Wk 10: Post modern approaches

• No single founder- A collective effort by many
• Postmodernism asserts that there are no absolute truths, and, instead, there are only different interpretations formed in language.

• Postmodernism acknowledges how human relationships and communication create vocabularies that interpret our experience – that is, our “realities” are socially constructed. 
• This is also referred to as the linguistic paradigm.
• .  In this light we will finally recognize that words are much more powerful when used as “tools” to facilitate change and connection as opposed to when used to try to describe some “objective reality” (such as a psychiatric diagnosis).

• Postmodern is a word used to describe changes in ways people think- especially the way they view truth and reality.
• Postmodern thinking would state that their world view is that 'there is no worldview'.
• Social constructionism is this idea that the client’s reality exists without disputing if it is accurate or rational.

• Solution-focused brief therapy
• Solution-oriented therapy
• Narrative therapy
• Feminist therapy

• A theory of knowledge that examines the development of jointly constructed understandings of the world that form the basis for shared assumptions about reality.
• In postmodern therapies social constructionism is the view that any understanding of reality is based on the use of language and largely a function of the situations in which people live.
• Postmodernists assume there are multiple truths
• The DSM and diagnosis is a social construct.

Explanations of mental illness affect outcomes: the chemical imbalance view led people to feel less hopeful and capable in the face of their problems and more disposed to use medication.

• Generate new meaning in the lives of clients
• Co-develop, with clients, solutions that are unique to the situation
• Enhance awareness of the impact of various aspects of the dominant culture on the individual
• Help people develop alternative ways of being, acting, knowing, and living

Therapy grounded on a positive orientation-- people are healthy and competent

SFBT shares similarities with positive psychology

Past is downplayed, while present and future are highlighted- little interest in how the problem might have emerged

Therapy is concerned with looking for what is working

• Therapists assist clients in finding exceptions to their problems
• And to recognize the competencies they already have
• It is a non-pathologising approach that emphasises competencies instead of deficits

There is a shift from “problem-orientation” to “solution-focus”, ‘what is working rather just what is broken’

Emphasis is on constructing solutions rather than problem solving, no particular right or absolute solutions

• The problem itself may not be relevant to finding effective solutions
• People can create their own solutions
• Small changes lead to large changes
• The client is the expert on his or her own life
• The best therapy involves a collaborative partnership
• A therapist’s “not knowing” affords the client an opportunity to construct a solution

• Skillful questions allow people to utilize their resources
• Asking “how questions” that imply change can be useful
• Effective questions focus attention on solutions
• Questions can get clients to notice when things were better
• Useful questions assist people in paying attention to what they are doing and can open up possibilities for them to do something different

Customer-type relationship: Client and therapist jointly identify a problem and a solution to work toward

Complainant relationship: A client describes a problem, but is not able or willing to take an active role in constructing a solution

Visitors: Clients come to therapy because someone else thinks they have a problem

• Pre-therapy change: (What have you done since you made the appointment that has made a difference in your problem?)
• Exception questions: (Direct clients to times in their lives when the problem did not exist)
• Miracle question: (If a miracle happened and the problem you have was solved while you were asleep, what would be different in your life?)
• Scaling questions: (On a scale of zero to 10, where  zero is the worst you have been and 10 represents the problem being solved, where are you with respect to __________?)

• We live our lives by stories we tell ourselves
• And what others tell us
• These stories shape our reality of what we see, feel and do
• They are in social and cultural context
• Client is not the victim leading a hopeless life, they instead emerge as courageous victors who have vivid stories to recount

• Clients construct the meaning of life in interpretive stories which are interpreted as ‘truth’
• Therapists:
• Encourage clients to share their stories
• Listen to a problem-saturated story of a client without getting stuck
• Demonstrate respectful curiosity and persistence
• Believe the person is not the problem, but the problem is the problem

• Collaborate with the client in identifying (naming) the problem
• Separate the person from his or her problem (externalizing)
• Investigate how the problem has been disrupting or dominating the person
• Search for exceptions to the problem
• Ask clients to speculate about what kind of future they could expect from the competent person that is emerging
• Create an audience to support the new story

• To become active facilitators
• To demonstrate care, interest, respectful curiosity, openness, empathy, contact, and fascination
• To adopt a not-knowing position that allows being guided by the client’s story
• To help clients construct a preferred story line
• To create a collaborative relationship-- with the client being the senior partner

• Always asked from a position of respect, curiosity, and openness, and from a not-knowing stance
• Questions are the search of a difference that will make a difference.
• What are the exceptions?
• Can lead to taking apart problem-saturated stories

• Mapping the Effects of the Problem: discuss the influences and consequences of the problem in all areas of the client’s life, including home, school, work, familial relationships, peer relationships, relationship with oneself, identity formation, and future possibilities.
• Listen for signs of strengths of the client
• Build a new story of competence by having “re-authoring conversations”.

• Living life means relating to problems, not being fused with them;
• Externalization is a process of separating the person from identifying with the problem
• Externalizing conversations help people to free themselves from being identified with the problem
• Externalizing conversations can assist clients in recognizing times when they have dealt successfully with the problem

Problem-saturated stories are deconstructed before new stories are co-created

The assumption is that people can continually and actively re-author their lives

Unique possibility questions enable clients to focus on their future

An appreciative audience helps new stories to take root

• Third generation behaviour therapies have been developed and centre around 5 core themes:
• An expanded view of psychological health
• A broad view of acceptable outcomes in therapy
• Acceptance
• Mindfulness
• Creating a life worth living

Perhaps developed in response to the trap of positive thinking

• ACT involves fully accepting present experience and mindfully letting go of obstacles
• In ACT there is little emphasis on changing the content of a client’s thoughts. Instead, the emphasis is on acceptance (nonjudgmental awareness) of cognitions
• The goal of ACT is to allow for increased psychological flexibility
• There is evidence demonstrating the effectiveness of ACT for a variety of disorders

• Mindfulness is integral to ACT, ‘paying attention with openness, curiosity and flexibility
• At the core of mindfulness and therefore ACT is contact with the present moment
• Start with a distressed client “drop your anchor in the middle of an emotional storm”
• Also an emphasis on “flexible perspective taking”, which has been also coined “self-as-context”
• It can include interventions based around empathy, compassion and defusion from the conceptualised self

1) defusion: distancing from, and letting go of, unhelpful thoughts, beliefs and memories

2) acceptance: making room for painful feelings, urges and sensations, and allowing them to come and go without a struggle

3) contact with the present moment: engaging fully with your here-and-now experience, with an attitude of openness and curiosity