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Postmodern Systems Theory- Constructivism, Narrative, and Solution Focused.

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Angie O'Gieblyn

on 9 November 2012

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Transcript of Postmodern Systems Theory- Constructivism, Narrative, and Solution Focused.

Postmodern Therapy From A Systemic Lens Narrative Collaborative Therapy Solution Focused Solution Focused Couple Therapy
with
Insoo Kim Burg Case Example
Narrative Therapy Dr. Stephen Madigan Journal #3: Patterns and Dynamics
What family-of-origin dynamics have influenced how you interact within your current family?
How do these dynamics impact your relationships outside of the family?
Consider triangulation that may currently occur or that has occurred in the past. Journal Discussion Basic Assumptions Basic Assumptions
Collaborative Therapy
Solution Focused Therapy
Narrative Therapy Where We Are Headed -Reality is socially constructed
-Language driven
-Therapy is collaborative
-The client is the expert on their life (content vs process)
-Client's understanding of the problem and solution is key
-A focus on meaning making
-Tends to be brief The Shift Begins.... "Instead of focusing on patterns of interaction, constructivism shifted the emphasis to exploring the perspectives that people have about their problems. Meaning itself became the primary target."
-pg. 214 Constructivism Collaborative Therapy Social Constructivism Narrative Therapy Harlene Anderson
Harry Goolishian
Lynn Hoffman
Tom Anderson Kenneth Gergan Michael White
David Epston Theory Therapy Key Features of Collaborative Therapy Therapist as de-centralized
Goal Setting
Interventions
Reflecting Teams Discussion....
How has your reality been constructed? Overview Best known strength-based therapies
Positive, active approach
-Help clients move toward desired outcomes.
Brief therapy approaches influenced by
-Mental Research Institute (MRI)
-Milton Erickson’s brief therapy and trance work
Popular with clients, insurance companies and mental health agencies
Therapists spend a minimum of time talking about the problems and instead focus on moving clients towards solutions Common Myths 1) They propose solutions to the clients
2) They never talk about problems
3)They never talk about the past
4) Emotions are not discussed Myth Truth 1) They assist clients in identifying solutions
2) They spend LESS time talking about the problem
3) They use the past to figure out what has worked and what hasn't. They view the past through a strengths based lens
4) They use emotions as cues Key Contributors Steve de Shazer and Insoo Kim Berg
-Solution-Focused Brief Therapy
Milwaukee Brief Family Therapy Center
-Scott Miller, Barry Duncan,
Mark Hubble,Yvonne Dolan, & Linda Metcalf
Bill O'Hanlon &Michelle Weiner-Davis
-Solution-Oriented Therapy Overview of the
Therapy Process Solution-based therapists help clients identify their preferred solution by:
Talking about the problem, exceptions, and desired outcomes
Working with clients to take small active steps in this general direction each week
This can take 1 – 10 sessions or it may take years depending on the complexity of the case Keys to the Therapeutic Relationship Beginner's Mind
-Would this be hard for you? Using client's language Dual Track Thinking Optimism and Hope Case Conceptualization/Assessment Exceptions/What Works
Strengths Resources Client Motivation: Visitors, Complainant, and Customers.....(see book pg 251-252)
Visitors: usually brought to therapy by an outside other such as spouse, parents, courts
Complainants: identify a problem but expect therapy or some other person to be the primary source of change
Customers: identify a problem and want to take action towards the problem Every client is unique
Clients have the inherent strength and resources to help themselves
Nothing is all negative
There is no such thing as resistance
You cannot change clients; they can only change themselves.
There is no cause and effect
Solutions do not necessarily have anything to do with the problem.
Emotions are part of every problem and every solution
Change is constant and inevitable; a small change can lead to bigger changes.
One can’t change the past so one should concentrate on the future Solution Focused Assumptions Goal Setting Goal language – positive, measurable and concrete
Meaningful to client
Interactional
Situational
Small steps
Clear role for client
Realistic
Legal and ethical a) Solution-Generating Questions: Miracle, Crystal ball, Magic wand, and Time machine questions work best when therapist:
Prepares client for a solution-generating question
Creates a compelling vision
Asks for behavioral differences
b) Small steps: Scaling questions for goal setting
c) One Thing Different: Client-generated change Interventions Pre-treatment Change

Formula First Session Task
Between now and the next time we meet, I would like you to observe, so that you can describe to me next time, what happens in your family/life/etc that you want to continue to have happen.

Scaling questions for weekly task assignments
On a scale of 1-10…

Pre-Suppositional questions and assuming future solution
What will you be doing differently when these issues are resolved? Coping Questions
This is so hard – how have you kept it from getting worse?

Exception questions
Are there times when this does happen?

Miracle, Crystal Ball, Magic Wand, and Time Machine Questions
If you go to bed tonight and a miracle happens while you are asleep, and when you wake up in the morning your problem is solved, how will things be different?

Compliments and encouragement Research & Challenges -Strong, growing evidence base for the model

-Three key practical and philosophical challenges of establishing solution-focused
Difficult to adequately manualize and capture the spirit and epistemological positioning that is essence of the model
Shallow adherence to techniques without grounding in the theory results in an inaccurate enactment of the therapy
Certain philosophical principles such as honoring each clients uniqueness and recognizing change processes outside of therapy are at odds with the making global assessments of the effectiveness of this approach Diverse Populations Widely used with diverse populations in the US, Canada, and internationally
Easily adapted for a wide range of value systems and communication styles
Has been studied with a range of client ethnicities in a wide range of contexts
Approach can be used to identify strengths to access unique emotional, cognitive, and/or social resources inherent within diversity -Dominant Discourses
We “story” and create meaning of life events using available dominant discourses – broad social stories, practices, assumptions, and expectations about how we should live
-“Problems”
Experienced when a person’s personal life does not fit with these societal discourses and expectations
-Externalization
Process involves separating the person from the problem Overview Narrative Therapy Contributors Michael White was the first to write about the process of externalizing and along with David Epston, he wrote the first book on Narrative Therapy

Jill Freedman and Gene Combs developed the narrative approach emphasizing the process of social construction of realities -Involves finding new ways to view, interact with, and respond to problems by defining the role of the problems in their lives
-Broadly involves the following phases:
Meeting the person
Listening
Separating persons from problems
Enacting preferred narratives
Solidifying
-Process thickens and enriches a person’s identity and life accounts Overview of the Therapy Process -Meeting the Person Apart from the Problem
-Separating People from Problems: The Problem is the Problem
-Optimism and Hope
-Co-author/Co-editor
-Investigative Reporter
Developing an expose or account of the problem Therapeutic Relationship Problem-saturated stories
-People define themselves by the problems
Unique outcomes and sparkling events
Dominant cultural and gender discourses
Local and alternative discourses: Attending to client language and meaning Case Conceptualization/Assessment Goal Setting Narrative Therapy does not include a set of predefined goals – goal setting is unique to each client
Increase the clients sense of agency – the sense that they influence the direction of their lives
Therapist allows the client to take the lead in defining the preferred realities and helps the client reflect on where the idea came from and the effects it will have Externalizing: Separating the Problem from the Person
Metaphors
Relative Influence Questioning: Mapping Influence of the Problem and Persons
Externalizing Conversations: The Statement of Position Map
Externalizing Questions
Problem Deconstruction: Deconstructive Listening and Questions
Mapping in Landscapes of Action and Identity/Consciousness Intentional vs. Internal State Questions
Scaffolding Conversations
Permission Questions
Narrative Reflecting Team Practices
Re-Membering Conversations
Definitional Ceremony
Letters and Certificates Interventions -Children
Externalization works well with children – particularly the Externalizing Process which adapts well to play and art therapies
Acting out unique outcomes & preferred narratives often accelerates their adaptation of new behaviors

-Domestic Violence
Jenkins (1990) has developed a Nine-Step Model for working with men who batter which requires the client to take full responsibility for the violence and ending it Specific Populations Diverse Populations Ideal for marginalized populations, approaches focus on how the client’s problems relate to the broader socio-political context
The local discourse focus of Collaborative therapy ensures that the client’s cultural values and beliefs are central to the therapy process
Both Narrative and Collaborative Therapy have international roots and are practiced in numerous countries around the world Summary and Thoughts? Conversational Partners: “Witness”
Curiosity: The Art of Not Knowing
Client vs. Therapist Expertise
Everyday, Ordinary Language:
Inner and Outer Talk Overview of The Therapy Process Collaborative therapists do not have set stages of therapy or an outline for how to conduct a session
Guiding principle: facilitate generative, two-way dialogical conversations
Key is to avoid monologues which lead to a therapeutic impasse (bridge building-key)
If this happens, the conversation is gently shifted back to a dialogical exchange of ideas Case Conceptualization Involves two key questions -
1)Who’s Talking? Problem-Organizing, Problem Dissolving Systems
Multiple perspectives are collected defining the problem allowing the participants’ understanding of the problem to evolve
2)Philosophical Stance: Social Constructionist Viewing
Focus is always on how clients construct meaning about the events in their lives, their worldview -Self-Agency
Increase sense of agency, sense of competence and ability to take meaningful action
-Transformation
During therapy, some “original” aspects remain while other aspects are added or diminished
-Setting Collaborative Goals
Therapeutic goals included in a treatment plan are constructed collaboratively with clients using everyday language Conversational Questions: Understanding from Within the Dialogue
Mutual Puzzling Questions and Process: “Kicking Around” New Meanings
Being Public: Therapists Inner Dialogue Tom Anderson and colleagues developed the idea of having the families listen to the team’s conversation behind the mirror
The idea is to develop multiple, contradictory perspectives in order that new meanings will be developed with clients Significant Contributions to the Field Not-Knowing and Knowing With
Collaborative therapists avoid “pre-knowing” also called assuming
Based on a social constructionist epistemology, clients with apparently similar experiences, such as “psychosis,” “mania,” or “sexual abuse,” have unique understandings of their situations
Therapists view the clients knowledge as equally valid with their own Because Collaborative Therapy is more a way of talking and being in the world, the process has been applied to numerous other contexts including:
Education and Pedagogy
Research
Business Consultation
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