In our managed care era, group therapy, long the domain of traditional psychodynamically oriented therapists, has emerged as the best option for millions of Americans. However, the process can be frustratingly slow, and studies show that patients actually feel worse after months of group treatment than when they began. Can and should "the group" speed a person's progress? Now, in this "must have" book, marriage and family therapist Linda Metcalf persuasively argues that the collaborative nature of group therapy actually lends itself to time-limited treatment. She combines the best elements of group work and the popular solution focused brief therapy approach to create new opportunities for practitioners and patients alike. Among the topics covered in this valuable guide are: how to learn the model how to design a group and recruit members how to identify exceptions to a group member's self-destructive behaviors and thoughts how to help members focus on their successes rather than their failures how to keep the group solution focused when therapists or members fall back into old patterns This unique resource also includes case examples and session transcripts to follow, together with reproducible forms that can be used as they are or tailored to a therapist's needs. "Solution Focused Group Therapy" is an up-to-the-minute, highly accessible resource for therapists of any orientation. Managed care companies in particular will welcome this model, which deals so effectively and economically with today's biggest problems, including eating disorders, chemical dependencies, grief, depression, anxiety, and sexual abuse.
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Linda Metcalf, Ph.D., is a marriage and family therapist in private practice in Arlington, Texas. She works extensively with school systems as a consultant in Solution Focused Brief Therapy. Dr. Metcalf is the author of Counseling Toward Solutions and Parenting Toward Solutions.Excerpt. © Reprinted by permission. All rights reserved.:
Chapter One: Changing Directions in Group Therapy
Even if you're on the right track, you'll get run over if you just sit there.
-- Will Rogers
The adolescents in the early morning process group stumbled into the group therapy room. Some of the kids dove toward the large pillows on the floor; the rest reluctantly approached and flopped onto the couches. The tech (mental health technician or MHT) followed them in, flipped through his roll sheets, found their names, and attempted to gain their attention by threatening them. Those who listened were acknowledged, and those who did not listen were asked to move closer to the tech. For the most part, the teens stared at me, wondering what they would be expected to do that day. I looked at them and noticed their reluctance to be there.
It was a typical Monday morning in 1990 at a local psychiatric facility in Texas. Here I facilitated group treatment for various mental health problems, such as chemical dependency, anger, dysfunctional family dynamics, sexual abuse, and depression. I had used such theoretical models as strategic therapy, structural therapy, and family-of-origin therapy in running the groups, orienting each group session around what the treatment team deemed helpful to the patients. On that Monday morning I decided to try something new. I wanted to begin integrating into the context of the adolescent group some of the solution focused brief therapy ideas I was currently using in individual therapy sessions. I had set up a video camera in the corner of the room beforehand so that I could view the entire process later. Some of the teens seemed to be surprised and caught off guard when I began the group with a different type of question than what they were used to. "Look back over the weekend and tell me what seemed to go slightly better for each of you," I said. Silence. It was the kind of silence where you wonder if you're speaking some alien language. I was thankful when, after a few minutes and a repetition of the question, Dylan spoke:
Well, I visited my family on Sunday, and we did not fight. That's good for them but bad for me. When I got back here last night, one of the techs asked how things went, and when I told him, he said I stuffed my feelings and that if I kept it up, eventually I would probably explode again. That's how it always is. I go along and do okay until my old man does something stupid, and then I blow up. That's how I got sent here.
LM: So, Dylan, was this the first time you were able to not fight?
DYLAN: Since I've been in here it is.
LM: You know, you said someone called it stuffing your feelings. I think it sounds as if you just self-disciplined yourself.
DYLAN: [Stares, without commenting]
LM: In fact, I'm quite impressed with you. I wonder what your parents would say they noticed about you while you were self-disciplining yourself this weekend.
DYLAN: Everybody seemed to have a pretty good time. It was quiet. We actually talked without anybody getting too mad. It was pretty different.
LM: Did anyone in the group happen to see Dylan when he came back last night from his visit?
SUSIE: I did. He seemed cool. His parents didn't look mad like they usually do.
TOM: Yeah, I'm his roommate. He seemed okay. Usually he comes back upset, but last night he was better.
DYLAN: But isn't it bad if I keep on stuffing these feelings and don't say what I need to tell my parents when they make me mad?
LM: I don't know. What usually works best for you, telling them how you feel and getting mad or self-disciplining yourself like you did last weekend and somehow talking to them calmly?
DYLAN: Self-disciplining myself.
The adolescent process group was part of an inpatient treatment program, and the clients were assigned to the group by a treatment team consisting of a psychiatrist, a case manager, a nurse, and a psychologist. The patients also received individual therapy so that they could have personal time to discuss intimate issues. The group therapy component was added so that patients could learn how similar issues had affected others and how they were solving them. For the most part, the group sessions focused on confronting substance abusers and talking about recovery, describing sexual abuse experiences, toning down angry outbursts, discussing the effects of depression, or learning about unhealthy relationships. These sessions were a continuation of individual therapy, but in group therapy a problem focus was used as a theoretical basis.
I continued to facilitate the adolescent group process with a solution focused approach for the next few weeks, always beginning the group with the same type of question and always looking for what was going better in the group members' lives. Dylan became one of my more outspoken group members, often interrupting other members to remind them to self-discipline themselves. The tech began to remark how this morning process group was easier to manage than the other groups and how the kids talked about how much they liked it because I seemed to like them. I noticed that several of the kids in the group who were previously referred to as "sleepers" had begun to talk more and to sit on chairs rather than on pillows. Some teens even moved to sit closer to me. Most seemed better able to recall issues they were working on each week, and the war stories decreased drastically. I was sold.
THE SOLUTION FOCUSED VERSUS THE PROBLEM-FOCUSED GROUP
The wise don't expect to find life worth living; they make it that way.
In psychodynamic group therapy, members reveal their issues, express their unhappiness or distraught feelings, relate to and confront others who feel as despondent as they do, and search for insight that might lead to new behaviors and actions. Over the years, I have learned from many clients that while these groups are supportive, they are also unproductive, continuing for months and sometimes years on end and focusing just on what went wrong in the past. Clients emerge from those groups with insight yet wearing their hearts on their sleeves and ready to rationalize and defend why they had their particular disorders or complaints. There seemed to be few actual strategies that developed within those groups; instead, psychodynamic therapists offered so-called proven strategies that were described as "the way to recovery." When clients returned to a group session without having tried such strategies, they were considered "not ready to change" or "resistant." (Some clients have told me that they often left such groups feeling worse than when they began attending them.)
When changing the direction of group therapy by integrating a solution focused approach, it is important for the therapist to give group members new ideas with which to construct new stories and to discourage them from adding to the pathological dialogue. For example, the change of atmosphere in the aforementioned adolescent group seemed to guide group members into more productive conversations, with more solution-friendly attitudes. However, the change took time and constant coaching and redirecting on my part to keep group members on a solution track instead of a problem track. Normally, the teens were told what they needed to do by the technicians and therapists. Dylan, for example, was told not to "stuff " his feelings. He previously lacked the confidence and self-awareness to understand his own competency, making him dependent on staff to solve his problems. Treatment was typically prolonged, since clients were not discharged until they performed the behaviors the treatment team decided they should perform. I offered Dylan an opportunity to become the sole expert on his life. This was a new process that sparked his curiosity and interest and pushed his participation to the next level. He began to respect himself in an environment that promoted such respect. When the group took a new direction, Dylan's apparent change of attitude, his new self-respect and positive beliefs about himself, became contagious.
I believe that people enjoy being part of a solution focused process group primarily because it helps them find a comfortable place in the world, one in which their problems do not seem to take over. Such a safe experience offers an oasis to even the most despondent client. Despondent clients are more likely to give up their pathological descriptions when they discover that such descriptions are not going to be discussed. Instead, clients are invited to revisit the past and reminisce about the times when life was better. This experience often has the same uplifting effect as looking at old photographs of loved ones. As clients recall more pleasant times, they realize that life was not always so difficult; as each member hears others make this discovery, a kinship develops within the group, creating an atmosphere of hope. As clients realize that they have had successes in life, whether in the past or in dealing with a current situation, they seem to enjoy the idea that others, namely, fellow group members, have noticed such success. In solution focused group therapy sessions, the group helps to define the direction for its members to follow, validating and giving permission to each member to try new strategies.
A BRIEF HISTORY OF SOLUTION FOCUSED BRIEF THERAPY
If you are not part of the solution, you are part of the problem.
-- Eldridge Cleaver
Traditionally, when clients came to therapy, they did so with a desire to understand how their lives went wrong. They looked to therapists to give them explanations in the hope that understanding the root of the problem would tell them what to do differently in order to correct the problem. Thus, therapists oriented themselves in the past instead of the present and searched for why problems occurred, that is, for information they could give their clients. For some action-oriented clients, such explanations motivated them enough to try the strategies handed down to them by their therapists. For other clients, such explanations gave them more reasons to feel and act incompetent. When Milton Erickson began working with clients in the mid 1950's, he took a new approach to therapy, one that offered new ideas for therapists to consider. "He addressed himself consistently to the fact that individuals have a reservoir of wisdom learned and forgotten but still available. He suggested that his patients explore alternative ways of organizing their experience without exploring the etiology or dynamics or the dysfunction."
With this new approach emerged a new sort of client: one who could leave therapy with identified tools to solve future problems independently. The therapist became someone who helped the client access these resources and put them into use. This respectful stance became one of the basic constructs of solution focused brief therapy. However, the solution focused approach was still years away, even though a brief therapy was emerging on the West Coast.
At the Mental Research Institute, John Weakland, Richard Fisch, Paul Watzlawick, and others worked with clients within a time limit of ten sessions. Their purpose was to reorganize the thinking of clients instead of trying to promote insight. In the view of the therapists at MRI, problems occur when the actions in life are mishandled. The greater the effort a person makes to try to solve the problem through inappropriate actions, the more entrenched the problem becomes and the less responsibility the person takes to solve it. The problem-focused approach involves thinking that problems are interactional and can best be solved when clients do something different around the problem.
In the 1980s, solution focused brief therapy took a different turn in reference to how problems are viewed. Steve de Shazer and his team at the Brief Family Therapy Center in Milwaukee began looking at "what has been working in order to identify and amplify these solution sequences." In this approach, the recognition that a client's problems do not constantly occur encouraged therapists to focus on those problem-absent times as exceptions and to investigate which features of those times could be used in constructing a solution to the presenting problem. By identifying the specific interactions, behaviors, and thinking that helped them in past situations, clients were more apt to regard themselves as competent and to realize that they could solve their own problems with minimal assistance. Therapeutic tasks began to develop from these exceptions that clients presented to their therapist. The therapist's task became one of creating opportunities for clients to see themselves as competent and resourceful. Sometimes that meant asking a client to observe for a few days the times when the problem occurred less often; other times the client was to carry out small, specific tasks that he identified as helpful in dissolving the problem. With these new, less intrusive actions, the therapist assumed a less directive role. In believing that clients are the expert on their own life, the solution focused therapist became a sort of facilitator, guide, or assistant to the client; the purpose of such a therapist was to create opportunities for clients to see themselves as the expert on their own life.
ASSUMPTIONS FOR FACILITATING SOLUTION FOCUSED GROUP THERAPY
People gather into groups to discuss their situations and to learn from each other new perceptions and ways of thinking that may influence their solutions for living. In solution focused groups, the focus of the conversation is on those times when a group member's problem is not a problem. The beauty of such groups emerges when members observe how others are able to discover such problem-free times, motivating them to try and find such discoveries within themselves. When group members participate in this collaborative process, the strategies grow geometrically. The result? Group conversations become even more efficient in promoting discussion of problem-free times and clients become more action oriented.
To explore the differences between problem-focused and solution focused group therapy, I will discuss several basic ideas adapted from the solution focused assumptions offered by O'Hanlon and Weiner-Davis in their book In Search of Solutions. These numbered points are guidelines for the solution focused therapist to use during group therapy.
1. Keep the group nonpathological, redescribing problems to open up possibilities.
When group members describe themselves and their lives with a problem focus or a diagnosis, these descriptions continue to reinforce their beliefs about themselves, keeping them stuck in old actions. I have observed this situation particularly in groups for persons who were abused sexually. Group members may complain and express frustration over either their inability to be intimate sexually or emotionally because of the trauma or their inability to stop their promiscuous actions. These feelings are well founded and should command a therapist's respect. However, a therapist who validates these feelings may provide such group members with an explanation that will serve only to reinforce their destructive actions. The negative behaviors that trouble such clients may then become part of their personal belief system about themselves, thus discouraging any chance for escaping from the trauma and moving toward intimacy.
When group members label themselves in such a problem-focused or pathological manner, I have found it helpful to offer a new description that invites them to think about the exceptions. Many people enter group therapy because it was mandated by a court or because it was suggested by their individual therapist or physician. Every client's dia...
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Book Description Free Press, 1998. Hardcover. Book Condition: New. Never used!. Bookseller Inventory # P110684847442
Book Description Free Press, 1998. Hardcover. Book Condition: New. 1. Bookseller Inventory # DADAX0684847442