Core Competencies in the Solution-Focused and Strategic Therapies: Becoming a Highly Competent Solution-Focused and Strategic Therapist PDF
Preview Core Competencies in the Solution-Focused and Strategic Therapies: Becoming a Highly Competent Solution-Focused and Strategic Therapist
Core Competencies in the Solution-Focused and Strategic Therapies Core Competencies in Psychotherapy Series Series Editor Len Sperry Florida Atlantic University, Medical College of Wisconsin Competency represents a paradigm shift in the training and practice of psychotherapy that is already challenging much of what is familiar and comfortable. This series addresses the core competencies common to highly effective psychotherapeutic practice and includes individual volumes for the most commonly practiced approaches today: cognitive behavior, brief dynamic and solution focused therapies, and others. Volumes in This Series Highly Effective Therapy: Developing Essential Clinical Competencies in Counseling and Psychotherapy Len Sperry Core Competencies in Counseling and Psychotherapy: Becoming a Highly Competent and Effective Therapist Len Sperry Core Competencies in the Solution-Focused and Strategic Therapies: Becoming a Highly Competent Solution-Focused and Strategic Therapist Ellen K. Quick Core Competencies in the Solution-Focused and Strategic Therapies Becoming a Highly Competent Solution-Focused and Strategic Therapist E L L E N K . Q U I C K New York London Routledge Routledge Taylor & Francis Group Taylor & Francis Group 711 Third Avenue 27 Church Road New York, NY 10017 Hove, East Sussex BN3 2FA © 2012 by Taylor & Francis Group, LLC Routledge is an imprint of Taylor & Francis Group, an Informa business Printed in the United States of America on acid-free paper Version Date: 20110705 International Standard Book Number: 978-0-415-88530-0 (Paperback) For permission to photocopy or use material electronically from this work, please access www. copyright.com (http://www.copyright.com/) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organiza- tion that provides licenses and registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging‑in‑Publication Data Quick, Ellen Kaufman. Core competencies in the solution-focused and strategic therapies : becoming a highly competent solution-focused and strategic therapist / by Ellen K. Quick. p. ; cm. -- (Core competencies in psychotherapy series) Includes bibliographical references and index. ISBN 978-0-415-88530-0 (pbk. : alk. paper) 1. Solution-focused therapy. 2. Strategic therapy. 3. Core competencies. I. Title. II. Series: Core competencies in psychotherapy series (New York, N.Y.) [DNLM: 1. Clinical Competence. 2. Psychotherapy, Brief--methods. 3.Outcome and Process Assessment (Health Care) WM 21] RC489.S65Q53 2011 616.89’147--dc23 2011019125 Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the Routledge Web site at http://www.routledgementalhealth.com CONTENTS Foreword VII Preface XI About the Author XVII 1 Introducing the Clinical Competencies of the Solution‑Focused and Strategic Therapies 1 2 Understanding the Conceptual Basis of the Solution‑Focused and Strategic Therapies 13 3 Forming an Effective Therapeutic Alliance 29 4 Maintaining an Effective Therapeutic Alliance 47 5 Performing an Integrative Solution‑Focused and Strategic Assessment 63 6 Developing a Case Conceptualization and Intervention Plan in the Solution‑Focused and Strategic Therapies 79 7 Implementing Solution‑Focused and Strategic Methods and Interventions 97 8 Monitoring and Evaluating Clinical Outcomes 113 9 Maintaining Treatment Gains and Planning for Termination 127 v Contents 10 Practicing the Solution‑Focused and Strategic Therapies With Cultural and Ethical Sensitivity 141 11 Becoming a Highly Effective and Competent Solution‑Focused and Strategic Therapist 157 References 175 Index 181 vi FOREWORD When Ellen Quick approached me during the 2010 European Brief Therapy Association (EBTA) Conference in Malmo, Sweden, asking me to write a foreword to her forthcoming book on competencies in the solu‑ tion‑focused and strategic therapies, I gave an enthusiastic “yes.” Having met Ellen at various EBTA conferences and having read her book on stra‑ tegic solution focused therapy, I knew what a sharp thinker she is. Also, I knew that we work along similar lines, trying to promote a flexible and integrative “hybrid”—as she calls it—way to understand solution‑focused work. But then, on second thought, I found that I had some reservations. As a university person, I know how boring the literature on competencies can be and how easily it can slip into bureaucratic, confusing jargon. Some months later, when I read the manuscript, I realized how unwar‑ ranted my worries had been. Ellen had produced—again—a very inter‑ esting text, brilliantly written, easy to read, and full of relevant clinical examples that illustrate “real therapy” and give a vivid account of clinical practice. In fact, the book sparked so many ideas and reflections that I find it difficult to condense them in a brief foreword. I would like to start by stat‑ ing that Ellen Quick’s combination of the strategic and solution‑focused perspectives is an excellent way to do justice to the historical and con‑ ceptual continuity that exists between the two approaches. Although the solution‑focused model evolved from Mental Research Institute (MRI) strategic therapy (I do remember Steve de Shazer wondering, during ses‑ sion breaks, what homework task John Weakland would suggest), the two approaches are sometimes perceived to be at odds: “Problem talk” some‑ times appears to be “forbidden” in solution‑focused practice, and some strategic therapists seem to ignore solution‑focused ideas. The strategic solution focused model that Ellen proposes is an outstanding example of how to think in “both–and” instead of in “either–or” terms and of how to do so without getting too complex or losing therapeutic creativity. In addition, accepting that “one size will not fit all,” Ellen Quick adds very interesting elements to standard strategic and solution‑focused practice. And she does it without leaving the conceptual playground of solution‑focused and strategic theoretical premises. As a researcher on therapeutic processes, I appreciate Ellen’s explicit acknowledgement of the vii Foreword value of the therapeutic alliance in brief therapy. She not only recognizes the important role of the alliance as an outcome predictor but also shows how solution‑focused and strategic techniques and attitudes actively contribute to a strong alliance. Her discussion of the stages of change model opens the option of acknowledging and using clients’ ambivalence toward change, a topic that is usually neglected in straightforward solu‑ tion‑focused literature. And Ellen’s advocacy of therapeutic transparency is a welcome antidote to the more manipulative flavor that strategic ther‑ apy can have when performed in an unskilled manner. Another impor‑ tant asset of the strategic solution focused model is that the “do more of what works; change what does not” philosophy is transformed into advice that can be offered to clients. This psychoeducational element of Ellen’s work might seem at odds with the cherished “not‑knowing” position of solution‑focused therapists, but it makes a lot of sense in the real world of therapy, where therapists are often expected to bring in not only their procedural knowledge on therapeutic conversations but also some direct advice for their clients. The analysis of solution‑focused and strategic therapy in terms of therapeutic competencies yields a number of interesting outcomes. It pro‑ vides a more nuanced view of solution‑focused and strategic practice, as it distinguishes the performance of novice, advanced beginner, competent, proficient, and expert practitioners. Conceptually, this is more construc‑ tive than the simple dichotomy between good and bad or between “solu‑ tion‑focused” and “solution‑forced” therapy. The discussion of various degrees of competence will allow solution‑focused and strategic trainers to anticipate possible difficulties in the learning process of their trainees. It will also help researchers to spell out criteria for competence and pro‑ ficiency, an issue that is certainly relevant in the evaluation of treatment integrity and adherence. In this way, the dissemination of strategic and solution‑focused practices in academic settings is also made easier. This book also builds bridges between the solution‑focused and stra‑ tegic therapies and the more problem‑ and diagnosis‑oriented world of clinical psychology and behavioral healthcare agencies. Solution‑focused therapists do not usually talk about their “case conceptualizations” or their “integrative diagnostic assessments,” but Ellen shows how this language can be used without putting solution‑focused theories at risk. In addition, dialogue with other approaches is promoted. Concepts like “resolving transference and countertransference” and “repairing thera‑ peutic alliances,” foreign to many brief therapists, are discussed in a viii Foreword solution‑focused and strategic way. This promotes collaboration with the broader community of psychotherapists, as does Ellen’s willingness to integrate procedures like mindfulness, dialectical behavior therapy, and acceptance and commitment therapy. A number of challenges remain. Some differences between strategic and solution‑focused therapy may seem more “irreconcilable” (to quote one of Insoo Kim Berg’s published cases [Berg, 2008]) than others. For instance, the MRI concept of “second‑order change” may appear to be inconsistent with the solution‑focused emphasis on progressive, cumu‑ lative change, and the “strategizing” and “leading from behind” posi‑ tions may seem irreconcilable. Another challenge is how far one wants to go in the direction of using specific therapeutic procedures for specific populations or problem types, as strategic authors such as Nardone and his colleagues (Nardone & Watzlawick, 1993; Nardone & Portelli, 2005) have done. Ellen Quick proposes an elegant way to integrate different procedures, inviting therapists to use empirically supported treatments in a strategic way (Would this be a 180‑degree change in regard to this client’s attempted solutions?) and/or in a solution‑focused manner (Is this client already doing some of it?), always staying attuned to clients’ feedback and unique needs. Perhaps, as in Berg’s session, differences that initially appear to be irreconcilable can be approached in a way that invites collaboration. I am confident that this book will be a valuable resource for many different readers. For the newcomer to strategic or solution‑focused ther‑ apy, it provides an excellent way to get started, without losing sight of the broader context of general psychotherapeutic principles and practices. A seasoned solution‑focused or strategic practitioner will find a stimulat‑ ing and fresh view of his or her preferred practices, as well as new ideas and invitations to expand one’s therapeutic resources. For trainers in solu‑ tion‑focused and strategic therapy, Core Competencies in the solution‑Focused and strategic therapies offers an expanded map of the training process in these approaches, with precise language to describe the competencies involved. And for psychotherapy researchers, it offers a wide array of hypotheses to be tested. One could hardly ask for more! Mark Beyebach, PhD director, Master’s Programme in Family therapy and systemic Intervention Universidad Pontificia de salamanca, spain ix
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