Case Approach again.

In case anyone cares, here is yet another case approach to my life, this time from a different "therapeutic lens". Enjoy.

Case Approach to Postmodern Therapy

Theory Assumptions
In the Postmodern approach to therapy, there is an assumption that a client’s reality is socially constructed, and that reality should not be disputed against for accuracy or rationality; it is what it is. There are four slightly different approaches to Postmodern therapy, which include Collaborative Language Systems, Solution-Focused Brief Therapy, Solution-Oriented Therapy, and Narrative Therapy. For this case approach, I will focus on the Solution-Focused Brief Therapy approach. In this approach, the focus is clearly on solutions to a particular problem or problems, and not the problem itself. The focus is also on the present and the future, not the past. Therefore, there is little attention given to clinical diagnosis, history, or exploring the cause of the problem or problems. In focusing on a solution or solutions to a problem, the therapist directs the client to focus on what is working and exceptions to problem patterns. The therapist works in a collaborative relationship with the client, but acknowledges that the client is the expert of her life story - it’s satisfactory moments, problems and solutions. The client is encouraged to do things differently if a problem exists. The goal is to find a satisfactory solution to the client’s problem or problems in as quickly a time frame as possible, therefore this type of therapy is considered “brief.”

Assessment Methods
In the assessment process of Solution-Focused Brief Therapy, the therapist works to promote a sense of optimism and hope in the client. The therapist first finds out what the client wants. In this case, the client desires to feel content in her current life situations, both in relationships and in her student role. Though the therapist recognizes that the client is presenting with depression and anxiety, she does not focus on the pathology of the diagnosis. Instead, she will encourage the client to change her actions, since what she is currently doing is obviously not working for her. The therapist, for example, may suggest that the client get a steady job in order to feel more satisfied and content with her position as a student again, since she once felt more important when she had a steady job. Other suggestions may include spending more time with others, since the client currently feels sad and isolated when she is alone. Once the client can make these changes and feel some sense of satisfaction or conflict-resolution, then the therapy can end.

Goals
Goals are to be addressed at the beginning of therapy, so that the focus is on solutions and the end is in sight. They are to be specifically chosen by the client, though the therapist may help in formulating them. The goals may be small, but realistic, so that the client can more easily make changes in order to solve the current problem in her life. They are action-oriented, and attainable, concrete, and specific. One goal that the client may make is changing her views in a particular situation. For example, while the client may not feel “successful” now because she is not working for a steady income and she is a full-time student, she could change her perspective of the situation so that she feels content in her role as a student, and satisfied where she is in life. While this may be applied immediately, a long-term goal may be learning how to change her views to more optimistic ones and applying them to other situations in her life. Another goal involves changing the “doing” in the problematic situation. In this way, the client may have a goal of actually changing what she is doing in order to alleviate negative emotions and to feel more content. For example, the client may see that if she spends more of her time working to earn an income, or doing more for others, she may learn that she feels better about herself and more content with the fact that she is a working student. In doing for others, she may find that she feels a greater sense of worth and meaning, as well. While the client may make small changes in the near future, it may take a little more time to make some changes, and therefore these greater changes may be considered long-term goals.

Intervention Techniques
Though the relationship between the client is collaborative and solution-focused, there are three types of relationships that can describe the position of the client: customer, complainant, and visitor. Currently, the client takes the position of the complainant, whereby she recognizes a few problems in her current life situation, but she feels unable to make changes in order to solve the problems. The ultimate position of the client would be a customer, whereby the client not only recognizes her problems, but she is also able to take an active role in solving the problems. With a little encouragement, this client could easily transition to the customer position.

There are several techniques that could be used to help the client focus on solutions to her current problems. One of these techniques involves asking the client about the actions she has taken thus far to solve the problems. In recognizing these actions, the therapist points out that the client is doing something positive to change things, and that there is hope. For the current client, recognizing that she has sought help, both medically and psychologically, could give the client a sense of hope in finding resolution, since she has already taken the first steps.

Another technique involves asking the client exception questions. These are questions that ask the client what things were like when the problem either did not exist at all or was not as intense as it currently is. For example, the therapist may ask the client what her life was like when her depression was not as intense as it is now.

Another technique that Solution-Focused Brief therapists may use is asking “The Miracle Question.” This is asking the client what her life would be like should she wake up one day and the problems that she is currently experiencing did not exist at all. In asking this question, the therapist asks the client how she would know the problems were solved, and what would be different. This process opens up opportunities for the client to imagine what it would take to alleviate her problems, and then actively make changes in order to solve the problems.

Other techniques that can be used include asking scaling questions, giving the client a Formula First Session task, and providing feedback at the end of sessions. The therapist may ask scaling questions in order to determine progress that the client has made, which may be mood-related and/or action related. Also, in giving a “homework assignment” or task between the first and second session, the client gains both a sense of awareness of his or her problems in relation to their solution, and a sense of optimism that things can and will change. By giving feedback, the therapist helps the client to understand the orientation of the solutions to her problems, as well as the progress she has made. This feedback can be given in the final 5 to 10 minutes of each session. Finally, after the client is able to construct a satisfactory solution to her problems, then the therapy can end. This type of therapy is meant to help the client to solve problems as quickly as possible, but should allow for the client to return to the therapist should she have difficulty with problems in the future. Termination of therapy should be a healthy, positive experience for both the client and the therapist.