Jacqueline Kappelman, MS, LPC

Reminder The following sides are my original slides for my

workshiop. Per request many changes were made during the actual presentation. For more information in general or related to the conference please feel free to contact me.

JKAPPELMAN@OLLUSA.EDU

210-246-2174

Overview Highlight 2 Main

Components of SFBT

Pre-Session Change

Goal Setting

Incorporate Multicultural and Animal Assisted Therapy Concepts

Cultural Case Vignette

Pre-Session Change/Joining

Breakout/Case Vignette

Goal Setting

Breakout

Discussion/Q & A

Education and Training Final year of Psy D at

Our Lady of the Lake University in San Antonio, Texas

Licensed Practicing Counselor

Populations of Experience:

Veterans

Dual Diagnosis

At Risk Teens

Domestic Violence

Substance Abuse

Latino Population

Underserved Populations

Behavioral Health

Research Interests

Solution Focused Therapy with Domestic Violence

Solution Focused Therapy with the Latino Population

SFT with Latino Sexual Minorities

Solution Focused Animal Assisted Therapy

Pre-Session Change & Joining Joining and exploring for Pre-Session Change can be

one of the most essential steps of therapy process

Eventual aim of session to build a goal, find exceptions to problem, highlight client strengths

Pre-Session Change can begin as early as setting the appointment, and through joining and exploring for Pre-Session Change many SFBT concepts are elicited for use later in the session.

Common Factors in Therapy

Asay & Lambert, 1999

ExtratherapeuticChange

40%

Therapeutic Relationship

30%

Expectancy 15%

Technique15%

Extratherapeutic ChangeExtratherapeutic Change

40%

Therapy may affect change more indirectly than directly.

Biggest impact out of session so try to include the client’s worldview or life into session.

Joining & Pre-Session Change incorporate Multicultural components naturally by finding out about work, family, activities just as a standard way of building rapport.

This exploration also includes MC components useful for goal setting (collectivistic cultures).

Therapeutic RelationshipTherapeutic Relationship

30 %

SFBT concepts such as joining, exploring for pre-session change, normalizing instead of pathologizing,

highlighting exceptions and strengths are built on strengthening the therapeutic relationship.

Ethnic matching research shows clients value respect of culture and beliefs and need to feel heard and connected.

Power differential changed

ExpectancyExpectancy

15 %

SFBT instills hope: BRIEF therapy

SFBT concepts like exceptions, small goals, highlighting client strengths shows clients they can maneuver through challenges.

Use of client’s worldview and language makes problems more “everyday” and not severe pathologies.

When learn how to handle these problems clients transfer skills to more chronic conditions.

TechniqueTechnique

SFBT, although only one factor of the four common factors is built into and strengthens the previous three factors.

15 %

Joining Through Gathering Background Information

Many clients want to jump right into the problem.

Want to know who the client is as a person, outside of the presenting problem.

Builds therapeutic relationship, sets the tone for the therapy process to be collaborative and conversational.

Opportunity to learn about sociocultural components such as family, roles, and spiritual/religious activities.

Chance to obtain strengths, exceptions, support systems, and components for goal setting that can be used for reframing later in the session

*The solution may not be directly related to the problem.

Joining: Framing a Solution Focused Session while Integrating Sociocultural Components

Getting to know the client’s system Who does the client live with?

(MC* - some cultures have extended family members residing in the same home. These individuals may be a source of support or culturally it may be relevant to invite these members into session)

Names, Ages, Occupations of other members in the household (personalization)

Where does the client work? (Even though client may not work, make an assumption the client does something

with his/her life. This often leads to more details)

Who referred client? If a referral this person is a part of the client’s system and may be useful in the

therapy process, either through setting goals, identifying strengths and exceptions

How did the client know now was the time for therapy? Also a chance for strengths since the client knew to come in (even if mandated) Could possibly will lead to the presenting problem, but can also tell what is different

from where the client would like to be (goal setting)

*If it’s not working, do something different.

Examples of Pre-Session Change A few ways to view this concept

Directly asking for Pre-Session Change What has gotten better since set up the appointment? Tell me about the times when you have been handling the problem

better since (it started, you set up the appointment, etc). *If it works, do more of it.

Another way to look at this idea is pre-session exception exploration and observation Presenting Problem on intake depression Client made appointment, arrived on time, engaged in the joining

process, identified support systems and activities involved with (work, school, etc.)

No outward asking for change but through joining explored for exceptions which indicate change and vice versa (noticed changes which indicate exceptions).

* Small change leads to big change.

Pre-Session Change Examples Continued A different way to view pre-session change is by exploring the

fact that things have not gotten worse. How have you managed to keep things from getting worse?

How have you managed to survive this long with things this bad?

Pre-Session change is more than just having previously made changes before arriving to session. Pre-Session Change can be a change in thinking about the problem prior to delving into the session (framing SF therapy session). What would need to happen today to make this session helpful?

What are you hoping to get out of therapy?

*The future is both created and negotiable

* No problem happens all the time; there are always exceptions that can be utilized

*The language for solution development is different from that needed to describe a problem.

SFBT and Culture SFBT has a natural “covert” cultural sensitivity.

By exploring background during joining learn some aspects that are tied to culture

Support system

Who client lives with

Client’s role in the home, family, community

Although not directly cultural questions these are opportunities to link in culture

Client lives with parents, would client find it beneficial to include parents?

Cultural Considerations

SFBT offers the opportunity to address cultural issues subtly or more openly.

The systemic example above allows for respect of collectivistic cultures but without overtly addressing this.

Also important to go into the session considering cultural components

• Cultural Considerations: Collectivistic culture vs

Individualistic

Advice Seeking

Acculturation

Immigration

Loss of Face

Shame in seeking treatment

Mental illness as human weakness

Language

Hierarchy

Slow to warm

Animals in Therapy Animals have been used for therapeutic purposes

either directly or indirectly as far back as 1699 and possibly earlier.

Today volunteers may utilize animals in Animal Assisted Activities (AAA) .

Animals are currently used in therapies such as psychotherapy, occupational therapy, physical therapy, and speech therapy among other professional settings.

Animal Assisted Therapy (AAT) "AAT is a goal-directed intervention in which an animal

that meets specific criteria is an integral part of the treatment process. AAT is directed and/or delivered by a health/human service professional with specialized expertise, and within the scope of practice of his/her profession.

AAT is designed to promote improvement in human physical, social, emotional, and/or cognitive functioning [cognitive functioning refers to thinking and intellectual skills]. AAT is provided in a variety of settings and may be group or individual in nature. This process is documented and evaluated.“

- Delta Society

AAT and Theory

AAT has been grounded in many theoretical orientations including SFBT.

Research identified 18 major AAT techniques grounded in theory, 16 of the techniques were grounded in SFBT.

Matching AAT Techniques withCounseling Guiding Theories

AAT Technique AAT Technique

Counselor and client engage with therapy animal outside of traditional therapeutic environment (taking animal outside for a walk)

Using the client’s worldview, building rapport, exceptions, reducing power differential

Counselor reflects/comments on client’s relationship with therapy animalIdentifying client strengths, exceptions, normalizing

Counselor encourages client to perform commands with therapy animalExceptions, solution building, empowering

Excerpt adapted from Chandler, C., Portire-Bethke, T., Minton, C., Fernando, D., & O’Callaghan, D. , 2010

AAT, Theory, and Goals

Matching AAT Intentions with Counseling Guiding Theories

INTENTIONS/GOALS INTENTIONS/GOALS

Building rapport in the therapeutic relationship

Modeling specific behaviors

Enhancing client’s self confidence

•Research identified 10 major AAT intentions/goals grounded in theory, 8 of the goals/intentions were grounded in SFBT.

Excerpt adapted from Chandler, C., Portire-Bethke, T., Minton, C., Fernando, D., & O’Callaghan, D. , 2010

General AAT Goals and Techniques

Animal Assisted Goals and Techniques in the Four Functional Domains

PSYCHOLOGICAL/SOCIAL GOALS AAT Technique

Improve Socialization, Communication,Reduce Isolation, Boredom, Loneliness,Increase Self Esteem

empowering, goal setting, within client’s worldview, and exceptions

•Practice commands with therapy animal•Engage in play with an animal•Learn about animal, then take animal around and verbally introduce animal to others•Take animal for a walk (outside, around unit, around room, etc)•Receive apparent acceptance from an animal•Give appropriate affection to an animal

•There can be general overarching goals with various specific interventions to utilize and combine within the theory.

Excerpt adapted from Gammonley, J., Howie, A., Kirwin, S., Zapf, S., Frye, J., Freeman, G., & Stuart-Russell, R. 1997

Utilizing AAT to enhancePre-Session Change

Interaction with therapy animal in the waiting room, the hall, or while first entering therapy room.

Ability to make use of SFBT principle of working within the client’s worldview.

Natural opportunity to elicit pre session changes of strengths, exceptions, and characteristics for empowerment or normalizing.

Client presents for depression but interacts with therapy animal. She overcomes her depressed mood during the moment and engaging with the animal.

Breakout

Goal Setting Clients can present with what may seem like

large, overwhelming problems

SFBT tries to shift collaboratively from problem focused discussion to solution focused discussion

Helping a client develop an attainable goal instills hope (one of the common factors)

Goal Formulation

Goals should be

Small

Concrete

Observable/Measurable

Within the client’s control

Present Centered

In process form(not the absence of something)

SFBT Concepts to Remember with Goal Formulation and Follow Through

Client is the expert (expert

on their life and experiences)

Change is always occurring

Exceptions suggest solutions

Small change leads to big change

People are resourceful

• Clients are always cooperating (not resistant client, client trying to tell you something that you are missing)

• If it’s not working, do something different

• If it works, don’t fix it• Once you know what

works, do more of it• Small change leads to big

change

Ways to Identify Goals Elicit and reinforce exceptions

How did you do that?

That must have been difficult, I don’t think I could have done that!

Utilizing Deconstructing Questions including:

Scaling

Relational Questions

Hypothetical solutions

Miracle Question

Cultural Considerations

Action oriented vs Insight oriented

Family oriented/collectivistic

Spiritual/Religious

AAT and Goal Setting The action of including a therapy animal in session

often interrupts the feedback cycle clients are “stuck” in.

*If it’s not working do something different.

Can make use of the therapy animal in a relational way

Once you are less depressed what will Spot notice about you? What about your own dog that sees you more often?

SFAAT: Application of Goals In session activities

Challenges faced can be normalized and paralleled to obstacles outside of therapy room.

Successes open space for deconstructing steps taken, scaling confidence at various steps along the way, and amplifying solution talk.

“How were you able to motivate yourself to keep trying when Spot would not listen to you at first?

How can you apply that idea to the goal we set a little bit ago?

How does this relate to how you handle/can handle things with your daughter?

SFAAT: Application of Goals

If something is working, do more of it.

Impromptu interactions imply exceptions.

The language necessary for solution talk is different from problem talk.

Have to learn a new way of communicating.

Learn to take on multiple viewpoints.

Goal Setting Breakout Out

Question and Answer

References Assay, T.P., & Lambert, M.J. (1999). The empirical case for the

common factors in therapy: Quantitative findings. In M.A. Hubble, B.L. Duncan, & S.D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 33-56). Washington, DC: American Psychological Association.

Atkinson, D. (2004). Counseling American minorities (6th ed.).Dubuque: McGraw Hill.

Chandler, C. (2005). Animal assisted therapy in counseling. New York: Routledge, Taylor & Francis Group.

Chandler, C., Portire-Bethke, T., Minton, C., Fernando, D., & O’Callaghan, D. (2010). Matching Animal-Assisted Therapy Techniques and Intentions with Counseling Guiding Theories. Journal of Mental Health Counseling, 32, 354-374.

References Corcoran, J. (2000). Solution-focused family therapy with

ethnic minority clients. Crisis Intervention, 6, 5-12.

de Shazer, S., Dolan, Y., Korman, H., Trepper, T., McCollum, E., & Berg, I.K. (2007). More than Miracles. New York: Routledge, Taylor & Francis Group.

Delta Society (2009). Retrieved on November 10, 2011 from http://www.deltasociety.org/

Gammonley, J., Howie, A., Kirwin, S., Zapf, S., Frye, J., Freeman, G., & Stuart-Russell, R. (1997). The Human Animal Health Connection Animal-Assisted Therapy: Therapeutic Interventions. Delta Society, Bellevue, WA.

Nelson, T. & Thomas, F. (Eds.) (2007). Handbook of

solution-focused brief therapy. New York: Haworth Press.

References Parshall, D. (2003). Research and reflection: Animal-

assisted therapy in mental health settings. Counseling and Values, 48, 47-56.

Pichot, T., & Coulter, M. (2007). Animal-Assisted Brief Therapy: A solution-Focused Approach. New York: Routledge, Taylor & Francis Group.

Walter, J. L. & Peller, J. E. (1992). Becoming Solution-

Focused in Brief Therapy. New York: Routledge, Taylor & Francis Group.