Strengths-based Therapy

Distinctive Features

John Murphy, Jacqueline Sparks, John J Murphy, Jacqueline A Sparks

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781138684102
• eBook ISBN: 9781315512952
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Strengths-Based Therapy: Distinctive Features offers an introduction to what is distinctive about this innovative client-directed approach. Written by two experienced practitioners of strengths-based therapies, this book translates SBT principles and practices into concise, evidence-based ideas and techniques that mental health practitioners can immediately apply on the job. Using the popular Distinctive Features format, this book describes 15 theoretical features and 15 practical techniques of Strengths-Based Therapy.

Strengths-Based Therapy will be a valuable resource for psychotherapists, clinical, health and counselling psychologists, counsellors, psychiatrists, marriage and family therapists, social workers, and all who wish to know more about this unique approach to therapy.

Part 1
Distinctive Theoretical Features of SBT

1
History of SBT

Strengths-based therapy (SBT) is a client-directed approach that invites people to participate in every aspect of care and to apply their indigenous strengths and resources toward personally meaningful goals. As described below, SBT draws from a variety of sources, ideas, and methods.

Milton Erickson

Psychiatrist Milton Erickson practiced in the mid-1900s and died in 1980, but his pioneering ideas live on in the helping professions. The following ideas are particularly relevant to SBT: (a) clients are inherently resourceful and capable of changing, including those diagnosed with serious disorders; (b) the main reason to discuss past problems is to discover current resources; (c) clinicians should tailor services to each client; and (d) effective therapy helps clients discover and apply their natural strengths and resources. Consult the Erickson Foundation for additional information (www.erickson-foundation.org).

Donald Clifton

Donald Clifton’s work in the 1950s increased people’s awareness of strengths-based ideas at a time when such ideas were rare. He was an educational psychologist who developed StrengthsFinder, an assessment tool that helps companies and individuals identify and apply their strengths. The American Psychological Association called Clifton the father of strengths-based psychology and the grandfather of positive psychology. Though not a therapist himself, Clifton’s work solidified the theoretical foundations of SBT.

Social work

Strengths-based ideas are embedded in the writings of social worker Bertha Reynolds during the mid-1900s. Having observed the adverse effects of poverty and racial discrimination on the lives of her clients, Reynolds criticized the practice of “blaming the victim” by assigning psychiatric diagnoses to people who were reacting to oppressive social and political forces. Her influence is evident in the strengths-based principles of contemporary social work (Saleebey, 2013) and the social justice themes of SBT.

Counseling

The counseling profession has endorsed many strengths-based practices throughout its history. These practices include acknowledging client assets, emphasizing health and wellness, and advocating for socially just, culturally responsive services. Counseling organizations and scholars have repeatedly cautioned clinicians against diagnosing clients without carefully considering the impact of situational, developmental, sociocultural, and environmental factors (Sue & Sue, 2016).

Psychology

Psychological therapies have historically adopted a diagnostic-prescriptive approach to analyzing and correcting client difficulties. Recent proponents of positive psychology recommend greater attention to clients’ strengths without minimizing their pain and struggles. Seligman, Rashid, and Parks (2006) note: “For over 100 years, psychotherapy has been where clients go to talk about their troubles, symptoms, traumas, wounds, deficits, and disorders. … In its emphasis on troubles, psychology … has seriously lagged behind in enhancing human positives. … Indeed, therapies that attend explicitly to the positives are few and far between” (pp. 774–775). SBT has also benefitted from the person-centered ideas of psychologist Carl Rogers, especially the emphasis on building strong client/therapist relationships.

Family therapy

Family therapy emerged in the 1950s as practitioners questioned intrapsychic approaches that minimized the influence of family and other social factors. Fueled by systemic theories from the UK and US, such as attachment theory (Bowlby, 1953) and cybernetic systems theory (Bateson, Jackson, Haley, & Weakland, 1956), family therapists operated from two main assumptions: (a) problems do not originate from within a person, but result largely from unproductive family communication patterns, and (b) family therapy produces more powerful and lasting changes than intrapsychic therapy. SBT and other systemic therapies have embraced the idea that problems do not automatically imply client pathology. More than just another treatment model, family therapy offered a new paradigm from which to approach clients, problems, and solutions.

Postmodern therapies

SBT borrows from postmodern approaches of the late twentieth century, all of which began as family therapies and were subsequently applied to individual and couple therapy. These approaches share the following assumptions and features: (a) there are many possible meanings or stories, versus one objective truth, that can be ascribed to clients and problems; (b) clients’ personal meanings are shaped largely by the social contexts and conversations in which they participate; (c) therapeutic dialogue invites clients to consider alternate meanings and actions that help them achieve their goals; and (d) therapists collaborate with clients by accommodating their goals, preferences, and strengths.

Solution-focused therapy. Steve de Shazer and Insoo Kim Berg developed this approach in the 1980s based on their observation that clients can improve their lives without thoroughly understanding or discussing their problems (de Shazer, 1985; de Shazer, Berg, Lipchik, Nunnally, Molnar, Gingerich, & Wiener-Davis, 1986). Therapists help clients (a) describe a preferred future in which the problem is absent or less intrusive, and (b) increase “exceptions to the problem,” referring to times when clients act in accordance with their preferred future. Drawing clients’ attention to their successes enhances hope and provides tangible evidence that they can improve their lives. Refer to de Shazer et al. (2007) and www.sfbta.org for more information.

Narrative therapy. Developed by Michael White and David Epston in Australia and New Zealand (White & Epston, 1990), narrative therapists believe clients are deemed “problematic” when their opinions or actions do not fit the dominant preferences of groups or societies in which they participate. Guided by the notion that persons are distinct from the problems they experience, therapists help clients re-write their life stories by (a) critiquing the dominant social, cultural, and political norms against which clients evaluate themselves, (b) “externalizing” or reframing problems from internal pathologies to external influences and entities, and (c) helping clients change their relationship with problems and reclaim their lives. White (2007) elaborates on these and other features of narrative therapy.

Collaborative therapy. Originally called “collaborative language systems therapy” when developed by Harlene Anderson and Harry Goolishian (1992) in the United States and Tom Andersen (1992) in Norway, collaborative therapy maintains that the meanings we ascribe to events, experiences, and ourselves emerge largely from our social interactions and conversations. Problems result from narrow, inflexible dialogues within oneself and between oneself and others. Collaborative therapists adopt a position of “not knowing” in regard to clients—a relational stance that fosters new meanings and encourages clients to experiment with different ways of thinking and living. Like other postmodern therapies, this approach views clients as experts on themselves and trusts them to apply therapeutic conversations in ways that are uniquely useful to them. Consult Anderson and Gehart (2007) for more information.

Pluralistic therapy. Pluralistic therapy, developed in the United Kingdom by Mick Cooper and John McLeod (Cooper & McLeod, 2011), urges clinicians to approach clients, treatment methods, and therapeutic conversations with an openness and flexibility that allows for tailoring therapy to each client rather than imposing one’s pre-established beliefs and techniques onto clients. By encountering clients from a position of “unknowing” (Spinelli, 2015), pluralistic clinicians are willing to be challenged and influenced by clients, and to employ a wide range of theoretical ideas and methods to accommodate each client’s unique circumstances, goals, and response to treatment. Refer to Cooper and Dryden (2016) for additional information.

Feminist-influenced therapies. Feminist-influenced approaches view individuals within their sociocultural contexts based on the notion that psychological problems, especially those experienced by women and other marginalized groups, often reflect political and sociocultural injustices rather than individual pathologies (Hill, 1998). Client problems frequently result from the lack of social power, and clinicians promote egalitarian relationships in which clients assume active roles in shaping therapeutic content and goals. We view these as important considerations for all clients, not just women and other non-dominant groups.

Client-directed, outcome-informed (CDOI) practice

CDOI practice, originally called client-directed practice by Barry Duncan and colleagues (Duncan, Solovey, & Rusk, 1992), integrates client resources into treatment, collects systematic client feedback, and gives clients a central voice in therapy—all of which are core aspects of SBT. CDOI practice is not another model of therapy, but a set of transtheoretical values that enable clinicians of all orientations to improve services by putting clients first throughout the helping process. See Duncan (2014) and https://heartandsoulofchange.com for more information.

Recovery movement

The recent mental health recovery movement or “recovery model” has roots in many countries. This consumer-led movement maintains that all persons with mental health challenges are capable of living dignified lives despite their diagnoses and difficulties (Ramon, Healy, & Renouf, 2007). The movement draws from studies of the World Health Organization showing high rates of recovery from schizophrenia and other major struggles, and from personal testimonies of persons who have recovered from significant challenges. Recovery-based services build on people’s strengths and help them recruit local, natural support systems such as family, friends, and community resources. As the name implies, the recovery movement is more of a philosophy than a therapeutic method.

In summary, SBT borrows from the innovative ideas and methods of many individuals, disciplines, and approaches. The next chapter describes how SBT blends these influences into a flexible set of therapeutic attitudes and actions.

2
SBT as transtheoretical and value added

SBT is a transtheoretical and value-added approach, meaning it can be applied to all clients by practitioners of all theoretical orientations to benefit whatever else is done in therapy. This chapter describes the core aim and features of SBT, along with common misunderstandings about strengths-based practice.

Core aim and features of SBT

The core aim of SBT is captured in two words—client involvement. Client involvement, also called client participation or engagement, refers to the extent to which clients participate in and contribute to therapy. SBT clinicians encourage client involvement by being client directed and alliance minded.

Client directed. SBT privileges clients’ perspectives and involves them in every aspect of therapy. Duncan and colleagues (Duncan et al., 1992) coined the term “client directed” to operationalize empirical findings on common factors of change, which indicate that therapeutic success depends largely on the activation of common elements of helping that operate regardless of the therapist’s specific treatment model or theory (Lambert, 2013). These elements include clients’ resources, expectations, and perceptions of the client/therapist alliance. Of all such elements, client factors are the most powerful by far. Client factors consist of everything clients bring to therapy, which includes their unique strengths, wisdom, resilience, hopes, life experiences, cultural heritage, values, social supports, and ideas about what might help them. The extent to which clinicians incorporate these elements into therapy strongly impacts outcomes (Duncan, 2014). Common factors research provides compelling empirical support for putting clients at center stage by accommodating their strengths, feedback, and preferences.

Alliance minded. To say therapy is a relational process is stating the obvious, but we do so because the medical model continues to influence mental health professions in ways that can dehumanize those involved and minimize the importance of the client/therapist alliance (Elkins, 2016). The medical formula of diagnosing problems and prescribing treatments works well for broken bones, but not so well for therapy and counseling. Research repeatedly points to clients, therapists, and their alliance as the most potent ingredients of successful therapy (Wampold & Imel, 2015). It follows that the most effective practitioners are those who establish strong alliances, recruit client resources, and involve clients in every aspect of care.

One reason SBT appeals to practitioners is that its methods enhance the overall effectiveness of services regardless of one’s theoretical orientation. For example, a therapist of any orientation who routinely collects client feedback and adjusts services accordingly will be more effective than one who does not do so. Like other methods of SBT, feedback enlists clients as partners in the change process (alliance minded) and gives them an ongoing voice in shaping services (client directed). The transtheoretical, value-added quality of SBT enables practitioners of all persuasions to add strengths-based practices to their therapeutic repertoire without abandoning other methods that are helpful to clients.

Misunderstandings of “strengths-based”

When presented as a specific treatment model or theory, strengths-based practice has been criticized for assuming people have everything they need to resolve every problem they face. This naïve assumption is not part of our SBT approach because it disrespects the complexity of clients and their struggles. SBT customizes therapy to each client, which often involves skill-building activities relevant to the client’s preferences and goals.

Two other inaccuracies about strengths-based practices are that they lack empirical support and they rush clients into discussing strengths before acknowledging their pain and problems. Nothing could be further from the truth. First, every technique in this book is based on research findings related to common factors of effective therapy. Second, SBT is invitational rather than dictatorial; it meets clients where they are and never pressures them into discussing strengths (or anything else) without their consent. As an additional safeguard, SBT collects session-by-session feedback from clients to give them an ongoing voice in therapy and guard against imposing the therapist’s preferred ideas or techniques.

Implications for SBT

This book invites you to view and apply SBT as a flexible framework of practice rather than a restrictive model of therapy. Practitioners of all theoretical orientations can improve their outcomes by implementing the client-directed, alliance-minded principles and practices of SBT.

3
Clients as heroes of change

Hero is not a word that typically comes to mind when thinking about people in counseling. In fact, clients may be viewed as non-heroic—anxious, dysfunctional, misguided, and the like. The literature related to common factors, client agency, and client resiliency turns this familiar narrative on its head. SBT honors the heroic qualities of clients and invites practitioners to rewrite the therapy drama by casting clients in leading roles.

Client/life factors

Derived from meta-analytic and comparative outcome research, common factors are those elements shared by all legitimate psychotherapy approaches. Psychotherapy is effective not because of how approaches differ, but because of what they share (Wampold, 2001). 86% of psychotherapy outcome can be attributed to client/life factors—those aspects specific to the client and incidental to the treatment delivered (Duncan, 2014; Lambert, 2013)—that is, anything having to do with the client and his or her life that aid in recovery apart from participation in therapy. The portion of outcome variance attributable to clients far outweighs any other common factor, including therapist and alliance effects.

Client/life factors include client motivations, a supportive family or community, or previous strategies for dealing with dilemmas. They also involve serendipitous events in clients’ lives that create favorable conditions for recovery. For example, a counselor struggled with helping a family reduce conflict involving their teenage son, Luke. Luke’s persistent refusal to follow rules, get ready for school, and do homework added to the family’s stress of dealing with long commutes, a hostile landlord, and an unsafe neighborhood. Following several months of no change, the family moved into a small home in a new school district closer to the parents’ work. They returned to counseling with a new outlook and described their excitement working together on their new home. Luke was attending school and family arguments were far less frequent. The counselor immediate...

Table of contents

• Cover
• Title
• Copyright
• Contents
• List of figures
• Foreword
• Preface
• Acknowledgments
• Abbreviations
• Part 1 DISTINCTIVE THEORETICAL FEATURES OF SBT
• Part 2 DISTINCTIVE PRACTICAL FEATURES OF SBT
• Appendix A
• References
• Index