The first day back at college after the Christmas break – and what a Christmas break it had been for me! Sadly, my holiday had been one of my worst Christmases ever – I had gone down, big time, and had been put on some very strong medication to try to help me deal with it. Needless to say, it didn’t particularly help; it simply tranquilised me so that I felt disconnected from everything around me. I made a decision to stop taking the drugs that were having this effect a few days before my return to college, and am sorry to say that the effects of the withdrawal were still taking their toll on me, and as such, my concentration levels on this day were, let us say, “patchy” Even now, a day later, I am struggling to keep my mind focussed on writing this journal – I know I must try to write down how I feel though, as it is important for me, as a counsellor, to remember the chaos of these feelings whilst in crisis, as this is how many clients will be in initial sessions, and possibly again and again, throughout treatment, as the road to psychological wellness is not always a straight line(in fact it rarely is).
Today’s session was spent discussing ‘solution focused brief therapy’; an approach to psychotherapy based on solution-building rather than problem-solving, and pioneered by Steve DeShazer, who is quoted as stating that ‘the essence of psychotherapy was that the client is helped to make a change in their situation.’
SFBT targets the solution; what the client is striving to achieve through therapy, rather than the situation, event or obstacle that brought them to treatment. The therapist works with the client to place their attention on the present and future, not the past. The client begins by first envisioning what their desired future looks like, and then taking small steps toward achieving that outcome. It is an effective treatment model used across a whole range of presenting issues. As the name describes, it is a short course (anything up to 20 sessions) of therapy.
First, the problem is identified and described; “How often does … happen? How long has it been going on? Has it ever happened before? How did you deal with it then?”
Any goals that the client wishes to achieve are discussed, clients to are encouraged to identify these goals, even when they are finding it hard to see any way through their problem – “What do you want to get out of being here? What will it be like when the problem is solved? What will you be doing instead? When that happens, what difference will it make? What else will be different? What else?” The counsellor can use their questions to facilitate the client viewing their possibilities in a more positive light, encouraging them to imagine the ‘knock on’ effects that reaching their goals will have.
Exceptions to the problem are noted and attended to, helping the client to start to take on ideas that could lead to potential solutions. “What about times when the problem is not happening? Or when it is less? You mentioned earlier that some days/times are better. What is it like at these times? What are you doing instead at these times?”
Scales are another useful tool for the counsellor to use, “If you think of a scale from 0–10 with 10 being the best. Nought is how you felt when things were at their worst. Ten is as good as things can be in relation to this problem. Where are you now on that scale right now? Give it a number, for example 2 or 3. How long will it take to get to 10? Maybe 10 is too big a goal? Is something lower more realistic? What number will be acceptable for you?” his helps to break the goals down into something achievable so a sense of success, and the encouragement gained from that success can be achieved.
The miracle question is designed to elicit a clearer picture of the client’s future without the presence of the current obstacles they face. “Suppose you go to bed and to sleep tonight as usual and while you are asleep a miracle happens and the problem that brought you here today is solved. But you are asleep and don’t know that it has been solved What will be the first small signs that this miracle has happened and that the problem is solved?” This gives the client the opportunity to visualise how there life could be – a powerful tool in itself, in terms of encouragement and inspiration.
DeShazer said “All that is necessary is that the person involved in a troublesome situation does something different.” It was once I read this, that I realised that SFBT is very similar to the kind of counselling that I had been receiving on an ‘every other day’ basis through the christmas holiday break. My counsellor said those very words to me “just do something different”. He asked me to scale in my mood at the beginning of every session, and he asked me the ‘miracle question’. First at the beginning of the sessions with him, and then again as we neared the end (we haven’t quite got there yet – I will still be seeing him once more). Thinking back, more clearly now, we set goals at the beginning of the treatment and he (very skillfully, without me even realising he was doing it) drew my attention to any exceptions to my own ‘bleak prognosis’ of my future.
Finding it as hard as I have to concentrate recently, this simple yet effective treatment outline was more than enough to focus on. As a client in crisis, I can see now, and understand that any deeper probing into the past may have been too much for me to cope with at that moment – even though, when the psychiatrist tried to tell me this, I argued with him, that being a student counsellor myself, I knew the difference, and I wanted ‘proper therapy’(!)
So, big BIG learning for me - even with my ‘addled’ brain!
I cannot recall many details from the more practical part of the day. I know that I was ‘present’ for the individual skills part – I may have floated off during the process group a little, and I am quite sure that my mind had fully checked out by the time we hit ‘supervision’ at the end of the day, but in my defence I don’t think I did too badly really; considering the medication I was coming off of. In my head, the feeling was similar to as if I had attended a college session at the tail end of having had a bad cold. I know that I wouldn’t have been able to ‘counsel’ for a full hour in the ‘real world’, but I did muster everything I had in order to manage the 25 minutes skills practise we did, and it did seem to go ok. Certainly, when I reported back to my therapist this morning, he was pleased with my progress, in terms of mood, and quite surprised when I explained to him that his techniques were the ones we had been learning about!