SFBT, CBT, and New Directions

Coaching: SFBT or CBT

Specific task or goal – both

Relationship is to task – both

Collaborative approach – SFBT

Defined desired outcome – both

Great minds think alike, or whose techniques are

whose?: • Both:

• Goal setting

• Homework

• SFBT:

• Visualizing the goal or thickening the description

• Scaling

• Noting exceptions

• Building on spontaneous exceptions

CBT is an individual approach, so:

Not Miracle question

Not Genogram

Not Expanding the system

Not the same idea of the interactional cycle

Techniques common to both, especially in groups and

coaching :

Giving information - from multiple perspectives, without attachment

Developing step by step strategies

A Mini Example • 17 year old in alternative to suspension program for cursing teacher

• Catalyst was learning music program had been cut

• Deceased father was jazz musician; 17 year old has strong interest

• Outcomes: Mother and 17 year old worked together as team to apply him to music magnet program ( one of several options we brainstormed with them), and to produce multiple mutually exciting college plans

• Referral to family therapy at their request for grief issues

It would have been wrong (in my view):

To ignore request for family therapy and desire to talk about grief issues

Or to ignore immediate need to give 17 year old educational options and mother hope for future

In this case, dividing line between coaching and therapy relatively clear

Mother referred to her son's "advocate" and to her own desire for a "therapist"

In this case, two locations and two teams - but can be two stages of work with one person

What would a CBT person have done different?

Taught specific coping skills (whereas I preferred to work within client’s reality);

Most probably not have expanded the system (i.e. same school)

More individual focus

EARS (SFBT) :

Elicit positive changes

Amplify (may include resources)

Reinforce

Start again

(Berg & Szabo, 2005)

SMART (CBT):

S pecific goal

Measurable outcome

Attainable goal – don’t make it too hard

Realistic goal – example given is 5 percent fewer anxiety attacks, not no anxiety attacks

Time - set a deadline

What do you notice?

SMART goal looks like outcomes you learned about in assessments

SMART goal is not necessarily tied to a spontaneous exception or to the client’s world view

SMART goal does not necessarily expand the system (whereas the best SFBT goals do)

ROPE (SFBT journaling exercise):

Recall at least three times when you were the person you want to be

Organize your memories - what do these times have in common?

Present and future - what can you do now that is like that? What can you do in the future that is like that but more? (Resources)

Expand on these goals - tell others about them

(Systemic Change in Schools, 2012- note use of second person voice, also used as reflective journaling task)

CBT journaling:

Situation

Automatic Negative Thought

Resulting Emotion

Evidence against Automatic Negative Thought

New Emotion

So: CBT is more directive, educational,

and:

Therapist is right, client is most likely wrong

BUT:

A funny thing happened on the way to the 22nd

century…

Recent developments in CBT mirror/echo recent developments in brief therapy

Classic behaviorism: Behavior is repeated when it is

reinforced

Training pigeons and dogs

This always works!! IF one can avoid reinforcing what one doesn’t want to reinforce; if the reinforcement is valid and suits the individual ; if the desired behavior occurs and can be noticed

Classic pedagogy

Usually mis used in practice (e.g. name on board example)

Has given birth to its own field – applied behavior analysis

Most evidence based treatment for autism

Second Wave: Cognitive/Behavioral Because most of our behaviors are not directly and immediately reinforced;

Because what we think of ourselves and others matters

The idea is to model appropriate behaviors, and teach appropriate cognitions

Beck Depression Inventory

Isolation

Negative thoughts

Idea is to replace

Equally effective as couples therapy – but requires more work on the part of the client

Third Wave: This is where the interest and focus is

today

ACT: Acceptance and Commitment Therapy

DBT: Dialectical Behavioral Therapy

ACT Hayes & Wilson, Jacobsen & Christiansen, 1990’s.

Encourage acceptance of feelings in the present

You don’t want to go to work because you are anxious; you can go to work and fully experience your anxiety; both are valid

Mindfulness, living in the present

Mindfulness Exercise Pause for a moment

Look around and notice five things you can see

Now notice five things you can hear

Notice five things in contact with your body

Allow yourself to experience both the negatives and positives of these things

Fully experience them

Now take a deep breath and decide what your focus will be

DBT Marsha Linehan, 1990’s, out of own painful adolescent experience

Non pathologizing resolution of common dilemma: instead of who’s telling the truth, self definition of “unusually sensitive”

Accept unusual sensitivity and go with what works

Intense support – weekly groups plus individual plus phone contact

DBT Exercise

Panic list for feeling overwhelmed:

Bite a hot pepper;

Thrust finger into ice until it hurts;

Cover your arm with a layer of Elmer’s Glue and let it harden, then peel it off slowly

These are alternatives to cutting and self mutilation

More DBT self help exercises:

Eat a raisin mindfully and slowly

Choose a random object and list 30 different uses for it

Crank up loud music and dance

Rip up a phone book

Again, these are self generated “what works” to handle strong emotion, but are also therapist suggestions

Different and the Same:

Third Wave still more likely to be “teach”-y

But comes much closer to entering client’s reality

Interesting additions related to entering client’s reality in the moment

Interesting additions (esp. DBT) to “what works”

Equifinality SFBT came through cybernetics and interactional cycle through hypnosis to entering client’s reality, expanding system, and focusing on what works

Third Wave CBT came through behavioral reinforcement through cognitive teaching to accepting client’s reality, expanding system in the case of DBT (through self help groups), and focusing on what works

Positive Psychology

Martin Seligman, 1990’s – through learned helplessness to resilience to the study of happiness

Now a full fledged movement within psychology

Evidence based

The Equation

S + C + V = Happiness

Easiest to manipulate is V

Similar to SFBT and expanding the system, similar to all family therapy, but also perhaps different (need not be related)

Convergence of ideas Individuals create their own reality more than was previously thought

The most effective therapies work within that client’s reality

What you pay attention to gets bigger, in life as well as in specific situations

Reality is more varied and open to interpretation than we thought

Motivational Interviewing

W.R. Miller, behavioral psychologist interested in problem drinking

Analyzed more successful therapists in program

Focus on goals and reinforcement of change talk - less focus than SFBT on interactional context and on spontaneous exceptions

Evidence based, in wide use in mandated contexts

Appreciative Inquiry: Coaching for a whole

organization www.appreciativeinquiry.case.edu

Affirmative topic choice

4 steps: Discovery (correlates with exceptions); Dream (correlates with expansions or miracle); Design (how can organization do more of what is working); Destiny (formerly delivery)

www.ovation.net to contact David Cooperrider

Registration process

Appreciative inquiry – divide into 4 groups