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Copy of Brief Therapy

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Sébastien SCHEIDT

on 9 October 2013

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Transcript of Copy of Brief Therapy

And Finally
Mental Research Institute
Brief Therapy

Photo based on: 'horizon' by pierreyves @ flickr
Structure of Therapy
Metaframeworks Domains

Interventions
Key Figures
Key Concepts
Theoretical Background:

Gregory Bateson
Milton Erickson
Heinz von Foerster

Clinical Application:

Richard Fisch
Don Jackson
Paul Watzlawick
John Weakland
History
Mental Research Institute (MRI) in Palo Alto, California, founded by Don Jackson in 1958.
Inside of the Institute, a Brief Therapy Center was founded in 1966 by Fisch, Weakland, and Watzlawick.
MRI group recognized need for short-term, pragmatic , goal-oriented therapy.
MRI group incorporated ideas from Bateson, Erickson, and von Foerster to establish a brief-treatment therapy approach.
MRI is one of leading sources of ideas in interactional/systemic studies, psychotherapy, and family therapy.

First order change- involves change in the system interactional pattern and occurs when the system itself remains unchanged.
Second order change- requires change in the organization of the system and is characterized by a change in the client’s perspective and assumptions. A change in the system is referred to as change of change. It also means change of formation and problem resolution.
Communication- interactional patterns that sustain problems are most basically communication/behavioral sequences that therapists can observe and intervene upon
Report and command functions- report (content) and command (relationship)
Report- is the literal message
Command- is the action that cues the message recipient on how to interpret the message and thereby define the present relationship.
Metracommunication- refers to the command aspect (or action or behavior) of communication. (The communication about the communication). Includes nonverbal cues that that accompany the content of the message
Reframing- to change the conceptual and or emotional setting or viewpoint in relation to which a situation is experienced and to place it into another frame which fits the facts of the same concrete situation equally well or even better and thereby change it entire meaning. (Watzlawick et al, 1974 pg. 95)
Prescribing the Symptoms- “Do more of the same” the therapist encourages the client to engage in symptomatic behavior. The symptomatic interactive pattern no longer serves it purpose of maintaining homeostasis, and the family must establish new interactive patterns.
Symmetrical relationship- the participants mirror each other’s behavior.
Complementary relationship- one person assumes a position and the other assumes the opposite position.
Double bind- is a consistent , ongoing contradictions between the report and command functions

Four stages

Identify and explore the problem
Identify attempted solutions and results of such solutions
Formulate a concrete goal
Intervene utilizing MRI techniques and the client’s language

Four step procedure to be utilized in approaching a problem

Define the problem identify how it is a problem
Determine what solution has been tried and identify the outcome of such attempts. Look for more of the same patterns and identify family rules that identify family rules that support the unsuccessful solutions.
Obtain a clear description of the concrete change to achieved
Formulate and implement a plan to produce change.

Mary came into our clinic with her three daughters Rosa, Maria, and Blanca ages 12, 15, and 17 suggested by Maria and Blanca’s school psychologist because of truancy and the little bit of time that they were in school they have been in lots of trouble. Blanca constantly get into physical altercations with boys and girls and Maria has been suspended and may be on the verge of being expelled because she was caught in the back hallway giving a boy oral sex. Mary’s boyfriend of 20 years is currently incarcerated and has been in and out of jail their whole lives. Mary is currently taking antidepressants and has had suicidal ideation in the past. She did attend a few therapy sessions but stopped as soon as her boyfriend was released from prison. Rosa age 12 lives in a fantasy world, she sometimes calls herself Bella from the “Twilight” series and believes that one day her vampire will come and rescue her. They are all in need of much help but their insurance only covers up to eight sessions of therapy.

Vignette
1.Define the problem and identify how it is a problem
Ask what is the problem that brought you here today? How is it a problem?
What does it stop you for doing or make you do that you do not want to do?
2. Identify previous attempts to solve the problem (attempted solutions) and the outcome.
Identify family rules, more of the same patterns, communication styles that support the unsuccessful solutions.
Explore the metacommunication
3. Assess the family system,
Identify the current behavior that is assisting in maintaining problem through interactional view.
Identify first and second order processes within family system, as well as in the therapy session.
Explore communication in terms of metacommunication and report and command congruencies and in congruencies.
Examine symmetrical and complementary relationships
Identify more of the same patterns in resolving problem issue.
Identify specific behavioral goals
Assist client in defining behaviorally defined, clear goals.
Direct system to go slow to assist in successful completion of tasks, to prepare for ups and downs of the treatment process, and to present a paradoxical approach.
Ask what change would indicate that progress has been made?
Instruct the family to take small, concrete steps and ask, at minimum, what change would indicate to you that a definite step forward has been made?

Early Stage
Middle Phase
1. Interrupt more of the same attempted solutions to assist in identifying solutions to the identified problem issue.

Discuss the problem while relabeling the symptoms
Present a therapeutic double bind by prescribing the symptom
Prescribe 180 degree shift from attempted solution
Reframe the problem
Use paradoxical directives
Intervene at higher order of system to facilitate second hour shift
Comment on metracommunication verbally or non-verbally
Modify directives each week based on family response note which solutions work and which do not
Initiate and assign specific behavior behavioral changes to assist with second order changes.
Make coverts or overts with directives or comments
Advertise the symptom
Utilize bellac ploy to solicit preferred behaviors from others


Late Phase



1. Interrupt any new problems that are identified/created by addressing the presenting issue

Identify attempted solution and prescribe 180 degree shift
Reframe the problem, possibly in relation to presenting problem
Present a therapeutic double bind by prescribing the symptom
Highlight successful solutions to the problem
Compliment the system on resolving the problem issue while highlighting the successful solution.

Internal Family Systems (IFS)
Low, Brief therapy, not an intervention to go inside and speak to the parts of the self. IFS is not typically addressed in this form of therapy.
 
Sequence
High, focus on patterns of interactions in the family surrounding the primary complaint, concept derived from Cybernetics, Focus on the here and now, First Order and Second Order change.
S1- High
S2- High
S3- Low
S4- Low
 
Organization
Low, not concerned with changing the organization of the family
 
Development
Low, no focus on the development of the family unit or the background history information.
 
Multicultural/Gender
Medium, while the focus is not on these areas, they are taken into account and interventions are shaped accordingly where fit
Full transcript