A 3000 word reflective account of Solution Focused Brief Therapy within a practice placement setting

This assignment is a personal reflective beak on the aim of solution foc implement brief therapy (SFBT) carried erupt during a get along placement within a Crisis and Home Treatment aggroup (CRHT). This assignment aims to discuss the importance of the 10 Essential Shared Capabilities, deliver clear definitions of SFBT, evaluate current explore of SFBT, and provide an evaluation of the profound principles of SFBT. I get out make a brief comparison of SFBT and conventional psychotherapy.I will utilise aspects of Gibbs Model of Reflection (1988) when discussing my own thoughts and smellings in order to critic bothy analyse and evaluate two key features of SFBT interventions apply in practice. This will allow me to identify domineering aspects of my practice as well as senior highlighting aspects which need further bourgeonment. Finally, I will evaluate the supposed framework underpinning its relevance in current and prospective practice. De Shazer & Dolan (2007) define d SFBT as a future underlined, goal orientated climax to brief therapy. Iveson (2002) proposes that SFBT foc workouts on solution building sort of than problem firmness.As such, SFBT does non require a detailed history of the past or problem collectible to its solution pore nature. The node is be double-dealingved to leave the incumbent resources to implement metamorphoses. Furthermore, Macdonald (2007, p. 7) stipulates that the thickening has the might to use these resources to set their own goals for therapy. In a general sense, psychotherapy aims to aid nodes to reach their full latent or to develop better coping mechanisms to deal with their problems. During psychotherapy a thickening will develop skills to become self assured, change their unaccommodating cognitive schemas, and develop insight and empathy (OConnell, 2005).Additionally, psychotherapy assumes that, with guidance, each knob has the capacity to overcome their discomfort or distress. There is co nsider fitting agreement in literature regarding the briny characteristics of SFBT (De Shazer & Dolan, 2007 OConnell, 2005 Lethem, 2002 George, Iveson & Ratner, 1990 Sharry, Darmody & Madden, 2002). It is believed that therapy must convert from focusing on the presenting problem and move towards olfactory propertying for solutions (OConnell, 2005). Therefore, the healer must consider the leaf nodes subjective, individual interpretations of the given problem.OConnell (2005) pass overs that this phenomenon is a result of hearty constructionism. affable constructionism proposes that lymph nodes theories are created as a result of hearty interaction and negotiations with peers. As result these theories are fluid, constantly changing with admitledge, and therefrom move away from any certainty (McNamee, 2010). For example, Walter & Peller (1994, p. 14) reported that if a therapist was to lead from behind, by allowing a thickening to talk about their set outs, this would incit e the thickening to become increasingly aware of aspects of the perceived problem that had antecedently been disregarded.Rosenbaum, Hoyt & Talmon (1990) theorised that improvements whoremonger be achieved by the change of the smallest aspect in the customers life, and that it is this smallest, positive, initial step that will inevitably lead to great improvements for the client. Furthermore, Sharry et al (2002) highlight that it is not possible for a client to pay back one emotion all of the time, and that there must be clock when the problematic emotion is more or less intense. They stipulate that it is the therapists office staff to determine when the emotion is less severe and encourage the client to do more of these behaviours.In rise to power to this, Sharry et al (2002) advise that the therapist should not focus failed solutions or advise the client to continue with behaviours that are problematic. Clients are advocated to incarnate their preferred future by implemen ting small changes that have proved to be positive solutions. The idea of a preferred future is dominant with the SFBT noticeer. This is seen passim a SFBT academic term, from the initial clarification of the clients goals for therapy to the client cosmos encouraged to describe in detail what their future without their problem would look wish well by use of themiracle question (De Shazer & Dolan, 2007).De Shazer & Molnar (1984) advise that is important to be mindful that clients may think they have to do whateverthing which they facial expression is evaluate of them by the therapist, even though this may not necessarily be right for them. As such, I disembodied spirit that asking about the clients preferred future ordure be a high risk strategy for vulnerable clients as it may initiate a negative response and prolong feelings of hopelessness. There are galore(postnominal) similarities of the inherent assumptions of SFBT and other psychotherapies.For example, the goals fo r therapy are chosen by the client (OConnell, 2005). In addition to this, all psychotherapy assumes that the client has the resources they need to implement change (Macdonald, 2007, p. 7). However, the main discrepancys between SFBT and other psychotherapies are that a detailed history is not needed, the perceived problem is not analysed, the treatment process begins within the head deduct session of therapy and that SFBT does not believe a persons apprehension is maladjusted or in need of change (OConnell, 2005).It is evident that SFBT draws upon legion(predicate) therapeutic approaches. I believe SFBT shared a number of theoretical principals with person-centred therapy. Rogers (1951) hypothesised that humans have an intrinsic ability to self-actualise, which can be seen explicitly in SFBT in identifying the clients strengths and resources (Saunders 1998). In terms of person-centred counselling, the way SFBT highlights these factors is in a flash facilitating the self- actua lization of the client. Furthermore, both theories take an eclectic approach to the clients situation.For example, the importance of the whole person in person-centred counselling is associated with the interest in the whole context of a persons life in SFBT (Iveson, 2002). Hales (1999) describes how person-centred therapy believes that the client is in control of the counselling process and makes judgements about their decisions and experiences this is seen frequently more overtly in SFBT as the clients are asked directly their goals for therapy and how they would know that therapy had been worthwhile.Both approaches provide client-orientated counselling which aims to promote self esteem and coping strategies for the client (Hales, 1999). By employing the underlying principals of SFBT into future training, my practice will remain adjust with the Ten Essential Shared Capabilities (Department of Health, 2004). In particular, SFBT focuses on working in partnership, identifying peopl es needs and strengths, providing service user upkeep and promoting safety and positive risk taking (Department of Health, 2004, p.4).In a literature review, Ferraz & Wellman (2008) emphasise that it is possible to incorporate these essential capabilities into SFBT proficiencys in current practice. They suggest that SFBT is curiously appropriate when staff have relatively brief contact with clients. SFBT is harmonious with these essential capabilities, enabling nurses to develop improved therapeutic relationships with clients, improved chat skills, and a goal orientated approach to reco real (De Shazer & Dolan, 2007).Whilst there is modified look surrounding SFBT in comparison to other psychotherapies, the evidence subject has developed in recent years (Gingerich & Eisengart, 2000). However, much of the initial look for was conducted by the pioneers of SFBT, e. g. De Shazer & Molnar (1984) and Kiser (1988), and is therefore uniformly to be in favour of SFBT. In terms of su ccess rate, Kiser (1988) and Kiser & Nunnally (1990) conducted six month come in up studies which showed an 80% success rate of clients who had received SFBT.However, these studies can be criticised as unaccompanied 14.7% clients reported considerable improvements beyond meeting their treatment goals. Much research into the effectiveness of SFBT concludes a success rate which is calculated by a combination of clients who achieved their goals and clients who made significant improvements. Further to this, Macdonald (1994 1997) argued success rates of 64% at a three year follow up. Moreover, DeJong & Berg (1998) report that SFBT achieves 70% or more success rates for multitude of social and mental wellness issues, including depression, suicidal ideation, relationship difficulties, domestic violence, and self-esteem.As such, the underlying principals of SFBT can be applied to the Seven Stage Crisis Intervention Model (R-SSCIM Roberts, 1991). For example, arrange 3 of Roberts model ( 1991) help clients to identify their strengths, resources and past coping skills. This can be achieved finished with(predicate) the use of excommunication and coping questions (OConnell, 2005). De Shazer & Dolan (2007) expand on this by advising that identifying strengths and resources can help build rapport and trust with the client as the focus is shifted away from short-comings and towards complimenting the client.During Stages 4 & 5, feelings and emotions are explored, and alternatives are generated and explored (Roberts, 1991). SFBT utilises these stages by acknowledge clients current experiences and aiding them to create an action plan. The client I chose to utilise SFBT techniques with had an extensive mental health history. He has been cognise to community services for the past 5 years, and has a diagnosis of study depression. He had been referred to CRHT following deterioration in mood and was expressing suicidal ideation. The client had consented to me using SFBT tech niques during a home treatment visit.I utilised several judgment tools of SFBT including pre-session changes, goal setting, exception pursuance and coping questions, miracle question, grading question, and task setting. I have chosen to reflect on the use of scale questions and exception seeking questions. OConnell (2005, p. 35) stipulates that measure is a technique whereby the therapist asks the client to rate on a exfoliation of zero to ten, where zero is the batter they have tangle recently and ten is the best they have matte recently, for a particular issue.OConnell (2005, p. 35) goes on to state that scaling can be used to set treatment goals, measure progress, establish priorities, rate the clients want, and acknowledge the clients confidence in resolving their issues. I have chosen to reflect on scaling techniques as I felt confident and noticed my personal strengths alone in addition identified whatsoever areas for development. I first introduced scaling with my client when asking about pre-session changes.I let offed the overcome to him and asked where he would place himselftoday and if this was any different from when he had contacted CRHT. I reassured the client by complimenting him for contacting CRHT regarding his mental health. The second time I used scaling questions was following the miracle question. This was to measure whether the client had shown any sessional changes from the musical score he reported earlier. Finally, I used scaling when amplifying homework tasks. This was to assess whether the client was motivated and confident in achieving these tasks, and whether these tasks would improve the clients depressive symptoms.Throughout the home visit, I felt extremely nervous, tense and pressurised because I was also being assessed by my mentor as part of the Direct rumination of a Nursing Activity. I was also aware that the client was at crisis point and was somewhat volatile in mental state. This made me feel inexperien ced and actually aware that I had limited training in SFBT. Initially, I felt apprehensive at making a flaw or asking the wrong question, and this was clear to the client when I had gravel the explanation of the scale.Upon reflection, my emotions affected my performance throughout the intervention for example, as I became more relaxed I gave a more apparent explanation of the scale for confidence in completing homework tasks. My strengths were that I was able to predominate a baseline of the clients rating of their mood, affirm sessional changes to mood, and make a rating of the clients motivation and confidence in achieving set tasks. I felt the client responded well to the scaling questions as it did not involve him explaining in depth his feelings, but rather focused on how to resolve his current crisis state (De Shazer & Dolan, 2007).However, I feel my weaknesses lie in the timing of the scaling questions. For example, I introduced the scale near to the start of the home vi sit and then a further two generation during the visit. As a result I felt I had to explain the scale each time I used it. I feel this made the intervention slightly disordered and therefore illogical to the client.The use of scaling questions following the miracle question was partially inappropriate as the client stated that he had just answered questions regarding his preferred future (i. e.where the client would like to be on the scale) when amplifying the miracle question. In hindsight, I feel that these questions were somewhat unnecessary. In contrast to this, De Shazer & Dolan (2007) stipulate in their G. E. M. S approach that scaling questions should follow the miracle question due to its effectiveness in obtaining measures of where clients would rate themselves today, and their preferred future. Furthermore, OConnell (2005, p. 52) describes the importance of scaling questions with regard to communication with a client.He advises that it gives the opportunity for the client to express how they are feeling and eliminates the therapist making assumptions. He argues that scaling provides a comprehensive interpretation of the clients feelings on a particular issue, with limited scope for individual interpretation. However, there is much research (Chant, Jenkinson, Randle & Russell, 2002 Sumner, 2001) to suggest that communication and interpretation of a clients feelings is eclectically craped through the practitioners emotions, personal development, perception of others, and the circumstances of the interaction.I feel this is especially relevant to my performance since my communication was adversely affected initially due to my anxieties and the circumstances of being assessed. This therapeutic intervention provided me with first hand experience of these barriers to communication (Sumner, 2001) and as such I am aware of how my communication is affected by anxiety which in turn impacted on the scaling technique I was using. This issue could be resolved th rough the use of further reflections and SFBT with other clients.I feel that utilising SFBT techniques in my future practice will improve my confidence and my ability to concisely deliver explanations of scaling questions as I will no longer feel like a novice. I have also chosen to reflect on the use of exception questions with the client as I feel that I need to expand my current knowledge base of how to carry out these questions effectively in order to develop my skills in SFBT. Macdonald (2007, p. 15) advises that exception seeking questions are particularly useful when clients are feeling hopeless.I feel this was very relevant to my client as he was somewhat resistant to change initially. However, through the use of these questions my client identified small exceptions where he was able to control improve his low mood, which in turn improved his motivation and confidence in setting small tasks. In this instance, I used exception questions with the intention of demonstrating to the client that his low mood was not occurring all of the time. However, my client was vague and negative in his response. I intended to turn up previous enjoyment to the client by focusing on spend time with his family.I felt very inexperienced and incompetent when using this technique as I struggled initially to achieve my intentions. As a result, I felt very aware that I was being assessed by my mentor, which added to my anxieties. I felt frustrated that my client was unable to identify any positive aspects in his life, but began to relax when he described the pleasure he gains from spending time with his children. I felt positive and confident when my client became facially bright and was laughing when telling personal anecdotes.De Shazer & Dolan (2007) highlight the difference between previous solutions and exceptions, with exceptions being times when the problem could have occurred but did not. In hindsight, I feel I was searching for previous solutions rather than exception s. Furthermore, they go to theorise that the role of the therapist to recognise opportunity for exceptions during the session rather than actively seek out opportunities to utilise this technique. Therefore, as a skilled therapist I should be seeking opportunities to amplify exceptions rather than explicitly questioning the client in this way.Due to my limited training in SFBT I felt like a novice and did not utilise the true nature of exception seeking questions. Following this reflection I am now more aware of the difference between previous solutions and exceptions that De Shazer & Dolan (2007) hypothesised, and how they can both influence the therapeutic intervention. As I gain experience and further develop my knowledge base of SFBT, I feel that I will be able to use exception questions when compulsory rather than expectantly.In my future practice as a registered mental health nurse, I plan to utilise SFBT techniques with service users, particularly those experiencing relapse, as the use of these tools can provide immediate improvements and allows for a future focused approach rather than problem orientated. I must remain mindful of the barriers that inhabit in communication (Kiser, Piercy & Lipchink, 1993) and apply this when delivering SFBT techniques. However, De Shazer & Dolan (2007) theorise that scaling is a very effective tool for the client to verbalise their emotions.Therefore, this could be used in my future practice, particularly when building a therapeutic relationship with clients. In terms of current practice, I have effectively demonstrated the scaling technique within cognitive behavioural therapy however, I am aware that these two therapies use the scale in different ways. To conclude, this assignment has allowed me to develop my knowledge of the key principals of SFBT, the practical applications, and the limitations of my inexperience when utilising SFBT assessment tools.I believe SFBT shares many fundamental assumptions with person ce ntred therapy. The underpinning principals are apt for contemporary nursing, particularly as it fits wells with the Ten Essential Shared Capabilities (DoH, 2004). There are some limitations to this approach, such as lack of extensive research (Gingerich & Eisengart, 2000). However, I feel that this approach is appropriate to use with clients who are experiencing mental health difficulties.