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*Brief Problem Focused Therapy*

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Key Figures
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Gregory Bateson, Milton Erickson, Richard Fisch, Don Jackson, Jay Haley, Virginia Satir, Paul Watzlawick, and John Weakland.
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Where was it developed?
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@ the Mental Research Institute of Palo Alto in California; designed to address a client’s presenting complaint in an efficient and parsimonious manner. Client problems are repeated ineffective attempts to solve that problem.
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Report Functions
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content or literal message of communication
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Command Functions
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relational aspect of communication that provides information for how the recipient should interpret the message.
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Metacommunication
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“Communication about communication” Includes various nonverbal cues that accompany the content of the message.
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Double Bind
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Conflicting, often destructive, view of communication. Bind includes contradictory messages given at the report and command level.
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First Order Change
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When there is a change in the system’s pattern of interaction that does not include a change in the organization of the system itself
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Second Order Change
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Change that occurs at the system level that requires changes within the organization of the system itself; MRI approach seeks this.
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Symmetrical Relationships
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Form of interaction characterized by participants who mirror each other’s behavior; at risk for becoming competitive
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Complementary Relationships
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Interaction characterized by participants who assume opposite positions; at risk for becoming oppressive
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The PROBLEM
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Result of recurrent mishandled difficulty–to the extent that it remains unresolved. Mishandled in three ways: 1. Failing to take necessary action 2. Taking action that should not be taken 3. Taking action that does not address problem
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Interactional View of Problem
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Assumption that a problem is maintained by the actions of both the individual and another; alternating the interaction also alters the problem.
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More of the Same-Solutions
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Tendency for individuals to attempt to solve problems by repeatedly implementing the same solution; ongoing pattern creates a + feedback loop where attempted solutions perpetuate/worsen problem.
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Source of Dysfunction
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*Problems are source of dysfunction Object of change in MRI Brief Therapy approach; problems are conceptualized as difficulties that cannot be resolved due to repeated, unsuccessful attempts to solve the difficulty. Demands of the problem lead to further attempts to solve the problem w/ variations of similar unproductive solutions.
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Four Common Unproductive Attempts to Resolve Problems
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1. Mistaken attempts at changing existing difficulty 2. Initiating unnecessary changes 3. Not taking necessary actions 4. Making changes at the wrong level
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Role of Therapist
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-Provokes thought/insight -Explores unsuccessful solutions -Encourages clients to describe their experiences of problem -Aligns w/ the individual who has highest level of motivation or “customership” -Client language helps therapist manuever and heighten the change process w/ their influence -Therapist frams alternatives in way that emphasizes hope & agency -Therapist uses direct questions and focusing interventions to stay on task
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Four steps in Assessment Phase for Brief Therapy
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1. Define and identify problem 2. Explore actions family has tried 3. Formulate clear description of change to be achieved 4. Create and implement a plan to alter attempted solutions
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Two Fundamental Questions for therapist
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“What is the main problem or problems?” “How has the client been trying to deal with these problems up to this point?”
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Typical Course of Treatment in MRI
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Follows progression from identifying problem, interruption of ineffective solutions, and introduction of a more productive solution to problems. Shoham and Rohrbaugh (2002) suggest: -Presenting problem is defined (behavioral terms) -Minimum goals for treatment -Past solutions to problem examined -Positive feedback loops are associated w/ ineffective solutions -Emphasis given to doing “less of the same” -Client language/preferred perspectives -Small change interventions are pursued.
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Early Stage Goals
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1. Define the problem. *Therapist interviews fam about the problem. Problem explored in terms of nature of the complaint. 2. Identify “customership” or client motivation. Who believes therapy will be most helpful? 3. Identify previous solutions/their outcome. Special attn. paid to “more of the same” patterns.
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Interim Goals
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*Interrupt “more of the same” solutions to highlight these typically employed solutions and their links to the problem. *May include therapeutic tasks that reframe the problem, relabel symptoms, or paradoxical directives including prescribing the symptoms or 180 degree shift in approach to the problem.
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Late Stage Goals
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*Interrupt potential new problems that occur bc of shifts *Therapist may again identify previously attempted solutions and suggest alternatives including: a 180 degree shift, reframe the problem, and present a therapeutic double bind. *Highlight newly implemented successful solutions *Identify and explore second order changes in system
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Initial Interview Questions
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Therapist explores problem and attempted solutions. Focus given to describing behaviors rather than prompting explanations. “What is the problem you are seeking help for today?” “How is this problem a situation for you now?” “What keeps things from getting worse??”
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Reframing
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Meaning of the problem or attempted solution is redefined in a way that creates new meaning for the client.
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“Do More of the Same”
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Recommendation for the client to engage in symptomatic behavior in order to reduce resistance/disrupt current interactive pattern.
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Relabeling
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Therapist uses language in relationship to symptom or problem that does not alter behavior, but provides new meaning.
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“Go Slow”
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Paradoxical intervention encouraging client to complete assignment carefully; normalizing treatment setbacks and varying progress rates.
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“Making the Covert Overt”
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therapist makes specific reference to family’s underlying behaviors/patterns that organize their interactions.
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Bellac Ploy
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therapist compliments a client (paradoxically) that influences him to behave in a way that is consistent with the compliment.
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Therapeutic Double Bind
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therapist provides metacommunication about an existing double bind in the family system; may tell symptomatic client to continue
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Process of Change
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Brief problem focused model focuses on small changes. Therapist assists individuals/families in discontinuing persistent and unsuccessful solutions to difficulties. Change occurs through the reduction in the practice of unsuccessful efforts/initiation of more successful alternatives. Therapist maximizes use of client’s language and motivation to foster the adoption of an alternative response.
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Primary Theoretical Contributions
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Illustrates MRI approach to effecting focused/minimal change in the family system. Model illustrates a pragmatic systems approach to communication and patterns of interaction. -Interventions are focused on disrupting “ironic processes” that keep individuals and families stuck in a problem. -Models influence is evident (related BUT conceptually different) in distinct treatment approaches of Strategic Therapy and Brief Focused Therapy.
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Techniques/Interventions
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*Initial Interview Questions *Reframing *”Do More of the Same” *Go slow *Making the Covert Overt *Bellac Ploy