|A 2000 word case study of the care of one client in crisis for whom SF approaches were used- either ‘successfully’ or ‘unsuccessfully’. The essay will draw on evidence and theory as well as reflection on care to discuss SF engagement with the client, assessment, intervention, risk management and evaluation.
Issues which should be considered for discussion, as appropriate to the client:
e.g. Difficulties and strengths in engagement, and variations in the client’s apparent desire and ability to engage. Relationship of these variations to the maintenance of a SF approach. Ways this has been, and could be in the future, addressed. Ensuring curiosity and compassion are maintained by the helper.
Mutual Assessment of need and goal-setting
e.g. Ways in which assessment was attempted as a genuinely collaborative, therapeutic venture between worker and client.
Methods of assessment and goal-setting used; by interview, any assessment tools used, collation of other evidence available.
Degree to which assessment was balanced between validation of deficits, symptoms and problems and solutions, resources and preferred futures
Adapting and using existing workplace paperwork to become a solution-focused aid to engagement, assessment and solution-finding
Relationship between engagement, assessment and goals/desires;
seeing each as part of the other; how engagement was used to enable
development of clear goals; how method of assessment chosen was
applied to relate to level of rapport; how goals emerged from a SF
conversation; extent to which collaborative assessment could be
used to enhance rapport and engagement and a genuinely SF
Maintaing safety/Managing risk
e.g. Use of collaborative SF personal safety plan where appropriate, reflecting the client’s ability to use the plan.
Use of SF self assessment and management techniques.
Use of multi disciplinary team in managing risk and maximising support for the individual worker, drawing on team strengths, competencies and resources
Using SF techniques appropriately, sensitively and genuinely-
interventions emerging from conversation
Beginning session with sessional outcomes; mid-session checks;
feedback from client and others
|To build on current individual and team strengths in communicating with clients in crisis; develop competencies in a range of solution-focused interventions that both validate the client experience and find a collaborative path to safe, mutually-satisfactory outcomes; to be able to apply these competencies to direct client care, to teaching, to management and to supervision
|On completion of this module the student should be able to:
Subject knowledge and understanding
• Give a broad overview of current policy related to evidence-based practice in psychological therapies
• Explore the research base for and application of solution-focused conversational approaches recommended in the literature
• Understand the similarities and differences between solution-focused and other psychological approaches
• Have a critical understanding of the strengths and limitations of a solution-focused approach.
• Understand the necessity to ‘start where the client is’, acknowledging and validating people’s experiences and the possibilities in their lives
• Critically discuss the need for a balance between past, present and future.
• Discuss the application of solution-focused personal safety plans in the engagement with, exchange of information with and future-planning of care for specific individuals.
• Understand the contribution of solution-focused approaches to recovery principles such as sustaining hope, whilst maintaining realism and pragmatism
• Make clinical judgements regarding safety and wishes of clients in crisis and justify plans and solution-focused interventions on the basis of flexible, reflective, person-centred assessment.
• Recognise the inherent uncertainty of the therapeutic process
• Understand the crucial elements of maintaining compassion and curiosity in acute care
• Conceptualise solution-focused approaches as an integral part of the whole process of care- in relationships between staff as much as between staff and clients.
• Be prepared to ‘hold theories lightly’
• Form a therapeutic engagement based on a shared, collaboratively formulated, understanding of client’s current difficulties and on their dreams, desires and goals
• Exchange information by interview and other means to form tentative assessments and develop a collaborative ‘miracle’ and measurable, scaled outcomes.
• Use the solution-focused skills of pre-session change, problem-free talk, exception-finding, scaling, circular questioning, contexts of competence and experimentation to help bring about clear, measurable change
• Identify own strengths, competencies and resources, using supervision and inter-professional support to assist in this and to help integrate into clinical practice.
• Use solution-focused approaches to help clients develop skills which can be used after crisis and prevent ‘relapse’.
• Work positively and collaboratively with clients perceived as ‘aggressive’, ‘difficult’, ‘resistant’ or ‘manipulative’.
• Collaborative relationship building
• Literature searching and evidence based practice skills
|Introduction to SFC; research findings and the evidence-base; national policy currently relevant to SFC; drawing on other therapeutic approaches; validation strategies; the self and SF conversations: recognising own resources, competencies and strengths; SF conversational approaches to assessment and engagement; specific SF intervention techniques; forming SF personal safety plans in partnership with clients; working with violence, self-harm and the threat of suicide; evaluating SF care
|Methods of Teaching/Learning
|Overall Student Workload: 100 hours, of which 30 are contact hours
There will be three teaching days to explore therapeutic approaches, research and theoretical support for those approaches and begin application to client care. The three half day supervision groups will alternate with the three timetabled days, to allow participants to share their current work with the client and seek the support and guidance of the group in developing that care, applying the principles taught on the study days.
It is important to remember that the supervision groups must not replace the usual arrangements for clinical support and management of safe practice that already exist. They are purely to support the student as they develop their practice using the taught material and reading from the module, and to assist in the production of the academic assessment attached to the module. It is essential that robust supervision and care management systems remain in place and are complimented by the course supervision.
Indicative reading (more reading will be indicated during lectures)
Macdonald, A (2007) 'Solution-Focused Therapy: Theory, Research and Practice' Sage London
De Shazer, S, Nolan, Y, Korman, H (2007) ‘More Than Miracles’
O’Connell B and Palmer S (2003) ‘Handbook Of Solution Focused Therapy’
George, E, Iveson C and Ratner R (2001) ‘From Problem To Solution’
BT Press London
Macdonald AJ, Ross J (2003) 'Solution-focused brief therapy in general practice', Journal of Primary Care Mental Health and Education, 7, 68-69.
Macdonald AJ (2007) 'Brief therapy in adult psychiatry: results from 15 years of practice' Journal of Family Therapy 27, 65-75.
Iveson, C (2002) 'Solution-Focused Brief Therapy' Advances In Psychiatric Treatment 8, 149-156
Macdonald AJ ‘(2007) Applying solution-focused brief therapy in acute mental health care' In: Thomas FN and Nelson T (Eds) 'Applications of solution-focused brief therapy' Howarth Press: New York
Brief Therapy Practice: www.brieftherapy.org.uk
Solution News: www.solution-news.co.uk
The Solutions Focus: www.thesolutionsfocus.com
Bill O’Hanlon: www.billohanlon.com
Scott Miller: www.talkingcure.com
Solution Focused Brief Therapy Association: www.sfbta.org
|30TH JULY 2010