CHAPTER 10: Solution-Focused Therapy in the Treatment of Substance Abuse and Addiction Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory First Edition Todd F. Lewis Developed by Katie A. Wachtel, University of North Carolina at Greensboro

Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved 10-2 Introduction A postmodern approach that aims to understand client’s constructions about a problem and then co- construct ways to view it so that solutions emerge naturally Brief, strength-based, goal-focused This chapter discusses the major tenets of Solution- Focused Therapy (SFT), identify application strategies for individuals with addiction, and discuss how SFT can be implemented in group counseling

Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved 10-3 The Major Tenets of Solution- Focused Therapy Many substance abuse clients present as if they “are” their problems SFT promotes the notion that clients are separate from their problems (externalization) Developing solutions can occur outside of talking about problems Solution-talk can promote change Focus on solutions rather than problems

Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved 10-4 The Major Tenets of Solution- Focused Therapy Continued Look for solutions by asking questions about when the problem is NOT happening (exceptions) Pay attention to what works rather than what does not work Actions are circular Use verbs to highlight problems as changeable and temporary Change is constant Promotes the client as the expert

Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved 10-5 The Major Tenets of Solution-Focused Therapy Continued Role of the Solution-Focused Clinician Find out what the client wants Look for more of what is working and do it more Clarify and define goals Focus on present and future Theory of change Clients become more flexible in their thinking and behaving Clients become aware of exceptions to the problem Criteria for Effective Counseling Outcomes Co-construction and realization of an ACTIVE solution/goal

Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved 10-6 Application of Solution-Focused Therapy with Substance Abuse Problems Focus on what is going right for the client, rather than what is going wrong Help clients realize resources they possess to reach their goals What does the client want? What has the client done to get what he wants? What does the client have to do to get more of what he wants?

Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved 10-7 Application of Solution-Focused Therapy with Substance Abuse Problems Continued Step one: Establish a cooperative clinician-client relationship Step two: Develop treatment goals. Make them: Relevant Small Concrete Focused on the presence of something rather than the absence Start at the beginning Reasonable to client abilities Perceived by the client as involving hard work Step three: Orient the client toward a solution to substance use

Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved 10-8 Solution-Focused Based Techniques Miracle question Scaling questions Exception questions Presupposition questions (future oriented questions) Relationship oriented questions Taking in the good (TIG) Exploration of goals Taking a break

Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved 10-9 Solution-Focused Group Therapy SFT has been incorporated into group therapy (SFGT) Goals can be different for different members Exploring exceptions is effective (talk in terms of periods of sobriety) Miracle question can be processed in a group format Note: Outcome research on SFT and SFGT is building, but more is needed

Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved Solution-Focused Therapy in the Treatment of Diverse Populations SFT is useful with diverse populations because of its belief in honoring what the client wants and client strengths Studies have shown SFT to be effective with African- American, Latino, and Asian clients Clinicians must be aware that solutions can look different for different cultures There is argument that by focusing on the self, SFT ignores cultural and racial issues that impact clients; SFT does not promote collectivism

Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved Running Case Study: Michael Clinician uses SFT to help Michael begin to think about solutions rather than problems Clinician helps develop concrete, behavioral goals, reframes goals to focus on the presence of something rather than the absence of something, emphasizes the work necessary to obtain goals, uses the miracle question, helps Michael identify exceptions, reinforces successes to focus on strengths, and uses scaling questions, presupposition and relationship oriented questions Michael is able to set small, obtainable goals and begins to focus on strengths and solutions, rather than problems

Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved Strengths, Limitations, and Ethical Issues Related to SFT Strengths SFT can be used independently or along with other treatments Respectful, strength-based, focuses on client wants/needs Little incompatibility for other treatment models Flexible and economical Emphasis on strengths, resources and abilities Helps build confidence and self-esteem Well-suited for group therapy

Lewis. Substance Abuse and Addiction Treatment: Practical Application of Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights Reserved Strengths, Limitations, and Ethical Issues Related to SFT Continued Limitations Some may see as too simplistic Can be difficult to know where to go after the first few sessions Limited empirical support Does not sufficiently address the physiological aspects of addiction Unfamiliar referral sources may question the effectiveness Ethical Issues Requires sufficient training to be used ethically Fails to take physiological aspects into account