SW 521 Interventions II Module 5 Curricular Module for SW521: Interventions II Denise Krause University at Buffalo, School of Social Work

SW521 Interventions II Module 5 Module Topic: Integrating Solution Focused Techniques with a Trauma Informed and Human Rights Perspective. Purpose Statement:

To introduce the assumptions and basic skills of solution focused practice. To review the principles of trauma informed care. To identify practice techniques congruent with a human rights perspective. To provide students examples of practice consistent with a trauma informed and human rights perspective. To create an opportunity for students to practice solution focused techniques.

Learning Objectives:

Explain the assumptions of solution focused practice. Identify the intersection between solution focused practice and trauma informed care principles. Describe how using solution focused skills is consistent with a human rights perspective. Apply microanalysis to a case example. Demonstrate solution focused techniques.

Required Readings: Article: DeJong, P. & Miller, S. (1995). How to interview for client strengths. Social Work 40(6), 729-736. Fernando, D. M. (2007). Existential theory and solution-focused strategies: Integration and application. Journal of Mental Health Counseling, (29)3: 226-241. Miley, Karla Krogsrud, M. OMelia, B. DuBois. Generalist social work practice: An empowering approach (6th edition). Boston, MA: Allyn & Bacon. Judith Milner, J. & Singleton, T. (2008). Domestic violence: Solutionfocused practice with men and women who are violent. Journal of Family Therapy (30)1: 2953.
1

Article:

Chapter 9:

Article:

SW 521 Interventions II Module 5 Article: Sexton, T. L. & Schuster, R.A. (2008). The role of positive emotion in the therapeutic process of family therapy. Journal of Psychotherapy Integration (18)2, 233-247.

Lecture Outline: I. General Discussion A. B. Introduce class agenda Ask class for their initial thoughts about the readings on solution focused practice. 1. 2. 3. 4. Instructor listens for elements of solution focused model and reinforces Instructor validates perspectives and is curious about students perceptions Instructor asks students how what they read connects to what they have learned about social work practice thus far. Instructor asks for students initial perception on how a solution focused approach is trauma informed (refer to trauma informed care principles from Interventions I)

C.

Scaling Question-Modeling the Model 1. Instructor asks: on a scale of 1-10 where 10 is you are completely confident in your ability to integrate solution focused techniques into your practice and 1 is the opposite of that, where are you right now? Use solution focused scaling follow up questions: what lets you know you are at a 3? wow, you are half-way what will you be doing different when you are at a 6? Work with students on behavioral descriptions of change including relational questions tied to how others will know they have moved up on the scale.

2.

3.

II.

Solution Focused Practice: Definitions and Assumptions A. Solution focused work is work with clients that focuses on what clients want to achieve through the work rather than on the problem(s) that made them seek help. Solution focused workers believe that if a person has the capacity to describe something as a problem that person also has the capacity to describe what better means. 1. Is grounded in the clients story-listening to what is different in this clients story
2

B.

SW 521 Interventions II Module 5 2. 3. C. The worker uses respectful curiosity to invite the client to consider a future that is different The worker and client pay attention to when the differences have occurred and try to build on those times

The appeal of a solution focused approach 1. Emphasis on client strengths 2. Anchored in behavioral changes 3. Focus on successes 4. Shared vision for outcomes Assumptions of solution focused practice (Kim Berg) 1. Solution building v. problem solving 2. Future is created 3. Assessment is an intervention 4. Work must be goal-directed 5. Every solution begins with one small step 6. Clients have resources and strengths 7. There is no one right way 8. Clients are experts on their own lives 9. Workers are hopeful, optimistic and respectful of clients ACTIVITY 1: Solution Focused Assumptions Solution Focused Practice and a Human Rights Perspective 1. Revisit the concepts of (from first semester) a. Indivisibility (Interconnectedness). Whether they relate to civil, cultural, economic, political or social issues, human rights are inherent to the dignity of every human person. Consequently, all human rights have equal status, and cannot be positioned in a hierarchical order. b. Universalizibility Rights belong to everyone or no one. Human rights are universal and inalienable. All people everywhere in the world are entitled to them. c. Interdependence and Interrelatedness: Human rights are interdependent and interrelated. Each one contributes to the realization of a persons human dignity through the satisfaction of his or her developmental, physical, psychological and spiritual needs. The fulfillment of one right often depends, wholly or in part, upon the fulfillment of others. http://www.unfpa.org/rights/principles.htm

D.

E. F.

SW 521 Interventions II Module 5 2. Ask class How do the assumptions of solution focused practice support the concepts of a Human Rights perspective? Or have the same pairs as in ACTIVITY I write down how their assigned assumption supports the concepts of a Human Rights perspective. The Use of Language

III.

Solution Focused Practice: A.

Context of language-this is key and intricately connected to assumptions 1. Consider: language creates a psychophysiological response in us whether we are actually having the experience or whether we are just pretending to have it. (Miller). 2. IE when we hear a story about pain, fear, love, we usually experience an emotion/physical reaction 3. By creating opportunities for clients to experience positive futures, the worker facilitates the change process Problem Talk (deShazier) As we listen to people describe their problems and search for an explanation, fact piles upon fact and the problem becomes heavier and heavier. 1. Pathologizing or labeling 2. Time spent in talking about what is NOT working 3. Keeps all of us stuck in the past 4. Creates atmosphere of negative feelings 5. More time constructing a problem Solution Talk 1. Talking outside of the problem 2. Reinforces times when the problem is NOT a problem 3. Amplifies possibilities 4. Creates atmosphere of positive feelings 5. What happened to someone vs. what is wrong with them. Probability (OHanlon) -Studies indicate that people are willing to make the leap from possibility to probability and that once an event is judged as likely they make the further leap from probability to actuality -Instructors may note how important this may be for someone who has experienced trauma.

B.

C.

D.

E.

Goal Oriented Talk 1 We notice what we pay attention to.

4

SW 521 Interventions II Module 5 2. Emphasize that talking solutions puts solutions in the forefront. Make connections to goal-oriented statements. a. In the positive b. In process form c. In the here and now d. As specific as possible e. In the clients control f. In the clients language

F.

Language Examples (Kim Berg, DeJong, 2008) 1. Suppose, (pause) ... This is a good word to help clients begin to imagine an alternative future to a problematic situation without promising that their preferred future will occur. Since it takes considerable effort for clients to set aside the intrusion of problem-focused thoughts, it is good practice to use pauses to help clients make the transition to thinking about alternatives to problems. IE: "Suppose your daughter were respectful of you, (pause) ...what would she notice you doing differently with her?" Instead. It is quite normal for clients to not know what they want when they first meet with a practitioner. The process of sorting this out usually begins by talking about what they do not want. Therefore, be prepared to repeatedly help clients to define what they want by building from what they find troublesome. The word "instead" is very useful. IE: "What would you do instead of 'screaming at the kids'?" "When," not "if" "When" encourages a future focus and creates more hope that a different life could happen. "If" retains the future focus, but introduces more doubt. IE: "When you smile at him and talk to him in a normal voice, what will be different around your house?" "How come?" This question is less confrontational than "why" and asks: | "What were you thinking?" IE: "How come you decided to run away from home?" Tentative language. Tentative language is a consensus building language; it invites and allows space for the listener to offer perceptions and ideas on the topic. IE: I wonder what will happen when. Could it be that. Perhaps.Is it possible that. Introduce doubt into unhelpful certainties IE: what gives you the impression that you are depressed? where did you get the idea that ?
5

2.

3.

4.

5.

6.

SW 521 Interventions II Module 5 I dont know whether you dont trust people or you are just appropriately cautious until you are sure the person is trustworthy. 7. Complimenting-For clients to notice what they do that is good for themselves. a. Direct Compliments-A statement with a positive attribute or a positive reaction to a client's statement. IE: I like the way you dress her; That's good; That's great!; WOW! **Use such statements sparingly, but use positive reactions frequently; both are better when they reflect the client's values. Indirect Compliments-A question that implies something positive. 1. When asking questions, use the same words that clients use when they describe a desired outcome. IE: How have you "managed" to make "the household so calm?" What other times have you used your "small mouth?" 2. Imply compliments "through" relationships IE: What do you suppose the social worker noticed when you talked to her that lets her know you are making progress with your treatment? IE: The principal says all the teachers have noticed some big improvements. What would you guess they've noticed about you? **Because the worker is not the source of compliments these can be easier for the client to respond to. 3. Imply that the client knows he or she is doing what is good for him or her. IE: Instead of saying "that's good," ask, "How did you decide that was good for you?" or "How did you know that would help with your son?" or "How did you figure out that it will work?"

b.

**Often, clients respond by telling you how they know what is right for them, i.e., what their values are (rather than the worker imposing values). c. Self Compliments-A statement made by the client saying they do what is good for themselves. IE: I decided to quit using cocaine because I got smart.

SW 521 Interventions II Module 5 I decided that since I was going to school, anyway, I might as well do some work. **React to the client statement with curiosity .Self-compliments can be an early sign of progress. Later in treatment, a contact dominated by self-compliments indicates the client is near termination. G. ACTIVITY II: Solution Focused Dialogue IE:

SW 521 Interventions II Module 5

Integration of Trauma Informed Care and Solution Focused Practice

SW 521 Interventions II Module 5

This is the number one priority in child welfare, as well as in TIC. This includes the respect and attentiveness to discomfort by all the personnel who interact with the family or child. When assessing for safety and creating a safety plan, a child welfare worker can use solution-focused methods like scaling and relationship questions to respectfully inquire about the family/childs perception of safety and ways they feel safety can be improved. In solution-focused work, the worker is a partner, not an expert, so the sharing and clarification of information about the child welfare process is inherent in the relationship. The use of a not-knowing attitude, coping questions, and exception finding are important components to building trust. The miracle question, relationship questions, an exception finding are all useful solution-focused ways of providing families/children with choice over their services in a way they can have ownership over and follow through on.

Safety (psychological & physical)

Trustworthiness

To build trust requires the conveying of information in a clear, consistent manner. The worker will strive to respect the boundaries of informed consent in order to engage and build trust. Families and children should have the opportunity to exercise choice over the services they receive. Part of having choice means the family/child must be informed of their rights as responsibilities throughout the process. This means being with rather than doing for or to. Families/children will have a significant role in planning and evaluating services as well as in the process of goal setting and service priorities.

Choice

Collaboration

In solution-focused work, the process is built on collaboration. The family/child is the expert on their problems and the child welfare worker is there is help facilitate realistic solutions. Coping and exception questions are useful in helping maintain the sense of partnership. This may require work in parallel process and scaling questions make tangible the evaluation of progress. Empowerment is a core philosophy of solution-focused work. Exception finding, compliments, miracle question, scaling, and choice encourage the family/child to find and own workable solutions to their problems without force or coercion. Solution-focused work is not a pathological approach to service provision, but rather one that focuses on strengths and resources of a family/child.

Empowerment

It is important to recognize the familys/childs strengths and skills and building on those to create hope for the future

Shift of Perspective

Away from the traditional problem-solving method, toward an approach that asks: What has happened to this person rather that What is wrong with this person. The use of everyday language, as opposed to legal or clinical jargon facilitates a better connection and may encourage a shift toward more positive thinking.

Language

Solution-focused language is clear, helpful, and positive. The child welfare worker will speak with the language of solutions to foster hope.

Krause, Green, Muto, 2010

SW 521 Interventions II Module 5

IV. Integration of Trauma Informed Care and Solution Focused Practice A. Present the comparison chart and discuss with large group. Ask group how the comparison fits with their understanding of these at this point in their professional development. (Even though the chart is written in the language of child welfare, ask students to extrapolate to other fields). Play another 10 minutes of the I know he is not Good for Me, but. DVD. Ask class to reflect on the clients history and what the client is saying is important to her now. How does the worker integrate traumatic elements of the clients history into what the client wants for herself in the present? Emphasize the trauma informed language in the student responses. Segue into the exception questions

B. C.

D. E.

V. Solution Focused Skills A. Exception Questions 1. When is the problem not a problem? -what is different at those times? 2. When was the problem just a little bit better? -Tell me about a time when you were less depressed. 3. Amplify the problem-free times -What did you notice about yourself then? What were you doing different then? What did your children notice about you then? 4. Be curious about the problem free times -How did you manage to do that? Miracle Question-Preferred future question 1. Suppose that one night, while you were asleep, there was a miracle and the problem that brought you here was solved. How would you know? What would be different? How will your partner know without your saying a word to them? 2. Helpful Suggestions: a. Remember to include and the problem that brought you here was solved b. Follow up with relationship questions IE: What would your husband/wife/sister/children notice about you? c. Work with the clients response until you have a good idea of what the Miracle is in behavioral terms

B.

10

SW 521 Interventions II Module 5 C. D. Play another 10 minutes of the I know he is not Good for Me, but. DVD. Process how the exception questions were asked and how they influenced the session. Transition to scaling questions Scaling Questions: Skills to quantify and measure change 1. On a scale of 1 to 10, with 10 being the best things could be, and 1 being the worst they could be, where are things right now? 2. Where do you want them to be next week? What will you be doing different when you are at a 6 instead of a 5? 3. Always have the higher scale number (10) be the desired change Coping Questions: Recognizes capacities in difficult times 1. How are you managing with all this going on? How have you managed to prevent it from getting worse? 2. This sounds hard ---How are you managing to cope with this to the degree that you are? 3. How did you manage to get out of bed this morning? 4. With all youve been through, how are you managing to get by? What has been helpful that got you through so far? 5. Have you been in this situation before? What did you do to get through it then? What was the most helpful to you? Who helped you the most then? Relational Questions: Encourages perspective 1. What would your best friend (boss, mother) say you are like when you are calmer? 2. What would ____notice different about you that will tell her that things are better? 3. What would your girlfriend say she likes best about your being sober? (Not What your girlfriend would say she hates about your being drunk?) Play another 10 minutes of the I know he is not Good for Me, but. DVD. Discuss the clients ambivalence and how the worker addresses this throughout the interview. Ask class what they notice about the client based on the workers questions. Listen and reinforce language that is consistent with trauma informed care. ACTIVITY III: Large Group Practice

E.

F.

G.

H. I.

J. 6.

Closure A. B. C. Ask class for one take away something that will resonate with them Compliment them as a group on their hard work noting that they are doing important work that will make a difference. Instructor asks: on a scale of 1-10 where 10 is you are now completely confident in your ability to integrate solution focused techniques into your
11

SW 521 Interventions II Module 5 D. practice and 1 is the opposite of that, where are you right now? Emphasize what is different and what they will continue to work on to move up the scale.

In-Class Activities: I. Activity 1: 1. Solution Focused Assumptions.

Ask students to count off by nines. They are assigned one of the nine assumptions and are asked to: -pay attention to how the worker (Yvonne Dolan in this DVD) demonstrates that she is operating from these assumptions. Play a 10-minute clip from a solution focused interview. (for the purposes of this outline, the DVD I know he is not Good for Me, but. will be utilized). After the segment, ask students to partner with others who have the same number and discuss their thoughts. Process in the large group by asking for their impressions. Also focus on the details of what they observed: what the worker said/did and how the client responded. Emphasize the workers listening skills and not knowing stance. Indirectly ask about the trauma informed principles here. IE: how does this stance with the client create safety? Empowerment, etc?

2.

3.

4.

5. 6. II.

Activity II: Solution Focused Dialogue We dont have to know a lot about a problem to be useful in helping people with solutions. 1. Break class into pairs. Each partner will be in both roles. 2. Ask students to think of a problem they have that they feel comfortable sharing with a classmate (stress the appropriateness of their disclosure). 3. They will each have 5 minutes to interview their partner. The goal is that they are helpful to their partner without asking what is the problem.

12

SW 521 Interventions II Module 5 4. Brainstorm ways they could start their interview (IE: how will you know I have been useful to you?) 5. At the end of 5 minutes ask them to switch 6. Process as a large group by asking: what did the interviewer do that was helpful? what did you find successful in how you approached the task? III. Activity III: 1. Large Group Practice

Ask for a volunteer to play the role of the client. Ask the volunteer to think of a case or situation and to be the client in that case. The volunteer should give minimal information about themselves (name, age, agency context). The rest of the class sits in a horseshoe shape around the client. They will each have the opportunity to ask one question or make one validating statement and ask one question of the client. After their question, the next person in the line asks a question. The questions need to flow logically and build from the previous question and the clients answer to the question. (So the last person cannot have a preplanned question). The instructors job is to hold to the integrity of the solution focused approach. If a question or statement falls outside of the solution focused model, the instructor stops the flow and asks the questioner to rephrase or think of a different way to ask the question. The instructor also writes down the questions (on the board/flip chart) as the class moves along. If the class has not gotten to what the client will find helpful (ie: goal statement) about meeting with the class, the instructor should point this out and help the class get back on track. Once the class is successful with understanding what the client wants, the session usually takes a turn and the client begins to shift. The questioning can go on as long as necessary. Each person should get at least one turn with asking a question. Congratulate the class on completing a very difficult exercise. Process the activity by asking the client first for what it was like for them. Accentuate their attention to detail and also asked what type of questions were most useful. Ask the rest of the class what they noticed about the questions as they went along. What did they find natural? What was a struggle for them? How were they able to mange staying focused. Reinforce their capabilities as a group.
13

2.

3.

4. 5.

6. 7. 8. 9.

10.

SW 521 Interventions II Module 5 Supplemental Recommended Readings: Harris, M. & Fallot, R. (Eds). (2001). Using trauma theory to design service systems. New Directions for Mental Health Services, 89. Kim, J. S. (2008). Examining the effectiveness of solution-focused brief therapy: A metaanalysis. Research on Social Work Practice, 18, 107-116. Lee, M. Y. & Greene, G. (2011). Solution-oriented social work practice: An integrative approach to working with client strengths. London: Oxford University Press. OHanlon, B. (2004). Even from a broken web. Brief, respectful solution-oriented therapy for sexual abuse and trauma. Child & Adolescent Mental Health 9(1), 46-47. Reichert, E. (2003). Social work and human rights. NY: Columbia University Press Siegel, D.J. (2003). An interpersonal neurobiology of psychotherapy: The developing mind and the resolution of trauma. In M.F. Solomon & D.J. Daniels (Eds.), Healing trauma: Attachment, mind, body, and brain. (pp.1-56). NY: WW Norton & Company. Shulman, L. (2009). The skills of helping individuals, families, groups and communities (6th. ed.). CA: Cengage. Wettersten, K.B., Lichenberg, J.W. & Brent, M. (2005). Associations between working alliance and outcome in solution-focused brief therapy and brief interpersonal therapy. Psychotherapy Research 15(1-2), 35-43. Young, S. & Holdore, G. (2003). Using solution focused brief therapy in individual referrals for bullying. Educational Psychology in Practice, 19(4), 271-282. Supplemental Resources: DeJong, P. and Kim Berg, I. (2008). Interviewing for solutions. (3rd. Edition). CA: Thomson. (ISBN: 978-0-495-11588-5) DeJong, P. and Kim Berg, I. (2008). DVD for interviewing for solutions. (3rd. Edition). CA: Thomson. (ISBN: 978-0-495-09882-9) Dolan,Y., Kim Berg,I., and de Shazer, S. (2008). know he is not good for me but (DVD). Alberta, Canada: Solution-Focused Brief Therapy Association www.sfbta.org). Gonzales, J., Kim Berg, I. & DeJong, P. (1999). Safety planning in childrens protective services: Building solutions with clients (VHS). Canada: Solution-Focused Brief Therapy Association (www.sfbta.org).
14

SW 521 Interventions II Module 5

Kim Berg, I. (2008). Back to the future through the past: Helping clients to design their own solutions to sexual abuse (CD). Alberta, Canada: Solution-Focused Brief Therapy Association (www.sfbta.org). Kim Berg, I. (2008). Dying well (CD). Alberta, Canada: Solution-Focused Brief Therapy Association (www.sfbta.org). Kim Berg, I. (2008). Its her fault (CD). Alberta, Canada: Solution-Focused Brief Therapy Association (www.sfbta.org). Sebold, J., Uken, A. and Kim Berg, I.. (2008). Treating domestic violence offenders (CD). Canada: Solution-Focused Brief Therapy Association ( www.sfbta.org). Trauma Focused Cognitive-Behavioral Therapy at http://tfcbt.musc.edu/ University at Buffalo School of Social Work Podcasts: http://www.socialwork.buffalo.edu/podcast/index.asp Episode 61 - Dr. Lenore Walker: The System is Broken: Challenges to Trauma-Informed Approaches with Parents and Children Affected by Domestic Violence Episodes 38, 40 & 42 - Dr. Mo Yee Lee: Integrative Body-Mind-Spirit Social Work Myth-Busting to Build Accurate Understanding Episode 21 - Dr. Denise Bronson: Doing Evidence-Based Social Work Practice United for Human Rights at http://www.humanrights.com/#/what-are-human-rights

15