Eclect Ic St Ru Ct Ural Brief Th Er Apy

8/14/2019 Eclect Ic St Ru Ct Ural Brief Th Er Apy

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Eclect ic St ru ct uralBrief Th er apy ( ESBT) a son www .cop in g.or gJames J. Messina, Ph.D.

C6436 Individual CounselingTheories and Practices


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A Therapy Truism How many therapists does it take to

change a light bulb?

Just one, but the light bulb has to wantto be changed.


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Rationale for ESBT-Brief Model How do therapists motivate clients to overcome

their resistance

Clients stay in treatment for from six to tensessions Clients report maximum gains after three to six

sessions

Brief therapy models have been found to have nosignificant difference in their effectiveness thanthose of long term therapy models (Budman &Gurman, 1988; Cummings, 1986; Budman &

Stone, 1983).


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Therapists who hold to a Brief

Therapy model Have values & beliefs about what can & cannot be

accomplished in therapy Believe effective therapy results in the resolution of current

problems & not in the major modification of personality orcharacter structure

Believe their job is to fix leaks rather than build a customdesigned house form the ground up.

Establish challenging but limited goals for treatment Work toward insight but also facilitate behavior change Believe their primary goal is to initiate a healing process that

can continue throughout the clients lives (Gelso & Johnson

1983)


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Why People Seek out Brief

Therapy Most people do not desire lengthy process to

uncover all subconscious and conscious drives

which affect their mental health. They seek out therapy because they are in some

form of crisis, which affects their mental well,being

They want to find coping strategies, which willassist them to alleviate their currentlyexperienced pain


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Brief Therapy Helps Clients Identify whether or not they are light bulbs

wanting to be changed See if a match exists in their temperament and

personality styles with the therapists See if right mix of motivation and simpatico between

clients and therapist so change can occur in a briefperiod of time

If there is not a match, therapists need toencourage them to not pursue therapy until areadiness and willingness to do what it takes to

change so that they can become turned on lightbulbs.


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Literature on Brief Therapy Leaders in brief therapy include: Bennett (1983,

1986); Budman (1988); Cummings (1986, 1988);de Shazer (1982, 1985, 1988); Haley (1985); the

MRI Group of Weakland, Fisch, Segal, andWatzlawick (1974, 1978, 1982); Strupp & Binder(1984); Talom, (1990); and Wells (1990).

Reviews of the research (Bloom, 1992; Rosenbaum,

Hoyt & Talmon, 1990; Hoyt, 1995; Rosenbaum,1994) repeatedly have found brief therapy aseffective as time-unlimited traditional therapies,regardless of diagnosis or duration of treatment.


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I. Long-Term Therapists Seek change in basic character Believe that significant psychological change is

unlikely in every day life. See presenting problems as reflecting more

basic pathology.

Want to "be there" as clients make significantchanges.


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II. Long-Term Therapists1. See therapy as having a "timeless" quality &

works if clients are willing to wait for change.

2. Unconsciously recognize fiscal convenience ofmaintaining long-term clients.

3. View psychotherapy as almost always benignand useful.

4. See clients being in therapy as the mostimportant part of clients life


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I. Short Term Therapists

1. Prefer pragmatism, parsimony and least radicalintervention & do not believe in notion of "cure."

2. Maintain adult developmental perspective fromwhich significant psychological change is viewedas inevitable.

3. Emphasize clients strengths and resources;

presenting problems are taken seriously4. Accept many changes will occur "after therapy"

and will not be observable to the therapist.


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II. Short Term Therapists1. Do not accept timelessness of some models

of therapy.

2. Fiscal issues often muted, either by thenature of the therapist's practices orstructure for reimbursement.

3. View psychotherapy as being sometimes

useful and sometimes harmful.4. See being in the world as more important

than being in therapy.


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I. Assumptions about Clients

in Brief Therapy Model The clients have experienced "faulty learning

at some point in early life. The clients and their/her environment interact

and influence each other reciprocally. The interpersonal environment of the clients

is never neutral. It influences the clients

positively or negatively.


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II. Assumptions about Clients

in Brief Therapy Model Although personality, character, social supports

etc. are all very important in peoples life

patterns, chance encounters and chance eventsare also prominent factors in shaping life'scourse.

People understand experience, at least in part,

on the basis of their stage of development. There will be little to no therapy achieved until

the clients are ready to change.


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I. Critical Therapist Factors inBrief Therapy- Therapist must:

Maintain clear, specific focus & structure Maintain active therapeutic role by suggesting activities or

insights, collaborating and problem solving using tasks,

homework assignments, by asking questions Remain aware of the value of "time" in process,each

session be valued as vital to the desired outcomes. Make time between sessions spent in carrying on the

therapeutic process by homework assignments: readings,journal writing, practice of new behaviors such as exercise,joining self-help groups, public speaking, volunteering &trying new interactional patterns in the family, marriage andwork or school setting if applicable.


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II. Critical Therapist Factors inBrief Therapy - Therapist must:

Try new strategies, do something different, novel tomotivate & challenged clients to deal with the presentingproblems successfully

Be flexible, eclectic in a variety of treatment modalities forindividual, couple, family, group

Use innovative session duration and re-scheduling See end of treatment as interrupting vs. terminating

encourage clients recognize therapy is a process over wholelife cycle and can return on an as needed basis. Be clear with the clients: relapse is a part of recovery to

return to therapy is not failure but good common sense. Recognize disincentives:bias of training programs, too many

therapists, financial survival need


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I. Clients factors in Brief

Therapy Common belief that 85% to 90% of all clients are

appropriate for brief therapy Koss and Shiang (1994) indicate that individuals who

appear to benefit most from brief therapy are: Whose problems had a sudden or acute onset Were previously reasonably well-adjusted Could relate well with others

Had high initial motivation when entering the therapeutic process Brief therapy may be inappropriate for individuals whose

personal characteristics are in contrast to those notedabove & some types of psychological disturbances;substance abuse, psychosis, and personality disorders.


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II. Clients factors in BriefTherapy: Clients must:

Have an average intellectual ability & capable ofunderstanding the issues involved able to read and write inorder to many of the assignments

Be psychologically minded & open to psychologically orientedinsight, interpretations and suggestions

Have some social support system in place where they canturn for support & understanding during their time in the

therapeutic process. Be motivated for change: light bulbs that are ready. Have social orientation relate problems in social context Have clear present problem or principle complaint, which can

be identified in therapy. Have ability to collaborate with therapist in the process.


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III. Clients factors in BriefTherapy: Clients must have:

Have been able to have established at least one meaningfulrelationship in their lives

Have capacity for rapid emotional involvement & equally

rapid emotional separation. Have good ego strength. Have the ability to express feelings. have the expectation that therapy will be successful. Be excluded based on the belief that therapists do not try

to treat the untreatable Therapists think all therapy "trial therapy" for 3 sessions &

either: transfer inappropriate clients, use alternative or

adjunctive modality of treatment, or offer no treatment


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Characteristics of Eclectic

Structural Brief Therapy (ESBT)1. Theoretical Basis

2. Length of Session

3. Frequency and Regularity of Sessions4. Duration of Treatment

5. Location of Therapy

6. Initiation of Therapy

7. Termination of Therapy

8. Goals of Therapy

9. Therapeutic Process


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Impact of Low Self-Esteem

T h i n k i n g d i s t o r t e d

b yi r r a t i o n a l b e l i e f s &

o l d b e h a v i o r a l s c r i p t s

F e e l i n g s d i s t o r t e d

d e n i e d , r e p r e s s e d ,e x a g g e r a t e d o r

e x p l o s i v e f e e l in g s

B e h a v i o r s d i s t o r e d

u n h e a l t h y , i r r e s p o n s i b l e ,c o m p u l s i v e , u n p r o d u c t iv e ,

s e l f - d e s t r u c t i v e

U n r e s o l v e d L o s s I s s u e s U n r e s o l v e d A n g e r I s s u e s

S e l f - D e s t r u c t i v e B e h a v i o r s P e r s o n a l A d j u s t m e n t P r o b l e m s

C o n t r o l I s s u e s F a u l t y C o m m u n i c a t i o n s

I n t e r p e r s o n a l R e l a t i o n s h i p P r o b l e m s

C o m p u l s i v e P e r s o n a l i t y T r a i t sL o o k i n g G o o d , A c t in g O u t , P u l l i n g I n ,

E n t e r t a i n i n g , E n a b l e r , T r o u b l e d P e r s o n ,

P e o p l e P l e a s e r , R e s c u e r , N o n f e e l in g

L O W S E L F E S T E E M

S o u r c e s o f L o w S e l f - E s t e e md y s f u n c t io n a l e n v i r o n m e n t s , d i s a s t e r o u s r e l a t io n s h i p s , c o d e p e n d e n c y ,

p h y s i c a l a b u s e , e m o t io n a l & v e r b a l a b u s e , s e x u a l a b u s e , a d d i c t i o n s ,

d i s a b i l i t y , p e r s o n a l f a i lu r e s , c h r o n i c i l l n e s s , n e g l e c t , p u t d o w n s


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Healthy Adult Self-Esteem

S e l f N u r t u r i n gu n c o n d i t i o n a l s e l f lo v e & a c c e p t a n c e

a c c e p t s e l f a s u n i q u e

o p e n & h o n e s t in p e r s o n a l fe e l in g s

N u r t u r in g E n v i r o n m e n tr e c o g n i t io n & a c c e p t a n c e

d e f i n e d & e n f o r c e d l i m i t s

r e s p e c t & f r e e d o m t o b e s e l f

N u r t u r i n g R e l a t i o n s h i pu n c o n d i t i o n a l l o v e & a c c e p t a n c e

g o o d c o m m u n i c a t i o n s

w a r m t h , c a r i n g & l o v e o f o t h e r s

S e l f - w o r t h S e l f - D e s e r v e d n e s s

P r o d u c t i v e P e r s o n a l i t y P e r s o n a l l y R e s p o n s i b l e

C r e a t i v e P r o b l e m S o l v e r A l t r u i s m

L e a d e r s h i p H e a l t h y C o p i n g S k i l l s

H e a l t h y S e l f - c o n c e p t O p t i m i s m

H e a l t h y S e l f - E s t e e m

N e c e s s a r y C o n d i t i o n s f o r G r o w t h


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Self-Esteem Recovery Model

R a t i o n a l T h i n k i n gl e a r n w h a t i s r e a l i t y & n o r m a l ,

d i s p e l i r r a t i o n a l , c r e a t e a f f i r m a t i o n s

H e a l e d R a t i o n a l F e e l i n g sl e a r n h o n e s t a n d o p e n i d e n t i f y &

e x p r e s s f e e l in g s

H e a l t h y R a t i o n a l B e h a v i o r sa c t o n r a t i o n a l t h o u g h t s a n d f e e l in g s ,

a c c e p t r e s p o n s i b i l i t y - L e t G o t o G o d

L e t g o o f L o s s I s s u e s R e s o l v e A n g e r I s s u e s

E l i m i n a t e S e l f - D e s t r u c t i v e B e h a v i o r s I m p r o v e d p e r s o n a l f u n c t i o n i n g

S e l f - c o n t r o l - l e t t i n g g o o f o t h e r s I m p r o v e d C o m m u n i c a t i o n s

I m p r o v e i n t e r p e r s o n a l r e l a t i o n s h i p s

I m p r o v e d S e l f - E s t e e m

C h a n g e d O l d P e r s o n a l i t y T r a i t sr e w r i t e o l d s c r ip t s , r e d e f i n e s e l f

S o u r c e s o f R e c o v e r yI n d i v i d u a l , c o u p l e , f a m i l y , g r o u p c o u n s e l i n g , T r e a t m e n t

P e e r s u p p o r t , 1 2 S t e p P r o g r a m s , B u d d i e s a t S E A ,

A A , N A , G A , O A , A l a n o n , A C O A , C o D A


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I. ESBT model Flexible Processof Theoretical Integration

Limited and collaboratively set realistic goals similar toReality Therapy (Glasser 1965 & 2000)

Collaborative relationship between therapist and clientssimilar to Person Centered Therapy (Rogers, 1961)

Rapid and early assessment done by therapist utilizingtechniques from Systemic Family Therapy (Bowen, 1978;Haley, 1985; Minuchin & Fishman, 1981; Satir, 1983;

Whitaker, 1976) Focused interventions similar to the Multi-model Behavioral

Therapy (Lazarus, 1995)

Staying centered in the here and now with the clientssimilar to Existentialist Therapy (May & Yalom, 1995)


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.Process of TheoreticalIntegration

Directed activity accomplished by the clients similar toCognitive Therapy (Beck, 1976; Ellis & MacLaren,1998; Meichenbaum, 1997)

Ventilation of emotions similar to the Gestalt Therapy(Perls, 1969)

Teaching how to identify and refute irrational thinkingsimilar to Rational Emotive Behavior Therapy (REBT)

(Ellis & Harper, 1997; Ellis & MacLaren, 1998)


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III. ESBT model Flexible Processof Theoretical Integration

Identifying, challenging and confrontingpsychological defenses similar to PsychodynamicTherapy (Freud, 1955)

Encouraging personal responsibility taking andaccepting the social consequences for ones actionssimilar to Adlerian Therapy (Adler, 1930, 1931, 1938)

Creative and efficient use of time

Selection process by which suitable clients who arelight bulbs ready to be turned on are enrolled inthis treatment model (Budman & Gurman, 1988)


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I. Goal of Techniques ("art" of

the science of therapy) in ESBT Strengthen treatment gains Generalize learning from session to real experience

Allow for learning of new skill or enhancing of anold skill Empower clients who are demoralized, wounded &

feel like outcasts

Enable clients to personalize therapy so that theoutcomes are uniquely theirs


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II. Goal of Techniques ("art" ofthe science of therapy) in ESBT

Helps clients own the outcomes of therapy assomething, which they have done on their own

View selves as competent self-healers who cangain new coping skills and enhance old ones Enables renewed self-confidence, increased self-

worth and enhanced self-esteem


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Types of Techniques in ESBT

Init ia t ing : aimed at exploring clients'presenting problems gain understanding

Chal le ngi n g :aimed at assisting clients tochange their thoughts, emotions and actions

Concluding :aimed at evaluating clients'progress and degree of change.


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Initiating Techniques of ESBT

Conduct a Pre-session telephone call Mail out psycho-social-medical history forms Ascertain in the initial session if clients are ready for

treatment or if someone else is pressuring them intotreatment.

Ask clients how soon they expect to be helped and whatthey see to be the obstacles

Train clients in problem analysis and goal setting Explain the length and nature of ESBT treatment Keep clients in the "here and now"

Operate on assumption length of treatment only 1 session


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Major Initiating Message inESBT

Our parents did the best they could

knowing what they did at the time. We,as adults, must now take responsibilityfor our own lives and learn what"normal" is so that we can have

healthier, more productive lives.


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Challenging Techniques inESBT

Homework Have the client envision change

Use novelty, uncommon therapy Use one-down position "Columbo" Use humor in treatment Focus clients' roles past & current family Utilize metaphor or paradox Use Crystal Ball Technique Ask challenging questions of clients

Encourage Bibliotherapy


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I. Homework in ESBT

Self-esteem development (Family Systems: Satir, 1983,1988)

Life style of recovery (Reality Therapy: Glasser, 1965, 2000) Family of origin behavioral introjected scripts (Gestalt: Perls,1969) and irrational beliefs (REBT: Ellis & Harper, 1997)

Handling loss (Existential: May & Yalom, 1991) Personal growth (Behavioral: Lazarus, 1995, 1997; REBT:

Ellis & Harper, 1997; Cognitive: Beck, 1976 &Meichenbaum, 1997)


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II. Homework in ESBT

Handling relationships (Family Systems: Satir, 1983, 1988) Communications (Person Centered: Rogers, 1961) Anger work-out (Gestalt: Perls, 1969) Handling control issues (Reality Therapy: Glasser, 1965,

2000; Adlerian: Adler, 1930, 1931, 1938 & Dreikurs, 1964) Healing the inner child for self healing (Psychodynamic:

Freud, 1955; Family Systems: Bowen, 1978; Haley, 1985;

Minuchin, 1974, 1981; & Whitaker, 1976)


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TEA SystemThoughtsEmotionsActi ons


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TEA Sy st em


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AL ERT Sys te mASSE SSLESSENEASE O UTRELAXTAKE STE PS


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ANG ER Sys te mACCEPTNAM E I TGE T IT O UTENER GI ZERELEASE


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LET GO Sys te mLIGH TEN NE EDEXER CISE R IGH TSTAKE STE PSGI VE U P CO NTR OLORDER LIFE


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CHIIL D Sys te mCALMHEALINFORMLIGH TENDIRECT


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RE LAP SE S ystem RECO GNI ZE EXERCISE LEARN AC T PROTECT SUPP ORT


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RELAPSE System

SEAS SYSTEM


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SEAS SYSTEMMIND-BODY CONNECTION

BRAIN ra tiona lreasoni ng HEART -GU Tinvolun ta ryorg an ic syst ems hea rt r at e

pr essur e g as tr icacid adrenaline IMMU NE SYST EM


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Concluding Techniques

Post-treatment sculpting

Journal review

Clients conduct therapy session with self

Contract clients to try it on own no therapy

Inventory where client is at their time Give client a progress report


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I. Haleys (1985) tips toconsistently fail in brief therapy:

Do not attend to the presenting problem of theclients.

Dealing with the clients past is essential so dealwith it extensively.

Focus only on symptoms. Predict a worsening of the symptoms or symptom

substitution. Over focus on clients diagnosis & criteria necessary

for diagnosis. You must use only ONE theoretical framework. Don't be directive.


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II. Haleys (1985) tips toconsistently fail in brief therapy:

Assume change must be observable to be realchange.

Insist on years of treatment to bring about

change. Evoke guilt in the clients. Ignore the clients wanting quick results. Don't define goals in therapy. Don't collaborate with your clients. Assume all responsibility for success or failure the

clients in therapy. Don't evaluate your effectiveness.

Eclect Ic St Ru Ct Ural Brief Th Er Apy

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