deShazer emphasised the importance of building solutions Client-therapist relationship: the visitor, visitor, complainant and customer-type relationship. The. Many clinicians who have trained with deShazer and his partner,. Insoo Kim Berg , have Be able to explain the client-therapist relationship to each goal in any .. It is usually unnecessary to know a great deal about the complaint in order to seller, browser-listener, and visitor-host type relationship (Berg &. Miller, Insoo Kim Berg, along with her husband Steve de Shazer, founded the Brief B. Transform the client from being a "visitor" or "complainant" to being a "customer." .. This happens not only in therapy, but in other types of relationships as well.
These therapies focus on human interactions and the problems that evolve from ineffective ways of coping with situations. There is always some element of social interaction in the development, maintenance, and change process for any problem. By taking these interactions into account, the therapist can better support the client through the change process.
A basic tenet of this approach is the assertion that human problems can be understood by applying the principles of human systems.
Problems do not exist in a vacuum; they exist because of relationships with others. The strategic therapist believes that a positive change to one part of a system will positively affect the rest of the system.
This approach is distinct from a structural view of systems, however; whereas the structuralist sees the need to consider and try to change dysfunctional aspects of the larger family structure, the strategic therapist does not necessarily posit a systemwide dysfunction--only the existence of ineffective interactions within the system.
A strategic approach accepts the fact that clients may not always provide accurate information about the real nature of their problems. It is possible to work with the client's view of what is happening and make progress, even if that view is only partially "correct. The therapist might ask, "If your boss is driving you to drink, how does that happen and what can you do about that? By working within the client's frame of reference, the therapist can define what the client might do to change key interactions that contribute to substance abuse, without buying into the premise that it is only his boss' behavior that must change.
However, different models discussed later in this section use different tactics to explore the nature of the problem, as follows: The therapist using Eriksonian therapy seeks to define the client's problem in the client's terms and probe the way she understands the problem i. Compared to other strategic interactional models, the Eriksonian approach moves more quickly to action, seeks to effect change more quickly, and places greater emphasis on the unconscious processes underlying change.
The therapist using solution-focused brief therapy spends most of the first session defining goals. Throughout the session, the word "problem" is avoided. The therapist using the MRI model seeks to define the problem in the client's terms and understand the "frame" in a manner similar to the Eriksonian approach. However, this modality focuses on modifying ineffective solutions that have been previously attempted. The therapist using Haley's problem-solving therapy pays special attention to gaining an understanding of power issues in relationship to the problem e.
Later Sessions Once the therapist has encouraged a person with a substance abuse disorder to take further steps toward change, the subsequent sessions will focus on identifying and supporting additional steps in the same direction. The following are examples of techniques that might be used in the remaining sessions with the client in this case study. Set up a termination point. The therapist could ask the client to describe the signs that things are getting better for him, or ask, "What things will you be doing differently?
She could use affirmations, continue to use scaling questions, and "join" with the client by acknowledging how difficult it is to change and rebuild his life.
The therapist should also be aware of the client's motivation to change and continue to ask the client what he thinks will happen if changes take place. This technique demonstrates respect for the client's values.
The therapist could continue to gather information about the stressors that trigger the client's substance abuse and help him to determine how he can handle them differently. The therapist should ask the client about ways he has successfully handled stressors in the past and expand on those successes.
The therapist could use images and symbols to help the client see the problem in a helpful way. For example, the client might find a new job and throw himself completely into it. The therapist could tell him that he is a shining star: What can you do to keep shining? The therapist might also focus on assisting the client to improve other aspects of his life. The client's continued belief in his own strength and basic goodness should be supported.
The therapist should help him see himself as an individual who wants what's best for both himself and his family. One effective strategy is to encourage the client to adopt a "helper" role in some area of his life. This shifts the focus further from his view of himself as a helpless, incompetent addict to a strong, caring, competent person who can help others. This client's participation in AA might give him the opportunity to help others in this manner. As the end of the therapeutic process nears, the therapist helps the client prepare for the future.
Following are suggestions for how the therapist can do this. Prepare the client to maintain positive change through difficult times. It is useful to convey the idea that the learning curve is never a straight slope; rather, it is a curvy line, with peaks and dips.
There will be slips. It is unrealistic to expect perfection. Life will continuously have "ups and downs"--the goal is not to make things even but to cope effectively with these ups and downs. Identify what the potential next stressors and challenges will be.
“VISITOR,” “COMPLAINANT,” “CUSTOMER” REVISITED | Doing Something Different | Taylor & Francis Group
Work through the following question with the client: For example, how will significant people in his life react to his change in behavior? Ask the client to look into the future at the end of the treatment period and tell the therapist where he intends to be at a certain time this is an Eriksonian approach.
The therapist could ask for a specific date when the client expects to get there and ask the client to call the therapist on that date. This process sets up an expectation of progress and accountability. Through this work he came to emphasize unconscious factors in change and the importance of indirect ways to shift meanings and behavior. His approach is active, building on clients' resources to help them attain their goals. The therapist and client cooperate in building an awareness of the client's experience and an understanding of its meaning.
Together, they build a context for change. Erikson's interventions emphasize the following: Suggestion as a means of bypassing an impasse, reframing the problem, and taking a first step toward solving it Metaphor as indirect intervention--a way to help the client retrieve resources and create a unique response that builds a bridge for learning; the therapist uses the client's metaphors e.
In solution-focused brief therapy, the emphasis is placed on building exceptions to the presenting problem and making rapid transitions to identifying and developing solutions intrinsic to the client or problem Cooper, Basic tenets of this approach include the following: Focusing on competence rather than pathology Finding a unique solution for each person Using exceptions to the problem to open the door to optimism Using past successes to foster confidence Looking to the client as the expert Using goal-setting to chart a path toward change Sharing the responsibility for change with the client The basic tenets of the solution-focused model are fairly simple; they are the same when used for treating substance abuse disorders as they are for treating other mental health concerns.
A therapist uses these same principles for an individual client, family, or group. The therapist emphasizes finding solutions to a problem, not on discovering the cause or origins of the problem.
According to Giorlando and Schilling, The innovative perspective of solution-focused therapy shifts the emphasis from problems to solutions, empowering the client to access her internal resources, strengths, and past successes, with therapist and client working collaboratively to achieve change in a shorter time than that required by traditional schools of psychotherapy Giorlando and Schilling, Berg and Miller relate the "central philosophy" of solution-focused therapy in the following three rules Berg and Millerp.
If it doesn't work, then don't do it again--do something different! Solution-focused interviewing strategies include the following based on Giorlando and Schilling,presented in a typical sequence. These strategies can be applied at different points in the therapeutic process as appropriate. Ask the "miracle question" i. Ask about exceptions e. Explore differences between current status and the desired problem-free state e. Use scaling to determine how well the client thinks things are going, how willing she is to work toward the "miracle," her confidence in her ability to change, and the steps needed to improve the situation from one rating on the scale to the next highest.
Try taking "time-outs" and suggest to the client "While I step out, I want you to think of the next smallest step you could take that would bring you to the next number on the scale.
Many of these clients have never had this success acknowledged before. Suggest tasks that the client can perform to improve her situation e. The MRI Therapeutic Model The Mental Research Institute's brief therapy model is based on the belief that problems develop from, and are maintained by, the way that normal life difficulties are perceived and handled Fisch et al.
Solution Focused Brief Therapy | Presentation for ARP
Normal difficulties become problems when an individual continually mishandles a situation, using the same ineffective approach each time. A client's belief system can cause him to develop ineffective approaches to problems that result in maintaining or even exacerbating the difficulty.
The more the client uses an ineffective solution to solve a problem, the more the problem is reinforced and maintained. The solution lies in helping the client change his perception of the problem, then either modify the attempted solution so it has a greater chance of success or devise a more effective solution.
These new solutions generally referred to as second order change work best if they are sufficiently different from the ineffective, previously attempted solutions. In each session, practitioners using the MRI brief therapy model should try to do the following: Define the problem in behavioral terms.
For example, a client may say, "I feel compelled to join the others at work in drinking, although as a result I have such a 'short fuse' that I get in fights and even hurt my wife. What is her "frame of reference" or "position"?
It is important to understand how the client views her problem and what attitudes she has toward the problem. For example, a client might insist that her substance abuse is the result of pressures at work.
However, the therapist notes that she began using after the death of her spouse and therefore hypothesizes that the substance abuse is related to her deep grief. The challenge for the therapist is to work with the client's position in a way that allows for a more useful understanding of the problem, and therefore for new, more effective solutions. What behaviors are to be changed and what would be the signs of change? What has the client done to try to solve the problem?
What has worked, and what has not worked? Help the client change his perception of himself, others involved, or the problem situation so that new options can appear. Develop second order change. Help the client generate more effective solutions that lead in a different direction from the ineffective ones--either by modifying attempted solutions or by developing new ones. In the case of a client who has tried to control her drinking by obsessing over her need to stop drinking, the therapist might perceive that every time she thinks about controlling her drinking she activates her fears that she is weak and out of control.
The more she obsesses over controlling her drinking the more overwhelmed she becomes about the impossibility of the task. The therapist would try to help this client to stop obsessing over this task and instead view the situation as manageable and changeable in a step-wise fashion.
The therapist would help her see that she has been strong and capable in other aspects of her life and that she can make use of these strengths and competencies to handle his drinking problem.
Plan for maintenance of the new behaviors. Support continued improvement by preparing the client to meet future challenges and crises. The speed with which a therapist is able to move through these steps will depend on the client's particular problem, overall development, cognitive capacities, and his stage of readiness to change.
Haley's Problem-Solving Therapy Jay Haley wrote that "therapy can be called strategic if the therapist initiates what happens during the therapy and designs a particular approach for each problem" Haley,p. To do this the therapist will have to identify solvable problems, design interventions to resolve them, correct those interventions based on responses from the client, and evaluate the effectiveness of the therapy. Haley's problem-solving therapy emphasizes obtaining a clear statement of the problem and an accurate picture of the interactional sequences that maintain it.
Through observing the client's symptomatic behavior, the therapist can often understand the underlying problem metaphorically. For example, if a child runs away it can indicate that the family is "running away" from confronting an issue. This behavior often signals a solution as well, calling attention to what needs to be changed. To map out a family's organization, the therapist should observe communication sequences--who talks to whom, and in what order.
The therapist should try to answer questions such as, "What function does the symptom serve in stabilizing the family? The individual is not necessarily responsible for having created the symptom which would fit in well with a disease concept addiction.
According to Haley's model, a wife may drink to avoid expressing her rage at her husband for having an affair. The husband implicitly understands that by confronting his wife's drinking, a confrontation might ensue over his infidelity and that could destroy the marriage. He may be willing to change, but not from personal motivation.
The complainant is burdened by the problem, but she may see the solution as resting outside her influence. The customer is ready and willing to solve the problem. He is aware of both his contribution to the problem and its solution and is invested in addressing his behavior. The customer will consider new ideas and be open to new ways of solving the problem. Applying the 3 Types What not to do According to Kim Berg the three types are useful to the therapist, because the therapist can know how to interact within these relationships.
For example, she recommends that tasks not be assigned to complainants or visitors, because they are not asking for change. The best approach with these client types is to affirm their current successes, so that they desire to remain in therapy and eventually either find something to work on visitoror discover their contribution to the problem, and their role in its solution complainant.
These client types remind us to consider whether we started therapy well--on the client's terms. When you ask about her goals for therapy, she has difficulty articulating a specific goal. What is Jenny's relationship to therapy?
- Solution-Focused Therapy for Substance Abuse
- January 7, 2010
- 1 | The Visitor
A good systemic therapist would work with Jenny to get her husband to join therapy, but this is another post for another day. The main goal with visitor is to establish a meaningful connection, so that she is interested in returning to therapy.