language and the “Non-Assuming Stance”

Language is an essential ingredient in any form of communication. Human systems are language meaning-generating systems. Every person has his or her own unique way of using words, talking, and communicating. In essence, we each have our own personal dialect. In solution-focused therapy, it is critical to try and understand and speak the dialect of the clients we are talking with. All the questions asked are designed to elicit the client’s view of the solution. This week we will work on creating shared dialects with the clients we speak with. We will learn how to highlight positive words, guide the conversation with questions, and understand the impact of pre-suppositional language within the interaction. 

The non-assuming stance is another important solution-focused skill. This stance entails a general attitude in which the therapist’s actions communicate an abundant, genuine curiosity, a need to know more about what has been said, rather than preconceived opinions and expectations about the client, the problem or what must be changed. It means putting the client in the role of the expert on their own life and having faith that they have the resources and skills necessary to solve their problems. This takes skill and will be explored this week.

Tuesday: Goal Negotiation and Follow-Up 7/18/2017

Negotiating goals with clients is an essential skill in solution-focused therapy. This approach concentrates intensely on developing well-formed goals. In all forms of therapy, both the clinician and the client work on establishing criteria that tell them when they have succeeded and can end therapy. This necessitates collaboratively developing criteria for success. It is one thing to know where you don’t want to be, but quite another to know where you want to go instead. Negotiating goals with clients helps define the direction of treatment, determines whether treatment is successful, and strengthens the treatment alliance. Today we will focus on how a solution-focused clinician negotiates the goals and tasks of therapy.

1. Best Hopes

Learning solution-focused therapy requires steering conversations toward what client’s best hopes and aspirations are for in their lives. Inviting clients to imagine a future time without the problem and then work backwards is a very different and novel process than most people are familiar with. Beginning the conversation with what their best hopes are, and how you could be most helpful for them so the meeting is worthwhile for them, maintains the focus on what is most important for the client.

2. Development of Well-Formed Goals

One thing all brief therapy has in common is that it starts with the end – trying to figure out how clients will know they have achieved what they wanted from therapy and knowing when to end. Negotiating goals with clients is an essential solution-focused skill which helps define the direction of treatment, whether treatment is successful, and strengthens the therapeutic alliance. Goal negotiation is difficult enough when one person is involved, but for clinicians working with multiple people (ie) such as parents, families, couples and systems, goal negotiation becomes even more challenging. This week we will learn skills that facilitate goal negotiation both for individuals and when there is the need to simultaneously negotiate goals with multiple clients. We will learn about qualities of well-formed goals, constructing goals as the presence rather than the absence of something, and how scaling questions and the Miracle question further facilitate goal negotiation.

3. Scaling

Scaling questions ask clients to rate their goals, satisfaction, confidence, treatment progress, among a myriad of other possibilities on a scale from 1-10. They are an essential solution-focused skill, provide great versatility and can be used to assess the client’s perception of almost anything. They can also be asked from a multitude of perspectives. They are quick, simple and easy to ask, making them especially useful for the busy clinician. Scaling questions help direct the treatment towards what the client wants and is most important to them, increasing their motivation to change. 

4. Miracle Question

The Miracle Question was created by Insoo Kim Berg when a client in desperation suggested “Maybe only a miracle will help”. It is not simply a question, but a tool used to facilitate clients thinking about future possibilities when their problem is solved. It requires a great deal of imagination and is distinctive in requiring clients to envision their life without their presenting problem. This question helps clients define their goals and illuminate solutions.

Wednesday: Solution-Focused Assessment and Follow-Up 7/19/2017

Completing a clinical evaluation is a highly skilled endeavor requiring expertise in many areas, including that of obtaining the necessary information to treat clients most effectively. One question that often arises in learning solution-focused therapy is how to balance maintaining a solution-focused conversation with the need to obtain required diagnostic information. Each theoretical approach may have a different focus of assessment and treatment, but regardless of model, there are common domains that measure treatment effectiveness, and determine whether treatment has been successful. Today we will focus on how to perform a solution-focused assessment, review of systems, including assessment of substance use, trauma, suicide, safety, mood, anxiety, prior treatment history, family history and information required to meet agency and clinic standards. We will also focus on how to remain solution-focused in follow-up sessions.

1.How to maintain a Solution-Focused conversation while gathering necessary clinical information

As Insoo Kim Berg talked about, being solution-focused does not mean you are “problem-phobic”, and when practicing the solution-focused approach, of course problems arise in the conversation. In the solution-focused approach, client’s problems are contextualized and viewed through a competency-based lens, though the use of carefully constructed questions. This week we will learn how and when to integrate a solution-focused assessment and review of systems.

2. Solution-Focused Safety Assessment

Evaluation of  safety issues including suicidal and self-harming behaviors is critical when evaluating clients in treatment. Solution-Focused questions are valuable in safety planning and can help to collaboratively concretize a safety plan in detailed behavioral ways. Client’s VIPs are crucial to integrate within the assessment of safety. Understanding a client’s reasons for living, their “good reasons” for their behaviors and using scaling questions to collaboratively develop a  safety planning will be discussed.

3. Second Session and Beyond

One could hope that after a wonderful initial solution-focused conversation, all of the client’s problems would be solved. Of course, this is often not the case. This week we will focus on how to remain solution-focused in follow-up sessions, when things are better, when they are worse, and how to continue to amplify details of the client’s successes. We will start by exploring the question “What’s better?” and continuing to focus on activating resources throughout follow-up conversations. There are times when things are worse for clients. In these situations, it is still possible to remain solution-focused. We will learn about coping questions, exploring what client’s need, and investigating the details of micro-successes in these situations.

Thursday: Solution-Focused Applications 7/20/2017

For the next two days , we will learn how to apply and generalize solution-focused approaches in different settings, and of course continue to practice our skills.  I am so excited about have Yvonne Dolan join us! We will discuss how the  Solution-focused approach is integrated within the treatment of trauma, substance use disorders, and in the treatment of children and families. We will also learn about how to integrate Solution-focused approaches when treating  clients with medications and in medical settings. We will learn about how to provide solution-focused supervision and consultation and end with solution-focused research.

1. Solution-Focused approaches in treating Trauma – Post-traumatic success and Attachment

Today we will introduce the concept of Post-Traumatic Success and highlight sources of recovery, resilience and post-traumatic growth. We will discuss how to foster hope and optimism. We will define Recovery, Resilience and Post-traumatic growth and how individuals may arrive at a higher level of psychological functioning after a trauma has occurred. We will learn strategies to pay attention to areas of growth during challenging situations and traumatic events, while also not coming at the expense of empathy for pain and suffering.

2. Solution-Focused approaches in treating Substance Use disorders

The growing number of adolescents and young adults presenting for treatment of addiction poses many challenges. Most adolescents and transitional age youth do not voluntarily seek treatment, and are mandated by their parents, schools, criminal justice systems or child welfare agencies. Engaging youth and families remains challenging despite continuing advances in evidence-based treatment approaches.  Solution-Focused Brief Therapy is now included in Substance Abuse Mental Health Service Administration’s National Registry of Evidence-based Programs and Practices (SAMHSA NREPP). A special emphasis will be placed on how to use this approach to engage externally motivated youth and their families in substance abuse treatment.

3. Solution-Focused approaches in treating youth and families

Simultaneously engaging with both youth and families that seemingly have very differing goals takes skill and is paramount in successful treatment.  

A special emphasis will be placed on how to use this approach to engage multi-stressed youth and families, and skills to engage with externally motivated clients building on their strengths and resources, and  how to utilize a system’s perspective to enhance goal negotiation.

4. Solution-Focused approaches applied to the medical setting

The SF approach can be very beneficial in understanding the impact of illness on the patient, their best hopes for treatment, how they are coping, understanding the patients knowledge and expertise, and supporting their family, significant others, and the other members of the medical team.

Friday: Solution-Focused Applications 7/21/2017

1. Solution-Focused approaches applied to consultation

Supervision and consultation are complex and essential skills. We will  discuss how Solution-focused conversational skills can be applied to consultation, facilitating team meetings, collaborating with multiple providers and working within agency and complex systems.

2. Solution-Focused approaches applied to supervision

Solution-focused supervision approaches are designed to construct a sense of competence and confidence with the supervisee, agency, and staff. We will explore applications of SF in supervision. Learning solution-focused supervision allows a supervisor to have a two-fold effect. The first effect is to enhance a clinician’s/agencies/staff sense of themselves as competent and successful professionals. The second is to indirectly influence client outcome through the supervisory/consultant relationship. This approach is empowering to the supervisee/consultee, supervisor and to the client.

2. Solution-Focused approaches applied to wellness and self-care

How to attend to your clients while attending to yourself is critical. We will explore how solution-focused skills can help in your own wellness and self-care.

3. Research and Solution-Focused Therapy

Today’s practice contexts demand that clinicians follow the best evidence-based practices. SF has followed evidence-based practice by gathering and using evidence as part of its clinical process. We will learn about the state of solution-focused research and practices. We will have an opportunity to review the solution-focused brief therapy treatment manual, a solution-focused fidelity instrument, outcome measures, and incorporating outcome and session rating scales in solution-focused therapy. We will also look at solution-focused brief therapy outcome research.

4. Final Thoughts and Reflections

I am looking forward to your thoughts about what was most helpful in the class, what you will immediately try with clients you serve, as well as challenges and any changes you think could be made to improve this class in the future.