PU Discussion

DB 3.2

In Peter Szabo’s video (2008), when asked to rate his level of functioning on a scale of 1 to 10, the client reports that he is at a 6. Szabo then asked the client how this is different from when he was at a 1, to which the client responded that he is now spending only three days in the office when he used to spend much longer at work and would often sacrifice family time (Szabo, 2008). He now follows an agenda and feels accomplished at the end of the work day instead of taking on every task handed to him and bringing his work home after hours. This is a considerable amount of progress that the client has displayed, to which the counselor justifiably congratulated his client, which is another technique in SFT. Szabo then asks his client additional scaling questions, such as how he would know that he has progressed to a 7 or 8. The client responded that he would know he has progressed once he comes to the realization that there will always be things that need to be done and feels satisfied that he has done what he can (Szabo, 2008). The client already mentioned earlier in the video that a 10 for him would involve only working one day in the office and leaving work behind him; thus, the miracle question produced reasonable plans to reach the next goal of a 7 on the functioning scale.

Scaling questions allow the client to rate their progress or level of motivation on a scale of 1 to 10, with 1 being the lowest and 10 being the highest value (Trepper et al., n.d.). Meanwhile, the miracle question is a way to ask about a client’s goal in a way that acknowledges the immensity of the problem while simultaneously guiding the client to develop smaller, more manageable goals (Trepper et al., n.d.). These two techniques can be easily incorporated into a future SFT session. For instance, if a new client with an alcohol use disorder comes to my office for their first appointment, I may ask scaling questions to identify their current progress in their recovery. I may ask, “On a scale of 1 to 10, where would you say you are in your recovery progress today?” I would then follow up with questions such as, “What is preventing you from reaching a 5? What would a 6 look like for you?” This would assist the client in creating smaller, more feasible goals that lead up to their main goal for a desired future. To determine the client’s main treatment goal, or desired future, I would ask a miracle question such as, “If you were to wake up one day and the problem that brought you here today was miraculously solved overnight, what would be different?”

References

Szabo, P. (2008, May 16). Scaling questions [Video]. YouTube. https://www.youtube.com/watch?v=HC6As-jzoQ0.

Trepper, T. S., McCollum, E. E., De Jong, P., Korman, H., Gingerich, W., & Franklin, C. (n.d.). Solution focused therapy treatment manual for working with individuals. Research Committee of the Solution Focused Brief Therapy Association.

The video displayed the use of scaling questions; on a scale of one to ten how is your anxiety in this situation? These kinds of scaling questions will give the counselor an idea of where the client is at as well as give the client an understanding of his/her own emotions. These questions help the client gain awareness of solutions to their issues. Stevens & Smith (2017) point out that counselors need to find creative and efficient techniques for recovery treatment. Using scaling questions is easy for both the client and counselor to understand. Questions are like a data collection tool for counselors (Strong et al., 2009).

The solution-focused technique uses scaling questions to understand clients’ concerns and solutions to them (Strong et al., 2009). Using scaling questions allows the client to understand their issues and understand they are capable of solving them. In one session the counselor may ask, on a scale of one to six, one being hard and six being easy, how did it feel to be around that trigger. The client may say a six as he or she is starting out but in the second or third session the client may reduce that number to a three. This would show the client that they were able to control their emotions around something that used to be hard for them to do. This also will give them more motivation as they see their progress.

Motivational interviewing is used to motivate the client toward positive changes (Stevens & Smith, 2017). Using this technique, the counselor will congratulate or commend them for doing the work and continue using encouragement to continue the great work. That positive regard gives them motivation that they are on the right path. That assists them in making positive changes and living a healthier life. They ultimately want to change and be happy, they need support and encouragement. DiBlasi et al., (2022) explain that the relational tone between the counselor and the client is empathetic, non-judgmental, and collaborative. Empathy is essential in the helping field as counselors can never judge a client and must have empathy for what they are feeling. This facilitates change in the client and a feeling of being supported. If a counselor shows any judgment, the client may regress and go back to those negative behaviors. Motivational interviewing also is an attempt to evoke the client’s own motivation to make changes (DiBlasi, 2022).

Applying harm reduction is a technique in which counselors will discuss issues surrounding the use of the substance but relate it to the client’s situation. The client will receive information on the drug they use and how it may negatively affect people. Stevens & Smith (2017) point out that when using this technique, the counselors may also give the client useful information on things such as syringe exchange. Reynolds et al., (2022) explain the stigma surrounding harm reduction techniques because they do not revolve around abstinence. As a counselor, it will depend on where the client is on the stages of change when using this method. If a client is showing no signs of changing, this technique may inform them and lead to future changes.

References

DiBlasi, T., Tafrate, R. C., & Kassinove, H. (2022). Core mechanisms of change in motivational interviewing: An attempt to separate relational from technical element effects. Psihologijske Teme, 31(3), 743–761. https://doi-org.postu.idm.oclc.org/10.31820/pt.31.3.14

Reynolds, G., Lindsay, B. L., Knaak, S., & Szeto, A. C. H. (2022). Opioid use stigma: An examination of student attitudes on harm reduction strategies. International Journal of Mental Health and Addiction, 20(6), 3381–3397. https://doi-org.postu.idm.oclc.org/10.1007/s11469-022-00756-7

Strong, T., Pyle, N. R., & Sutherland, O. (2009). Scaling questions: Asking and answering them in counselling. Counselling Psychology Quarterly, 22(2), 171–185. https://doi-org.postu.idm.oclc.org/10.1080/09515070903157321

Three therapeutic goals that this writer believes would pertain to Cherry’s case are as follows:

1. Learning healthier and more appropriate coping skills for stress and anxiety.
2. Coordinating mental health therapy with SUD therapy, as Cherry is obviously struggling with the divorce and could benefit from a full mental health assessment.
3. Possibly helping with budgeting skills to attempt to avoid additional financial stress from being a single parent.

Additionally, the therapist could assist Cherry with identifying hobbies and interests that do not include substance abuse and help to encourage her to participate in activities with other adults who have similar interests.

If the ex-husband is willing to participate in family therapy, this could possibly help all involved to understand the feelings of one another and assist each other in a manner that benefits the children and everyone involved. Regardless, Cherry needs assistance with recognizing those situations that are triggering and lead to her drinking and/or abusing benzodiazopines if she is to be able to avoid a slip in the future.She has experienced a significant life change and most likely needs to establish support and new friendships. As part of SFBT therapy, the therapist should help Cherry work to obtain small small changes in the beginning, allowing her to experience some initial success and reducing the risk of set backs or relapse (Winbolt, 2011). Cherry may set a goal to avoid drinking when the children go to bed at night and work to find alternative activities in which she could spend her leisure time.

It is likely that Cherry is so overwhelmed that she does not recognize her own strengths and resilience that have gotten her this far. SFBT techniques can help her in several ways. The therapist can guide the conversation so she is better able to identify how she has resolved problems in the past. SFBT assumes that clients already possess the strength and the experience to make necessary changes, but they simply need encouragement to help them recognize and utilize these qualities (Trepper, n.d.). Cherry could be reminded that change is always occurring and inevitable, therefore, aiming for positive changes is important, and seeing these changes will help Cherry develop self-esteem and increase her motivation (Winbolt, 2011). With each session, the therapist could allow Cherry to discuss the changes she is making, such as avoiding alcohol after her kids go to bed.

This writer would also work to keep focus on the present and future. By helping Cherry focus on where she is going and what she wants to achieve, rather than what has happened to her in the past, she can work on controlling what happens to her in the future and not why it happened (Winbolt, 2011). Of course she is probably feeling depression because of the divorce, maybe even feeling as if she is a failure or that she has wasted years of her life. What she needs to understand is that she can’t change the past, but she can create a better future, even if it is not exactly how she thought that future would pan out.

References

Trepper, T., McCollum, E., De Jong, P., Korman, H., Gingerich, W., Franklin, C. (n.d.) Solution focused therapy treatment manual for working with individuals. Research Committee of the Solution Focused Brief Therapy Association.

Winbolt, B. (2011). Solution focused therapy for the helping professions. Jessica Kingsley. https://eds-p-ebscohost-com.postu.idm.oclc.org/eds/ebookviewer/ebook?sid=cf365ed9-2ae5-4d93-8bcf-f034e04f67fd%40redis&ppid=pp_31&vid=0&format=EB.

DB 3.3

In Cherry’s case, I would encourage her to focus on remaining abstinent before addressing her chief complaints of stress and anxiety. One assumption of SFT is that clients are not incapable or dysfunctional; rather, they are functional and capable with limited resources (Winbolt, 2011). Therefore, Cherry should be educated on the resources available to her that would assist her through her recovery journey and manage her life stressors. We would likely discuss attending AA and NA meetings at least three times a week for three months, following up weekly to ensure her attendance and monitor her recovery progress. Another goal might be creating a structured daily schedule that outlines her family and work obligations. This would help Cherry establish routines that provide ample time to complete family and work obligations without overwhelming her or mismanaging her time. Finally, a third goal may be creating a self-care routine. By coaching Cherry on mindfulness activities and self-care habits she can practice on-the-go or during her alone hours, this would eliminate the temptation to use substances by replacing her maladaptive habits with healthy coping skills.

As part of her counseling, I would educate Cherry on the warning signs of a relapse. Then, I would coach her through how to promptly reverse a relapse once she recognized the symptoms. If Cherry relapses, I would first praise her for reporting this information to me and emphasize the progress she has made up to that point. Then, I would help her identify what triggered her to start using substances again and discuss which abstinence techniques have worked or didn’t work. Based on this information, we would scale her progress and develop smaller, more manageable goals for her to achieve (Trepper et al., n.d.).

I believe scaling questions and the miracle question would empower and motivate Cherry to continue remaining abstinent. Scaling questions would help identify where she rates her functioning and recovery progress, identify what she needs to reach the next step, and develop a reasonable plan of action based on these goals (Trepper et al., n.d.). Meanwhile, the miracle question would allow Cherry to manifest an ideal, substance-free future in which her chief concerns are resolved (Trepper et al., n.d.). This is her main treatment goal and what each short-term goal would ultimately amount to by the end of treatment.

Another consideration for SFT is identifying exceptions, or instances in which the problem could have occurred but didn’t (Trepper et al., n.d.). These may be situations in which Cherry was given the opportunity to use substances but refrained from doing so, or circumstances in which she was falling behind on her obligations but managed to overcome these obstacles. Highlighting these exceptions to the problem not only emphasizes the client’s capability and progress, but it also reveals techniques that have worked in the past (Trepper et al., n.d.).

References

Trepper, T. S., McCollum, E. E., De Jong, P., Korman, H., Gingerich, W., & Franklin, C. (n.d.). Solution focused therapy treatment manual for working with individuals. Research Committee of the Solution Focused Brief Therapy Association.

Winbolt, B. (2011). Solution focused therapy for the helping professions. Jessica Kingsley. https://eds-p-ebscohost-com.postu.idm.oclc.org/eds/ebookviewer/ebook?sid=cf365ed9-2ae5-4d93-8bcf-f034e04f67fd%40redis&ppid=pp_31&vid=0&format=EB.