regarded as the essence of life that drives our need to live, procreate and prosper. Aggression which is also known as the Thanatos represents the force of death and shows the need for us to live and eliminate threats to our life, capability and prosperity. While it might seem that Ego has a tough job balancing both Id and Superego, it does have some helpful support. There are some tools in the arsenal that the Ego can utilise in order to carry out its role of the mediator and to help secure it. These are known as Ego Defence Mechanisms or Defences. In situations where it is required for the Ego to satisfy both the Id and Superego, it will put into use the defences that are given in the table below. Ego defences need not always be unhealthy as can be seen in the examples mentioned above. As a matter of fact, inability or insufficient usage of these defences can lead to several other issues in the life of an individual. At the same time, over usage or wrong timing of these defences can also be equally detrimental. 3.2.5 Limitations Some of the resistances were peculiarities of the ego determined by heredity. Some were acquired in defensive conflicts. Few, like the ease or stubbornness with which libidinal cathexes were released from one object and displaced to another, were due to “changes in some rhythm of psychical life development which we could not yet apprehend.” Some of the resistances that prevented a release from illness were expressions of “the behaviour of the two primal instincts which are life and death, their distribution, fusion and de-fusion,” which permeated all provinces of the mental apparatus—id, ego, and the superego. The feeling of guilt and seeking punishment, is the result of the ego’s relationship with the superego, which accounted for the phenomena of masochism and negative therapeutic reaction, was only one expression of this resistance. The issues that are faced here are basically that it is difficult to test the Freudian theory due to the nature of its predictions (mostly those related to defence mechanisms), which are found to be unclear and unfalsifiable. Another issue is that those theories that could be tested cannot be supported with empirical evidence. 3.3 GOAL OF PSYCHOANALYTIC THEORY The purpose of psychoanalysis varies based on the recipient, but they focus mainly on personal adjustment, usually inducing a reorganisation of internal forces within the person. The main objective is usually to help the recipient to obtain insight to make them conscious of the psychodynamics that are the basis of their issues. This understanding enables the recipient to modify their present living situations. People continuously confront their repressed memories and learn to deal with related feelings, emotions and confusions. 51 CU IDOL SELF LEARNING MATERIAL (SLM)
The second objective is to support the recipient go through a stage of development that has not yet been solved in the primary phase. If successful, the recipients will be able to live a productive life and are free of their issues. The ultimate goal here is to enable the recipients to live successfully in the society by adjusting to its demands. The aim of psychoanalysis is that an individual is able to handle his or her unconscious impulses in a reasonable and mature way. But the question remains as to how the unconscious mind can be accessed. The methods used vary based on the practitioner. Few methods have been recommended by Freud to obtain the objective of psychoanalysis. Some of them have been given below: Free association Dreams or fantasies: Individuals can be taught to access and interpret long repressed memories or incidents that may be the root cause of their problems. 3.4 TECHNIQUES IN PSYCHOANALYTICAL THERAPY The six basic techniques of psychoanalytic therapy are Free Association, Dream Analysis, Interpretation, Analysis of Transference. These have been discussed in detail below 3.4.1 Free Association Freud and subsequent psychoanalysts widely used this technique as they considered that it provides important insights into the They were of the view that mental events are interconnected with each other in a meaningful way and the clue to what lies in the unconscious can be interpreted from the ongoing stream of thoughts, memories, images and feelings that we experience. It comprises of the person lying on a couch in a partly darkened room producing an uncensored, non-calculated account of their ponderings and emotions during the course of the session. The nature of responses made during a free association session indicate the concerns and preoccupations of the unconscious mind without interventions by the Ego or the conscious mind. Client reports immediately without censoring any feelings or thoughts. The individual is asked to lighten up or relax and freely recall childhood memories or emotional experiences. In this way, unconscious material enters the conscious mind, and the counsellor interprets it. Sometimes the individual might resist this exercise by trying to obstruct the memories or by dismissing their importance. Psychoanalysts make the most of these moments by attempting to support the individual to overcome their resistance. 52 CU IDOL SELF LEARNING MATERIAL (SLM)
3.4.2 Dream Analysis This is a particular tool belonging to the psychoanalytic school of thought proposed by Jung and Freud. It is the foremost scientific approach to the study of dreams. It gives an important set of clues to the unconscious mind, because dreaming is a thought to express levels of unconscious wish fulfilment expressive of the individual’s deepest conflicts and desires. According to Freud, dreams help us express our innermost desires and urges that cannot be expressed during the time we are awake as they are unacceptable to the society. This way, we can satisfy our secretive desires and urges which are usually buried in the unconscious when we are awake. Here, the client talks about his or her dreams to the counsellor regularly. Freud suggests that dreams are crucial to comprehending the unconscious. He was able to get significant insights into the root cause of his client’s issues through dream analysis. But Freud did not give any clear-cut methodology or processes to be used to understand and interpret dreams. Therefore, there is no way to ascertain if an interpretation is correct or not. The practitioner or counsellor makes use of techniques such as free association to bring forth unconscious memories. The clients are expected to recall the dreams they had. The counsellor then studies the dream and its aspects namely, the manifest and the latent material. 3.4.3 Interpretation The interpretation should include parts of all techniques that were mentioned previously. The counsellor helps the client understand the findings from various sessions of free association, dream analysis and resistances. Here, the counsellor guides the client in understanding the significance of personal experiences. Interpretation is based on the counsellor’s evaluation of the past experiences and personality traits of the client which could be the cause of his or her problems. The counsellor puts forth the findings and explains them to the client. Counsellors should also consider if their client are in the right frame of mind to consider their findings. Interpretation process should be well-timed so as to achieve a better insight into the unconscious mind and its urges. As a general rule, it is prudent to time the interpretation process when the occurrence to be interpreted is close to the conscious mind. Additionally, it is also necessary that the interpretation begins at the conscious level and extends only as far as the client is able to manage. Also, a resistance should first be acknowledged before going further to examine the conflict that caused it. 53 CU IDOL SELF LEARNING MATERIAL (SLM)
Defense Description Example arguing against an anxiety provoking stimuli denying that your physician’s diagnosis of cancer is correct and Denial by stating it doesn’t exist seeking a second opinion taking out impulses on a less threatening slamming a door instead of hitting as person, yelling at your Displacement target spouse after an argument with your boss avoiding unacceptable emotions by focusing focusing on the details of a funeral as opposed to the sadness Intellectualisation on the intellectual aspects and grief placing unacceptable impulses in yourself when losing an argument, you state “You’re just Stupid;” Projection onto someone else homophobia supplying a logical or rational reason as stating that you were fired because you didn’t kiss up the the Rationalisation opposed to the real reason boss, when the real reason was your poor performance taking the opposite belief because the true having a bias against a particular race or culture and then Reaction Formation belief causes anxiety embracing that race or culture to the extreme returning to a previous stage of sitting in a corner and crying after hearing bad news; throwing a Regression development temper tantrum when you don’t get your way forgetting sexual abuse from your childhood due to the trauma Repression pulling into the unconscious and anxiety sublimating your aggressive impulses toward a career as a boxer; acting out unacceptable impulses in a becoming a surgeon because of your desire to cut; lifting weights Sublimation socially acceptable way to release ‘pent up’ energy Suppression pushing into the unconscious trying to forget something that causes you anxiety Table 3.1: Interpretations in Psychoanalytical Therapy 3.4.4 Analysis of Transference Freud was instrumental in discovering and developing the transference concept which evolved further under other theorists. This concept stemmed out of improper conclusion to a treatment. The client starts feeling that the counsellor played a significant role in their past, usually the role of a parent. Here, there is a transference of feelings and emotions that the client could have experienced with someone else in the past, but which is now transferred to the counsellor. This is a common occurrence. Patients are not conscious of this transference of feelings that has taken place. Again, this enables the client to experience emotions that were previously buried. The feelings that are experienced could be favourable or unfavourable towards the counsellor. When the transference is positive, the client will have an optimistic outlook towards the counsellor. Strong positive feelings could also lead to sexual thoughts towards the counsellor. When the transference is negative, the client may become hostile especially if the client’s expectations are not met. This could cause counter transference. These occurrences lead to an increase in the emotional attachments which could impact one’s reasoning and behaviour in the relationship between a client and therapist (transference and counter transference). 54 CU IDOL SELF LEARNING MATERIAL (SLM)
3.5 CLIENT CENTRED THERAPY Client centred therapy was proposed by psychologist and humanist Carl Rogers in the 1940s and 50s. This is also called the person-centred therapy and is a non-direct method of talk therapy. History Carl Rogers is one of the most well-known and leading psychologists in the 20th century. He was also a humanist and strongly subscribed to the belief that people are basically good natured. He was also of the view that people wanted to realize their full potential and be the best that they can be. This is called the actualizing tendency. At the beginning, Rogers labelled his therapy as non-directive. He wanted to be non-direct, but later on concluded that therapists lead their clients on even in very minute ways. Not only that, even the clients have a need to be guided along by their therapists. Client-Centred Therapy: In due course the process came to known as client-centred therapy or person-centred therapy. It is now known as Rogerian therapy. Roger intentionally used the term “client” as opposed to “patient”. He was of the belief that the term patient referred to someone who was physically ill and was looking for treatment. By referring to the individuals who sought his services as clients, he paved the way for them to address the issues that they face, control their destiny and thereby prevail over their difficulties. This self-direction forms the crux of the client centred therapy. Rogers and Freud had similar views regarding the manner in which therapeutic relationships could help understand clients and lead to long-term changes. Freud focused his efforts on the unconscious memories and their interpretations which he believed were the source of his client’s problems. On the other hand, Rogers was of the view that a therapist should not direct their client. It follows that the therapist should not direct, be judgemental or give suggestions to the client. The client should also have an equal role to play in the therapeutic procedure. 3.6 STEPS IN CLIENT CENTRED THERAPY Clients are defensive and resistant to change. In this stage, the clients hang on their past experiences and the feeling and emotions that they had in the past instead of focusing on the present Rogers (1958). When the client accepts their present situation, they can move on. Clients become slightly less rigid and begin to discuss external events or individuals. In this stage, feelings tend to be described as “unowned” or even as past objects. Clients begin to discuss themselves. They perceive themselves to be an inanimate object and not a person. This is to avoid discussing the present situation. 55 CU IDOL SELF LEARNING MATERIAL (SLM)
Further progress is made, and the clients discuss deeper emotions as they have now established a personal connect with the counsellor. Clients begin to accept the present and can express their current feelings. They also gain confidence in the decisions they make. As a result, they start taking ownership of their actions. They start accepting irregularities and contradictions. The clients start becoming congruent and start developing Unconditional Positive Regard(UPR) towards other people. This phase suggests that the clients do not need counselling anymore (Wilkins, 2000). The clients become self-reliant, empathetic and thereby start showing UPR towards individuals in the external world. The final phase of the therapy is marked by the transition from heteronomy (ruled by outside forces) to autonomy (ruled by internal forces) (Kensit, 2000). 3.7 TECHNIQUES IN CLIENT CENTRED THERAPY There are a few core conditions, which he considered are necessary if clients need to make progress in counselling. These conditions describe counsellor qualities and attitudes, which will facilitate change and growth from within the client. One of the most crucial of these attitudes is the counsellor’s capability to gain an insight into the client’s feelings. Another is esteem towards the client, while a third describes the counsellor’s congruence or trustworthiness. Figure below shows the crucial conditions for effective counselling. Figure 3.2 : Crucial Conditions for Effective Counselling 3.7.1 Empathy The word empathy describes the counsellor’s capability to gain awareness of the client at a deep level. It involves an awareness of the issues that the client is actually experiencing. Rogers cites the internal frame of reference to denote the client’s unique experience of personal problems. The counsellor needs to get inside the client’s reference frame. If not accomplished, then no real point of contact is made between counsellor and client. Rogers 56 CU IDOL SELF LEARNING MATERIAL (SLM)
makes use of the term external frame of reference to explain this shortfall in understanding and contact. When a counsellor perceives the client from an external frame of reference, chances are low that the client’s view is clearly heard. To stay within the internal frame of reference of the client, it is required for the counsellor to listen carefully to what is being conveyed (both verbally and non-verbally) at every stage of counselling. The counsellor needs to imagine and appreciate the client’s situation, and this admiration for the client’s experience then has to be conveyed to him. 3.7.2 Unconditional Positive Regard All humans have a need for positive regard starting from infancy. This need is so imperative that small children will do almost anything for achieving it. People constantly seek love and respect from others. However, unfortunately they are often given these emotions and feelings conditionally . Parents may say, or imply, that their love is given on condition that certain criteria are met, and when this happens, it is impossible for children to feel valued for themselves alone. According to Rogers, the counsellors should unconditionally show warmth and positive attitude towards their clients for them to feel accepted. This will show that the clients are valued without any conditions attached, even if they perceive themselves to be negative, bad, frightened or abnormal. Acceptance implies a non-judgmental approach by counsellors, as it is basically caring in a non-possessive way. When attitudes of warmth and acceptance are shown during counselling, it is likely for the clients accept themselves, and become more confident in their own abilities to cope. However, acceptance of clients does not necessarily mean that the counsellors must approve of everything they do. The ethics and views held by clients may differ quite dramatically from those held by individual counsellors, but even in these circumstances clients deserve (and should receive) respect and positivity from the people in whom they confide. 3.7.3 Congruence or Genuineness The words genuineness and congruence describe another quality, which Rogers believed counsellors should possess. This quality represents sincerity, authenticity and honesty within the counselling relationship. In order to be genuine with clients, counsellors should be themselves, without any pretence or façade. This means, of course, that counsellors need to know themselves first. Without an understanding of one’s own self, it is not possible to develop an honest and open relationship with the clients. The significance of counsellor genuineness is that it acts as a benchmark for clients who may find it difficult to be open and genuine themselves. 3.7.4 Transparency This means even negative feelings, if any, regarding a client, are expressed. The therapist shows non-possessive feeling of love towards the client and can, after a point of time, be 57 CU IDOL SELF LEARNING MATERIAL (SLM)
empathetic enough to understand the client enough to metaphorically walk in the individual’s shoes. 3.7.5 Concreteness The next condition, concreteness, is the counsellor’s ability to focus on the client’s discussion on specific events, thoughts and emotions that matter while discouraging intellectualised story telling. Concreteness is a precaution against the rambling that can happen when other three conditions are employed without sufficient attention to identifying the client’s themes. If the counsellor accepts wholeheartedly that each client is a person and relates empathetically to their reality and behaves in a truthful manner, the client will be free to discover and express the positive core of his being. As clients perceive themselves more positively in the nurturing environment, they will function more effectively. Counsellors not only provide the nurturing environment that is missing in the client’s life but also serve as role models of how fully functioning persons relate with others. 3.7.6 Self-Disclosure The extent to which person-centred therapists may express and disclose information pertaining to themselves in person-centred relationships is contentious. Nevertheless, there is general agreement that self-expression, self-disclosure and willingness to be known are different from congruency. The therapist responds to their client from the therapist’s frame of reference. The therapist should be eager to know regarding the progress and success of therapy. The issue of a therapist’s self-disclosure to their client is constantly revisited and many are of the view that at times and in limited ways this could be a useful thing to do. Self-disclosure and self-expression are most likely to be useful to the client and the therapeutic relationship when: They are relevant to client and their present experiences. They are a reaction to the client’s experience. A reaction to a client is persistent and particularly striking. In reply to the questions and requests, the therapist answers openly and honestly and helps dispel the mystique. When it seems that the client has a question but does not directly voice it. To put forth an empathic observation – that is to convey a perception of a particular facet of the client’s communication or emotional expression To correct for loss of acceptance or empathy or incongruence. To give insights and ideas. 58 CU IDOL SELF LEARNING MATERIAL (SLM)
3.7.7 Cultural Awareness in Client Centred Counselling In Culture-Centred Counselling, recognising the importance of culture can augment therapy and result in effective treatment of all clients. This involves being culturally aware by acquiring knowledge which is required for all methods of treatment that could be used by a therapist. Cultural awareness means being cognisant of culture differences that may use different standards for loudness, speed of delivery, spatial distance, silence, eye contact, gestures, attentiveness and response rate during communication. Few examples of these would be: Arab people may avert their eyes when listening or talking to a superior. Someone from South America may consider it impolite if you speak with your hands in your pockets. Your Russian patients or clients may kiss you on the cheek to show gratitude. If your new colleague is from Norway, they may hesitate to use your first name until they know you better. For the Chinese or Japanese, showing happiness through facial expressions is allowed. They usually mask their anger and sadness as showing them to the outside world is considered unacceptable in their culture. All this may seem like a lot to consider, but the tips for considering cross-cultural communication are very basic: Use common words Follow basic words of grammar Avoid slang Repeat basic ideas without shouting Paraphrase important points Check for understanding 3.8 CLINICAL UTILITY OF CLIENT CENTRED THERAPY Particularly in his latter works, Rogers placed importance on those attitudes of the counsellor, which are the “necessary and sufficient conditions” for therapeutic change (1957). The particular techniques the counsellor uses, his training, technical knowledge, and skills are entirely secondary, compared to these basic characteristics of the counsellor. Success in therapy depends on the therapist/ counsellor communicating and the client perceiving 1. The therapist’s own congruence. 2. His positive regard for the patient, which is given unconditionally, and 59 CU IDOL SELF LEARNING MATERIAL (SLM)
3. His accurate empathic understanding. (Korchin, 1986) Concept of Self The self can be described as a differentiated part of the individual’s phenomenal or perceptual field defined as the totality of experience and comprises of the conscious perceptions and values of the ’I” or “me”. The self-concept denotes the individual’s acceptance of the kind of person he or she is. The self-concept is one’s image of oneself. Especially included in this are the consciousness of being (What I am) and consciousness of function (what I can do). The self-concept includes not only one’s perceptions of what one is like but also what one thinks one ought to be and would aim to be. This latter part of the self is called the ideal self. The ideal self is the concept of self which the individual would like to have most. It is similar to the superego in Freudian Theory. (Hjelle & Ziegler, 1992) Rogers suggests that when the self-forms, the organismic valuing process alone governs it. For example, a toddler or a child assesses each novel experience based on the manner in which it helps or stops his or her innate actualising tendency. Infants assess their experiences based on whether it is appealing to them or not, whether it is likeable or not and so on. These assessments are based on their unbidden response to experiences and completely authentic. The structure of self is subsequently shaped through interactivity with the environment, particularly the environment composed of significant others (e.g., parents, siblings, and relatives). As the child becomes socially sensitive and as their cognitive and perceptual abilities mature, the self-concept becomes increasingly differentiated and complex. To a large extent, then the content of one’s self concept is a social product. We have our true self and according to Rogers, we do have social self. Rogers believed that when we interact with significant people in our environment, like for instance with parents, brothers, sisters, friends, teachers, etc., we begin to develop a concept of self that is largely based on the evaluations of others. That is, we come to evaluate ourselves in terms of what others think and not in terms of what we actually feel. Such a self-concept carries with it conditions of worth. With unconditional positive regard, the self-concept carries no conditions of worth. In fact, there is a congruence between the true self and experience, and the person is psychologically healthy. Counsellor’s Congruence or Genuineness is the first and primary requirement, for nobody can respect others or be empathic unless he is himself open to experience, free of facade, and self-deceit. The counsellor should be aware of his own full experience and feelings and should be able to communicate them to the client openly where and when necessary. This does not mean that the therapist necessarily burdens the client with his personal feelings at every turn, but he should know them himself and be willing and able to share them when necessary. Counselling or Therapy depends on the readiness of the client to share his deepest and most intimate feelings with the therapist. This is in fact hard enough to do under any circumstances and it all the more difficult if the therapist is not a real person himself. 60 CU IDOL SELF LEARNING MATERIAL (SLM)
Unconditional Positive Regard The therapist should convey to the client that he/she cares for them in a genuine manner, with faith in his own potential. This means making no judgments regarding the client, approving some but not all of his actions or feelings. The therapist’s acceptance or warmth is given unconditionally. He is as ready to accept negative as much as he accepts the positive feeling from the client. It is an un-possessive regard for the client as a unique individual, which allows the client freedom to have his own feelings and his own experiences. (Rogers, 1966) in his later work with schizophrenics, came to realise that grossly immature or regressed clients may require more conditional regard, as for instance, telling the client, “I’d like you better if you acted in a more mature way.” However, with most clients, unconditional positive attitude remains one of the essential requirements of therapy. According to Rogers, everyone has the natural desire to have love, respect and admiration from important people in their lives. This requirement for positive regard stems from self- awareness, and it is all-consuming and persistent. This can be first noticed in an infant’s need for love and affection and is mirrored in the manner in which an individual rejoices when approval is shown and gets frustrated when disapproval is shown. Rogers suggests that positive regard may either be natural or developed later on. He further explains that imposing conditions to a child to assess their worth could lead to issues in their becoming a wholesome individual. A child tries to imitate others and tries to achieve benchmarks set by other people rather than striving to achieve what he or she really wants. Thus, he comes to evaluate his worth as a person (valuable and invaluable) in terms of only those emotions, actions or thoughts that received approval and support. He will feel that in some respects he is prized and in others not. This process results in a self-concept that is out of tune with organismic experience and hence does not act as a solid foundation for psychological health. (Hjelle & Ziegler, 1992) Rogers feels that it is feasible to give or receive positive regard irrespective of the worth placed on specific facets of a person’s behaviour. This means than an individual is accepted unconditionally. This unconditional love and affection can be viewed in a mother’s love for her child. It follows that having unconditional positive regard does not mean an absence of discipline and rules in a child’s upbringing. It is just that the child feels secured and are given love and affection no matter what. When children perceive themselves in such a way that no self-experience is more or less worthy of positive regard than any other is, they are experiencing unconditional positive self-regard. Unconditional positive regard is when a child feels that no action of theirs can impact the positive regard they receive. For Rogers, the existence of positive self-regard that is unconditional enables an individual to progress toward becoming a completely functioning person. In such people, the “self” is deep and broad as it contains all the thoughts and emotions that a person is capable of experiencing. 61 CU IDOL SELF LEARNING MATERIAL (SLM)
3.9 SUMMARY Psychotherapy is process in which people with psychological problems and mental issues interact with a psychotherapist who supports them to change certain activities, thoughts and feelings so that they can live better. The outcome of psychotherapy is dependent on the client, the therapist and the processes used by the therapist. Many variants of psychotherapy exist, ranging from the methods used by Freud through modern techniques base on learning and cognition. Psychoanalysis is a process of psychotherapy that focuses on helping individuals gain knowledge of their hidden inner conflicts and repressed wishes. The objective of Freudian psychoanalysis is to have an awareness of the unconscious mind to deal with behavioural issues in the current environment. The major methods that are followed are free associations, dream analysis, resistance and transference. Psychodynamic therapists view maladaptive behaviours as symptoms of an underlying conflict that have to be resolved if behavioural issues are to address. The client centred model has an optimistic view of people in general. Clients are good and possessing the capabilities for self-understanding, insight, problem solving, decision making, change and growth. The counsellor’s role is similar to that of a facilitator and reflector. The counsellor facilitates a counselee’s self-understanding and reports to the client the expressed feelings and attitudes. In this therapy, giving information for problem solving is not usually considered a counsellor responsibility. The counsellor would not try to disturb the counselee’s inner world but provides a climate where the counselee could bring about change in himself. The crucial conditions of counselling as described by Rogers are empathy, unconditional positive regard and congruence or genuineness, which are considered mandatory for therapeutic personality change. The counselling skills, which are necessary for the development of a therapeutic relationship between counsellor and client, are active listening, responding to clients through reflection of feeling and content, paraphrasing and summarising, asking open questions and responding appropriately to silence and client nonverbal communication. Silence, acceptance, restatement, empathy and immediacy responses occur frequently when the client takes the lead on what is discussed and being responsible for outcomes. Client centred therapists encourage careful self-exploration, but they do not try to confront or interpret to gain insight quickly. How the humanistic counsellor deals with their client and motivates the person to utilise his/her maximum potentials rather than improving the past demerits of life. Healthy individuals, in Roger’s view, are those who can symbolise their experiences accurately and completely. Unhealthy people however distort or repress their 62 CU IDOL SELF LEARNING MATERIAL (SLM)
experiences and are therefore unable to symbolise them accurately and experience them fully. In Rogers’ view, the subjective experiencing of reality serves as the foundation for all the individual’s judgments and behaviour. It is this phenomenological, inner reality, rather than external, objective reality, that plays a major role in determining the person’s behaviour. This rationale tells us the phenomenological basis of Roger’s client centred therapy/counselling. Humanistic Psychology came into being forty years ago with the theory of development of human potential for the overall growth of the individuals. Humanistic psychology sees man as having purpose, values, options and right for self-determination, instead of being the helpless victim of his unconscious or of environmental reinforcement. Of his free will, he can maximise his potential for growth and happiness. The greatest of human motives is the drive to achieve self-actualisation. As per phenomenological view, what an individual perceives to be real is what resides within the internal frame of mind of the specific individual which includes all that is within their awareness at any time. Also, an individual’s reality is not made up of only their own thoughts or perceptions but also serve as a basis for their own actions. Each person reacts to situations based on how they perceive it. In client centred counselling the particular techniques the therapist uses, his training, technical knowledge, and skills are entirely secondary when compared to the basic qualities of the therapist. Success in therapy depends on the therapist/ counsellor communicating and the client perceiving. The therapist’s own congruence, his unconditional positive regard and his accurate empathic understanding towards the patient. According to Rogers, we have our true self, and we have social self. Rogers was of the view that when we interact with important people in our environment, like for instance with parents, brothers, sisters, friends, teachers, etc., we begin to develop an idea of self that is significantly based on the evaluations of others. That is, we come to evaluate ourselves based on what others perceive and not based on what we actually feel. Such a self-concept carries with it conditions for worth. With unconditional positive regard, the concept of “self” carries no conditions for worth. In fact, where there are similarities between “self” and experience, the individual can be considered to be healthy psychologically. Rogers feels that every individual has the need for genuine love, care and affection from important individuals in their lives. This need for positive regard is a result of self-awareness and is all-consuming. There is a possibility to give and receive positive regard without considering the worth placed on certain facets of an individual’s behaviour. The individual is accepted as they are unconditionally. For Rogers, the existence of unconditional positive regard enables an individual to progress toward becoming a completely functioning person. In such individuals, the 63 CU IDOL SELF LEARNING MATERIAL (SLM)
“self” is deep and broad since it contains all the emotions and feelings that the person is capable of experiencing. As per Rogers, if there is a significant degree of incongruence between one’s concept of self and one’s evaluation of experience, then one’s defences may become non-functional. In such a ‘defenceless state’, with the incongruent experience accurately symbolised in awareness, the self-concept becomes shattered. Thus, personality disorganisation and psychopathology happen when the self is unable to protect itself against threatening experiences. Progress in counselling requires the counsellor to perceive feelings and experiences sensitively and accurately and to perceive and convey their meanings to the client during the therapeutic counselling sessions. Accurate empathic understanding happens when the therapist can sense the client’s inner world as if it were his own. In fair measure, the therapy’s success depends on the communication, and perception, of the therapist’s attitudes. Improvement in the patient involves, in effect, his incorporation and utilisation of these attitudes as a part of himself. Therapy should, therefore, make him more congruent, be better able to give others unconditional positive regard, and be more accurately empathic in viewing himself as others. These three conditions describe the essence of client centred counselling, and figure prominently in Rogers’ theory of personality and social philosophy. Within every one of us, according to Rogers, there is an innate motivation called the self-actualising tendency and active, controlling drive toward fulfilment of our potentials that enables us to maintain and enhance ourselves. As per Rogers, the actualising tendency serves as criterion against which all one’s life experiences evaluated. People engage in what Rogers describes as an organismic valuing process specially in the course of actualising. 3.10 KEYWORDS Self-theory emphasizes on the set of perceptions an individual has for himself and the understanding of the relationships he has with other people and the other facets of life. Carl Rogers has contributed significantly towards the self-theory. Humanistic Psychology is a psychological perspective that gained prominence in the middle of 20th century as a response to the limitations of Sigmund Freud's psychoanalytic theory and B. F. Skinner's behaviourism. Aggression is a term that we use every day to characterize the behaviour of others and even of ourselves. According to social psychologists, aggression is a behaviour that is intended to harm another individual who does not wish to be harmed (Baron & Richardson, 1994). Phallic Stage is the third phase of psychosexual development, between the ages of three to six years, wherein the toddler’s libido (desire) focuses on their genitalia as the erogenous zone. 64 CU IDOL SELF LEARNING MATERIAL (SLM)
Acceptance as per human psychology is an individual’s acceptance of a situation by considering all the negative conditions attached to it without trying to modify it. This is similar to acquiescence which is derived from the Latin acquiēscere (to find rest in). 3.11 LEARNING ACTIVITY 1. Conduct a session related on Is the ego, id, or superego the most important to the human condition? Explain your answers. ………………………………………………………………………………………………… …………………………………………………………………………………………………. 2. How will you keep employees updated with current developments and ideas about business training? ………………………………………………………………………………………………… …………………………………………………………………………………………………. 3.12 UNIT END QUESTIONS A. Descriptive Questions Short Questions 1. Write a short note on Freudian Psychoanalytic Therapy 2. What are the techniques in Psychoanalytical Therapy? 3. List down the techniques in Client Centred Therapy. 4. What are the core conditions of Rogers’s therapy for effective counselling? 5. What is self-disclosure? Long Questions 1. Explain Freudian Psychoanalytic Therapy and its various stages. 2. Explain the Client Centred Therapy and its techniques. 3. Explain the techniques in Psychoanalytical Therapy. 4. List the stages of Client Centred Therapy. 5. Briefly explain clinical utility of Client Centred Therapy. B. Multiple Choice Questions 1. Rogers core principle concentrate on _________ a. Empathy b. Unconditional positive regard c. Genuineness d. All of these 65 CU IDOL SELF LEARNING MATERIAL (SLM)
2. Freud’s theory emphasises ______as a major driving force in human nature. a. Sex b. Emotions c. People d. None of these 3. Which one of these is _____structural and topographical models of personality? a. ID b. Ego c. Superego d. All of these 4. Which of the following is not a Self-disclosure, which will be helpful to the client and the therapeutic relationship from? a. Response to the client’s experience. b. To make an empathic observation c. To point the attitude d. To correct for loss of acceptance or empathy or incongruence. 5. Psychoanalysis varies according to the client, but they focus mainly on __________. a. Personal adjustment, b. Finding problems c. Solutions to problems d. None of theses Answer 1 d) 2 a) 3 d) 4 c) 5 a) 3.13 REFERENCES Textbooks Capuzzi, D. Gross,D.R.(1999). Counselling and Psychotherapy: Theories and Interventions. Second edition. Merrill, Columbus, Ohio. Hough, M. (2006). Counselling Skills and Theory. Second edition. Hodder Arnold, Great Britain. 66 CU IDOL SELF LEARNING MATERIAL (SLM)
Reference Books Kensit, D. A. (2000). Rogerian theory: A critique of the effectiveness of pure client- centred therapy. Counselling Psychology Quarterly. Elaine Biech, 2015, Training & Development For Dummies, Wiley Publications Cooper, M., & McLeod, J. (2011). Person-cantered therapy: A pluralistic perspective. Person-Cantered & Experiential Psychotherapies. Websites www.health.harvard.edu https://www.simplypsychology.org https://courses.lumenlearning.com 67 CU IDOL SELF LEARNING MATERIAL (SLM)
UNIT - 4 PROBLEM FOCUSED PSYCHOTHERAPY Structure 4.0 Learning Objectives 4.1 Introduction 4.2 Concepts of SFBT (Brief Problem-Focused Therapy) 4.3 Development of Therapy 4.3.1 Ways of Knowing: Extending the Possibilities for Solution and Focused Practices 4.3.2 Scope of SFBT: A Review Based Theoretical Overview 4.3.3 Coaching: Starting from a Positive Ideal 4.3.4 The Solution-Focused Brief Therapy; Theory and Development 4.4 Concept of Psychotherapy 4.4.1 Definition 4.4.2 Aims of Psychotherapy 4.5 Summary 4.6 Keywords 4.7 Learning Activity 4.8 Unit End Questions 4.9 References 4.0 LEARNING OBJECTIVES After studying this unit, student will be able to: Describe the concepts of solution focused based therapy. State the aims of psychotherapy. Discuss the development of therapy of SFBT. Describe the brief history of SFBT. 68 CU IDOL SELF LEARNING MATERIAL (SLM)
4.1 INTRODUCTION Solution-focused brief therapy (SFBT) is a strengths-based intervention that was developed in the 1980s by Steve de Shazer, Insoo Kim Berg, and colleagues from the Brief Family Therapy Center (BFTC) in Milwaukee, Wisconsin. Previous research studies conducted on SFBT have inferred that it is really an effective intervention. Research on this model is still growing, with recent studies utilizing more rigorous research designs. Even though SFBT has been hailed as a recognized therapeutic model applicable to social workers and practitioners working in various disciplines, the present policy demands compel social workers to reflect effective services and to choose therapy interventions that have research support. Managed health care organizations have pressed for evidence-based treatment approaches, for example, and it is unlikely the mandate for research-supported practice will disappear any time soon. More recently state funding agencies have required that therapy interventions show evidence or be recognized and approved by federal agencies as evidenced-based interventions (e.g., the Substance Abuse and Mental Health Services Administration [SAMHSA] and the National Institute on Drug Abuse) or otherwise defend with research studies about the efficacy of the approaches being in application in community-based agencies. There are certain states moved for developing their lists of approved and evidence-based practices (EBP). This trend is a very new and subject to vary across states and as per local jurisdictions. It has the potential to raise the bar for making practical interventions and suggests agencies and involved practitioners to adhere to prescribed research standards while implementing community- based interventions. As of now, SFBT is in wide application in the community. However, it gets omitted from the present federal and state lists of EBP mostly because SFBT hasn’t got any recognition from relevant agencies to get adequate empirical support. Nonetheless, research on emerging practice approaches, like SFBT, is going on and quite promising, and efficacious interventions are being identified. It is generic that the practical knowledge and developments don’t make progress like the research knowledge and developments, thereby hinders the updates making their entry to the field in fashionable way. This is the scenario with therapy research and lists containing authorized community practices having proof. In this regard, Kim carried out a meta-analysis on SFBT and identified small results but are positive, especially for incorporating behavior problems such as depression, self-concept, and anxiety, among others., These results were subjected to comparison with other meta-analyses on social work practices and psychotherapy. Similarly, another meta-analysis conducted by Stams, Dekovic, Buist, and de Vries, it was inferred that small to moderate effects in which SFBT was better to no other treatment and as good as other treatments. Moreover, it was identified that the best outcomes were for change in behaviour at personal level and SFBT was in need of fewer sessions as compared to other therapies having identical results. Similar kind of systematic review carried in recent times on SFBT studies assessing outcomes right from children to adolescents in schools by Kim and Franklin led to the outcome that SFBT had many positive outcomes, as was demonstrated by medium and some large effect sizes 69 CU IDOL SELF LEARNING MATERIAL (SLM)
calculated for the specific behavioural and academic results that were being evaluated. With the recent increase in outcome of studies and these meta-analyses studies on SFBT, the following authors wanted to know: What is the basis researchers provide latest information to community-based practitioners in a timely fashion, and the way a therapy model for instance SFBT gaining momentum in research studies need to be taken into consideration for including in the lists of EBP. We were in confusion that how SFBT is subjected to rating by federal and state agencies facilitating registries that determine therapies as evidence-based, given the current research studies that involved sterner research designs. This reflects the objective of this article is for explaining the process of SFBT being examined by federal and state registries and thought about its insertion on the EBP lists. Our belief is that experience gained in the study would be useful to researchers and practitioners in need of getting answers to similar questions related to social work practice and concerned about interventions at the community level in their agencies that may not, still have been decided through registries and funding authorities as evidence-based. So, we start it by providing a general outlook on SFBT and EBP. Then there is a discussion on the effect of EBP on SFBT, which also include the process and results of SFBT reviewed to add it to the EBP registry lists involving the United States. 4.2 CONCEPTS OF SFBT (BRIEF PROBLEM-FOCUSED THERAPY) Solution Focused Therapy (SFT) is a type of brief therapy which builds upon clients’ strengths by helping them to evoke and create solutions to their problems. It emphasises more about the future rather than the past or the present. When it comes to a solution-focused approach, the counsellor and client devote a greater proportion of their time to solution construction than to problem exploration. Then they make effort for defining as clearly as possible as per the requirement of the clients to look through in their lives. This unit will offer an overview to the general structure of Solution Focused Therapy. These following sections have been added in this unit: overview, description and basic tenets of SFT, ingredients of solution focused therapy, the process and treatment principles of SFT, various intervention techniques and applications of solution focused therapy The Solution focused perspective originated in family therapy. Solution Focused Therapy treatment is on the basis of more than twenty years of theoretical development, clinical practice, and empirical research of the family therapists Steve de Shazer, Kim Insoo Berg and colleagues at the Brief Family Therapy Centre in Milwaukee, including Bill O’Hanlon, a therapist in Nebraska. The members of the Brief Therapy Practice in London pioneered the method in the United Kingdom. Solution-Focused Therapy is different in many ways from traditional approaches to treatment. Thus is a competency-based model, which minimises emphasis on past failings and problems, and instead focuses on the strength of client and previous successes. Again, emphasis is given on working from the understandings of client and his/her concern or situation and there may be different demand by the client. The basic tenets that inform Solution-Focus Therapy are as follows: It is based on solution building 70 CU IDOL SELF LEARNING MATERIAL (SLM)
rather than problem solving. The therapeutic focus should be on the client’s desired future rather than on past problems or current conflicts. Clients are encouraged to increase the frequency of current useful behaviours No problem happens all the time. There are exceptions that is there are times when the problem could have happened but did not. Client can use this to co-construct solutions, so can a therapist. Therapists play a role in helping clients in finding alternatives to unexpected patterns of behaviour, interaction, and cognition that remain in the repertoire of the client or can be co constructed by therapists and clients as it is. The model considers that there is already solution behaviours because its skill building, and behaviour therapy interventions is something different from others. It can be ascertained that a baby step towards changing increments lead to huge increments of change. Here the solutions of the client might not have any direct linkage to any kind of identified problem either by the client or the therapist. For a therapist, the communication skills matter for inviting the client for developing solutions. However, this skill is different from those professionals requiring diagnosing and treating problems of client. Solution Focused Therapy differs from traditional treatment in that traditional treatment focuses on exploring problematic feelings, cognitions, behaviours, and/ or interaction, providing interpretations, confrontation, and client education (Corey, 1985). On the contrary, SFT assists clients in developing an expected vision for the future, where the problem is likely to be solved, and research and amplify related exceptions of clients followed by strengths and resources to redevelop a client-specific passage to realize the vision. This is how each client finds way to a solution as per the definitions of goals, strengths, strategies, and resources. The client takes the initiative in stating the nature of resources and their application even in cases like the client relies on using outside resources for creating solutions. 4.3 DEVELOPMENT OF THERAPY de Shazer and staff working at BFTC made a deliberate effort for focusing on solutions rather than problems to deal with clients. Actually, it was something different from their usual task. In further developing the solution-focused model, specific techniques like miracle and exception questions were designed to aid in identifying solutions (see De Jong & Berg, 2008; de Shazer & Berg, 1997, for more details). SFBT comes under the purview of social constructionism metatheory due to its philosophy and there is a belief system that the application of language is for constructing reality for the client (Franklin, 1998). The experimental studies conducted on communication theory reflect that this kind of approach is dependent on usage of language strategically to bring a change in perceptions (Tomori & Bavelas, 2007). In SFBT, the therapist further uses language and resort to Socratic questioning to construct goals in tandem with the client and works collaboratively to iron out the problem by utilizing the client’s strengths. The goals define what clients looking for different in their lives, and resources are identified to attain these goals (Berg & De Jong, 1996). A part of the intervention’s plead to people involved in social welfare lies in its strengths-based focus. De Jong and Miller (1995) drew the attention of others that that the 71 CU IDOL SELF LEARNING MATERIAL (SLM)
history on has its origin in the principles that are based on strengths-perspective, still specific social workers seek specific tools and techniques while there is hardly any strengths-based practice. Building on Saleebey’s (1992) summary of strengths-based assumptions and principles, De Jong while working with Miller developed a case study on SFBT leading social work’s customs of using strengths-based principles by incorporating various solution- focused brief therapy techniques and assumptions. SFBT is one of the sought-after models of therapy in the profession of social work. The reason behind it is that it has roots in the resiliency, previous solutions, and exceptions of the client. Again, it has been applied to the majority of problems and populations involving social workers. All these have included sexual abuse (Dolan, 1991), family therapy (McCollum & Trepper, 2001), substance abuse (Berg & Miller, 1992; de Shazer & Isebaert, 2003), and persistent mental illness (Eakes, Walsh, Markowski, Cain, & Swanson, 1997). There are books on self-help written from a solution-focused perspective (Dolan, 1998), and solution-oriented principles are being applied to areas beyond the scope of psychotherapy, including interventions in social service agencies (Pichot & Dolan, 2003), education (Rhodes & Ajmal, 1995), and business (Caufman, 2001). From a preliminary manual developed by Trepper and McCollum (2003), the Research Committee of the Solution-Focused Brief Therapy Association (SFBTA) has developed a research treatment manual that fulfils the criteria for operating manuals proposed by Carroll and Nuro (1997). The manual describes the manoeuvre of the SFBT model with individuals and describes the following aspects of the model: (a) overview, description and SFBT rationality; (b) goals and the method of goal setting in SFBT; (c) how SFBT is distinct from other treatments; (d) active ingredients which are specific in nature and therapist behaviors in SFBT; (e) the type of relation between a client and a therapist in SFBT; (f) format; (g) format of the session and content; (h) congruence with concomitant therapies; (i) target population; (j) meeting requirements of people in special category; (k) characteristics of therapists and requirements; (l) therapist training; and (m) supervision (Trepper et al., 2008, p. 1). This manual serves as a structure or outline for those researchers in need of developing manuals for conducting certain SFBT studies while targeting problems. 4.3.1 Ways of Knowing: Extending the Possibilities for Solution Two particular experiences this year stimulated a growing curiosity about to which it could be considered as ways of knowing, and the connotations of this for my solution-focused practice. The first such experience occurred during the EBTA summer camp held on Inkoo Island belong to Finland in July. The entire group was in outdoors and standing in a circular curve. Ursula Buehlmann made a round along the circle with two packs of picture cards (Zürcher Ressourcenmodell), where each one was asked to select a card representing a fine outcome to which we were planning then. We were then invited to observe the picture and just let our thoughts happen. Specifically, we were told not to disclose what we were thinking. The more I saw at the picture, without talking, the more my thoughts developed. The second experience took place in a workshop in the form of a circle dance along with 72 CU IDOL SELF LEARNING MATERIAL (SLM)
poetry in an EBTA conference with venue in Bruges in September. Once we were done with the circle dancing, we were given instruction to write a poem highlighting the pantoum’s structure. In particular, we were instructed to just let our hands do the writing. My hand took me by surprise when I saw what it had written. In the introductory part of More than Miracles, the group united to have a healthy discussion on their practice that are purely solution-focused. Then write the book “seasoned therapists” (2007, p. xii). Here there is a condition that my clients and colleagues could only decide whether I should consider as a seasoned therapist or not. Still, I am quite aware of the fact that my solution-focused practice matters in various ways ever since I was introduced to the conditioned approach in 1991, i.e., taking – feedback from clients, reviewing videos of the therapists that I have got inspiration. All these aspects have been mentioned in the workshops conducted at various conferences. In this ongoing paper I would like to present some contemporary thoughts on differences between Steve de Shazer and Insoo Kim Berg in context to the methods of knowing and will share three case studies, where other methods of knowing could be helpful to the client. Then I consider of these numerous ways of knowing could have linkage to some new sources of inspiration in the realm of philosophy. So, I want to reach with a conclusion with questions regarding how we should rely on solution focused, when other means of knowing have their existence into the work. How SFBT Came About We can go through various versions of the SFBT regarding its existence. Eve Lipchik, is one such example, remembered that the approach was, “…the end result of the efforts made by a group of people sitting around at the Brief Family Therapy Centre in Milwaukee … and one energising another with their fervour for coming up with new ideas concerning the way people change.” (2002, p. xiii) I have a vivid memory of suggesting people seasoning with each other. Much gratitude to the work done by this group, where they introduced me regarding their ideas, where my work has got recognition since 1991. Positive goals for making change to assist people work out as per their requirement. Exceptions to help people recognise times when they have the opportunity of getting lifetime experience as per their need. Raising questions to guide people notice their journey so far as they like to be along with positive indications of progress. There is a Miracle Question in this respect to aid people work out as per their wishes and a little bit signs of progress. Positive feedback for helping people recognise how some degree of success has already happened. 4.3.2 Scope of SFBT: A Review Based Theoretical Overview The design and development of solution-focused approach is as per the strength-based approach having emphasis on the strength and resources of the client and gives all the power 73 CU IDOL SELF LEARNING MATERIAL (SLM)
to fix their own problems. By imploring the hypothetical solutions, miracle questions and inquiring about exception to the problem, Solution Focused Brief Therapy (SFBT) emphasizes on the solutions but considering the chronicles of the problem. In SFBT, therapists provide guidance to clients in finding out suitable alternatives to the present undesired state, which are believed to be within the clients’ collection or could be redeveloped by therapists and clients. SFBT emerged in 1980’s when de Shazer, Berg and their colleagues at their Brief Family Therapy Centre, Milwaukee started using their insights of carefully observing the cases to ascertain what was useful during therapy such that the client, rather than the therapist, was in authority of deciding the goals of the therapy and how it worked in a successful therapy. Shazer and Berg were in disbelief that one should get aware of the source of origins of the problem to solve it. SFBT has become a widely used approach in a broad range of contexts, including schools and family settings, and individuals, professionals and members of the community (Corcoran & Pillai, 2007; Kim & Franklin, 2009). However, an approach must be a testimonial based for the therapists to use it and for clients to know whether the approach being recommended is effective. The past studies done on solution-focused approach have brought out much evidence for SFBT as a successful intervention and the study on the same are still growing, with recent studies using more stern research designs. An attempt has been made here to conduct a literature review on SFBT and a few relevant studies demonstrating the effectiveness of solution-focused models in diverse settings are discussed. While evaluating the usefulness by means of an intervention, meta-analysis study is considered to provide the strongest evidence followed by studies based on experimental design. A metaanalysis inquiry by Stamps et al (2006) through 21 international studies including 1421 clients indicated that SFBT doesn’t tantamount to a larger effect than problem- focused therapy. However, they found that it produces a positive effect in less time and its technique of letting the clients chose their goals and solutions tend to provide more autonomy to clients when compared to other traditional methods of psychotherapy. SFBT was also shown to have best results for personal behavioural changes. Kim (2008) carried out a meta-analysis on SFBT examining 22 studies in three categories namely, externalizing behavior problems, internalizing behavior problems and family and relationship problems. He identified small rather positive results, when it comes to internalize behavior issues such as depression and anxiety including self-concept. Besides meta- analysis studies there were systematic reviews analysing numerous outcome studies, which had brought a comprehensive picture about SFBT. In the systematic review done by Gingerich and Eisengart (2000), 15 outcome studies were identified, and the conclusion drawn from those studies was suggesting a preliminary evidence for the efficacy of solution-focused therapy. Corcoran and Pillai (2009) in their comprehensive research study found that SFBT was highly effective in various therapeutic conditions including suicide prevention interventions (Rhee, Merbaum, Strube, & Self, 2005), marriage counselling (Zimmerman, Prest & Wetzel, 1997) and criminal offending (Lindforss & Magnusson, 1997). Gingerich & Peterson (2013) in this 74 CU IDOL SELF LEARNING MATERIAL (SLM)
regard conducted a qualitative analysis of 43 controlled outcome studies on SFBT and concluded that SFBT is a potent approach with many different psychosocial conditions with children and adults. The robust evidence in support of the efficacy of SFBT came to notice for depression treatment in adults and reviews supported the finding that SFBT was briefer, and costs reasonably as compared to alternative approaches. Bond et al (2013) in their systematic and critical evaluation of 38 studies in SFBT with children and families provided preliminary support to use SFBT, especially in terms of early intervention at a time where problems don’t appear so severe. Studies that establish SFBT as a valid tool to treat the problems related to children and adolescents were also immense in literature. In a study done by Zimmerman et al (1996), SFBT was used to demonstrate the improvement of the parenting skills of parents of adolescents. For comparing the effect of SFBT, a group of 30 parents received SFBT, while a group of 12 parents were put on a wait- list control list. The parents in the SFBT group showed more improvements than the control list. Triantafilou (1997) proved that SFBT is instrumental in minimizing behavior related disorder symptoms among children. On the other hand, the study by Littrell, Malia, & Vanderwood (1995) concluded that SFBT was really helpful for students in high school for enhancing mood and meeting goals. In this regard, Daki & Savage (2010) assessed the strength of SFBT in overcoming academic, socio- emotional, and motivational needs of children having reading difficulties, where the results showed that SFBT has the potential to improve children’s listening comprehension and reading fluency. Newsome (2004) conducted a study involving at-risk junior high school students, in which he demonstrated significant improvements in grades of experimental group getting SFBT when compared to that of control group. In a study with obese children, the families of obese children received solution-focused family therapy and the post session tests implied that there were remarkable improvements in weight loss, self- esteem and family climate (Novicka et al., 2007). One more study evaluated and suggested about the advantage of SFBT in a classroom environment as was conducted by Franklin, Moore, & Hopson (2008), where it has been confirmed that SFBT is valuable in improving the externalized and internalized behaviors of students. Corcoran (2006) in her study used SFBT to treat children with behavior problems and the results of the study indicated that there were higher treatment engagement in SFBT group while making comparison with other group who received ‘treatment as usual’. So many outcome studies have been done to prove the application of SFBT in clinical setting. Chung and Yang (2004) conducted a study in which solution focused group counseling was provided to the experimental group of families with schizophrenic patients. After eight group sessions post session measures revealed major reduction in family burden and expressed emotion in the experimental group as compared to control group. A study done by Wettersten et al. (2005) explored working alliance and therapeutic outcome and showed that six sessions of SFBT produced significant improvement in psychological symptoms. Eakes and 75 CU IDOL SELF LEARNING MATERIAL (SLM)
colleagues (1997) demonstrated the impact of SFBT in schizophrenic patients and their family members. There is a group of clients and their respective families got conventional outpatient therapy, whereas an experimental group of clients including their near and dear ones were provided treatment with a SFBT model. The SFBT group showed significant improvement in expressiveness, active-recreational orientation, moral-religious emphasis and family incongruence than control group. Lee et al. (2001) used SFBT in the treatment of depression and post-treatment measures as well as follow-up measures after six months revealed about noteworthy improvements in the symptoms. Hanton (2008) studied the effect of SFBT on seven depressed adults and the Beck Depression Inventory scores were found to have an improvement by an average of 55.12 per cent in the post session measures. In the case of specific populations, a study conducted by Estrada and Beyebach (2007) demonstrated significant differences in pre-post test scores on the Beck Depression Inventory-II (BDI-II), indicating that the SFBT treatment was effective in reducing the depressive symptoms of people with hearing impairment. Again, SFBT has been in application to treat other groups such as problem drinkers (Berg and Millers, 1992), sexual abuse survivors (Athood and Donheiser, 1997) and also in reducing domestic violence (Milner, 2008). Lindforss et al (1997) demonstrated the impact of solution-focused therapy in prison. In their study involving 30 prisoners in experimental group and 29 in control groups a follow up after 16 months showed that 60 per cent in the experimental group reoffended comparing to 86 per cent in the control group. It was also reported that there were more drug offenses and more total offenses in the control group than in the experimental group. Rhee et al (2005) conducted a study where they used brief telephone psychotherapy with callers to a suicide hotline. The callers either received solution-focused therapy or common factor therapy and some were in wait list control group. Both the treated groups showed significant improvements on post measures. Roeden et. al (2012) conducted a controlled study in which people with intellectual disabilities received either solution focused brief therapy or care as usual (CAU). It was found that the SFBT group did well than the CAU group involving psychological functioning, maladaptive behaviour, social functioning, , autonomy and social optimism. Cockburn et. al (1997) used Solution focused group therapy for rehabilitating orthopaedic people indulging in a work hardening program. Results indicated that 68 per cent in experimental group were at work within 7 days while only 4 per cent in the control group went back to work in the identical time period. A randomized study compared the effect of solution focused versus problem-focused coaching questions concerned with a real-life problem that the participants needed solving. Solution- focused questions produced a significantly greater increase in self-efficacy, goal approach, and action steps than problem- focused question (Grant, 2012). Indian practitioners have also begun to adopt solution-focused approach in clinical settings. However, literature review indicates very less studies published in solution-focused approach, where certain studies were being discussed here. Koorankot et al (2014) used SFBT to treat nine clients with depressive disorder who belonged to tribal community. Beck Depression 76 CU IDOL SELF LEARNING MATERIAL (SLM)
Inventory scores decreased significantly in the post session measures indicating that SFBT was really useful in allaying the depressive symptoms among the clients. In a case study by Reddy et al (2015) SFBT was shown to decrease the depressive symptoms and increase scholastic performance of a19-year old girl. There is growing evidence that SFBT is briefer comparing to other psychotherapy techniques. Clients can be treated sufficiently with SFBT, without much elongated and elaborative diagnosis (Gingerich & Peterson, 2013). A comparative study between a single session of SFBT versus interpersonal psychotherapy among 40 college students indicated no significant difference between the two treatments, demonstrating that single session. SFBT was effective in reducing depressive mood (Sundstrom, 1993). Lambert et al (1998) reported a treatment comparison study using OQ45, a self-report questionnaire measuring changes in symptoms, relationships and social functioning resulting from psychotherapy. The comparison study between 22 cases treated with solution focused therapy and 45 cases treated with psychodynamic psychotherapy revealed that both methods achieved 46 per cent recovery. The difference was that when solution focused therapy achieved the results in the third session of psychodynamic, psychotherapy took 26 sessions to achieve the same results. Littrell et al. (1995) in his study involving three treatment groups gave a problem- focused session followed by a task to the first group, second group received a session about the problem without task being followed and the third group was given a solution-focused session. Results indicated that sixty-nine percent were better in all groups, but the solution- focused sessions were shorter than those of the other groups. It takes minimum time and is reasonable, thereby making it a popular technique among clients and therapists. Based on the review of studies in solution focused brief therapy, it might be inferred that there lies a strong evidence that SFBT is really a worthy treatment for a variety of psychological and behavioural problems and across varied fields such as educational setting, clinical setting, prison, family counselling, and work and psychosocial rehabilitation. Various comparison studies indicate that SFBT is a briefer and less costly therapy when compared to other alternative approaches. From the literature analysis, it can be said that number of studies on SFBT has steadily increased with its setting and group of people in question being varied. Studies done in India are very few, however, the trend seems to be positive. 4.3.3 Coaching: Starting from a Positive Ideal At the NHL University in Leeuwarden, the student makes a “personal development plans” (PDP) with the help of a mentor. The learning goals are described, and the student adheres to this plan, and keeps track of what is achieved, and what still requires initiating. The focus of this plan is especially what is not mastered. It is well-known in current literature, that a positive self-image is seriously more inviting and motivating for exploring new possibilities from within, than an insufficient, especially negative formulated self-image which the “PDP” plan suggests. Advocating from the viewpoint of solution-focused theory, where the focus point starts from a different angle, namely “what possibilities, qualities and resources exactly 77 CU IDOL SELF LEARNING MATERIAL (SLM)
are available?” Therefore, I wish to propose a different starting point for the career orientation program. To encourage students to work on their learning goals and wishes, having linkage to specific competencies in their educational framework, it is extremely important that, priority wise student needs to be coached to discover and identify his or her own qualities (Cauffman & Dijk van 2009). The student gets chance to describe qualities, possibilities and resources in a personal quality plan (PQP). This plan should be replenished with new qualities the student acquires during his or her education. The career counselling teacher can subsequently coach solution focused (Berg & Szabo, 2007) to achieve a personal development plan (PDP), in which the personal quality plan (PQP) can be supporting to reach goals. By putting queries that are geared towards the future and with additional scaling questions, it enables the teacher to support the student with concise short learning goals to meet the final goal of the education requirements. The student becomes activated, to work on his personal learning goals from within their educational program, with the assistance of his personal qualities. The student gets encouragement from his own possibilities, resources and qualities to take renewed steps. Therefore, the personal development plan (PDP) that is created in this manner fits better with the individual possibilities for the student and this plan can really become a personal plan. Hereby the career coaching fits perfectly with the philosophy of inclusive education, where the prerequisites are the possibilities and talents of the student. Hereby it connects the diversity of needs for students with or without limitations. All students work on the same competencies, during their education, however they consciously use their own qualities, possibilities and resources for realizing these competencies. A positive start, and solution focused coaching, cares for the connection of the diversity, qualities and possibilities of the student. 4.3.4 The Solution-Focused Brief Therapy; Theory and Development Solution-Focused Brief Therapy (SFBT) is developed on more than thirty years of theoretical development and clinical practice also empirical research. SFBT is an extremely disciplined, pragmatic approach instead of a theoretical one. The developers have observed therapy by investing hundreds of hours over the years, carefully noting the questions and client’s answers, behaviors, and emotions paving way to clients conceptualizing and achieving viable, real-life solutions. The intriguing questions that proved to be the most consistently related to clients’ reports of progress and solutions were carefully noted and incorporated into the approach, while those that did not, were eliminated. Today SFBT could be stated as a client- directed, interactional, competency-based, future-oriented and goal-directed approach. This pragmatical and theoretically limited stance has been and still is revolutionary compared to traditional psychotherapeutic approaches that operate on theoretical assumptions related to the human mind, development and problems. SFBT is also different in giving special attention to and respect for the client’s descriptions, personal needs and goals compared to more traditional emphasis on hypotheses, diagnoses and strategies. This strategy has enabled developers and practitioners to come up with new and novel applications and practices in 78 CU IDOL SELF LEARNING MATERIAL (SLM)
many professional fields. Due to unavailability of a traditional academic theory has however had the consequence that SFBT has had difficulties in getting recognition especially within the mental health field. After the passing of the founders Steve De Shazer, Insoo Kim Berg and other pioneers, the next-generation SFBT-therapists have made their progress to develop the approach and looked for other theoretically and ideologically related approaches and thinking. Several have been found and these are now under consideration to be tested and maybe used as theoretical references. There are also several solution-focused developers trying to define SFTB in a more coherent and maybe traditionally theoretical way. I will end today by presenting some of these ideas. Ideas that need to be discussed further during the SF World Conference next September. Is there any SFBT theory? Many SFBT trainers, like myself, have heard the founders refuse to give explanations to why the interventions work and how to explain them. Both usually parts of a theory. They also claimed that they were not interested in treating common problems like depression known in other theories. This has resulted in that SFBT has remained more of a bundle of ideas and practices than a well-defined fact (Miller & de Shazer, 1998). Yet, from the first chapter of the first book to last, there are different theories explaining how SFTBT works. Each of de Shazer’s five books has, for instance, 3 to 5 chapters on theory (Bavelas & Korman 2014). Apparently, he and others wanted to make clear that their work was something different and designed for a specific context (ibid). This ascribes to the social constructivist notion that interaction is subjected to the best description within certain contexts or as Wittgenstein puts it as ’language games’, parts of an activity or form of life (de Shazer&Dolan 2007). Secondly especially de Shazer thought that theories should be like maps that describe something, not prescribe something. Diagnosis was for them only constructions of the users. He also thought that a theory would start to lead the focus away from what clients actually say and do to what the theory suggests is happening. MRI Brief Therapy Centre The development of SFBT started 1966 at Mental Research institute Brief Therapy Center (MRI) in Palo Alto, USA. Eight year later the team published a paper describing their interactional model. Their model was derived from the revolutionary book ‘Pragmatics of Human Communication’. Mental problems were shown in this book to be interactional and maintained in behavior by those involved. Consequently, the MRI model found a way in which the problems could be solved by changing the behavior in problematic situations. They described their model as ‘a general view of the nature of human problems and their effective resolution’ (Weakland etal 1974). – Sounds actually like quite a grand theory. ‘Our basic premise is irrespective of their primary origins and etiology, different problems people complaining to psychotherapists continue only provided they are allowed to maintain by ongoing behavior of the patient at present and others with whom he makes interaction… if such behavior is appropriately changed or eliminated, the problem will be resolved or 79 CU IDOL SELF LEARNING MATERIAL (SLM)
vanish…’ (ibid). They go on writing that only minor behavioural changes or its verbal labelling often are sufficient to initiate progressive development. The therapist’s primary task is to take intentional action to change the ineffectively functioning methods of interaction as effectively, powerfully, and efficiently as feasible (ibid). Situational difficulties – problems of interaction – outcomes of daily difficulties that involves adaptation to certain life changes in general, which have been badly handled by the concerned parties (and only sometimes fortuitous life difficulties). This leads to involvement of other life activities, relationships and symptom formation results. People with chronic problems have been struggling inappropriately for longer periods of time. Overemphasis is often related to universal presumptions of life (where there should be a proper and meaningful solution to everyday problems or underemphasis (denial of manifest difficulties). Some of these depend on more general cultural attitudes and conceptions. Brief Family Therapy Centre BFTC 1978 - 1987 The BFTC team in Milwaukee, USA, is best known from the writing and teaching of Steve de Shazer and Insoo Kim Berg, but the team has had about twenty skilled practitioners and researchers and therefore their model had different variations. They started their development from the MRI model in 1978. The team had a unique way to research and develop their work. Each week their ‘research team’ would look at tapes with something interesting, maybe new and potentially useful. They tried to analyse what was going on. If they found something new, they tried to use it with other cases, watched the results and if they were useful too, they could ask other team members to try out the new idea. They could then organize a study where the idea was systematically studied with more cases. This way the question ‘notice what you need to pursue happening’ and the miracle question, for instance developed. Quite early they discovered that solutions could be constructed from exploring what clients already were doing well. They started to call them exceptions. Something the MRI team sometimes used, but didn’t often find, because exceptions are rarely obvious. With an aim to ‘find’ them you must listen to clues about them. Then ask carefully about them. As they tested out the usefulness of exceptions, they found out that people had self-assurance and resilience that also might come handy in coping and building solutions The BFTC team gradually shifted their attention from designing interventions for clients to a more collaborative relationship with clients. This was possible, because supporting people for doing more or less of what they already were doing, assisting them to attain their goals for therapy and using clients’ expertise all supported a common ground with the therapist. Initially, they called it a ‘ecosystemic’ approach. The therapist became a part and parcel of the life of the client. Later they found out that a ‘fit’ with the aspect that the clients were thinking was enough. So, no motivation was longer needed, and no resistance occurred anymore (ibid). Clients were doing their utmost cooperation and the therapists too following Erickson’s tradition of utilizing whatever the client brings in. They also tried to formulate a theory to bring change to the work they were doing to explain in more general terms how the change happened. One of the 80 CU IDOL SELF LEARNING MATERIAL (SLM)
finest early explanations came from Buddhist philosophy; Change is constant. Stability is an illusion. Any new or different behavior could be used being a part of a therapeutic solution Any difference can be used as part of the therapeutic construction of a solution. It only has to perceived or interpreted as a useful difference. This is expected from a therapist and thus become a part of the solution, they wrote (Nunnally etal 1986). Building a Better Future – Solution Building 1988-2007 The focus on constructing solutions with questions like ‘How will your life be after this problem is solved?’, transformed their model into building a bright future instead of solving problems. After this shift the old ecosystemic concepts no longer seemed valid and– How could the questions like ‘notice what you are doing that ’ be explained? - after some search the concept ‘fit’ came up. Standard tasks only need to fit well enough to open the ‘door’ to a more satisfactory future for the client. This idea lead to the development of the’ Briefer’ computer model - a standardized procedure with their key questions as a decision matrix. This was interesting since it suggested that some form of standardized procedures were possible. During my training at BFTC the Briefer model gave in 70-80% of the cases a similar class of intervention as the team proposed. The therapy sessions done at that time also had a fairly unified structure. Some members didn’t however like this standardized model. They left, thinking it was too structured and limited. Family dynamics and feelings were, for instance not a part of this model anymore (Nunnally 2004, Lipchik Eve 2011). The development at this time, and later too, highlights the impact of the Ochams razor principle the developers used. Rather than looking at all factors that influence, they were looking for those most consistently influencing the outcome and discarding the rest. This simplified the model considerably. While the BFTC team became interested in how communication as an interpersonal process changed meanings. How words were constructed or invented through and the way they were implemented in social interaction (DeShazer 1988). Through this interest they sorted out that the language for solution development is different from that of problems. The language of solutions is more positive and hopeful. With less historical, behavioural and social restraints, a much happier future in which people are more architects of their destiny is viable to invent with clients (de Shazer&Dolan 2007). This is one way to explain why the miracle question is so powerful. This interest in how the interaction and language changes people lead the BFTC team to an old ‘friend’, Janet Beavin Bavelas. She had been the secretary for the original ground-breaking book ‘Pragmatics of Human Communication’ in 1967. After that she made an academic career in analysing professional conversations at the university in Vancouver. There she developed ‘micro analysis’, which is a special version of conversation analysis. One of its specialities is that she and her team used video taped conversations throughout of the analysis instead of transcribing them as many other researchers do, She was happy to analyse BFTC tapes together with the BFTC team and continued to collaborate with other SFBT researchers after Steve’s and Insoo’s passing. These analysis gave further evidence of 81 CU IDOL SELF LEARNING MATERIAL (SLM)
how change is happening in a dialogue through processes like ‘grounding’ presuppositions in questions, formulations, preserving and introducing topics etc (Froerer 2013). Looking at dialogues in such a detail has made it even more clear how even subtle changes in wording, timing, gestures and prosody make the change in therapeutic conversations. The following invented case example illustrates the BFTC approach: T: How could I assist you? C: I have problem with my health, at working place and with my family T: Ok, and what would inform you that coming here today was very useful for you? C: Well, If I somehow would get energy to start identifying these problems, but now I’m so tired, maybe even depressed. T: So, this getting energy to resolve the problems would be helpful? C: Yes, energy and not getting exhausted. T: What was until recently you had this energy that prevented getting exhausted? C: I suppose it was prior to my asthma got worse and maybe when I had an easier job. T: What did you conduct distinctly at that time? C: I think I had more strengths, and the work was easier. T: What else? C: Maybe I also took more often one thing at a time and not like know try to do everything at once. It’s just so difficult when things have piled up. T: Could it help also now to take one thing at a time? C: I guess it would. LTI Openness and brainstorming 1986- In comes Ben Fruman and Tapani Ahola from Helsinki, Finland. They started their Lyhytterapiainstituutti (LTI) training institute in Helsinki in 1986 and soon tracked down that the setup with a team behind the mirror and a therapist working with the family was too complicated to use and against the egalitarian values in Finland. Having unknown people watching and evaluating you doesn’t fit well there (it is actually a strange setup in most part of the world). Instead, they started to have all people present in a single room and participate in the therapy (Furman 1990). As a bonus they got rid of technical and organizational problems as well. This lead to new collaborative questions. How organize up to twenty people to act together? The best practice turned out to be ‘brainstorming’ together. Brainstorming meant that several options for directions, probabilities and solutions were discussed with the clients, giving them more possibilities than those they initially had in mind. This setting made it easier to invite more people from the clients’ network, which turned out to be useful if compared to the BFTC stance of settling with whoever turns up. From these experiences they added two components to the model. To utilize ‘supporters’ and discussing regarding the advantages of achieving the solution, which highlighted clients’ motivation and values relevant to them. The following invented case example illustrates the LTI approach: 82 CU IDOL SELF LEARNING MATERIAL (SLM)
T: What would you like to have happen as a result of coming here today? C: Well, I need help to deal with my health, work and issues related to family. T: And getting help to deal is only for you…? C: …somehow getting stronger and having more energy for taking care of them. T: How important is that for you at the moment? C: Very, because now I experience like a looser and others have to follow suit as per my activity. T: Who are these others? C: My children and my colleague, who does some of my work now. T: If you think of getting stronger and having more energy as a skill, what skill would you like to use very often? C: Well, I assume, because I now have less energy than before, I must know ways to do one thing at a time or do them more superficially. Maybe also let others help to some extent. BRIEF Best Hopes 1989 Another interesting path of development for the last 20 years has been executed by the BRIEF team in London. They started from the BFTC model and gradually moved to a stance even further distancing from problem connections by directing the interaction towards client’s ‘best hopes’. Instead of asking “What does bring you here?” which elicits a problem account. They started asking “What are your expectations from coming here?” that solicits the client for specifying a result from the start (McKergow &Iveson 2016). Some clients answered without reference to problems. Without understanding the problem, it was impracticable to demand for exceptions, thereby the subsequent question became a variation of the miracle question inducing a description with respect to the preferred future of the client. Exception questions were then replaced by finding instances of the chosen future already happening (ibid). Conceptually ‘best hopes’ seems to lie somewhere between next steps/goals and miracles. They have said that asking and elaborating on client’s goals, exceptions and miracles all are related to problems while best hopes don’t need to be. One can have best hopes without problems (ibid). Asking about best hopes is also contextual in that client consider what they perceive as possible in the situation at hand. These questions, with the assumptions they are going to achieve them, also ask for descriptive answers. They also continue the SFBT tradition of exploring behavioural and relational issues. BRIEF has reported that their model has shortened the process of therapy and has enabled the therapist more insignificant and helped the therapists to avoid becoming stakeholders in the clients lives. The credit for progress is easy to give to the client (ibid). The following invented case example illustrates the BRIEF approach: T: Can I start with just questioning the best hopes of yours after coming here today? C: Well, I hope I might possibly take better care of my family, myself and my job. T: Ok, so assuming that happens, coming home from here or returning to your work, how would you know that’s happened? 83 CU IDOL SELF LEARNING MATERIAL (SLM)
C: My children will for sure notice, because then I’ll start cooking and asking them how their day has been. T: Ok, what else? C: I’d probably make an appointment to a doctor to get help for my asthma. T: And how will your workplace know? C: My colleague will see me doing my work instead of complaining how tired I am. T: How will your children react when you come home, and start cooking and talk with them? C: I think they will be happy and play more together instead of fighting. T: How will that do for you? C: That makes me happier and maybe gives me a boost to do some more. The Bigger Picture 2007 The Occham’s razor principle that many SFBT researchers have used, lead them to narrow their focus of attention and primarily looking at their own work and consequently maybe leaving out interesting and useful ideas. After Steve’s and Isoo’s passing, Gale Miller, Mark McKergow and Michael Hjerth started discussion groups in Europe to look if there were other theories around that could be interesting to learn from and help to develop SFBT further. Positive psychology research into positive emotions is of interest to SFTB theory because the research indicates about unequivocal emotions have a great impact on problem solving and resilience (Fredrickson 2013). The research also provides SFBT therapists with words for possible client experiences that the client may have difficulty in putting into words. – With the risks of undue therapist influence on clients of course. Fredrickson (2009) has named ten most common positive emotions to be joy, gratitude, serenity, interest, hope, pride, amusement, inspiration, awe and love. Experiencing these ‘broaden the scope of attention, the scope of cognition and the scope of action. They build physical, intellectual and social resources and make people more resourceful and resilient (Fredrickson 2009). She suggests that they make people more flexible, attuned to others, creative and wise (Fredrickson 2013). Some of what she writes seem similar to what the BFTC team refer to as ‘creating a positive frame’ ‘giving compliments’ and the LTI team call ‘supporters’, ‘celebrating the success’ and ‘giving credits’ (Furman &Ahola 1992). The concept of hope has also for long been a part of the SFBT vocabulary (DeShazer&Dolan 2007). The TaitoBa team has incorporated the idea of setting up and maintaining a ‘positive atmosphere’ for and with the clients. Something most SFBT therapists actually do, but don’t pay attention to. This is in practice to greet clients friendly, have what hopefully is a nice meeting place. Talk about client skills and knowledge, build upon client induced humour, reflect on and introduce more positive feelings if the therapist feels it could be useful. We have also started to name positive feelings if clients refer to them and connect these references to desirable situations and the better future. Clients’ reactions seem to be in line of what Fredrickson suggests. SFBT strengths is in supporting clients’ situational change; How to handle certain situations. Some clients also want to understand and change their life in 84 CU IDOL SELF LEARNING MATERIAL (SLM)
more general way (McLeod 2006). A traditional reaction to this wish is to ask about where to start; ‘What is the first step?’. Then after success to assume that the clients are capable of taking further steps by themselves: ‘stay on track’. This might not be enough in all cases (Sundman 1993, Valkonen 2007, McLeod etal 2009). One way to address these more general wishes is to link the situational change to the way people make sense to their lives generally with life narratives (Miller 2008, McKergow & Iveson 2016). This might involve ways to use interactional and interpretive methods to be involved in constructing, developing or maybe reconstructing clients’ narratives? Maybe know more about how narratives project ongoing interactions into the past and future (Miller 2008)? Some clients ask for explanations to their problems and wonder what they mean to them. The typical SFBT tendency to change this concern into behavior seems in some cases to be expert, not client focused. If we believe that people know what’s best for them shouldn’t we respect them in this expression too? Some SFBT therapist do talk about meaning, but this is not usually expressed in public (Chang etal 2013). Something along this line has been done and researched in Northern Finland since the 1980s by Jaakko Seikkula and his team (Seikkula 2014) They developed ‘Open Dialogues’, a dialogical approach to acute psychosis. Theoretically their idea is based on the notion that words carry fragments of meaning and a more complete meaning arise through an exchange of words (dialogue) with others. When a person is traumatized, his or her emotions become unbearable. It might not be conducive to present the experience in words where the person might have difficulty in acknowledging himself and ensuring himself appreciated by others resulting in symptoms of mental illness, even psychotic behavior. Psychotic behavior can thus be seen as people’s way to communicate their experience of an overwhelming life situation for which they don’t have any words. Through a dialogue between people within a social network, in which all voices are heard and given equal weight, and concentrated on what is important to those involved, a new shared language and understanding replaces the symptoms. This language builds up the network’s inherent resources. In due course of time, the crisis might convert to an opportunity for betterment: an opportunity to reiterate the stories, reorganize the identities, and reconstruct the relationships that connect the self to the world (Burton 2015). From a solution-focused perspective the interaction that supports people in the social network to make sense for themselves is interesting. Could such an element in a solution-focused interaction make it easier to answer clients’ why questions without transcribing them into behavior? Or would this weaken the strongest behavioural element of SFBT? I have made trials with what I call a ‘reflective’ dialogue in my therapeutic work. Resembling the principles of open dialogues, I’ve reflected with clients and others present about alternatives (different voices), consequences, possibilities and differences before concluding what the goal, miracle, exceptions, doing more, doing differently, best hopes, next step or summary is, i.e., in all phases of the meeting and working process. It seems to me that the conclusions become more understandable for those present. They connect to some extent the situation at hand with people’s narratives. Could this furthermore be an extended version of reframing?! 85 CU IDOL SELF LEARNING MATERIAL (SLM)
Reframing expressions and situations together and with time instead of the expert based instant reframing done before? There are also several other theories with some fit to SFBT, like constructivism, perception theory, discursive psychology, pragmatist learning theories, phenomenology, agility theories, and even attachment theory, structural and normative as it is. The ‘why?’ and functional explanations de Shazer and others explaining the SFBT way of working were very particular about that they only wanted to describe how SFBT worked without any causal explanations. This can be called using functional explanations, which means giving account to an item by showing how it contributes to the system in which it occurs (French&Saatsi 2014). It’s an old and accepted way of explaining causes in terms of function in context to an intended outcome. This is what the SFBT developers might have been indulging all along. Connecting theory and practice in a pragmatistic way. Observing what is going on and making sense of it. Then deciding what a good outcome could be and how get there? After this trying out the proposed solution. Then evaluating and reflect on the result and the consequences. Finally adopt the new or better behavior (and explanation) (Dewey 1910). McKergow and Iveson (2016) suggests that SFBT don’t need any causal explanations, but instead descriptions of possible patterns how to influence. Therapists can make attempt to listen to the sayings of the client, but they might be averse to response everything said. They have the option of selecting to the specific part the answer of a client if they find it convenient in contriving the following question or other reaction. Therefore, they need to have a coherent framework for making these selections. Within the EBTA task-group assigned to work on a theory we have started to design such a framework. It could apart from asking typical SFBT questions contain selection criteria like this: The therapist reacts from moment to moment on what the client does, concentrating on what he observes that can be associated with a positive future, doing well, strengths or creating new alternatives. The therapist tries to bring into the dialogue differences that emerge related to what the client wants. The therapist helps the client to put expressed descriptions into perspective, for instance, what significance the change has and how she wants her life to be. The therapist all the time checks, modifies what he says until the client agrees to it. Therapists formulates what the dialogue has shown to be useful or could be useful for the client. The therapist is attributing agency to the client whenever possible. 4.4 CONCEPT OF PSYCHOTHERAPY 4.4.1 Definition Psychotherapy can be defined in a broad fashion as comprising three distinct components: a healing agent, a sufferer, and a healing or therapeutic relationship (Frank and Frank 1991). 86 CU IDOL SELF LEARNING MATERIAL (SLM)
Strupp (1986) clearly mentioned that psychotherapy is all about systematic application of a human relationship to make therapeutic intervention to alleviate emotional distress through causing enduring changes in the attributes such as thinking, behaviour and feelings of a client. The mutual engagement of the client and the psychotherapist, both cognitively and emotionally, is the foundation for effective psychotherapeutic work. Traditionally, the term psychotherapy has been in use to refer for treating mental disorders by means of psychological techniques, in a client-therapist relationship. It is a process in which a trained professional develops a professional relationship with the concerned client with the objective of providing assistance to the client with symptoms of mental illness, behavioural problems or for helping him towards personal growth. Wolberg (1988) conceptualizes psychotherapy as an endeavour to alter the behaviour and change the attitude of a maladjusted person towards a more constructive outcome. 4.4.2 Aims of Psychotherapy Aims of Psychotherapy is more than a talk between two people regarding some problem. It is a collaborative undertaking, started and maintained on a professional level towards specific therapeutic objectives. These are: Removing existing symptoms: To eliminate the symptoms that are causing distress and impediments is one of the prime goals in psychotherapy. Modifying existing symptoms: Certain circumstances may militate against the object of removing symptoms (e.g., inadequate motivation, diminutive ego strength or financial constraints); the objective can be modification rather than cure of the symptoms. Retarding existing symptoms: There are some malignant forms of problems e.g., dementia where psychotherapy serves merely to delay an inevitable deteriorative process. This helps in preserving client’s contact with reality. Mediating disturbed patterns of behaviour: Many occupational, educational, marital, interpersonal, and social problems are emotionally inspired. Psychotherapy can play vital role from mere symptom relief to correction of disturbed interpersonal patterns and relationships. Promoting positive personality growth and development: Deals with the immaturity of the normal person and characterological difficulties associated with inhibited growth. Here psychotherapy aims at a resolution of blocks in psycho-social development to a more complete creative self-fulfilment, more productive attitudes, and more gratifying relationships with people. It also aims at: Strengthening the client’s motivation to do the right things. Reducing emotional pressure by facilitating the expression of feeling. Releasing the potentials for growth. Changing maladaptive habits. 87 CU IDOL SELF LEARNING MATERIAL (SLM)
Altering the person’s cognitive structure. Helping to gain self- knowledge. Promoting mutual relations and communications. 4.5 SUMMARY Psychotherapy is a complicated process and almost 100 years have passed since the use of systematic therapeutic approach. Psychotherapy can help one to gain better insights of his/her condition or situation, identify and change behaviours or thoughts that adversely affect one’s life, understand relationships and experiences in a superior way and develop self-awareness. Thus, in this unit we discussed about the concept of psychotherapy with the help of its definition and aim. We further focused on various schools of psychotherapy like Psychodynamic Therapy, Behaviour Therapy, Humanistic psychotherapy, Existential Psychotherapy, Gestalt therapy and Interpersonal Therapy. We also deal with various phases of psychotherapy and discussed the modalities of psychotherapy like individual therapy, group therapy, family therapy, couple’s therapy and child therapy. We also discussed about ethics in psychotherapy and factors responsible for influencing psychotherapy. SF therapists variously begin a first ever session with one or more goal development question. These might variously include asking clients to explain their best hope so that it would be different due to therapy, what needs to occur because of coming in so that afterwards the client (and/or a person caring about them) will find reasons to look back and think that it was a good idea to come, or what needs to happen so that clients would be able to say afterwards that coming was not a waste of their time. Once a goal has been identified, SF therapists ask their clients questions designed to generate a comprehensive description regarding the life of a client and how it would be when the goal has been achieved. In a few cases, this may include the SF Miracle Question (see below). Once a thorough description has been developed of how the client’s life is likely to be different after the goal has been achieved, the therapist and client begin searching through the client’s life experiences and behavioural repertoire for exceptions, e.g., times when in at least some parts of the goal have already happened. More than Miracles” (deShazer & Dolan 2007) was an important opportunity for the authors to take stock of how SFBT had developed over the years since the group at BFTC published the seminal paper on SFBT (deShazer et al 1986), with a title deliberately chosen to honour the influence of the MRI group. Many have persisted to refine the approach. Chris Iveson and Mark McKergow (2016), with an article title chosen to mark a shift from solutions to descriptions, helpfully share the even simpler ways they have come up to have solution-focused conversations. Whilst I, too, find that these simpler ways of talking can often be very helpful, I have also been finding 88 CU IDOL SELF LEARNING MATERIAL (SLM)
that on occasions other means of knowing might be very helpful than talking. As of now, we have not only Wittgenstein to turn to make it clear of our doing, moreover the philosophies of embodied cognition and the enactive mind, there might be many other possibilities for useful solution-focused work as well as talking. 4.6 KEYWORDS Tenets is a concept or belief as honoured by a person or, mostly a group of people. \"Seek after pleasure while avoiding pain\" is a primary tenet of Hedonism. For e.g., \"God exists\" is a kind of tenet followed in almost all the religions. Solution-focused brief therapy (SFBT) gives emphasis on both present and future circumstances of a person and his/her goals instead of previous experiences. Thus, in this goal-oriented therapy compels a person to come to therapy for the symptoms or issues faced by him/her. Efficacious Interventions Intervention studies could be put into perspective on a continuum, subjected to the condition of a progressing to effectiveness trials from efficacy trials. Efficacy might be stated as the performance-based intervention in circumstances like ideal and controlled, whereas effectiveness indicates its performance in a 'real-world' situation. Psychosocial Rehabilitation is one such treatment approach that is designed to enhance the lives of disability people. Here the goal is teaching skills such as social, emotional and cognitive that are crucial for people mental disorder and work with them very much independently. Preliminary preceding or done in preparation for something fuller or more important. 4.7 LEARNING ACTIVITY 1. Conduct a session with a people suffering with problem solving using solving techniques. ………………………………………………………………………………………………… …………………………………………………………………………………………………. 2. Conduct a session using SFBT and analyse the circumstances and measure the outcome? ………………………………………………………………………………………………… …………………………………………………………………………………………………. 4.8 UNIT END QUESTIONS A. Descriptive Questions Short Questions 1. Write a short note on SFTB. 89 CU IDOL SELF LEARNING MATERIAL (SLM)
2. What are the aims of psychotherapy? 3. List down the development of therapy. 4. What are the concepts of SFBT and aims of psychotherapy? 5. What a short note on ‘The Solution-Focused Brief Therapy; Theory and Development’? Long Questions 1. Explain Solution focused based therapy. 2. Explain the concepts of SFBT. 3. Illustrate the development of therapy. 4. Describe the concept of psychotherapy. 5. Briefly explain ways of scope of ‘SFBT: A Review Based Theoretical Overview’. B. Multiple Choice Questions 1. The Solution focused approach originated in _________therapy. a. Family b. Cognitive c. Behaviour d. All of these 2. Solution-Focused Brief Therapy (SFBT) is based on over ____ years of theoretical development, clinical practice, and empirical research. a. Twenty b. Thirty c. Forty d. Fifty 3. SFBT was also shown to have best results for personal _____ changes. a. Physical b. Cognitive c. Behavioural d. Mental 4. SFBT has also been used to treat other groups such as problem ______. a. Physical disorder b. Mental disorder c. Facing stress 90 CU IDOL SELF LEARNING MATERIAL (SLM)
d Drinkers 5. SFT helps clients develop a ______ of the future wherein the problem is solved. a. Newer version b. Desired vision c. Relieve mental stress d. None of these Answer 1 a) 2 b) 3 c) 4 d) 5 b) 4.9 REFERENCES Textbooks Corey G. (2001).Theory and Practice of Counselling and Psychotherapy, Brooks/ Cole, Thomson Learning: U.S.A. Sharf R. S. (2000). Theories of Psychotherapy & Counselling, (2nd edition). University of Delaware: Brooks/Cole, Thomson Learning: U.S.A. Reference Books Jaseem, K., Mukherjee, T., & Asharaf, A. A. Z. (2014). Solution Focused Brief Therapy for Depression in an Indian Tribal Community A Pilot Study. International Journal of Solution focused Practices. Finger, R., & Galassi, J. P. (1977). Effects of modifying cognitive versus emotionality responses in the treatment of test anxiety. Journal of Consulting and Clinical Psychology, 45, 280-287. Altmaier, E. M., Leary, M. R., Halpern, S., & Sellers, J. E. (1985). Effects of stress inoculation and participant modelling on confidence and anxiety: Testing predictions of self-efficacy theory. Journal of Social and Clinical Psychology, 3, 500-505. Websites https://www.goodtherapy.org/ https://www.counselling-directory.org.uk/ https://www.simplypsychology.org/solution-focused-therapy.html 91 CU IDOL SELF LEARNING MATERIAL (SLM)
UNIT - 5 PROBLEM SOLVING Structure 5.0 Learning Objective 5.1 Introduction 5.2 History of Problem-Solving Therapy 5.3 Types of Problems Treated 5.4 Therapy Framework 5.5 Acceptance and Commitment Therapy- A Pragmatic Approach to Behaviour Change 5.5.1 The Selective Use of Supportive, Re-educative, and Reconstructive Approaches 5.5.2 Restoration of Mastery through Supportive Symptom Relief or Removal 5.5.3 Modification of Disturbed Attitudes through Re-educative Therapy 5.5.4 Personality Growth and Maturity through Reconstructive Therapy 5.6 Clinical Utility 5.7 Summary 5.8 Keywords 5.9 Learning Activity 5.10 Unit End Questions 5.11 References 5.0 LEARNING OBJECTIVES After studying this unit, student will be able to: Describe the therapy framework and specific approach to problem solving. Explain the history of problem-solving therapy. Illustrate the various types of therapy in problem solving. Explain the clinical utilities by problem solving. Illustrate the ACT and its goals. 5.1 INTRODUCTION In our day-to-day life we usually solve problems be it in the classroom, family, or workplace. It is nearly inescapable in everyday life. We use problem solving when we want to reach a certain goal, and that goal is not readily available. It involves situations in which something is 92 CU IDOL SELF LEARNING MATERIAL (SLM)
blocking our successful completion of a task. To study problem solving satisfactorily, a good way will be to start the chapter by solving some problems, try the below ones: Problem1: What one mathematical symbol can you place between 2 and 3 that results in a number greater than 2 and less than 3? Problem2: Rearrange the letters NEWDOOR to make one word. Problem3: How many pets do you have if all of them are birds except two , all of them are cats except two, all of them are dogs except two? There are many different kinds of problems, including many kinds of recreational problems, career and school-oriented problems (such as the problem of when one promotes or the problem of how to study for a test), personal problems (such as the problem of whom to marry or whether to have a child), and scientific problems (such as how to find a cure for cancer or how to prove a particular theorem) etc. All of us resolve many problems like these or others every day. Problem solving can be as commonplace as finding out how to prepare a meal, or as significant as developing a psychological test The concept of organisational change and various approaches to organisational change. It will further highlight normative re-educative strategy as one of the approaches to change. It will then explain the factors of implementing this strategy. Americans, such as Herbert Mead, William James, Charles Sanders Pierce, and John Dewey, were the philosophers responsible for the origination of the concept of pragmatism, more than a century ago. It is different from the concept of realism. For instance, it is not founded upon ambitious declarations that knowledge is the reflection of an underlying truth. It is different from idealism too. Pragmatism refuses to accept that the foundation of knowledge is the human mind. It is incompatible with rationalism, believing that theoretical rationality is not the pathway to dependable knowledge. The anchor for pragmatism is practical exercise. It also suffices as the examination of knowledge. The value of knowledge comes through when it is put into action, and the action reveals specific outcomes. The interest in pragmatism has acquired popularity in recent years, evinced by its display in several literatures. Some examples are Biesta (2007) in education, Baert (2004) in social theory, Posner (2003) in law, Shields (2003) in public administration, Hester (2003) in medical ethics, and Kloppenberg (1996) in philosophy. However, the concept does not seem to have made many inroads into the fields of health-related investigations or psychology. Pragmatism has a unique approach to dealing with the issue of knowledge. It offers a different query from the usual one, regarding knowledge. According to Rorty (1999), the usual question of, “Is this knowledge an accurate reflection of the underlying truth?”, the query turns into, “Will this knowledge prove useful for our purpose?” This shifting of ideas 93 CU IDOL SELF LEARNING MATERIAL (SLM)
has its roots in a critique performed on the Platonic Idea of Truth. Plato believed that human perceptions tended to be unsound. Regardless, something else existed beyond such flawed ideas. This was truth. It took the form of an enduring and heavenly domain comprising of ‘exemplary forms’. Plato used the allegory of a cavern to demonstrate his thoughts. The true exemplary forms are found outside the cavern and cast shadows on its inner wall. Human perceptions are just like these ordinary shadows. Gillespie (2006)’s study relates that Descartes and other philosophers like him, took this Platonic Idea of Truth forward. It is the foundation for modern diversifications of realism. Realism aligns with a correspondence postulate of truth. It also suggests that there is something real beyond surface appearances. Real knowledge, which, in fact, is knowledge, corresponds to the reality underlying these surface appearances. 5.2 HISTORY OF PROBLEM-SOLVING THERAPY Goldstein (2011) believes that we engage in problem-solving every single day. He also adds that all sciences have a common goal. Each one wishes to comprehend why and how anything works the way it does. According to Ciccarelli & White (2012), it is possible to understand the major goal of human behaviour via the usage of descriptions, predictions, and explanations. Even the monitoring of actions comes into play here. There is no guarantee that the problems we confront will always be easy ones. Therefore, resolving them cannot always be an immediate goal. Even the task of problem-solving cannot be easy. The Gestalt method of perusing problem-solving came into being in 1920, as a part of the discipline of psychology. It included various concepts, such as perceiving, believing, learning, exhibiting an attitude, and problem-solving, in its overall viewpoint. The task of problem-solving involves comprehending the representation of a particular issue in a person’s mindset. When a solution is offered, it seeks to reposition or convert this presentation into something else. According to Goldstein (2011), as human beings, we tend to remember vast quantities of information by resorting to innovative imaging or the process of chunking, believing that this will aid in resolving any issue. According to Piaget, children were inclined to be active learners, especially during the official pre-operational phase (Beck, 2013). With regard to knowledge, it refers to how we perceive the representations in our minds. We view these representations in alignment with specific classifications with regard to problem-solving. Goldstein (2011) suggested that anything that came to mind, could be classified as an illustration, definition, or an original model, which tended to position individuals or things in their appropriate places. Those, who designed tests, prepared them in such a way that they would allow people to develop the powers of perception, as well as encourage ingenious thinking patterns. An interesting query that came through involved the manner in which children handled issues that they might confront, within the framework of a faculty setting. How did they tackle individual/group relationships when placed within a group setting, or while having lunch with a group? According to Arean (2009), emotions could be positive or negative. However, they 94 CU IDOL SELF LEARNING MATERIAL (SLM)
would definitely affect the manner in which the concerned child handled issues in his/her life. An important consideration here is that when children develop social skills at an early age, they find it easy to make good progress in coming up with strategies for problem-solving, in later life. Children tend to possess a splendid set of potentialities, right from an early age. As a result, theoretical viewpoints regarding the process of human development, may prove to be distinctive in several approaches. Berk (2014) feels that children are highly energetic from the beginning. This mobility helps them to relate to the social, as well as the physical world, very easily. Therefore, problem-solving also becomes an easy task for them. The problem- solving treatment/therapy (PST) adheres to a time span of 30 minutes per session, when patients facing problems in their respective lives, desire it. PST suffices for individuals striving to get rid of bad habits or develop good ones. It suffices for helping them improve upon their poor action plans for dealing with life’s problems. PST sessions are so designed that they help patients to comprehend new action plans. According to Overholser (2013), problem-solving therapy sessions enable the creation of processes, such that every patient acquires an improved creative mindset, sense of emotional balance, and is capable of viewing everything reasonably. Question-answer sessions, should they form part of any kind of psycho-educational instructional sessions, tend to make a first- time participant feel defenceless or overwhelmed. As Overholser (2013) points out, the healer must realise that the therapy sessions come into play, merely as guides for ensuring effective psychotherapy sessions. According to Goldstein (2011), individuals, who took recourse to knowledge training during their sessions, found themselves better prepared and more able to understand how to cope with problem-solving while under pressure. Each individual has a unique way of approaching a problem and resolving it. However, the best method seems to be that wherein the problem acquires a specific representation in the mind. True, research investigations may have conveyed the impression that one person is smarter than the other, in alignment with the type of answer given for resolving the concerned problem. In actuality, there can be no comparison of ‘smartness’. It is just that every individual presented the issue in a different way. Now, resolving of problems comprises of varied layers of learning, as well as varied styles. According to Arean (2009), aspects like extreme tiredness, falling prey to heavy emotions, etc., can prevent fixed concentration on how to go about resolving a specific issue. Bearing this in mind, how does it become possible for a psychotherapist to understand if they are correct or not, especially while there is a reconstruction process in progress? Holowchak (2012) goes back to Freud’s ideas about the analyst. This analyst might offer inaccurate instructions, thereby creating confusion in the mind of the patient. This is particularly true with regard to children. According to Piaget, who focuses on the concrete operational phase, the thought processes of children tend to incline towards logic, flexibility, and organisation. The same does not occur during the preoperational phase. School-going children become good at handling hierarchical categorisation and seriation. Additionally, there is an improvement in spatial reasoning. This leads to children developing the ability to construct cognitive maps. They also learn to 95 CU IDOL SELF LEARNING MATERIAL (SLM)
become masters at handling systematic assignments. Berk (2014) suggest that children encounter difficulty with resolving an issue that is a mixture of a couple, or even more, bits of information. This is because the pieces of information do not fall into the same category. On the whole, however, children tend to have a centralised way of thinking. They concentrate only on a lone aspect of any situation, failing to consider other essential aspects. Berk (2014) continues with his musings. According to him, there is a major reason why children find problem-solving to be quite challenging. The presence of an overload of information, or the too many unfamiliar components, within their cognitive abilities, are responsible. Reports declare that queries cannot form a part of resolving issues. Weisberg (1992) focuses on the Gestalt method, pointing out that it had claimed that there were always concrete answers in the problem-solving process. It was best to go in for innovative thinking, while tackling problems. After all, every topic in the PST session was aimed at predicting the performance of the patient in handling issues, especially in the current context. To illustrate, the individual handling the issue might feel that he/she has provided the best solution, but in the absence of appropriate judgement, the solution proves useless. It is the same when the individual has no knowledge of all the pieces fitting into the picture. The resolutions may appear perfect. Weisberg (1992) suggests that coping oriented talents should come into play for encouraging self-efficacy, as well as the capacity to resolve issues on a day-to-day basis. Several research studies have discovered that individuals confronting unresolved solutions, tend to grant minimal importance to behavioural/cognitive factors. Problem-solving therapy or PST is a psychological intervention. It proves useful for tackling depression and offers diverse ways to defeat problems. Arean (2009) points out that a therapy session that has been designed, keeping older adults in mind, has proved to be excellent for treating depression in people belonging to a much younger age group. In conclusion, many people find it easy to tackle simple issues. However, what do they tend to do when situations become more complicated? It has been noted that in such a scenario, individuals refused to concentrate on understanding or creating strategies for resolving complex issues. Instead, they permitted themselves to become inattentive, unfocussed, and troubled. Furthermore, they found their cognitive abilities undergoing rearrangement. However, healthcare providers have found PST to be extremely beneficial as a more or less, direct interference. They believe that PST would prove advantageous for individuals suffering from poverty, lack of support from the general public, depression, or reduced memory. Researchers have comprehended the concept underlying this therapy, and definitely consider me to be a positive talent to possess. They realise that the major objective of each session, comprises of concentration on individual strengths, rather than on weaknesses or existing symptoms. Arean (2009) concludes that if individuals incline towards the creative method of problem-solving, they may expect splendid outcomes. The creative exercise must work in combination with divergent thinking, and not with convergent thinking. 96 CU IDOL SELF LEARNING MATERIAL (SLM)
5.3 TYPES OF PROBLEMS TREATED Your problems may be ill defined. Alternatively, they may be well defined. What is the difference between these two concepts? Let us take an example of an ill-defined issue. It could relate to figuring out a method to initiate peace. In this case, the exact nature of the issue tends to remain unclear. Naturally, there is insufficient information to come up with a tangible solution for resolving the same. An example of a well-defined issue would be the resolution of a jigsaw puzzle or a mathematical equation. In this case, the exact nature of the issue is highly visible. It follows, therefore, that there is sufficient, as well as lucid knowledge, to come up with a satisfactory resolution of the problem. In fact, it becomes very easy to make an uncomplicated judgement about whether the offered solution will prove effective or not. According to Greeno (1978), there is a way to categorise well-defined issues. This method is founded on the information and psychological talents required for resolving diverse types of issues. A typical, well-defined issue may fit into any of these three classifications – arrangement, inducing structure, and transformation. Each category demands the usage of a varied kind of knowledge and psychological skill. Arrangement Problems – It is essential that the problem solver reposition/recombine the components in a manner that is in alignment with specific kind of criteria. In general, the problem solver may come up with a set of arrangements. However, a lone arrangement, or even a few amongst the group, may qualify as the provider of a solution. Examples of arrangement problems, include jigsaw puzzles and anagrams. Inducing Structure Problems – Here, there is a presentation of certain elements. The problem solver must be able to pinpoint the existing associations amongst these elements. Once this is done, it becomes necessary to create a new bonding amongst them, thereby leading to a resolution of the issue involved. Thus, the problem solver has dual tasks. One of them is to determine the existing bonds amongst the elements. The second is to figure out the size and composition of all the elements involved. Transformation Problems – Here, the problem solver tries to convert the existing stage into an achievable goal stage. To illustrate, the original configuration of the Tower of Hanoi is the existing/initial state/stage. The idea is to move towards a goal stage/state. The goal is to ensure the placement of three discs onto the third peg. This is possible by taking recourse to a specific method, wherein the rules for repositioning the discs, come into play. Greeno (1978) believed that it was possible to resolve transformation issues via planning skills and the utilisation of a means-end analysis methodology. Means-end analysis refers to the recognition of variations present between the existing stage and the goal stage. After recognition, it becomes necessary to choose functions that should help to lessen the distinctions. The following problems are of a particular kind, requiring treatment Ordinary issues that affect the psyche and emotions Ordinary problems affecting the wellbeing of the mind 97 CU IDOL SELF LEARNING MATERIAL (SLM)
Striving to handle day-to-day life stressors Struggling to cope with mental health conditions that might result from day-to-day life stressors Trying to handle stress that is an accumulation of day-to-day life issues, such commuting long distances to work, tackling a tough job, etc Striving to tackle life events that might cause stress Inability to manage finances successfully Fear of losing a job, or depressed after losing one Family problems interfering with professional life Depression due to unhappiness in personal or professional life Finding it difficult to resolve concrete issues in life Presence of life-threatening medical conditions, such as cancer, heart disease, or any other illness, and the problems that accompany them Striving to cope with particular mental health symptoms, signifying depression. Struggling to handle the situation post-divorce, or bereavement Inability to handle relationships Urge to discover the true purpose of one’s life Striving to tackle issues that could lead to self-harm 5.4 THERAPY FRAMEWORK It would be worthwhile to comprehend how the therapy concerning problem-solving works. However, the understanding should come through more thoroughly, if an explanation regarding the background or framework surrounding the therapy is given. The problem-solving treatment/therapy is founded on a model relating to both, stress and good health. This therapy gives due consideration to resolving problems in real life too. This means that if you were to have a proficiency in tackling issues as and when they arose, you would have found the key to smoothening your life. The manner in which you handle the effect of stressful situations in life on an everyday basis, will enable you to deal with mental health issues that may/may not strike you, later on in life. The framework of problem-solving therapy comprises of two significant components. One of them deals with how you use the problem-solving orientation/guidance to tackle your life’s trials and tribulations. The other one refers to how you would bring the skills connected with problem-solving into play. Application of the Problem-Solving Guidance Once you have experienced the problem-solving treatment, you should find it easier to comprehend how this approach may be applicable to diverse arenas of your life. To illustrate, you might be striving to cope with a medical condition, or with depression. You may even be finding it tough to consume healthy diets every day. However, you are well 98 CU IDOL SELF LEARNING MATERIAL (SLM)
aware that you are facing a problem. Therefore, you decide to come up with a systematic approach that you will implement step-by-step. Usage of Problem-Resolving Skills There are diverse ways in which you may bring your skills related to problem-resolving, to the fore. The first step involves comprehending the method to recognise the problem. Second, you must understand how to define the issue, albeit in a simple and comprehensive manner. Third, you must probe the deeper aspects of the concerned problem. Fourth, work out certain achievable goals that go hand-in-hand with the concerned issue. Fifth, push your brain to come up with various alternatives for resolving the same problem. These solutions should be creative in nature. Sixth, peruse the list of solutions, and decide which one will prove to be the best for the concerned issue. Seventh, put your plan (solution) into action. Finally, evaluate the results of your strategy. This should suffice to help you work out your next course of action. In actuality, the problem-resolving therapy follows a four-pronged pathway. Defining and Formulating the Issue It is necessary to recognise your real-life issue first. Once you have identified it, you must map it out in such a way that it enables the creation of probable resolutions. Creation of Diverse Alternatives You must strive to come up with diverse potential resolutions to the concerned issue. In fact, you may never have considered all the innovative alternatives that you bring to the fore for tackling this particular life stressor, before. Devising Strategies for Making Decisions At this stage, you must initiate a discussion regarding the various strategies that may come into play for making decisions. These strategies should also serve to recognise various things that might prove to be obstacles for satisfactory problem-solving. Implementing the Solution and Verifying It This final step is all about implementing the solution that you have selected from amongst the various alternatives on hand. The outcome should suffice as verification of its success or failure in resolving the concerned issue. Aspects Involved in Problem-Solving Therapy 99 CU IDOL SELF LEARNING MATERIAL (SLM)
There are various features that are unique to this therapy, involving the patient and the healer. Any physician or mental health practitioner may administer it. It is possible to combine it with other types of treatment. The therapy may take place within the framework of a one-to-one setting, or a group setting. The duration of treatment could range anywhere between 6 and 16 sessions. Each session might last anywhere between 30 minutes and 120 minutes. The sessions are successful only when there is great collaboration between the patient and the concerned therapist. The therapy itself, involves these aspects. The emphasis is on real-life issues troubling the concerned patient. Therefore, the therapist concentrates on finding a solution that flows in a detailed, step-by-step pattern. The healer strives to create a workable action plan. Experts classify this intervention as a kind of cognitive behavioural therapy. The idea is to help the patient develop and improve upon personal empowerment. Towards this end, the therapist helps the patient move through various stages of psychotherapy. The therapist also brings into play, psychoeducation, as well as assignments to be completed at home. Thus, problem-solving treatment tends to be highly practical in its implementation. It prefers to focus only on the present, leaving the past to die its own death. 5.5 ACCEPTANCE AND COMMITMENT THERAPY- A PRAGMATIC APPROACH TO BEHAVIOUR CHANGE Acceptance and Commitment therapy (ACT) (pronounced as the word ‘act’) is an evidence based psychological intervention, which helps managing a wide range of problems. It is an empirically supported mindfulness based cognitive-behavioural therapy. This therapy based on Relational Frame Theory (RFT), a school of research focusing on human language and cognition. RFT provides an understanding of the power of verbal behaviour and language. ACT is rooted in the pragmatic philosophy of functional contextualism (Hayes, 1993). Functional contextualism provides an explanation about how context plays a role in comprehending the nature and operation of an occasion. Major Goals of ACT To encourage the approval of undesirable private experiences that can no longer be handled by the individual; to urge the patient to 100 CU IDOL SELF LEARNING MATERIAL (SLM)
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