Men and women, in an inpatient hospital setting, with mental health diagnoses and nicotine and alcohol addictions attended this meeting. Most of them appeared to be wearing comfortable clothing and were not dressed up. (The clothing attire is due to hospital code because of safety concerns. The patients are not allowed to have their shoes, belts, strings, cell phones, or any of their belongings that could be considered dangerous.) The majority of the individuals were from the city of Lancaster and appeared to be 30-50 years old. There was also a combination of people who were there by choice, and others who were there because they had to attend. Since everyone present had a mental health condition and an addiction, my session was different than going to an AA or NA meeting where the individuals come and go as they please as you will be able to tell immediately. (Some additional background information: the hospital breaks up the patients into 3 groups: A, B, and C. They are based on function and participation levels. The highest functioning group is "A" and the lowest is "C." The group I chose to write about was the "C" group because it was very different compared to the "A" group session and a typical AA meeting.)
A registered nurse ran the meeting. It was an open group format, run in a mental health section of the hospital. Everyone was in a class room with chairs positioned in a circle, and the meeting lasted 45 minutes. The format was pretty free flowing with directions and prompting questions lead by the leader. Since the conversation was lacking, the leader probed with different questions and received some responses. Once the leader saw that the individuals were not as talkative as she had hoped, she switched to another activity, not focusing on their addictions, and more people participated.
What did you observe in the meeting as far as interactions?
There were very few
interactions. Everyone appeared to be in a bad mood and on edge. They rated
their happiness on a scale of 1-10 (10 being the happiest) and almost everyone said that they felt like a 2. There was little to no eye contact and most people spoke quietly. After being able to review the individuals' charts, I was able to see that the reasons why they were in the hospital. A few included visual/auditory hallucinations, paranoia, bipolar episodes, suicide attempts, depression, and anxiety. Also, in addition to the meeting I took part in, the patients have 2 other group sessions that they are supposed to attend each day they are in the hospital. The meeting I was in was the last one of the day.
I was involved. I told
everyone my name and participated in the activity. Certain questions I was unable to answer and participate in though because I do not have an addiction to alcohol or nicotine, but I tried to be as involved as possible through out the session.
Do you think it was helpful to the participants?
Yes, I think it was helpful. It focused on their addictions for some parts but other parts were more relaxed and allowed them to get their mind
off of their addiction. At the end of the session, everyone rated their happiness again and
it was at least 2 points higher, which was great to see. They also appeared more pleasurable at the end of the meeting.
How does this connect to information you have learned through assigned readings and in-class discussions?
The withdrawal aspects connected directly to what we learned in class; it fit their actions exactly. They were fidgety and appeared to be on edge, irritable, depressed, and angry. Also, the few people who spoke about their addictions were really focusing on how irritable they were because all they wanted to do was smoke. They also spoke about how difficult it was and how they really need to change their lifestyle in order to try and make quitting possible. In class we spoke about how some people would feel intimidated or less likely to share in front of outsiders and I thought maybe that was the case for my recovery group, but maybe the group was just having an off day. Pictures From: http://www.drugfree.org/prevent?utm_expid=37310244-0 http://widowsvoice-sslf.blogspot.com/2012/01/happy.html http://widowsvoice-sslf.blogspot.com/2012/01/happy.html
Solution-focused therapy is based on the assumption that the future can be changed and negotiated regardless of the problem. It is focused around strengths and positivity that can be seen in the following quote from our text book, "The future is not a slave of the past events in a person's life; therefore, in spite of past traumatic events, a person can negotiate and implement many useful steps that are likely to lead him/her to a more satisfying life" (Wormer & Davis, p.106). Solution focused therapy also has an unintended consequence of helping counselors feel less burned out, more optimistic, and less likely to be captured by despair (Berg, 2013). Who Created This Approach?
http://www.sfbta.org/about_sfbt.html
The origins are found in Milton Erickson's work which strongly believed that solving the problem was more important than finding and elaborating on the root cause of the problem, and that clients had the ability within themselves and/or their social system to bring about change. (Wormer & Davis, 2008)
The
approach actually began in 1978 with Insoo Kim Berg and Steve deShazer. They borrowed money
and put up their house for collateral to open a small brief therapy office in
Milwaukee. Since this time, solution-focused therapy was no longer a “different
paradigm” and is practiced all over the world (Wormer & Davis, 2008).
Key Components/Several Techniques:
The Miracle Question is a helpful technique in supporting hope that things can be different in spite of many past attempts and failures. It leads the client directly into imagining, describing, creating, and embellishing on a day in the future without the burden of the particular problem. Through persistent questioning about what the person would be doing differently on this new, problem-free day, you see a natural progression to find out what small step the person could take in reality to reach a little bit of the whole, new picture. Below is a great explanation of the miracle question and how it can be helpful in therapy (Wormer& Davis, 2008).
Another example from our text book includes a young woman, who has anorexia, who wants to get taller. After learning from a dietitian that her low intake of calcium will impact bone growth, she began to add previously rejected foods to her diet. She was able to take more food in because the food became "medicine" rather than calories (Wormer & Davis, 2008).
Scaling Questions can be used in a variety of ways to help the client assess level of hope, determination, confidence, sadness, and how much change has occurred. This is similar to the motivational interviewing scales (1-10 how are you feelings today? 1 is the worst; 10 is the best.) (Wormer & Davis, 2008).
Coping Questions can be used to bring out the survival strategies of people who have been managing somehow in spite of their addictions. This helps build hope and self-efficacy. For example, "You've been through a lot in this past month with your gambling. How have you coped with so much, while still holding down a job?" (Wormer & Davis, 2008)
An Example of Solution-Focused Therapy: Mr. Glue-Head
http://www.elmers.com/msds/painterswat.htm
The individual is a young man who had to undergo treatment because of his desire to sniff glue and then be seen intoxicated in public. He had a long history of arrests and treatment episodes, but nothing had changed. Then while using a solution-focused approach that emphasized cooperation with the client, the therapist asked what he wanted to accomplish with this referral. The individual did not want to stop his glue sniffing, which he made known and very clear. All he wanted to do was stop getting arrested, so the therapist then offered an alternative solution. It was said that his sniffing could continue, just not in a public area or where people could see him. The individual agreed to try out the new idea and would return in a week to report his findings. A week later, he reported that the police never bothered him, even when they drove by to check on him. The results yielded that he did not get arrested any more and therefor did not get referred to any more treatment. This occurrence began to curtail his use of inhalants on his own (Wormer & Davis, 2008).
This example of Mr. Glue Head illustrates several main factors of the solution-focused approach. First, the therapist avoided issues that had always been considered problems by the therapist and others but that were not identified as problems by Elmer. Also, the therapist's focus was shifted to a problem that Elmer identified (not getting arrested). By following Elmer's lead, the therapist worked on doing something different than focusing on past solutions (Wormer & Davis, 2008)
Another example, below, from one of the founders of solution-focused therapy, Insoo Kim Berg, allows you to see how she performs her solution-focused therapy session. Notice how she steers away from the negatives of the relationship and strives toward the positives, and when the talking gets fast and negative, she redirects the conversation. The viewers can also see the difference between the first session and the last session and how different their interactions are. The couple went from being mad and yelling at each other to being happy and laughing, overall supporting solution-focused therapy.
Research:
There are not many research studies proving the effectiveness of this therapy, so many more need to be done. However, through some clinical trials, it has been shown to not only be as effective as other therapies, but also cost effective (Wormer & Davis, 2008).
In a national sample of 284 alcoholism counselors, it showed that 79% of the counselors endorsed solution-focused principles which includes identifying using client strengths and abilities, client-counselor collaboration throughout the course of treatment, highlighting and promoting already occurring non problem behavior, meeting the client's goal(s), and constructing solutions rather than resolving client problems (2008). This is helpful in the strides toward research and providing its effectiveness; however, more studies need to be performed.
The Cycle of Addiction is Characterized By: Frustration and internal pain lead to anxiety and a demand for relief of these symptoms. Then, fantasizing about using or behaviors to relieve the symptoms emerge. Obsessing about using drugs and alcohol occurs and how his/her life will be after the use of substances. After that, engaging in the addictive activity usually results and then losing control over the behavior. Resulting is feelings of remorse, guilt and shame. Finally a promise to oneself to stop the behavior occurs, and then the cycle continues from the beginning ("Cycle of Addiction," 2013).
Impact on addiction cycle:
Solution-focused therapy could impact the addiction cycle for the better. It could be responsible for breaking the cycle and leading to recovery through implementing the questions (listed above) to distract the individual and think about the future without the addiction. This could be effective in the very first stage of frustration and internal pain because it could allow him/her to think of something else, which would throw off the cycle ("Cycle of Addiction," 2013).
My Thoughts:
This approach may be extremely helpful in my career as an occupational therapist. Addictions can be found everywhere whether it is problems with gambling, substance dependence and misuse, and eating disorders (Wormer & Davis, 2008). There are many people in the world who are fighting an addiction and using this solution-focused therapy would be a great technique to use in occupational therapy. Particularly if an occupational therapist is located in a mental health unit because co-occurring conditions are common and to work on occupations and activities that effect one's life, you need to address the addiction if it is interfering. By using "big questions" to be a form of distraction, you might be able to introduce a new leisure activity into his/her life that might be enjoyed more than their addiction, or at least deter them for a short while.
http://occupationaltherapystories.wordpress.com/
Sources:
Berg, Insoo Kim. "What is SFBT?" Received on February 17, 2013 from
http://www.sfbta.org/about_sfbt.html
"Cycle of Addiction" (2013) Recovery Connection. Received on February 17, 2013 from
According to the DSM-IV-TR, individuals with
anorexia "weigh less than 85% of normal body weight, have an intense fear of
weight gain, and young women miss at least three consecutive menstrual cycles" (Van Wormer & Davis, 2008). Many of the physical signs and
symptoms are attributable to starvation including: cold intolerance, lethargy,
constipation, and the appearance of fine body hair (2008).
Addiction Criteria: (No longer a Bad Habit)
-An extreme fear of gaining weight or becoming
fat, even when underweight
-Refusal to keep their weight at what is
considered normal for their height and age. (Specifically 15% or more below the
normal weight)
-Have a body image that is distorted, focused on
body weight or shape, and refuse to admit that this weight loss is dangerous
The image to the left shows how anorexia affects the entire body.
The video clip (below) is of a girl and her fight with anorexia. Take notice of how it was never enough weight loss, and as soon as she reached her goal, she created another. Also, in her case, she knew she was loosing too much weight so she had to be deceptive and trick the scale when she weighed in. She was addicted to loosing weight, even when she knew it was bad for her.
The video below is of an interesting Italian, anti-anorexia campaign you must watch!
Statistics:
Eating Disorders Overall: -Eating disorders have the highest mortality rate
of any other mental illness (“Eating Disorders Statistics,” 2013)
-Women are much more likely than men to develop an
eating disorder (90% women; 10% men) (2013) -Only 1 in 10 men and women with eating disorders receive treatment (“Eating Disorders Statistics,” 2013) -95% of those who have eating disorders are between the ages of 12 and 16 (2013)
Anorexia: -One in 100 individuals with anorexia, who have sought
treatment, die each year (“Diagnosing Eating
Disorders,” 2012)
-Up to 20% of people with anorexia die, over a 20 year period, as a result of
complications brought on by the illness and/or suicide (2012)
-One in 200 American women suffer from anorexia (“Eating Disorder Statistics, 2006)
-Anorexia is the third most common chronic
illness among adolescents ("Eating Disorders Statistics," 2013)
-Men are less likely to seek treatment because
it is seen as a “woman’s disease” (2013)
-Over 20% of gay men suffer from anorexia (2013)
-The average lifetime duration for
anorexia is only 1.7 years (Van Wormer & Davis, 2008)
Although the majority of cases dealing with anorexia are from women, men can be anorexic too.
Helping an individual recognize that they have an eating disorder is the biggest challenge in treating the disease. Most individuals with anorexia will deny it and only go for help after their condition has gotten too serious. The goal of
treatment is to restore normal body weights and eating habits and then to maintain it. (Usually this is
a gain of 1-3 pounds a week.) (“Anorexia Nervosa,” 2012)
TreatmentPlansInclude:
-Increase social activity
-Reduce amount of physical activity
-Use scheduled eating
-Cognitive behavioral therapy
-Group therapy
-Family therapy
-Support groups online and/or in person
-Medications such as antidepressants (SSRIs) and
antipsychotics (Olanzapine)
to help treat depression or anxiety
(“Anorexia Nervosa,” 2012)
Sources:
“Anorexia Nervosa.” (2012). PubMedHealth. Received
February 2, 2013 from
