A Solution-focused Brief Approach to Working With Challenging Couples. Terry Trepper and Yvonne Dolan

Transcription

1 A Solution-focused Brief Approach to Working With Challenging Couples Terry Trepper and Yvonne Dolan

2 Trepper &Dolan, 2008 Solution-focused Brief Therapy Tenets Applied to Couples Therapy and Sex Therapy If it isn t broken, don t fix it. Many couples who present for couple issues or specific sex problems will rate themselves a 6 or higher They often come in to the first session saying that things are better or different Doing full-blown sex therapy programs with these clients would be inappropriate If something is working, do more of it. If you ask, and/or pay attention to what the clients are telling you about their love lives, their solutions are often occurring, and therapy should be to encourage more of that. If it s not working, do something different. Secondary problems, like avoidance of sex, are not useful strategies Regarding clients who present with sexual dissatisfaction, couples do not move up the scale via specific SFBT interventions, it may be useful to suggest different interventions, including behavioral sex therapy or medications Small steps can lead to large changes Often, things like the process of coming to therapy, or making private time, or having a cuddle nighth will lead to one or both initiating intimacy more, which will lead to The solution is not directly related to the problem. Couples often assume incorrectly that the solution to their sex problem has to do with sex directly (e.g. partner may buy sexy underwear for his mate, but this leads to her feeling pressure, and to more avoidance) Some solutions to low sexual desire that we have seen with clients have included: o Partner helping with the dishes o Getting a babysitter every Friday night o A good, intimate talk o Starting an exercise program together o Taking dancing lessons 2

3 The language requirements needed for solution development are different than those needed to describe a problem. For example, the diagnosis of hypoactive sexual desire disorder does little to help the therapist discover solutions a couple may have stumbled onto but forgotten Understanding the dysfunctional relationship patterns, attachment issues of one or both partners, previous sexual traumas, or past affairs may be interesting but not ultimately what will lead to solutions to the problem No problems happen all the time; there are always exceptions which can be utilized. Most clients (including any of the sexual dysfunctions) do not have the problem all of the time (there are exceptions to this rule, and in those cases, alternative interventions may be necessary) The future is both created and negotiable Hope is possible for all sexual problems and relationship problems Changing meaning, language, experiences can all contribute to a future filled with a great relationship and great sex! 3

4 Dolan & Trepper, 2008 Solution-focused Sessions With Couples Join first with individual and couple competencies, e.g. work, hobbies, accomplishments, client s special knowledge about their children and community. Acknowledge shared and individual competencies. Begin the session by finding out if anything has gotten better for the couple (individually and as partners) between when they scheduled the appointment, and coming to the session. If yes, ask how this happened while getting as many details as possible, ask further questions to identify any positive effects this has had, and (most important!) how this improvement might be maintained or repeated. As early in the interview as you can respectfully do so, ask each person to describe their best hope for the session. Scale hope. On a 0-10 scale, with 10 signifying being as hopeful as possible about things getting better, and 0 signifying no hope, where are you now? If the client says anything above 0, even a fraction of a point, find out what is occurring that causes them to have this degree of hope and what would need to continue to maintain this. If the client answers 0, find out what would need to continue to prevent things from getting worse. Find out (or have the client subsequently observe) what would be the smallest sign that things are getting the tiniest bit better, who would notice, and what would be the effects of noticing this. Normalize issues when possible to do so respectfully, e.g. You both work full time, you have 3 children under 10, and you also take care of your parents. I can easily understand why you say you feel overwhelmed. Most couples would say the same thing under those circumstances. Afterwards, they look back and ask themselves, how on earth did we get through that time when we had so many responsibilities all at once? Do not use the Miracle question unless the clients have indicated that they have at least some small degree of hope that things could get better and a desire to make them better. Listen with an ear tuned to exceptions and resources that could be used to help clients achieve their stated goals and respond by carefully summarizing Highlight individual and shared strengths and competencies Use the clients exact words whenever possible to do so respectfully Soften hostile or blaming language when possible by gently paraphrasing 4

5 Dolan and Trepper, 2008 Solution-focused Scaling Questions for Couples As most typically used by solution-focused therapists, scaling questions ask clients to rank aspects of their life on 10- point scales. These questions provide valuable information about where the client is in relationship to his or her miracle or goal. Scaling present wonderful opportunities to empower clients to explore exceptions and how they created them. The following demonstrates how scaling can open opportunities to emphasize exceptions. T: So, on a scale of one to ten (ten being that you have the relationship you want with each other and one being that it is the worse it has ever been) where would you put it? C: About a four. T: What lets you know that it is a four? C: Well, we aren t yelling as much. We actually sat down and had dinner together last night. We didn t really talk or anything, but we had dinner. T: Wow! You had dinner together and have cut back on the yelling. How did you do that? C: I got to thinking about what we talked about last time. You know. When you asked about my miracle? We use to have dinner together every night. So, I thought it might make my partner happy. T: Did it? C: Yeah. I think she was surprised I was there. Usually I stay at work until it s nearly time to go to bed and she feeds the kids by herself. She seemed happy I was there, and I know she liked that I helped with the baby. In addition to behaviors, scales are often used to quantify internal thoughts and feelings and the intensity of these thoughts and feelings, such as feeling more hopeful, or better in a relationship. 5

6 Yvonne Dolan and Terry Trepper, 2008 The Miracle Question for Couples Suppose tonight you went home and did the usual things you normally do at the end of the day. Eventually it gets late and you both go bed and fall asleep. It is a very deep, especially restful, sleep. Some time during the night, however, a strange thing suddenly happens without either of you knowing it: a Miracle happens. And the Miracle is that the relationship between you and your partner is immediately transformed into the one that is in fact absolutely ideal for each of you, and the issues or concerns that brought you to therapy have been so completely resolved that they are now no longer a problem. But of course when you first wake up in the morning, neither of you will have any idea that this has happened, because both of you were sound asleep when it occurred! As your day begins and progresses, what will be the first small things (the tiniest signs) that you and partner would each notice that would begin to alert you to the fact that your relationship has changed, that a Miracle really has occurred, and the problems are now gone.? PAUSE AND WAIT ATTENTIVELY AND PATIENTLY FOR THE COUPLE TO ANSWER Follow up with questions to elicit a highly detailed description of the Miracle from both partners, following up with questions like, Suppose that (detail of the Miracle description) really happened, how do you suppose you (or partner) would respond? Suppose your partner really did that (behavior described in Miracle), what difference would that make for you? How do you suppose you would you respond if you partner really did that? How would your partner respond to your response? (If one partner responds with a negative description of what the other would NOT be doing after the Miracle, refocus by asking what the partner would be doing INSTEAD that would indicate that the Miracle really had happened, and how they would then respond to the partner s unexpected new behavior. Once you have a highly detailed description of the Miracle, begin looking for exceptions (times in the couple s repertoire of past experiences when some aspect of the Miracle has already happened or could potentially happen. Follow this up with the Miracle Scale, in which ) 0 symbolizes a point in time before the couple even imagined the Miracle and 10 symbolizes their relationship having become the one they described in the Miracle. Find out where they are now, and invite them to experiment by keeping track (between now and the next session) of anything they or their partner does that helps them move in the direction of the 10. 6

7 Terry Trepper and Yvonne Dolan, 2005 Solution-focused Therapy Training Exercise 1.Participants form groups of at least 5 people as follows: 3 people are therapists. The therapists job will be to do as good a job as possible, and also to notice what seems to be most helpful to the client. The therapists may use anything they have learned in the training or in their work or life experience. 2 people *role play a couple. Ideally people should role play a real couple that they find challenging or have found challenging in the past. The client s job will be to notice what the therapists do that is useful or helpful. Afterwards they will be asked to rate the helpfulness of the session on a scale of 0-10 with 10 being Extremely Helpful and 0 being Not at all helpful. If there is a 6 th person, he or she person observes. The observers job is to try to predict what the couple will say was most helpful, and what number the client will give the team on the Helpfulness Scale. (There can be more than 1 observer.) 2. The teams conduct a 20 minute (or longer) first therapy session with the couple as follows: The 3 therapists on the team sit in a semi-circle facing the couple. If there is an observer, the observer sits behind the therapists. The therapists rotate, taking turns. Each therapist may ask exactly 1 question or say only 1 sentence in response to the couple during their turn. After the couple answers, (or even if the couple for some reason declines to answer), once a therapist has asked a question or made a statement it is the next therapist s turn. They continue to rotate in this manner throughout the session, each therapist attempting to productively build on what has preceded their turn. 3.After 20 minutes (or other time period determined by seminar leader) the client leaves the room for 10 minutes and rates the session on the Helpfulness scale. They also identify what was most helpful about the session. While the couple is absent, the team tries to accurately predict what the clients will say was most helpful. 4. After 10 minutes the client returns. Client, therapists, and observer exchange information and determine what they have learned from the exercise. They then share the results with the larger group, so that teams benefit from each other s experience as well. (*Alternately, 2 or more people can chose to role play a family dyad such as for example, a divorced parent and child.) 5, Optionally, the therapists and client can do a second session incorporating what was learned with the goal of raising the score the client gives on the Helpfulness scale. 7

8 Trepper and Dolan, 2008 Relationship Resource Identification Inventory Questions 1. Make a list of characteristics or traits that you appreciate about this person. 2. What did you first like about this person? Try to remember the first time you noticed this. What was that like for you? 3. What are the things that you do or have done together in that past that you want to have continue? 4. If this is a relationship with a child, what do you hope he or she will remember about your relationship when he or she reaches the age you are now? If the relationship is with a partner or peer, what do you hope each of you will remember about your relationship at the end of your lives? 5.What is most important for you to remember about this person when times are tough? 6. In what positive ways has knowing this person effected you? 7. How do you hope you will be remembered by the other person when you are old and contemplating the final year of your life? 8

9 Trepper and Dolan, 2008 Emergency Kit for Couples (Technique for Relapse Prevention) This is a letter or (an audio tape) resource that you will write (or make )for yourself. It should be written (or recorded) at a time when you are feeling calm and clear about your reasons (and the rewards for) embracing your Relationship Miracle. This letter or tape should contain, but is not limited to the following: A detailed description of your Miracle, from your own perspective, and as you imagine it from the perspective of your loved one Your answers to the Relationship Resource Identification Inventory Questions A list of practical things you can do that will move you closer towards your Relationship Miracle. A list of activities that nurture, comfort and/or center you Reminders of spiritual or philosophical beliefs that strengthen you Special advice or other reminders important to you. This might include music, a prayer, a letter from someone who cares about you, an aphorism, a photo, virtually anything that helps. Once completed, put the Relationships Emergency Kit in a place where you can easily find it whenever needed. Use it to regain strength and courage anytime you are feeling stressed, alone, or lost in your journey towards the life you want. Some people like to make several copies so that they can carry one in a briefcase or purse, leave one in a special drawer, car glove compartment, etc. 9

10 Dolan and Trepper, 2008 Developing Associational Cues for Relational Well-being and Intimacy 1. The therapist should communicate comfort and security by first inducing that state in self and communicating it non-verbally. Ask the clients to think of a time when they have felt close and happy with each other 2. Direct each client to notice and describe all the details of that experience including sights, sounds, feelings. 3.Invite the clients to take some time to enjoy the experience, and then make any adjustments* to the details of the experience that would enhance comfort and security, letting you know when the adjustments (if any) have been made. 4.When the experience is "just right," invite the clients to take some time to enjoy the experience one more time and then have each client select a symbol ("souvenir") to be used to recall this experience of shared comfort and security in the future. The symbol may be a sight, a sound, or a sensory experience that can be re-vivified. 5. Re-orient to external reality, ask the clients to identify the symbol, and to share this and whatever additional information about it that is appropriate and meaningful with their partner. 6. Invite the clients to focus on some simple task that causes them to focus away from the symbol, such as for example, rearranging the papers on the table. 7.Now have the client employ the symbol to re-access the state of comfort and security. 8.Re-orient with the suggestion that the client can use the symbol to re-elicit a deep state of comfort and security whenever needed. Suggest that the client will re-orient relaxed, refreshed, and alert. 9. (Optional.) Invite the clients to externalize symbol by writing it or drawing it first with dominant hand and then with non-dominant hand. Client can repeat this in future to access associational cue. 10. Discuss when and how clients can employ their symbols to optimize comfort and resourcefulness in their relationship. 10