Basic-Skills 2013 Email Handouts

BASIC SKILLS WORKSHOP (First Workshop in the Solution-Focused Interviewing Certificate Program)

In Association with Pathways Kingston Dr. Ronald E. Warner, C.Psych. CSFT, Program Director Email: [email protected]. Voicemail: 613 548 8209 Pathways, 993 Princess St. Suite 14, Kingston, 613 546 1422. Sept 17 & 24, 2013; 9:00 to 4:00 Introduction I wish to welcome you to the Basic Skills workshop. In order to help students be better prepared and get the most out of this intensive skill oriented workshop, I have attached the Basic Skills handouts (21 pages). This handout is also meant as a future resource, and is essential for completing the final workshop, Clinical Case Presentation. Please remember to bring the handouts, or at least the first 3 pages, to class since copies will not be available on site. Suggested Workshop Preparation By reading the handouts, and reflecting on the questions you wish to ask, you will be better prepared for this intensive “hands on” learning experience. For background information an article by Evonne Dolan, “I will Start My Diet Tomorrow”, is included, and illustrates what a solution-focused conversation looks like, and how this approach can be used for self-help purposes. Also included is the information for attending the Clinical Case Presentation workshop including an example of the required report. For the class preparation, at the very least, read the section, “Fast Track to Beginning Practice” (page 6) from my self-published book, Interviewing for Solutions: A Tri-Phase Approach to Positive Psychology”. 1) 2) 3) 4)

Describe the major the differences between problem-solving and solution-building interventions? What are the components of the Tri-Phase Solution Building Process? What are negative goals and how should they be reframed? Explain how the “not knowing/non expert” posture is central to the solution-focused approach.

Handout Outline Introduction Questions in Solution-Focused Interviewing (p.3) References (p.4) Fast Track to Professional Practice (p.6) “I’ll Start My Diet Tomorrow (p.11) Clinical Case Presentation Explanation (p.15 -for June 2012 module) Clinical Case Presentation Example (p.16) I wish you a very positive learning experience, and look forward to meeting you next month. Professor Ron Warner ([email protected]

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Objectives of the Basic Skills Workshop The aim of this module is to acquire an understanding of the principles, assumptions, and techniques of the solution-focused model in order to develop the skills to build solutions with clients collaboratively. More specifically, the objectives of this module are as follows:  to recognize the difference between problem solving and solution building interviewing questions  to utilize the three phases of questions in the solution building model  to understand how to conduct a microanalysis of the questions used in a helping interview WORKSHOP OUTLINE Day One  Positive Psychology; Recent Developments & Further Support for SFBT  A Paradigm Shift: Comparison of problem solving and solution-building models  Principles and Techniques  Demonstrating Application: I Love My Kids videotape  Small Group Practice - conducting first interview using solution-building interventions Day Two  Format for Second and Subsequent Interviews.  Dealing with Involuntary clients - 'Its Her Fault" tape  Promoting Post-Traumatic Growth; Optimizing Strength out of Adversity  Suicide Prevention: Strength-Based Interventions for “Hope into Action”  Audio Recording Example of Solution-Building for the Final Workshop (see p. 18)  Small Group Practice - continuing solution building Small Group Practice Sessions For training purposes the participants may be divided into groups of 4 or 5 based on specific common objectives- something they would like to change/improve in themselves. Examples of objectives in these highly structured groups include time management, stress reduction, weight loss/healthier eating, improved partner communication, fitness improvement, handling criticism better, dealing with difficult relatives, better parenting, coping with a physical/health limitation, smoking cessation, handling aging parents better, and overcoming perfectionism Recommended Text: DeJong, P., Berg, I., (2012-third edition). Interviewing for Solutions. Brooks/Cole. Internet Resources Solution-Focused Brief Therapy Association: sfbta.org Solution-Focused Therapy List- [email protected] SFT-L archives: www: maelstrom.stjohns.edu/archives/archives/sft-l.html European Brief Therapy Association: WWW: ebta.nu Businesses, organizations, teams: WWW: coachteam.com & thesolutionsfocus.com Scott Miller & Barry Duncan: WWW: talkingcure.com Bill O’Hanlon: brieftherapy.com

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QUESTIONS IN SOLUTION-FOCUSED INTERVIEWING: HANDY REFERENCE EMPATHY PHASE (1): ESTABLISHING RAPPORT: Client feeling understood. This includes all responses that acknowledge and validate the client including simple reinforcements (eg. um, yes, okay, etc.), repeating client’s words, summarizing, and full reflections. Also included in this phase is targeting strengths and giving compliments. A helpful question can be, “You must have had a very good reason for ---(name the problem behaviour).

GOAL SETTING PHASE (2) – DETERMINING CLIENT GOALS: “What’s Wanted” out of the interview; Goal Setting Direct Question: What brings you here today? How can I help you? What would you like to do or change about that? How were you hoping that I could help you with this problem? What would be helpful for us to talk about? First Session Formula Task: (Asking this question prior to the interview) Please observe, so that you can describe to me when we meet, what happens in your (family life, marriage, relationship, etc.) that is working well and you want to continue to have happen. Pretreatment/Pre-session Change Have you noticed any changes with your problem situation since making this appointment (or deciding to seek help)? and are these the kinds of changes you would like to continue to happen?

GOAL STRIVING PHASE (also called strategy phase) Exceptions When isn't the problem happening? Tell me about the last time you did not have these problems/symptoms? What is different about those times? What do you do differently (or think differently) then? What is happening that tells you that this problem can be solved? Outcome When this issue is resolved (or no longer a problem for you), what difference will that make? Miracle Question: Suppose tonight when you go to sleep a miracle happens and this "problem" is solved. When you wake up next morning what would be different? How would you be different? What would others notice? When was the last time even a little bit of the miracle happened? Scaling Using a scale of 1 to 10 (1 being the worst/lowest, 10 being the best/highest) where would you rate your (e.g., motivation, confidence, self-esteem, etc) right now? How important is it to you to make these changes - using a scale of 1 to 10 (1 being you will wait until someone else changes, and 10 being you will do everything possible) what number would you choose? Relationship. What would you partner say has to happen for her to take you back in the marriage? What would your (spouse/parent/friend/doctor) say is the reason s/he sent you to see me? What would (that person) need to see for s/he to believe you don’t need to come here anymore? Coping How have you managed to cope as well as you have with that "problem"? What have you been doing to fight off the urge to (feel depressed, etc)? How have you managed to keep this situation from becoming worse? If you hadn't been through this experience personally, would you have ever thought that you had the strength to survive like you have?

Brief Counselling Bibliography APA (2008). The Posttraumatic Inventory: Taking Stock –Growth Through Resilience (www.apa.org). Bannick, F. (2008). Posttraumatic Success: Solution-Focused Brief Therapy. Brief Treatment & Crisis Intervention, 8/3. Bavelas, J.B., McGee, D., Phillips, B., Routledge, R. (2000). Microanalysis of Communication in Psychotherapy. Human Systems: The Journal of Systemic Consultation & Management. 11, 1, p47-66 Berg, I. & Kelly, S. (2000). Building Solutions in Child Protection Services WW Norton. Berg, I. (1994). Family Based Services: A Solution -Focused Approach. Norton: New York/London Berg, I., Reuss, N. (1997). Solutions Step by Step; A Substance Abuse Treatment Manual. Norton. Berg, I., Miller, S. (1992). Working with the Problem Drinker; A Solution -Focused Approach. Norton New York/London. Cockburn, J.T. and others,(1997).Solution-focused therapy and psychosocial adjustment to orthopaedic rehabilitation in a work hardening program. Journal of Occupational Rehabilitation, Vol. 7, No. 2, 1997, pp. 97-106. de Shazer, S. (1988). Clues: Investigating solutions in brief therapy. New York: Norton de Shazer, S. (1985). Keys to solutions in brief therapy. New York: Norton. Dolan, Y. (1991). Resolving Sexual Abuse: Solution-Focused Therapy and Ericksonian Hypnosis for Adult Survivors. Norton. Duncan, B. Miller, S. (2000). The Heroic Client: Doing Client-Directed, Outcome-Informed Therapy. Jossey Bass Duncan, B. Miller, S.. Hubble, M. (1997). Psychotherapy with Impossible A Cases: The Efficient Treatment of Therapy Veterans. WW Norton. Durrant, M. (1993). Residential Treatment: A Cooperative Competency-Based Approach to Therapy and Program Design. WW Norton, New York Fish, J.M., (1996). Prevention, solution-focused therapy, and the illusion of mental disorders. Applied and Preventative Psychology, 5, 37-40. Fiske, H. (2008). Hope in Action; Solution-Focused Conversations About Suicide. Routledge. Franklin.C. Trepper, T.,Gingerrich.W.,McCollum,E. editors (2012). Solution-Focused Brief Therapy; A Handbook of Evidence-Based Practice. Oxford University Press Joseph, S., Linley, A. (2008). Trauma, Recover, and Growth; Positive Psychological Perspectives on Posttraumatic Stress. John Wiley & Sons. Hawkes, D., Marsh, T., Wilgosh, R. (1998). Solution Focused Therapy: Handbook for Health Care Professionals. Oxford: Butterworth Heinesmann. Hubble, MA., Duncan, B.L., Miller, S.D. (1999). The Heart and Soul of Change: What Works in Therapy.. Wash. D.C. APA Press. Huber, C. Backlund, B. (1993). The Twenty Minute Counselor: Transforming Brief Conversations into Effective Helping Experiences. New York: Continuum Publishing. Korman, H. (1997). On the Ethics of Constructing Realities. Contemporary Family Therapy 19 1, 105-120. LaFountain, R. Garner, N. (1996). Solution-Focused Counselling Groups: The Results are in. Journal for Specialists in Groups 21, 2, 128-143. L McFarland, B. (1995). Brief Therapy and Eating Disorders: A Practical Guide to Solution-Focused Work With Clients. Jossey Bass. McGee, Dan, et.al (2005). An Interactional Model of Questions as Therapeutic Interventions. Journal of Marriage and Family Therapy. 31-4. P215-227. Metcalf, L. (1998). Solution Focused Group Therapy. The Free Press, New York. Metcalf, L. (1996). How Parents Can Use Skills They Already Have to Raise Responsible Loving Kids. Prentice-Hall. Metcalf, L. (1995). Counseling Toward Solutions: A Practical Solution-focused Program for Working with Students, Teachers, and Parents. Center for Applied Research in Education. West Nyack, New York. Miller, S. Duncan, B. Hubble, M. (1997) Escape from Babel: Toward a Unifying language of Psychotherapy Practice. WW Norton. Miller, S., Hubble, M., Duncan, B. (1996). Handbook of Solution-Focused Therapy, Jossey-Bass Publishers. O’Hanlon, W. & Bertolino, B. (1998). Even From a Broken Web: Brief, Respectful Solution-Oriented Therapy for Sexual Abuse and Trauma. New York, John Wiley and Sons. O’Hanlon, W. Hudson, P. (1995). Stop Blaming, Start Loving. Norton. Peterson, C. (2006). Primer in Positive Psychology. Oxford Lee, M. Sebold, J., Uken, A. (2003). Solution-Focused Treatment of Domestic Violence Offenders. Oxford University Press. Lindforss, L., Magnusson, D. (1997). Solution-Focused Therapy in School. Contemporary Family Therapy 19, 1, 89103. Park, E. (1997). An Application of Brief Therapy to Family Medicine. Contemporary Family Therapy 19 1, 81-88. Rowan, Tim., O’Hanlon, B. (1999). Solution-Oriented Therapy for Chronic and Severe Mental Illness. . John Wiley & Sons

5 Selekman, M. (1997). Solution-Focused Therapy with Children: Harnessing Family Strengths For Systemic Change. Guildford Seligman, M. (1995). The Optimistic Child. Harper Perennial. Seligman, M. (1991). Learned Optimism. A. Knopf publisher. Slive, A., Maclaurin, B., Oakander, M., Amundson, J. (1995). Walk-in Single Sessions: A New Paradigm in Clinical Service Delivery. Journal of Systemic Therapies, 14 (1) 3-11. Talmon, M. (1993). Single-Session Therapy: A guide to practical, effective, and affordable therapy. Triantafillou, N. (1997). A Solution-Focused Approach to Mental Health Supervision. Journal of Systemic Therapies 16 (4), 305-328. Uken, A., Sebold, J. (1996). The Plumas Project: A Solution-Focused Goal Directed Domestic Violence Diversion Program. Journal Of Collaborative Therapies 4, 2, 10-17. Walter, J. Peller, J. (1992). Becoming Solution-Focused in Brief Therapy. Brunner/Mazel. Warner, R.E. & McConkey N. (2002). “What’s Wanted vs What’s Wrong”: Solution-Focused Strategies for Educators. OPC Register Summer 4,2 p21-25. Warner, R.E. (2000). Solution-Focused Training: Developing the Qualitative Practice Standards. European Brief Therapy Web Newsletter. www: ebta.nu Warner, R.E. (1998). A Mental Health Services Staff Training in Hospital Settings: A Solution-Focused Approach. Partners in Psychiatric Health Care 1, 1, 32-37. Warner, R.E. (1997) - Implementing the Solution-Focused Model: One Therapist=s Experience. Journal of Collaborative Therapies 5/1, 8-14. Warner, R.E. (1996). Comparison of Client and Counsellor Satisfaction with Treatment Duration. Journal of College Student Psychotherapy 10, 3,. 73-88. Weiner-Davis, M. (1992). Divorce Busting; A Revolutionary and Rapid Program for Staying toTogether. Simon & Schuster. Zimmerman, T. Prest, L. Wetzel,. (1997). Solution-Focused Couples Therapy Groups: An empirical Study. Journal of Family Therapy 19: 125-145.

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CHAPTER 2 (1)

FAST TRACK TO BEGINNING PRACTICE THE POWER OF QUESTIONS “Judge a man by his questions, rather than his answers.” Voltaire Too often we offer explanations or observations when we should be engaging in inquiry. It may be gratifying to display knowledge and expertise, but our explanations and observations rarely empower the people to whom we are speaking. Questions on the other hand, have the power and the potential to evoke and transform thought into an energized belief system which can become life altering. Questions can create new possibilities, new hope and new inspiration which can lead to transformation and higher levels of functioning and fulfillment. Strength-based questions, when used in Solution-Focused Interviewing, are potent inquiries because they are grounded in our clients’ successes, capabilities and aspirations. Such inquiries lead to an increased experience of optimism and positive feelings. And most important, recent research findings (see chapter 3) demonstrate that positive emotions also increase psychological well-being, future health and longevity.

Solution-Focused Interviewing: Description Solution-Focused Interviewing (SFI) is a non-clinical psychology adaptation of Solution-Focused Brief Therapy. The solution-focused interviewer learns the skills to conduct interviews, and less formal discussions, where clients’ existing strengths and resources are utilized to help them define their goals and develop solutions to their problems 2. This interviewing approach addresses solutions rather than problems by emphasizing client strengths, competencies and possibilities rather than weaknesses, deficits and limitations. The solution-focused approach differs from the conventional problem-based paradigm in that it de-emphasizes the connection between the problem and its solution. It also emphasizes the importance of client perceptions and de-emphasizes role of the practitioner as the expert who makes assessments and prescribes interventions (DeJong & Berg, 2002).

Problem-Talk Compared to Solution-Talk: An Important Distinction All client interactions, understandably, begin with a discussion of the problem or difficult situation. Questions directed at acquiring details to understand the problem promote problem discussion or more simply, “problem-talk”. One of the core skills of the solution-focused approach is to ask questions, early in the conversation which facilitate the client making the transition from problem-talk – talk about “what’s wrong” to solution-talk – talk about “what’s wanted”. All questions can be seen as either to promoting problem-talk or solution-talk. It is important to clearly understand the differences between these two approaches.

Problem Talk – “What’s Wrong” – The Traditional Helping Approach 1 Warner, R. (2010 revised). Interviewing for Solutions: A Tri-Phase Approach to Using to Positive Psychology 2 This description applies equally to Solution-Focused Brief Therapy.

7 Problem-talk is facilitated by questions which encourage discussion about “what’s wrong” including questions about the nature, frequency, intensity, duration and cause of the problem. Exploration of the problem is crucial, according to this paradigm, so that the client and professional can come to an understanding of the difficulty. The underlying assumption here is that resolution to problems only develops out of insight and/or knowledge gained from problem discussion. Some helping models (e.g., psychoanalysis) go further and maintain that it is of crucial importance to uncover and explore the “root” cause of the problem. The importance of finding the cause of the problem, for these models, is based on three presuppositions: that all psychosocial problems have a specific cause; that the cause can be identified, and that there is a connection between finding the cause and resolving the problem (Walter & Peller, 1992).

Solution-talk – “What’s Wanted” – A paradigm Shift In contrast to exploring what’s wrong, the solution-focused approach explores what the client wants to do about the specific problem. The interviewer listens sympathetically to the client’s statement about the problem, but looks for opportunities to ask questions about what’s wanted – to begin solution-talk. Solution-talk is promoted by interviewer questions which focus on client successes, strengths, resources and goals. The interviewer and client explore together a more hopeful vision of the future when the problem is resolved. Or, in situations where the client is dealing with loss, the questions explore the future when the client is coping as well as possible. Before solution-talk can progress the interviewer must first establish good rapport and be perceived as understanding the client and problem. The solution-building interview can also be differentiated from the conventional problem-focused interview by the positive ambience of the discussion. Underlying all inquiries directed to the client, is the presupposition that clients’ possess what they need to resolve their difficulties. Strength-based questions – all inquiries which are directed at and emphasize positive attributes – help clients become aware of their capabilities and create this positive atmosphere.

Operational Components of Solution-Focused Interviewing (SFI) 

The client’s and/or interviewer’s understanding of the problem is not considered a necessary condition for resolution of the difficulty The client’s unique personal strengths and resources are identified What the client wants to be different in his/her life – the goal – is explored Strengths are mobilized and goals are clarified to provide the foundation for the interviewer and client to co-construct a solution to the problem which initiated the interview

  

Example of Michael Who is Worried about a Job Promotion Interview Michael: Yesterday I was told that I had made it to the second round of interviews next Tuesday – but here is what throws me – Mr Jacobs, the senior manager, will be chairing the meeting! He has a reputation of being very critical and tough on employees and frankly many of us are intimidated by him. Last night I hardly slept at all worrying about this – I even had a nightmare of losing it during the interview! The following are examples of problem-focused questions which are likely to promote extended problem exploration and problem-talk.

Problem-Focused Questions: Examples  

What is it about Mr Jacobs that intimidates you? Have you personally had a run in with him before?

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Does Mr Jacobs remind you of other people in your life who have been critical of you? What specifically were you thinking about last night that kept you awake and caused a nightmare?

Now, let’s look at strength-based questions which promote solution-talk and would help Michael to see the strengths and competencies he possesses which will enable him to do well in the up-coming interview.

Solution-Building Questions: Examples    

So you had a first interview which was successful? Tell me about it? What do you think you said, or how did you handle yourself so that you convinced the committee to give you another interview? Based on that interview and also similar situations where you have been successful, what do you need to do to come across at your best? If Mr Jacobs asks you a tough question – one that you are not sure of, but you are at your best – how would you like to respond to him?

Any of the above questions will likely begin the process of solution-building and goal clarification. These questions will not be very helpful to the client, however, until the Empathy Phase of the interview has been effectively undertaken. The phases of the solution-building interview are explained later in this chapter. But first let’s examine the assumptions and principles of SFI.

Guiding Assumptions & Principles of Solution-Focused Interviewing Accentuate the Positive This principle is the foundation of the model. It is at the core of all strategies and questions. Focusing on the positive, what is wanted (rather than what is wrong) and emphasizing strengths and resources results in client change and empowerment. An important assumption here is that clients, regardless of their problems or situation, already possess sufficient strengths and resources to build solutions to their psychosocial problems. Problem analysis, exploring what is wrong, is considered counter productive in this strength-based approach. Our capacity to change is connected to our ability to see things differently (DeJong & Berg, 2002).

Construct Positive Goals

Goals, what the client wants, provide direction for the solution-focused approach. When goals are articulated by clients – goals that are based on what is most important to them – there is enhanced hopefulness and motivation to change. Goals need to be expressed in small, behavioural and positive terms. Negative goals – stopping or not doing something – are unproductive and need to be reframed. We do this by asking clients what they will be doing when the unwanted behaviour is no longer an issue. As long as clients can be helped to identify what they want, regardless of the nature of the problem or diagnosis, the solution-focused approach can be helpful (Sklare, 2005).

Assume a Not Knowing/Non Expert Posture Clients are considered to be experts on their lives – on what will “work” for them and on what they want for their future. Adopting a not knowing posture, a posture of genuine curiosity toward clients’ successes, strengths and aspirations instills motivation to change, hope and empowerment. All questions ought to be framed from this not knowing/non expert perspective – a perspective which could be described as one of complimentary curiosity.

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Use a Solution-Building Process The solution-focused practitioner is not an expert on client problems and their resolution, but rather has expertise in the solution-building process. The interviewer role in solution-building can be described as more of a coach asking questions which identify strengths, clarify goals and highlight values – what is most important to the client. This strength-based conversation instils hope in clients that they can take responsibility for making the desired positive changes in their lives. This approach is consistent with the notion that all psychological treatment facilitates naturally occurring selfhealing processes (Bohert and Tallman, 1999). The following describes the phases of a solution-building process.

Tri-Phase Model of the Solution-Building Process

Introduction

During my first decade of teaching the solution-focused model, I emphasized the “drivers” – the five primary intervention questions. I noted that students and workshop participants experienced two major difficulties when using these powerful questions. First, there were often difficulties related to the fact that the interviewer did not display adequate understanding of the client’s situation – in other words, the interviewer was not sufficiently empathic. The second difficulty related to there being insufficient clarity about what the client wanted – client generated goals. As a result of these two difficulties, I began teaching the model using a tri-phase approach which conceptualized the interview as being comprised of three discrete, but interactive tasks or phases. So, before asking any of the five primary intervention questions (now referred to as Strategy Phase questions), novices are taught to address two pre-conditional phases – Empathy and Goals. This conceptualization provides a template on how to engage the client in a more systematic manner and has resulted in more rapid acquisition of solution-building skills by novices.

Empathy Phase (1): Establishing Rapport The challenge of this phase is to demonstrate an understanding of and respect for the client’s world view in as brief a time as possible. This is accomplished by employing active listening and reflecting skills. It requires acknowledgment of the client’s circumstances and adequate validation of the client’s story. The interviewer identifies what and who is important to the client and pays close attention to and compliments clients on their strengths, successes and resources. Note: Emotions and negative feelings are acknowledged and validated, but not explored or expanded upon by the interviewer. Let’s return to the example of Michael, who is worried about his job promotion interview. An Empathy phase response could be as simple, as: That promotion is important to you – I can see why you are concerned. To use another example – that of an open heart surgery patient who expresses apprehension about her up coming surgery – an empathic response might be: It is perfectly understandable to be apprehensive about major surgery. Chapter 6 provides an in depth discussion of the Empathy phase of the interview. Once empathic responses have been given and ideally the interviewer has identified and commented on a client strength or resource, it is time to make the transition to the next phase.

Goal Phase (2): Providing Direction – What’s Wanted ” In this phase, the interviewer and client define a goal – what the client wants to have happen. Goals are defined in behavioural, small and positive terms. As the discussion progresses, goals change frequently and the interviewer needs to regularly check with the client to clarify these changes. Asking clients what is it that “tells” them that they can achieve their goals often uncovers strengths, resources and values which result in enhanced determination and confidence. When goals are explored from a solution-building perspective by using the following three steps, clients often find their motivation increases and the experience is frequently transformative and empowering.

Forming Solution-Focused Goals

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1. Ask “What’s Wanted”: Examples: How can I help you? What would you like to do or change about this? What is it that you want to have happen here? How are you hoping I could help you with this? With involuntary clients relationship questions can be very helpful; for example, What would (judge, teacher, parent, etc.) say is the reason s/he sent you to see me? What would be helpful for us to talk about right now? 2. Inquire About the Impact of Obtaining the Goal: Examples: What difference will reaching that goal make in your life? How will your relationship with your son be better when he improves his grades? 3.

Assess the Level of Motivation/Confidence: Examples: How important is that goal to you? On a scale of 1 to 10 where one is minimal – for now you can live with it – and 10 represents very important, you need to make changes now, what number would are you at? How did you get to that number? What would have to happen for you to move up ½ point on the scale?

Strategy Phase (3): Pathways to Goals and a Solutions The attainment of this phase is facilitated by the ground work undertaken in the two previous phases. It requires that the client begin to think about the possibility that there are new and better ways to deal with the situation, and to take responsibility for making changes which will turn their vision of what’s wanted into reality. The Strategy Phase involves the interviewer’s skilful use of the following primary intervention questions. Using one or more of these questions challenges clients to begin thinking about how they are going to build a solution to their problem.

The Primary Intervention Questions A) Exceptions to the problem: Finding exceptions shrinks problems, demonstrates abilities and strengths, and focuses on what is possible. The interviewer inquires about the times when the client’s problem/complaint is absent or minimal and what is different about those times.

B) Outcomes – preferred future: Here we ask clients about their future when the problem is resolved, or when they are coping with the situation as well as possible. The interviewer gathers as many details as possible about how clients’ lives/situations will be different when they are successful. The Miracle Question, the most powerful of all the outcome techniques, asks clients to imagine that the problem they are having is miraculously resolved while they are sleeping; and then asks them how they would know in the morning that a miracle had happened.

C) Scaling – goal assessment: Clients are asked about goal progress or some other issue related to the presenting problem/complaint. A scale is employed where 1 represents the “worst things have been” and 10

11 represents when the goal is achieved. After clients mention a number, two further questions are asked – how did you get to that number, and what would “have to happen” for you to move up one half point on that scale?

D) Relationship – other opinions: Clients are asked how some one else who knows them would answer a particular question. For example: What would your partner say is different about you when you are handling stress better at the office?

E) Coping – survival skills: Here clients are asked about how they deal with setbacks. For example: How have you managed to cope with this (problem/complaint) as well as you have? What has helped you even a little to get you through the day? See Appendix B for a brief summary of solution-building questions.

Overview Empathy Phase (1): Establishing Rapport Helping the client to feel understood Goal Setting Phase (2): Phase (3) Providing Direction

Strategy (or Goal Striving Pathways to Goals & Solution

Using our example of Michael, let’s see how a Solution-Focused Interview progresses through the 3 Phases. Michael: Yesterday I was told that I had made it to the second round of interviews next Tuesday – but here is what throws me – Mr Jacobs, the senior manager will be chairing the meeting! He has a reputation of being very critical and tough and on employees, and frankly many of us are intimidated by him. Last night I hardly slept at all worrying about this – I even had a nightmare of losing it during the interview! Interviewer: Sounds like this job promotion is pretty important to you and you are nervous about it going well. (Empathy phase response) Michael: Yes it is important. I have been doing this job for 5 years now and really feel I am ready to move up. But, I’m really afraid of blowing this interview – I’ve done that before! Interviewer: I hear you (Empathy response), but I am curious – you had a first interview which was successful? Is that right? Tell me about that? (Empathy phase and highlights a success) Michael: Yes, that interview went very well. I just felt prepared and in control – it was the best interview I ever had! Interviewer: So is that what you want – your goal is to be really prepared and at your best in the next interview? (Important transition to the goal phase) Michael: Oh yes – I really want this job. I feel ready for the additional responsibilities and frankly my family could use the additional income. (The goal is confirmed by the client) Interviewer: Sounds like you are ready and motivated to have this job. (Re-iterates the goal and Michael strongly nods agreement) So what do you have to do to prepare yourself for this interview? (Strategy phase question) Michael: Well last time I was able to keep myself really positive – well most of the time – and I wonder if that is why I was able to feel on top in the interview? Interviewer: Sounds right to me. (Empathy response) – So how were you able to do that – stay positive? (Strategy phase question.)

12 Other questions might be: what else would help Michael stay positive; what is it like for Michael when he is in a positive mood; how did he learn to stay positive; and how would he like to handle the tough questions which Mr Jacobs might ask.

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I'LL START MY DIET TOMORROW: A SOLUTION-FOCUSED APROACH TO WEIGHT LOSS Yvonne Dolan ABSTRACT. This article illustrates through a personal case example how Solution-Focused Brief Therapy concepts can help people lose weight and keep it off. KEY WORDS: Solution-Focused Brief Therapy; weight loss. (Yvonne Dolan, MA, The Solution Group, 27866 Meadowlark Drive, Golden, CO 80401. Contemporary Family Therapy, 19(l), March 1997. Copyrite 1997 Human Sciences Press, Inc.) One out of every three Americans is overweight. Obesity is currently the most common nutritional disorder in the western world and is occurring with increasing frequency in developing countries as well (Simopulous, Victor, & Jacobson, 1993). Diets usually fail. According to recent statistics, 95 percent of people who diet regain the weight they have lost (Gullo, 1995). Many then gain additional weight. The remaining five percent of dieters who succeed made me curious about how Solution-focused concepts (Berg 1990, 1994; de Shazer, 1982, 1985, 1991; de Shazer, Berg, Lipchik, Nunally, Molnar, Gingerich, & Weiner-Davis, 1986, Lipchik, 1988; Lipchik & de Shazer, 1986; O'Hanlon & Weiner-Davis, 1989) might be applied to weight loss and maintenance. After all, no one overeats all the time. This article will illustrate (through a personal case example) howSolution-focused concepts such as imagining a miracle (Berg, 1990; de Shazer 1988), identifying exceptions (de Shazer et al., 1986), scaling (Berg, 1990) can be utilized to help people succeed at losing weight and then keeping it off. Included is a Solution -focused Weight Maintenance Success Scale designed to prevent regaining after the loss has been achieved. IDENTIFYING THE PROBLEM Among the after Christmas bills came a packet of photographs including photos containing an image of a person I had known for a long time. I was dismayed to notice that she had put on a consider able amount of weight. She was me. Twice earlier that year I had attempted unsuccessfully to diet. I had celebrated my 40th birthday five years before by losing 15 pounds, but I had not kept it off. In fact, I had gained an additional five pounds. Then, after a delectable December visit to Belgium where I stayed at the home of a renowned chef, and indulged in the world's best chocolate, I had added a couple of pounds more. As the January snows settled, the problem of my excess poundage seemed very heavy indeed, and I began to feel depressed. For weeks I had been telling myself that I would start a diet "tomorrow." Tomorrow had come and gone many times. I felt hopeless. ASKING THE MIRACLE QUESTION As a therapist trained in Solution-focused therapy, I knew what I should do. I had better ask myself the Miracle Question. The relentless optimism that usually colors my beliefs about clients was nowhere to be found when I forced myself to describe my own Miracle. In fact I felt cynical, jaded, more than just depressed, resistant to defining what the damned miracle would be. Internalized Solution-Focused Therapist (ISFT): If a Miracle happened in the middle of the night while you were sleeping, and when you awakened your weight problem had been solved, what would be different? What would be the first thing you would notice?

14 ME: ISFT: ME: ISFT: ME: ISFT: ME: ISFT: ME: ISFT: ME: ISFT: ME: ISFT: ME: ISFT: ME:

Yeah, right. Well, the first thing would be that my clothes would fit. My jeans wouldn't be leaving bruises on me anymore. Hold on. That doesn't sound to me like the first thing you'd notice. We're looking for a little sign here, not a huge one. What would be the first and smallest sign? Okay, okay. I'd wake up in the morning and I would be in a good mood. How would that show up? Well, I would feel active. I would want to do something physical. What would be the smallest thing you could do? Take a walk or lift weights since I have them in the house. But dammit, I've done that before, for a year in fact, and I didn't lose any weight. I just became a more athletic fat person. In the interest of solutions, I'm going to ignore both your sarcasm and your foul language. What would be the next small thing you would notice the day you woke up after the miracle had happened? I Well, I guess I would make a point to eat breakfast. I always skip it. And what kind of breakfast would you have after the miracle? Something nutritious, light, healthy. And what difference would that make? I would feel a little bit encouraged, a little bit proud of myself as I started my day. And what difference would that make? Oh, shut up. Okay, I admit I would be less depressed. Moving along here, what would be the next small sign? Well, obviously I would eat a sensible lunch, but since you are me, you know that once I get past breakfast, the caloric trouble begins for me.

SEARCHING FOR AN EXCEPTION ISFT: You mean you've never in your whole life ever eaten a sensible, healthy, weight reducing sort of lunch? ME: I take it you're looking for an exception, a time, even once, when I was in control, and you want to know how that happened, and what was different about that time? ISFT: Yeah. So what was different? ME: I planned what I was going to eat ahead of time. That made a difference. ISFT: What else? ME: Well, when I was thin, I never ate carbohydrates for lunch. If I eat carbs, I practically always eat too many of them. I've seen myself do it. ISFT. Let's get back to the exception here, what did you eat instead of carbohydrates? ME: Anything healthy: fruit, vegetables, protein, you know. People don't get fat because they don't know what is fattening. I know what I should be eating. SCALING ISFT: So how confident are you that if you set your mind to it, you could eat the kind of lunch you just described? On a scale of 1- 10, just how much faith do you have that you could do it tomorrow? ME: Not much. I mean look at my track record. ISFT: Okay, I know, but pick a number. Just pick one. Be honest. ME: I'm somewhere between a 1 and a 2. 1 mean, what comes to mind, is why bother, it won't make a difference anyway? ISFT: So what would have to happen in order to raise it to a 3? ME: Well, if I told someone I was trying to do this, my self respect would be involved, my credibility as a person. ISFT: Who might you tell? ME: My husband. ISFT. Would that make it a 3? ME: Yeah. ISFT: What would raise it more? ME: If I told some other people as well, a couple of good friends, and maybe my sister. ISFT: If you told each of those people, how much would that raise the number? ME: It would be a 5. ISFT. Is that high enough that you would succeed in getting through lunch? ME: No, probably not. This is getting hard.

15 ISFT: Hey, I'm just asking you the same kinds of questions you ask your clients and you expect them to answer. What would raise the number a little more? ME: If I threw out all the foods that I tend to overeat. Not every thing in the house, but the stuff that triggers me to overindulge. It's stuff that isn't healthy for the rest of my household, anyway. IS FT: How much would that raise it? ME: It would be up to an 8. ISFT: What would make it a 9? ME: In order for it to be a 9, 1 would have to have a few days of sensible, weight reducing lunches under my belt, so to speak. ISFT: And then, what would bring it to a 10? ME: After I had lost the weight and had kept it off for a few months, then, only then would it be a 10. Back off! ISFT: We're not done with the Miracle yet. So after lunch, what would be the next small sign you or someone who cares about you would notice? ME: Okay, I would eat a light, healthy dinner, I wouldn't snack. These things are not news to me. If I could do them, I wouldn't be fat and miserable. NOT GIVING UP ON IDENTIFYING AN EXCEPTION ISFT: ME: ISFT: ME: ISFT: ME: ISFT: ME: ISFT: ME: ISFT: ME: ISFT: ME: ISFT: ME: ISFT: ME: ISFT: ME: ISFT: ME: ISFT. ME: ISFT: ME: ISFT: ME: ISFT: ME: ISFT: ME: ME: ISFT: ME: ISFT. ME: ISFT: ME:

Have you ever managed to eat a light, healthy dinner and not snack afterwards? Well, yes, but not in a long time. What was different about those times from a long time ago? Well, I was busy, or I was distracted from eating, or I was, I suppose, too sick to eat. When you were busy, what sorts of things were you doing? Lots of things: work, sewing, seeing friends, cleaning, all kinds of things. Are any of those things you could do now? Yes, I guess. After the Miracle, what things might you notice, or another person notice you doing at night instead of eating? What would be the first and smallest thing? Probably taking a walk. I used to love to take a walk after dinner. How confident are you that you could do that? On a scale of 1-10? Oh, God, you're not going to ask me to scale this, too, are you? Yep. Okay. 5. What would make it a 6? If I set up a time to go walking with another person after dinner. And what would raise it a little more? If I had other things planned as well, if I made a list of them and did at least one each night after dinner. And ]low much would that raise it? 8. And that is high enough. Get off my back! We're not done, yet. Are you willing to do the things you identified for the next week? I don't know. Well, what difference would you imagine it would make if, you did that for one week? I would feel better. I'd probably have lost a little weight. How confident are you that you could do that this week if you chose? Well, if I "chose," I could certainly do it. How motivated are you on a Scale of 1-10? Well, maybe a 3. What would raise it? If I looked in the mirror. Okay, if you imagine looking in the mirror how much would that raise it? Well it depends what I imagine seeing when I look in the mirror. ISFT: Well, what do you want to imagine? Myself thin, of course. Hmmm. Okay, okay? I'll do it. Just the thought of looking in a mirror right now terrorizes me. I'm an 8. No. When I really think about those pictures, I'm an 11! The motivation scale I gave you was 1-10. You were supposed to scale it somewhere between 1 and 10. Now I'm off the scale, my motivation is off the scale! Are you satisfied? I think you have now managed to become a weight loss customer rather than just an overweight complainant. What was that about?

16 ISFT: ME: ISFT: ME: ISFT.

I thought I would compliment you. It's part of the approach. Well, thanks, I guess. I'll be seeing you. You will? You bet. Later tonight when you walk over to that refrigerator, I'll be there, inviting you to scale your motivation. And tomorrow when you go by the bakery. And Saturday when you go to that Italian restaurant. And then next week ...

At the end of the first week, I had lost three pounds. I steadily lost approximately one pound a week for the next four months. Every day and at the end of each week I used scaling to assess my motiva tion and confidence that I could succeed in the goal of becoming thin. If I had a slip-up in terms of sensible eating, immediately afterwards, I used scaling to rate both my motivation and confidence that I could succeed, identifying the specific behaviors needed to raise both my motivation and confidence to a 10. To address the statistical likelihood of regaining the lost weight, I have invented daily and weekly versions of a Solution-focused Weight Maintenance Success Scale based on the behaviors I identified as exceptions to overeating. This scale could be altered as needed for different people to include individual behaviors associated with successful weight control. I DAILY SOLUTION-FOCUSED WEIGHT MAINTENANCE SUCCESS SCALE • Today I remained within a healthy range of caloric intake • Today I scaled my food control confidence level before each meal • Today I ate sensibly • I did not give into the urge to overindulge in trigger" foods • I have exercised within the last 24 hours • I spent some time relaxing unrelated to food • I spent some time today exploring creative interests unrelated to cooking or food WEEKLY SOLUTION-FOCUSED WEIGHT MAINTENANCE SUCCESS SCALE • • • • •  •

My weight is within normal range I exercised at least four times this week I scaled my food control confidence level before each meal I avoided trigger foods I relaxed each day in some way unrelated to food spent some time this week exploring creative interests unrelated to cooking or food I voiced my intention to remain in control of my weight to a person whose opinion of me I value

So far (five months later), the weight has stayed off. While research is needed to further substantiate this, my experience suggests that a Solution-focused approach is a potentially valuable resource for people seeking support and assistance with weight loss and weight control. REFERENCES Berg, I. K. (1990). A solution-focused approach to family based services. Milwaukee, WL Brief Family Therapy Center. Shazer, S. (1982). Patterns of brief family therapy. New York: Guilford. Shazer, S. (1985). Keys to solutions in brief family therapy. New York: Nor-ton. Shazer, S., Berg, 1. K., Lipchik, E., Nunnally, E., Molnar, A. Gingerich, W., & Wiener -Davis, M. (1986). Brief therapy: Solution-focused development. Family Process, 25, 207-222 . Shazer, S. (1988). Clues: Investigating solutions in brief therapy. New York: Norton. Shazer, S. (1991). Putting differences to work. New York: Norton. Gullo, S. B., (1995). Thin tastes better, New York: Dell. Lipchik, E., & de Shazer, S. (1986). The purposeful interview. Journal of Strategic and Systemic Therapies, 5 (1-2), 88-89. Lipchik, E. (1988). Purposeful sequences for beginning the solution-focused inter-view. In E. Lipchik (Ed.),

17 Interviewing (pp. 105-117). Rockville, MD: Aspen. O’Hanlon, W., & Weiner-Davis, M. (1989). In search of solutions. New York: Norton. Simopoulos, A. P., Victor, H., & Jacobson, B. (1993). Genetic nutrition: Designing a diet based on your family medical history. New York: Macmillan.

A MICROANALYSIS CASE STUDY REPORT: ASSESSING SOLUTION-BUILDING SKILLS FOR THE FINAL WORKSHOP, “CLINICAL CASE PRESENTATION” PATHWAYS PROGRAM (September 10 & 17, 2013)

EXPLANTION: Microanalysis3 is the examination of the theoretical presuppositions embedded in the questions the interviewer/therapist asks the client. Specifically, whether the questions constitute the traditional problem-solving paradigm (i.e., exploring deficits, dysfunctions, negative feelings and other questions of what is wrong, or the solution building paradigm focusing on strengths, resources, and a more hopeful future. With the solution building responses the student further analyses which of the three phases (Empathy, Goals, or Strategies (pathways to goals and solutions) the interventions best fall under. This report is intended as a qualitative self-assessment exercise. INSTRUCTIONS: Prior to the module conduct a solution-building interview of at least 20 minutes in length; if longer select any 20 minute contiguous portion. Preferably videotape the interview, or if this is not feasible an audio tape will suffice; students, however consistently report that videotape provides them with a superior learning experience and improved solution-building skills. 1) Select the best example of an Empathy, Goal, and Strategy phase interventions, and indicate verbatim how the client responded (see the example below). 2) Transcribe all of your responses to the client, and perform the microanalysis; which interventions are problemfocused and which are solution-building indicating which phase the intervention best falls under. Place this transcription as a appendix to your report. (see example on the next page) 3) Calculate the number of solution-building responses to the total number of problem-exploration interventions and indicate this ratio in your report. (e.g., 40 S.B. to 10 P.E. responses = 80% ratio) For classification purposes the End of Session Feedback component of SFBT should be included in Phase 3 with the Strategy questions. Similarly comments/questions about strengths or successes can be considered rapport building and designated Empathy Phase responses. Some of the interventions/questions may fall under more than one phase; select the one you believe is most appropriate. 4) For your presentation at the Module select about 10 minutes of your interview that you wish to play for the class, and do a complete transcription (both your interventions and the client’s replies) of this section. Bring 10 copies of this transcription for your classmates to follow your presentation. Have your tape cued to the beginning of this section you wish to play (the tape must be audible). 5) Include any final comments you would like to make about this exercise and learning process.

3 Bavelas, J.B., McGee, D., Phillips, B., Routledge, R. (2000). Microanalysis of Communication in Psychotherapy. Human Systems: The Journal of Systemic Consultation & Management. Vol. 11, 1, p47-66. McGee, Dan, et.al (2005). An Interactional Model of Questions as Therapeutic Interventions. Journal of Marriage and Family Therapy. 31-4. P215227

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AN EXAMPLE: MICROANLAYSIS CASE STUDY REPORT

Student: John Doe

Occupation: School Counsellor

Client Interviewed Description: A 28 male who presented with the problem of dealing with a difficult supervisor who was not only making the client’s work situation stressful, but beginning to effect his home life. This is the first and only meeting. (You are encouraged to conduct several interviews and select the best) Empathy Example Client: At our monthly meeting he said, “You have got all your facts wrong!” Interviewer: That must have been embarrassing. Client: Yea –particularly because all my staff were present! Goal Example Client: I was dumbfounded – I started arguing and was very upset Interviewer: So how would you have liked to handle that situation. Client: Well I don’t want to get angry and lose my cool! Strategy Example Client: I think I am going to have to have a meeting with my boss (goal) Interviewer: How are you going to raise this issue with him- how do you think it is best to approach this topic –knowing him as well as you do? Client: Well I know he is going to touchy on this issue. He reacts very strongly to anything that appears to be a criticism so I have to figure out a way that won’t make him defensive. Ratio of Solution-Building to Problem-Solving Interventions (This section should be placed at the end) There were a total of 35 interventions (not counting the single words) with 5 problemfocused questions for a ratio of 85% solution-building. Concluding Comments I conducted three taped interviews in total and learned more from each one. What I learned is that I need to go slower, and wait much longer for the client to answer. I am learning to become more curious about the strengths and successes of the client and how he/she has managed to get to this point in their life -rather than getting stuck in the problems and frustrations.

APPENDIX; MY INTERVENTIONS (Transcription) 1. So let’s begin- what is it you would like to discuss? 2. That must have been very embarrassing for you, and in front of your staff. 3. Has he done that to you before or other times he has criticized you?

topic again – how are you going to raise this topic with him?” Microanalysis Goal Empathy Problem-Focused

4. I can understand why you felt like resigning! 5. But how would you have liked to have handled that situation?

Empathy Goal

6. You want to be able to speak up for your self. 7. And tell me about the last time you were able to do that? 8. On a scale of 1 to 10 where 1 represents you have no confidence of being able to stand up for yourself, and 10 is very confident- what number would you give? 9. Good a 4! --and what makes you a 4 –what contributes to you being almost half way up the scale? 10. Your previous supervisor rated your performance as superior in all categories! 11. What would help you improve one half point in confidence on that scale? 12. I can appreciate this is going to be hard but in the future when you are able to stand up to your boss, -right you are going to be able to stand up to him? how will you be thinking and handling this situation differently with him?

Empathy (goal) Strategy/exception Strategy/scaling

Empathy (strategy/coping) Empathy Strategy/outcome Strategy/outcome

The end of the interview in the “Feedback and Next Step Action Plan portion the interviewer says” 35) “I admire your work ethic and how determined you are to make the department more efficient in spite of the critical and often undermining comments of your boss. And I agree with you on how important it is to have that conversation with him. But can we just go over your strategies for dealing with this

Interview break/pause Strategy/feedback and Next step action plan

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Transcript Example of the 10 Minute Presentation : re Addictions Coach 1: Hi, Brenda. Thank you so much agreeing to do this today. Client: Oh, you’re welcome. It’s not a problem. Coach 2: So, Brenda, actually I was just looking back and it’s been about a few weeks since the last time you and I met and I just wanted to check in with you before we start today’s session. I just wanted to see what you think, um, we need to do that could make this session as useful as possible for you. Client: Well, honestly, um, right now I find it’s just useful for me to talk. I mean, I don’t really have anybody to talk to. So, that really helps a lot. If you could just listen, that would be great. Coach 3: Of course, you know, this is your time so we’ll use it however you like to. So, since it has been a few weeks since last time we met, I’m curious to know, what’s been better for you since our last session? Client: What’s been better for me? What’s been better, uh, well, um, — Coach 4: Take your time. Client: I guess it’s better that I started to try those coping strategies that we talked about last session. You know, the ones I thought that might be helpful for me to stop using so much. Coach 5: Right, and how did that go? Client: Well, honestly it really helped! It really did help me from using. You know how much I’ve been struggling with this. It was amazing for me to be able to say ‘no’ for a change. I mean, I actually feel pretty good about it. Coach 6: Oh, so you were able to say ‘no.’ Say ‘no’ to who? Elaborate more and tell me a little bit more about that, Brenda? Client: Yah, I was able to say ‘no’ to Jen when she wanted to buy pills last weekend. I think you know Jen, I told you about her. She’s also on the program. Anyways, I always drive her to pick up and she usually tosses me some --- You know, to pay for the gas. But, you know, the last three times she called me I said ‘no’ to her. Coach 7: Really? Wow, that’s amazing, Brenda, that you were able to say ‘no’. I’m curious a little bit, how were you able to do that? How were you able to say ‘no’ to Jen, and you said, the last three times? How did you do that? Client: Well, um, I don’t really know. I guess I just realized that I’ve had it; I’ve had it with being an addict. I’ve had it with relying on pills, I’ve had it with using alcohol. I’ve really been trying to stay out of the bars. I don’t go anywhere near the beer store. Coach 8: Wow. Client: I’m just ready to make a change. Coach 9: Wow, Brenda. I mean, I’m amazed of what I’m hearing and of all that you’ve accomplished in the last few weeks. Client: Yeah, I guess I have. But I don’t feel that I’ve accomplished everything. I’ve actually been sober for the past few 18 days however, and since that time I’ve been reflecting on my life, sort of with a clearer eye. And I just feel like shit. I feel like I wasted so much time, -Coach 10: Hmmm, Client: Wasted so many years. I really should have been doing so much more with myself, you know? Coach 11: Mhmm. So it sounds like you don’t want to waste any more of your life?

21 Client: You’re right about that. I’m just tired of feeling like such a loser, such a loser in my life. Coach 12: Brenda, if I could for just one second, if you don’t mind, to go back for a minute. I’m amazed, really, at what I’ve been hearing and what you’ve accomplished these last few weeks with your addictions. Honestly to me it’s doesn’t sound like something that a loser would be able to do. I just wanted to kind of go back. Can you tell me some more? Like, how did you say ‘no’ and say ‘no’ to Jen? You said you were staying away from the beer store and out of the bars; how are you able to do that? Client: I don’t really know. It’s kinda like something ‘switched off’ in my head. I just decided that I’m sick; I’m sick of this shit. Sick of this life style, sick of the way that I’ve been wasting so much of my time on this, you know, using and drinking and I feel like you get to a certain point in your life where you say ‘I’m too old to be doing this shit’, you know? And I feel like that’s where I’m at right now. Coach 13: Mhmm, Client: Honestly, it wasn’t even that hard. Sure, I was temped to grab a pill here and there, and there were some times where a beer sounds great or I seek somebody else who needs a cold one. But I dunno, I’m just kind of distracting myself I guess. I’m sick of feeling like I’m a ‘weak’ person, like I’m a loser, like I always have to give in to things even if I don’t want to do it. I just end up doing it just because everyone else is. And I decided, ‘you know what? Enough is enough.’ Coach 14: Right. Wow. And you mentioned ‘weak’ there, and to me actually what you’ve been going through and what you’re saying, it really sounds like the opposite. It sounds like you’ve been pretty strong those last few weeks. Client: I guess, I guess. You know, I feel like it’s a small step. I don’t feel like I’m cured or nothing. I know that I’m ready to make changes. Coach 15: Right, it is a step. You know, I’d say it’s a very big step! If I could just for a second, there was something you said earlier, if I could just go back to that. You mentioned that you could have been doing more in your life? Client: I guess, sure. I mean, I should be in a much better position than I am for right now for my age. Honestly, if it wasn’t for the drinking or the pills I feel like I would be so much further ahead than I am right now. Coach 16: Right, like there’s so much more to get out of your life. Client: Absolutely. I want to do so much more; I want things to get better. But I always feel like I get my head in this space and start to make some progress and then I just end up slipping back to the same old, same old. Coach 17: Right. So Brenda, for right now, where we’re at in the present, let’s say that there’s a scale of 1 through 10. 10 being that everything in your life is exactly how you want it, it’s amazing, and 1 is being that nothing in your life is how you want it at all. 1 is really, really bad. Where do you see yourself right now? Client: On a scale of 1 to 10… I don’t know, I guess probably like a 5? Yah, let’s go with a 5. It’s kinda in the middle there and you know, I’m not sure. Coach 18: Right, okay, so you say a 5. I’m curious, so why would you put yourself at a five right now than, let’s say, a four? Client: Well, I guess maybe I feel like I’m making some progress, maybe I’m half way there because things are getting a little but better with the pills and the drinking. Coach 19: Right. Client: So that’s better. Coach 20: Absolutely. What do you think would need to happen right now, or soon, to be able to move you from where you are right now? So from that 5 to, let’s say, a 5 ½ ? Client: A half point?

22 Coach 21: Yah. Client: I don’t know, maybe keeping away from the pills? Like, not falling back to my old ways, you know? I feel like I’m just not destined to get it or something. Coach 22: Right. I can totally understand how that would feel frustrating at times for you. Can you tell me more about that certain kind of life you want? I’d love to hear about what you want. Client: I don’t want my life to be a struggle anymore; I’m tired of it. I’m tired of being miserable, I just want to be happy. I see people and I wonder how they can be so happy. I guess I just want to be happy, that’s it. Coach 23: Right. So, how will you know when you’ve achieved this life? How will you know when you’re happy? Client: I guess I’ll just know; I’ll sure feel different than I do now, I’ll know that! Coach 24: Right. If you can think about it a little more, how will you know? Client: I guess I’d probably smile more? Maybe laugh more? I might have a little more better ‘upbeat’ or positive attitude. Coach 25: Right. Can you think of what you’d be doing? Client: Well, I’d like to get out of the house, that’s for sure! Maybe see more of my family; they don’t really want me around a lot now. Hopefully, maybe I’d make some more friends who are clean, you know? Everybody I know, they’re all users. Coach 26: Oh, Client: I think maybe if I’d had more contacts and more friends I’d feel better. Yah, that’s probably how I ‘d know I was happier. Coach 27: Right, and is there anything else? Client: Well, I’d definitely have a job! I really want to work and make some money; I’m tired of being poor. I don’t have any money for anything. It’s so frustrating. That is a large part of my unhappiness; I don’t have money to do anything! Coach 28: Right, and I could see how not having a job being so difficult and difficult for anyone in that position. I’m curious, how have you been coping since that and dealing with this? Client: Well, I started sending out some resumes. Coach 29: Oh good! Client: I haven’t really heard back a lot yet, Coach 30: Wow, Client: I feel like that’s a good start anyway. Coach 31: Absolutely, that’s great! Finding a job I’m sure, as you know, can certainly take time. Is there anything else that you think might be helpful for you to help you obtain you goal of being happy? Client: Well, more money, work, more friends, closer contact with my family. Coach 32: Yeah, Client: Those are all things I could work on. The rest I guess I’ll just have to think about it and get back to you on that. Coach 33: Yes.