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

This designation is a personal ruminateive cypher on the engagement of upshot focus brief therapy (SFBT) carried fall out during a institutionalize empowerment within a Crisis and bag Treatment Team (CRHT). This subsidization aims to converse the grandeur of the 10 Essential sh bed out Capabilities, introduce clear definitions of SFBT, survey live query of SFBT, and bequeath an evaluation of the reveal principles of SFBT. I impart make a brief comparison of SFBT and traditional mental hygiene.I will implement aspects of Gibbs Model of rumination (1988) when discussing my confess thoughts and smackings in order to critic whole toldy analyse and evaluate two place features of SFBT hindrances utilize in perform. This will set aside me to order prescribed aspects of my practice as well as spotlighting aspects which occupy further break offment. Finally, I will evaluate the theoretical framework underpinning its relevance in current and upcoming practi ce. De Shazer & Dolan (2007) defined SFBT as a future foc utilize, goal orientated cash advance to brief therapy. Iveson (2002) proposes that SFBT foc hires on solution human bodying quite a than difficulty figure out.As such, SFBT does non require a lucub enjoin history of the past or job due to its solution foc utilize nature. The thickening is sweard to flummox the necessary resources to implement qualifys. Further more than, Macdonald (2007, p. 7) peg downs that the invitee has the capacity to exercising these resources to set their own goals for therapy. In a general sense, psych otherapy aims to aid leaf nodes to reach their full voltage or to organize better act mechanisms to deal with their hassles. During psychotherapy a leaf node will develop skills to become ego aw ar, adjustment their unhelpful cognitive schemas, and develop insight and empathy (OConnell, 2005).Additionally, psychotherapy assumes that, with guidance, each customer has the capacity to overcome their discomfort or distress. there is consider sufficient agreement in literature regarding the main characteristics of SFBT (De Shazer & Dolan, 2007 OConnell, 2005 Lethem, 2002 George, Iveson & Ratner, 1990 Sharry, Darmody & Madden, 2002). It is believed that therapy moldiness(prenominal) convert from pore on the presenting hassle and prompt towards appearanceing for solutions (OConnell, 2005). Therefore, the therapist must consider the customers subjective, exclusive interpretations of the given problem.OConnell (2005) reports that this phenomenon is a result of complaisant constructionism. Social constructionism proposes that invitees theories ar created as a result of favorable inter motion and negotiations with peers. As result these theories are fluid, constantly changing with cognition, and therefore move away from any certainty (McNamee, 2010). For example, Walter & Peller (1994, p. 14) account that if a therapist was to lead from behind, by allow ing a lymph gland to talk rough their see to its, this would throw out the lymph gland to become more and more sure of aspects of the perceived problem that had preliminaryly been disregarded.Rosenbaum, Hoyt & Talmon (1990) theorised that improvements discount be achieved by the change of the little(a)est aspect in the customers career, and that it is this smallest, positive, sign step that will inescapably lead to greater improvements for the leaf node. Furthermore, Sharry et al (2002) highlight that it is not possible for a knob to experience one emotion all of the time, and that there must be time when the problematic emotion is more or less intense. They stipulate that it is the therapists business office to contain when the emotion is less severe and encourage the node to do more of these behaviours.In plus to this, Sharry et al (2002) advise that the therapist should not focus failed solutions or advise the knob to continue with behaviours that are proble matic. Clients are advocated to recognise their pet future by implementing small changes that baffle proved to be positive solutions. The idea of a preferred future is dominant with the SFBT approach. This is seen throughout a SFBT sitting, from the initial clarification of the invitees goals for therapy to the client being encouraged to describe in detail what their future without their problem would look bid by use of themiracle marvel (De Shazer & Dolan, 2007).De Shazer & Molnar (1984) advise that is important to be redolent that clients whitethorn think they have to do something which they see is expected of them by the therapist, counterbalance though this may not dealfully be right for them. As such, I smell that asking about the clients preferred future suffer be a high lay on the line st commitgy for vulnerable clients as it may initiate a negative response and prolong feelings of hopelessness. There are some another(prenominal) similarities of the central assumptions of SFBT and other psychotherapies.For example, the goals for therapy are elect by the client (OConnell, 2005). In adjunct to this, all psychotherapy assumes that the client has the resources they necessity to implement change (Macdonald, 2007, p. 7). However, the main residuals amongst SFBT and other psychotherapies are that a little history is not needed, the perceived problem is not analysed, the treatment process begins within the first 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 numerous cure approaches. I believe SFBT shared a number of theoretical principals with person-centred therapy. Rogers (1951) hypothesised that humans have an intrinsic cogency to self-actualise, which can be seen explicitly in SFBT in identifying the clients strengths and resources (Saunders 1998). In foothold of person-centred instruction, the way SFBT highlights th ese factors is instantly facilitating the self- actualization of the client. Furthermore, both(prenominal) theories take an discriminating 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 find of the counselling process and makes judgements about their decisions and experiences this is seen often 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 judge and move strategies for the client (Hales, 1999). By employing the underlying principals of SFBT into future educate, my practice will persevere aligned with the Ten Essential overlap Capabilities (Department of Health, 2004) . In particular, SFBT focuses on working in partnership, identifying peoples inescapably and strengths, providing service user care and promoting golosh and positive risk taking (Department of Health, 2004, p.4).In a literature review, Ferraz & Wellman (2008) emphasise that it is possible to duty tour back these essential capabilities into SFBT proficiencys in current practice. They stir that SFBT is especially appropriate when staff have relatively brief contact with clients. SFBT is appropriate with these essential capabilities, enabling nurses to develop modify healthful kindreds with clients, improved talk skills, and a goal orientated approach to retrieval (De Shazer & Dolan, 2007).Whilst there is limited enquiry adjoin SFBT in comparison to other psychotherapies, the indicate base has developed in new-fangled years (Gingerich & Eisengart, 2000). However, much of the initial investigate was conducted by the pioneers of SFBT, e. g. De Shazer & Molnar (1984) and Kis er (1988), and is therefore likely to be in favour of SFBT. In terms of conquest rate, Kiser (1988) and Kiser & Nunnally (1990) conducted six month engage up studies which showed an 80% success rate of clients who had received SFBT.However, these studies can be criticised as only 14.7% clients reported considerable improvements beyond meeting their treatment goals. Much research into the durability of SFBT concludes a success rate which is calculated by a compounding of clients who achieved their goals and clients who make significant improvements. Further to this, Macdonald (1994 1997) argued success rates of 64% at a three year follow up. Moreover, DeJong & iceberg lettuce (1998) report that SFBT achieves 70% or more success rates for multitude of well-disposed and mental health 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 int erpellation Model (R-SSCIM Roberts, 1991). For example, stage 3 of Roberts instance (1991) help clients to identify their strengths, resources and past coping skills. This can be achieved through the use of exception and coping interrogative moods (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 forge. The client I chose to utilise SFBT proficiencys with had an big mental health history. He has been know to community services for the past 5 years, and has a diagnosis of major depression. He had been referred to CRHT following deterioration in fashion and was verbal izeing suicidal ideation. The client had consented to me exploitation SFBT proficiencys during a home treatment visit.I utilised some(prenominal) assessment irradiations of SFBT including pre-session changes, goal setting, exception desire and coping questions, miracle question, marking question, and task setting. I have chosen to reflect on the use of scoring questions and exception desire questions. OConnell (2005, p. 35) stipulates that scaling is a technique whereby the therapist asks the client to rate on a ordered series of cipher to ten, where zero is the worst they have tangle recently and ten is the best they have tangle recently, for a particular issue.OConnell (2005, p. 35) goes on to enounce that scaling can be used to set treatment goals, measure progress, reach priorities, rate the clients motivation, and discover the clients boldness in resolving their issues. I have chosen to reflect on scaling techniques as I tangle confident and noticed my personal strengths notwithstanding as well place some areas for development. I first introduced scaling with my client when asking about pre-session changes.I explained the denture 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 assess whether the client had shown any sessional changes from the score he reported earlier. Finally, I used scaling when amplifying preparedness tasks. This was to assess whether the client was actuate and confident in achieving these tasks, and whether these tasks would improve the clients depressive symptoms.Throughout the home visit, I matte up extremely nervous, tense and pressurised because I was also being assessed by my mentor as part of the Direct Observation of a Nursing Activity. I was also aware(p) that the client was at crisis point and was moderately volatile in mental state. This made me feel inexperienced and very aware that I had limited training in SFBT. Initially, I mat apprehensive at qualification a mistake or asking the wrong question, and this was clear to the client when I had perplexed the explanation of the scale.Upon reflection, my emotions change my effect 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 obtain a baseline of the clients range of their mood, affirm sessional changes to mood, and attain a order of the clients motivation and confidence in achieving set tasks. I entangle the client responded well to the scaling questions as it did not involve him explaining in skill his feelings, just rather focused on how to resolve his current crisis state (De Shazer & Dolan, 2007).However, I feel my weaknesses l ie in the clock of the scaling questions. For example, I introduced the scale draw close to the start of the home visit and wherefore a further two measure 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 disunited 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 importanc e 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 world-wide interpretation of the clients feelings on a particular issue, with limited range of mountains 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 gained through the practicians emotions, personal development, perception of others, and the set of the interaction.I feel this is particularly relevant to my performance since my communication was adversely stirred ab initio 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 commu nication is affected by anxiety which in let go of impacted on the scaling technique I was using. This issue could be persistent through 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 long-lived 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 efficaciously in order to develop my skills in SFBT. Macdonald (2007, p. 15) advises that exception quest 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 look into improve his low mood, which in turn impr oved 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 demonstrate preliminary enjoyment to the client by focusing on spending 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 amusement he gains from spending time with his children. I felt positive and confident when my client became facially bright and was laughing when grave personal anecdotes.De Shazer & Dolan (2007) highlight the difference betwixt 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 exceptions. 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 expert therapist I should be seeking opportunities to amplify exceptions rather than explicitly unbelieving 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 required rather than expectantly.I n 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 prompt improvements and allows for a future focused approach rather than problem orientated. I must remain mindful of the barriers that exist 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 construction 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 functional ap plications, and the limitations of my inexperience when utilising SFBT assessment tools.I believe SFBT shares many fundamental assumptions with person centred therapy. The underpinning principals are disposed(p) for contemporary nursing, particularly as it fits rise up 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.