Friday, August 15, 2008

Post Modern Therapy Blog

Here is a blog I just found that has some very nice summaries and reflections on various post modern theories, including Solution-Focused Brief Therapy and Narrative Therapy. It is bilingual, keep scrolling down for your preferred language. I prefer Swahili but don't actually understand it.

Tuesday, July 17, 2007

Annette Spiezio and Affiliates

I've added a new link to the side-bar, under Counseling Links. Spiezio and Affiliates not only offer quality counseling and consultation services here in the Chicago area. They also have a great line-up of workshop/training presenters.

On a personal note, I am two weeks away from completing my masters in counseling. Then a few more weeks before I begin the new journey of fatherhood. Perhaps I will find time in there to attend to this blog. Hmmm, not likely. In the meantime I hope you find the links in the side-bar to be helpful resources.


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Monday, April 30, 2007

Solution Focused Change

Here's a link to an interesting blog with a solution-focused slant. It's not strictly about counseling/therapy, infact the author seems more involved in coaching corporate businesses in using solution-focused leadership techniques. Nevertheless, there are some great pdf articles and lots of useful ideas.

solution focused change

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Monday, November 27, 2006

While I'm At It - Another New Link

Just found what looks like another great link...

In The Room is a blog focusing on Cognitive Behavioral Therapy techniques. The title is suggestive of the blog's focus on clinical techniques rather than theories. Mark's recent post on therapists' favorite questions has me thinking of some things I've been learning recently about 'purposeful' questioning and 'circular' questioning, both of which suggest that there is more to asking a question than simply asking a question.

What I mean is that a question may be used as an indirect suggestion. For example, asking a client "How do you think you might manage to get out of that power struggle with your wife?" may be an effective way to introduce the notion that he is in a power struggle.

In the case of circular questioning, the therapist asks questions which call attention to the interactive processes going on in a family or relationship. An example might be asking a daughter "Who in the family seems to notice first when Mom and Dad are in a power struggle?" This type of question invites any family members present to consider the recursive nature of their relationships.

New Link - Bill O'Hanlon

Hello Friends, Long time no write.

I've been busy, clocking away internship hours at a family therapy center. I've had a million things to write about, but not much time to do so. In the meantime I've added a link to the side bar. It's the website of Bill O'Hanlon, If your not familiar with Bill, he is a therapist who founded what he calls Solution-Oriented Therapy. As the name suggests, it's akin to Solution-Focused Therapy. I'm adding his link for a few reasons. One, I'm really interested in learning more about Bill and his work. My internship supervisors have turned me on to some of his articles, which have been very eye-opening for me. Secondly, the site is a great example of what a therapist with some ingenuity and entrepeneurial spirit can do.

Hope you are all well.

Thursday, June 01, 2006

Education vs Therapy

One question that was posed after the Partner Abuse intervention training in Springfield last week:

"You say that group interventions with men who batter should be educational groups rather than therapy groups. One distinction you make between the two is to say that education is directive, the facilitator takes the group in a pre-determined direction, whereas therapy 'meets the client where they are at'. Yet, then you talk about using Motivational Interviewing in Partner Abuse Intervention groups. Isn't 'meeting the client where they are at' a key principle of Motivational Interviewing and doesn't this contradict your distinction that these groups should be education rather than therapy?"

First, I appreciated that this question came up after the training because a similar question was asked during the training, essentially asking why we are advocating any therapy-based techniques if this is strictly education.

There are two points I think we need to keep in mind:

One is to make sure that we understand why we are making the distinction between therapy and education in working with men who batter. If we clearly identify why we focus on education rather than therapy it will help guide us in understanding when and why we bring in elements from the therapeutic realm. I believe that a main reason for this distinction is that philosophically, to say we are doing therapy with domestic batterers runs counter to the principles which founded this work. If you look at the history, batterer's intervention was born out of a hope to further provide safety to victims. Any healing (a word that may be associated with therapy) on the part of the perpetrator is secondary, if considered a goal at all. Perhaps a goal that many people are more comfortable with is change (cognitive and behavioral) rather than healing.

Some other reasons to lean away from calling this work therapy:

  • It might suggest mutual responsibility for the violence between perpetrator and victim.
  • Some therapy models might recommend rage-expression or anger management, approaches which may increase risk of violence or fundamentally misunderstand the beliefs that support domestic violence.
  • Other therapy models might see the violence as poor impulse control, rather than as an exertion of control over one's partner.
  • If a man becomes violent again, a therapy-based approach might see this as "relapse" behavior, which suggests his "affliction" got the best of him rather than seeing the behavior as a calculated choice on his part.

Understanding these basic principles, I think it is possible, if not necessary to bring in techniques from the realm of therapy without softening on these principles. In other words, we may borrow Irvin Yalom's idea of peer-modeling in group without using his concept of client-driven group goals. Perhaps where we borrow most from the therapy world is in cognitive-behavioral techniques, which focus on confronting thoughts and expecting behavior change. But again, I think we are borrowing techniques more than embracing theories.


My second point may be an extension of the first, and it relates directly to the phrase "meeting the client where he is at".
If therapy involves meeting the client where they are, and we are not doing therapy, why talk about Motivational Interviewing (MI) which largely seeks to meet the client where they are?
I think (my beliefs, here!) that there is a key difference in what we traditionally mean by this in therapy and what the MI model suggests. The Rogerian concept of self-actualization, or self-efficacy, which guides many therapists, really takes this idea of "meeting the client where they are at" seriously. It's a belief that the client will take you where they need to go. It's also a belief that the client has what they need to achieve self-actualization and the key role of the helping professional is to affirm and accurately empathize.

Motivational Interviewing is not exactly the same. If any thing, it's like Carl Rogers with a hidden motive. Here's a quote from the original MI book by Rollnick and Miller:

"...Motivational interviewing differs from the method described by Rogers as it is consciously directive. The terms "client-centered" and "non-directive" are sometimes used interchangeably, but they refer to different aspects of counseling style. Motivational interviewing is intentionally addressed to the resolution of ambivalence, often in a particular direction of change. The interviewer elicits and selectively reinforces change talk and then responds to resistance in a way that is intended to diminish it."

Motivation Interviewing, Miller, W., & Rollinck S. 2002, Guilford Press, NY p.25

I think that if motivational interviewing can help a facilitator effect behavioral change in a batterer's group participant, then it's worth looking at. I am constantly using MI skills in batterer's groups to elicit change-talk from the men with the goal of helping them move in a direction that I am very intentionally hoping they move toward.

I hope some of this helps to clarify. I also hope to hear your thoughts as you read this. Click on the word "comments" below this post if you'd like to leave a comment. As always, I am very open to other opinions, corrections, challenges, etc.

Tuesday, May 30, 2006

A Month of Trainings

Well, I've just finished a month of trainings. I presented a workshop on Motivational Interviewing at St. Leonard's House in Chicago. Then, a workshop on working with men who batter at Safe Passage in DeKalb, IL. Followed by our semi-annual 3 day batterer's intervention training for IL Dept of Human Services in Springfield. Then, this morning I met with the staff at Emmaus Ministries to talk about working with resistance (ambivalence) and exploring the grey areas of doing para-professional urban ministry work. (whew!!)

To those of you who participated in one of these trainings, I truly appreciate the opportunity to interact with you and discuss the various clinical issues that arose. Feel free to contact me by email or phone, or to leave comments or questions here by clicking on the word "comments" after each post. I will try to post some follow-up posts to tie together loose ends that come to mind as I reflect on the trainings.

Thanks for stopping by.

Tuesday, May 09, 2006

Motivational Interviewing

Motivational Interviewing (MI) is a model of reframing and working with what is often referred to as client resistance. I'll be giving a workshop on Motivational Interviewing this Friday, so I thought I would summarize some of my thoughts here in preparation. And also provide some links to resources on MI.

I was first introduced to MI while working in the substance abuse field. It was, infact, developed in this field. This makes quite a bit of sense, given the ambivalence that individuals in early recovery or "pre-recovery" often experience.

The whole model revolves around this idea of ambivalence, a concept that could be summed up in a statement like, "I feel strongly both ways." Ambivalence is not a lack of motivation, but rather two competing motivations in different directions. For example, the substance abuser who is sick and tired of the consequences brought on by drug use, yet at the same time cannot fathom life without the drug. This sort of "fence-sitting" ambivalence typically makes behavioral change difficult.

In the counseling setting, such ambivalence is, unfortunately, seen by many clinicians as resistance or a lack of motivation. According to the MI model, what often occurs in the counseling relationship is that the ambivalence of the client gets played out in the therapeutic relationship.

An example might clarify:

Joe comes to counseling to quit smoking. He feels "strongly both ways", wanting to quit but not wanting to quit. The counselor, wanting to help enhance Joe's motivation, might ask Joe if he's thought about the health consequences of smoking. Joe says he has, but then proceeds to point out the relaxation and enjoyment he gets from it. Because the ambivalence inside Joe is complex, whenever one side of the argument (for or against smoking) is brought up, he may feel inclined to rebutt the other side of the argument just to balance things out.

This may often lead to a pattern in which the counselor is arguing for change, while the client is arguing for the status quo, or a lack of change. MI offers techniques to help the client become the one arguing for change. In some ways, MI does not look a whole lot different from classic Rogerian therapy. However, it may be seen as Rogers with more of a goal in mind. It is, perhaps more directional and behavioral in nature.

I'll leave it at that for now, so this post doesn't get too long. Next post, I'll describe some of the basic techniques. In the meantime, check out the Motivational Interviewing Website for tons of useful info, articles, etc.