Solution-focused brief therapy: School-based strategies and

Solution-focused brief therapy: School-based strategies and techniques Joshua M. Nadeau, PhD Clinical Director, Tampa Rogers Behavioral Health Tuesday, August 11, 2020

Disclosures Joshua M. Nadeau, PhD, has declared that he does not, nor does his family have, any financial relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the presentation. Dr. Nadeau has declared that he does not have any relevant non-financial relationships. Additionally, all planners involved do not have any financial relationships.

Learning objectives Upon completion of the instructional program, participants should be able to: 1. Define and provide three characteristics of solution-focused brief therapy (SFBT). 2. List and describe at least two advantages of SFBT when used within the school and/or classroom setting. 3. Describe at least three techniques common to SFBT that have empirical support for addressing symptoms of anxiety or depression within the school and/or classroom setting.

What we’ll cover in this webinar What is solution-focused brief therapy (SFBT) Definition Defining characteristics Differentiating from other mental health treatment approaches Rationale for SFBT in the schools Rationale/evidence for mental health treatment via SFBT Treatment barriers common to school/classroom settings Comparison of treatment approaches in the classroom Strategies and techniques for implementing SFBT in the classroom Assessing for change Goal-setting Implementation and monitoring

What is solution-focused brief therapy (SFBT)? Definition Defining characteristics Differentiating from other mental health treatment approaches

What is SFBT? A pragmatically developed approach to therapy Systems theory-based family therapies of 1950/60s Wittgensteinian philosophy Buddhist thought A systemic therapy Clients/patients are systems (we treat whoever shows up) Solutions are interactions (involve other people) Changes grow, expand and interact (Carr, 2014; Constable & Walberg, 2016; de Shazer et al., 2007)

But what is it? SFBT is a therapeutic approach based on solution-building instead of problem-solving. Explores current resources and future hopes rather than present problems and past causes Two "big ideas” of SFBT: Exceptions found in problem behavior.however serious, fixed or chronic the problem, there are always exceptions, and these exceptions contain the seeds of the client's solutions Determining goals of therapy.the clearer a client is about their goals, the more likely they are to achieve them

SFBT – Characteristics Stance of therapist: Positive, respectful and hopeful Collegial instead of hierarchical Cooperative instead of adversarial General assumptions: People contain strong resiliencies Most people have strength, wisdom and experience to effect change Thinking about "resistance" Natural protective mechanisms (be cautious, go slow) Therapist error (intervention doesn't fit the client/situation)

SFBT – Solutions and exceptions Solutions: Exceptions: Most people have previously solved many (many) problems. There are times when a problem could occur, but doesn’t A previous solution is something a person/family has tried on their own that has worked, but for some reason they haven't continued this successful solution (and may have even forgotten about it). An exception is something that happens instead of the problem, usually without the person's intention (or even understanding)

SFBT – Use of questions Questions are used in all models of therapy; however, they are the primary communication tool – and intervention! – in SFBT Tendency to avoid interpretations Challenges/confrontations are rarely used Questions are mainly focused upon present and future (not past). why? Problems are best solved by focusing on what is already working now, and how you want your life to be in the future Not on how things used to be and where a problem came from

1 Core principles There are eight core principles that serve as de facto practice guidelines. 8 7 2 3 SFBT (de Shazer et al., 2007) 6 4 5

1 If it isn’t broken, don’t fix it

1 If it isn’t broken, don’t fix it 2 If it works, do more of it

1 If it isn’t broken, don’t fix it 2 If it works, do more of it 3 If it’s not working, do something different

1 If it isn’t broken, don’t fix it 2 If it works, do more of it 3 If it’s not working, do something different 4 Small steps can lead to big changes

1 If it isn’t broken, don’t fix it 2 If it works, do more of it 3 If it’s not working, do something different 4 Small steps can lead to big changes 5 The solution is not (necessarily) related to the problem

1 If it isn’t broken, don’t fix it 2 If it works, do more of it 3 If it’s not working, do something different 4 Small steps can lead to big changes 5 The solution is not (necessarily) related to the problem 6 The language for solution development is different from that needed to describe a problem

1 2 If it isn’t broken, don’t fix it If it works, do more of it 3 If it’s not working, do something different 4 Small steps can lead to big changes 5 The solution is not (necessarily) related to the problem 6 The language for solution development is different from that needed to describe a problem 7 No problems happen all the time; there are always exceptions that can be utilized

If it isn’t broken, don’t fix it 5 The solution is not (necessarily) related to the problem 6 The language for solution development is different from that needed to describe a problem 3 If it’s not working, do something different 7 No problems happen all the time; there are always exceptions that can be utilized 4 Small steps can lead to big changes 8 The future is both created and negotiable 1 2 If it works, do more of it

Rationale for SFBT in the schools Rationale/evidence for mental health treatment via SFBT Treatment barriers common to school/classroom settings Comparison of treatment approaches in the classroom

Evidence base - SFBT 2013 Social work review (controlled outcome) of 43 studies Overall positive results for child academic and behavioral problems Strong positive results for adult mental health, and for ‘crime & delinquency’ 2015 Meta-analysis (mental health) of 9 studies in mainland China Provide support for use of SFBT in reducing internalizing problems Implications for the use of SFBT among ethnic minority populations 2017 Marriage/Family therapy review (process) of 33 studies Supported use of co-construction and strength-oriented techniques (Franklin et al., 2017; Gingerich & Peterson, 2013; Kim et al., 2015)

Evidence base - SFBT 2014 India pilot study (Tribal community) External (non-native) providers within low-SES aboriginal community MH setting SFBT effective in reducing depressive symptoms 2014 Netherlands trial: (Web-based SFBT for youth 12-22 years) Web-based ‘chat’ style of interface – entirely virtual SFBT Waitlist in depressive symptoms 2018 SF-TIC trial (solution-focused trauma-informed care) Positive results among child welfare workers in building prosocial behaviors Facilitated adaptive functioning while preventing retraumatization (Koorankot et al., 2014; Kramer et al., 2014; Krause et al., 2018)

Evidence base – SFBT in education Research in applying SFBT focuses upon school counseling and social work, and within organizational structure and curriculum (Franklin et al., 2001; Gerlach, 2020) School counseling: Elementary (Springer, Lynch, & Rubin, 2000) Middle (Franklin et al., 2001; Franklin et al., 2008) High (Franklin et al., 2007; Litrell et al., 1995) Special needs (Lloyd & Dallos, 2008) In all cases, SFBT showed improvements and – when compared with other approaches – performed as well or better in fewer sessions

Treatment barriers Time Space Training Materials Permission

Strategies and techniques for implementing SFBT in the classroom Assessing for change Goal-setting Implementation and monitoring

First session – Assessment The first session consists of four important and related tasks: 1. Identifying goals 2. Revealing motivation(s) 3. Identifying exceptions and solutions 4. Establishing metrics [Do you notice anything missing from this?]

Task #1– Identifying goals Task Associated questions Determine what the person hopes to achieve from working together What do you hope to get out of our work together? How will you know if this is useful?

Task #2 – Revealing motivation(s) Task Associated question Determine what their life would be like if they met their goal(s) If tonight (while you were asleep) a miracle occurred and problem was resolved, what would be different when you awoke?

Task #3 – Identifying exceptions and solutions Task Associated questions Determine what they're already doing (or have done) that might help achieve their goal(s) Tell me about times when problem doesn't occur? When are the times that bits of the miracle already happen?

Task #4 – Establishing metrics Task Associated question Determine what might be different if they made a small step towards their goal(s). What would your parent (friend / teacher) notice if you moved another 5% towards the life you want to live?

Session 2 – Assessing and goal-setting During the second session, the focus is upon: Assessing for change Goal-setting Solutions and exceptions

Assessing for change: “Have you noticed a change since we met last time?” Things are starting to change or improve Ask additional questions about the changes, seeking details Focus is on ‘solution-talk’, emphasizing strengths/resiliencies “If these changes continue, is that what you would like?” Things are about the same “Is it unusual that things have not gotten worse?” (exception) “How have you managed to keep things from getting worse?” (solution) Moving toward ‘solution-talk’ Things have gotten worse (or continue to be challenging) Move into the rest of the session “How can I be helpful today?” “What would need to happen today to make this a useful session?”

Goal-setting As you might expect, goals should be: Specific Measurable Achievable Reasonable Time-bound More importantly, they should be solution-focused: “The teacher to treat me nicely” vs. “the teacher not to yell at me” “Graduating from high school” vs. “not dropping out of high school” “Having more energy” vs. “not feeling so tired all the time” “Facing my fears” vs. “not avoiding things I’m scared of”

Implementation – Solutions and exceptions As the therapist, listen for talk of solutions, exceptions and goals. Support them with enthusiasm, to keep solution-talk in the spotlight Three-step process: 1. Listen carefully for solution or exception 2. Punctuate by repetition, emphasis, detailing, and congratulating 3. Connect the exception to the goal (miracle) “If exception happened more often, would your goal be reached?” This uses different therapy muscles than problem-focused work! Reduce the focus on etiological and maintaining factors Increase effort toward solutions and signs of progress

Sessions 3-5 – Implementation and monitoring For the remainder of treatment, each session is focused on: Scaling of goals Solutions and exceptions Coping and compliments Experiments and homework

Monitoring – scaling of goals A powerful intervention in SFBT involves scaling each goal A subjective measure of where the client is with respect to a given goal. On a 0-10 scale (or Red-Yellow-Green, or Cheese to Deluxe pizza ) Where were things when we first set our initial session? Where are things now? Where will things be on the day after the miracle (‘success’ in therapy) Guidelines Find the type of scale (numbers, letters, colors, emojis, etc.) best for them! Give anchor points (beginning, middle, end) to set the scale Rather than arguing or shutting down a rating, seek to limit-test/expand

Why scaling? Two major components to scaling: 1. Solution-focused assessment (ongoing progress measure) 2. Standalone intervention (allows focus on previous solutions and exceptions, while punctuating new changes) With three possible inter-session routes: 3. Things can get better (Punctuate and focus on solution-talk) 4. Things can stay the same (Compliment maintaining, ask how they kept things from getting worse) 5. Things can get worse (Revisit goal and consider different solutions)

Implementation – Solutions and exceptions Again, follow the same three-step process: 1. Listen carefully for solution or exception 2. Punctuate by repetition, emphasis, detailing, and congratulating 3. Connect the exception to the goal (miracle) “If exception happened more often, would your goal be reached?” Modeling these steps consistently helps clients to internalize solution-talk in their day-to-day routines

Monitoring – Coping and compliments If a client reports the problem as not getting better, the coping question focuses on validation and solutional reframing: “That sounds hard; how do you cope with this as well as you are?” “That seems tough; how have you prevented if from getting worse?” Another feature unique to SFBT is use of a break: The therapist will usually ask the client to work on a task (homework list), then step out of the room for a short (5-minute) break The therapist will use this break to quickly write down feedback, a list of compliments, and suggested interventions After the break, compliments are given on participation and engagement

Experiments and homework In SFBT, there are two intersession activities discussed: Experiment – suggested by therapist, based on exceptions Homework – designed by the client, based on solutions/exceptions Homework is not considered a necessary ingredient. Non-completion is assumed to indicate: Something realistic interfered with completion (work, illness) Client did not find the assignment useful Assignment was not relevant to the intersession interval

Time for questions and answers Q&A

Where to get additional information http://www.sfbta.org https://www.sswaa.org https://www.solutionfocused.net https://www.nasponline.org

About the presenter Joshua M. Nadeau, PhD Clinical Director, Tampa Dr. Nadeau is a licensed psychologist (PY 9015) who directs the clinical programs at Rogers Behavioral Health’s Tampa location. Dr. Nadeau focuses on the use of cognitive behavioral therapy for the treatment of OCD and related disorders, as well as in the adaptation of evidence-based techniques to address the unique needs of youth and adults with autism spectrum disorder (ASD) and other neurodevelopmental disorders. Rogers Miami location 844-468-9696 or 350-929-0600 rogersbh.org/locations/miami-fl