In this assignment, there is a case example of Solution-focused Practice with evidence based. There are three theories which are role, activity and continuity to support the practice. Introduction
Solution-focused Practice is a relatively new therapy which is just turning into a well-developed counseling model within these 20 years but there do not have much information about working this therapy with the elderly. There are many literatures about SFT working on different services groups like eating disorders person (McFarland 1995), long-term psychiatric patients (Rowan and O’Hanlon 1999), children (Selekman 1997), and the couple relationship (Hoyt and Berg 1998; Hudson and O’Hanlon 1991; Quick 1966). Especially with the aging population, this is one of the efficient and fast counseling methods to help clients to solve their problems. In this essay, three main theories which are role, activity and continuity will use for supporting as an evidenced based and helping to explain what factors might lead to the elder arise some problems. Then, it will take Mr. Poon as a case study to illustrate the whole process of SFT which will include intervention skill and questioning strategies. The ethics issue that may arise from the practice will, also, be discussed. Some suggestions is given which assist to further elaborate how can SFT be more wisely use in the elderly filed. Case background
Mr. Poon is a 61-year old gentleman who retired for over a year. He has a wife, two children and two grandchildren. After a year later, now, he is found that his retired life is not as good as his though when he was still working. He thinks his retired life is boring and meaningless. Recently, he does not sleep well and lose weight. Therefore, he came to find us to help with his situation and hoped that he could change his retirement life. The aim of Mr. Poon to find us is to let us help with his situation and hoped that he could change his retirement life. Informed consent
Informed consent is the process by which the service provider discloses appropriate information to a competent client so that the client may make a voluntary choice to accept or refuse research (Appelbaum, 2007). Informed consent should sign before a study began. During the research process, we may ask some in depth questions that may require a lot of sensitive topics that patients may not want to reveal to others. The finding of interview analysis may publish to the public or institutions. Therefore, participants can decide whether they should join the research or not after explanting what is the research context and where the analysis is going to be publish. To do this, it can give a clear focus on coming study and have a psychological preparation to the client before it started. Signing an informed consent, it can offer some rights to the participants. Firstly, this implies all the privacy of research subjects can have a legal status to protect and have the right to sue the researchers if the researchers do anything that is excluded from the informed consent to regulate the research process. It helps to higher the confidentiality. Secondly, it provides a right to the participants can be withdrawn out from the study at any time if they do not feel right about the research. Thirdly, they have right to choose to disclose their name or not like using an anonymous name or real name. Therefore, it is a must to sign informed consent before any research or interview with the participants to protect them. Assessment
Hoping to help Mr. Poon to change his retirement life as possible, it is important to have an assessment that is supported by the evidence base. In this case, Mr. Poon has stepped into the next stage of his life, and it is named as ‘aging.’ In this stage, it has brought him into some new experiences like taking care of grandchildren, having extra spared time or travelling around, etc… According to McInnis-Dittrich(2005), social theories of aging can help to provide descriptions of various ways of the social scientist have observed or speculated that elders adapt to the social environment around them. It can, also, provide a general idea of understanding of the senior clients before we started to do actual interventions Role Theory
The most general theory to explain how elders adjust to aging as a social role is role theory (Cavan, Burges, Havighurst& Goldhammer, 1949; Phillips, 1957).Roles are sets of expected behaviours patterns defined by an individual’s relationship to another person or social institution(McInnis-Dittrich, 2005). It assumes that life is defined as different roles. The qualities of elders’ adjustment relied on the ability of moving their own roles identified from one stage to another stage while they are aging. Roles that may relate to the middle age may be parent, worker, spouse, and activity community member. For the elder, those roles will be changed to associate with age related roles, for instance grandparent, retiree and widow. During the aging, elders may lose their roles in middle age and gain new ones. A person’s self-esteem and social identity are combined with one’s social role. According to the role theory, a successful aging is accomplished to move from one set of role to those appropriate to their age norms. Dissatisfaction with the aging process develops when people are unable to make this shift or cannot identify new roles to replace the olds (Havighurst & Albrecht, 1953). In this Case, Mr. Poon has not completed moving to his elderly roles.
Mr. Poon was a hard working employee before he retired. He could have the satisfaction on work and make use of his talent on word processing. Now, he does not need to work and stay home. He just aimlessly walks around to be his ‘work.’ The loss of this role let him feel that he is not well-functioning as he was, thus lead to low level of well-being with role exist( Thoits, 1992). Besides, his role of grandparent is defined by the relationship to his grandchildren. His grandchildren are still toddlers. He is only able to see them when his elder son and daughter-in-law who were required to work on the days and take care of them. without well-formulated relationship with his grndchildren, at he cannot fulfill his role on grandfather and created a dissatisfaction of his life. Inversely, if he can able to forge his new role with the significant others in society predicts, he will adapt to his old age (McInnis-Dittrich, 2005). Activity Theory
It is predicts that elders who maintain active and mutual relationship with their environment are those most likely to age successfully (Maddox 1966; Spence, 1975). “Elders who travel, work part time, or participate in a wide range of social activities find old age a rewarding and satisfying time in their lives. If elders with-drawn from social activities, they are more likely to become depressed and dissatisfied with old age” (McInnis-Dittrich, 2005, P. 75). It is same as role theory, the degree of satisfaction of the elders are relied on themselves. In 2011, there was a new research that extends activity theory by demonstrating that combining effortful activities with restful activities leads to greater happiness among elders (Oerlemans et al, 2011). In this study, there were 438 participants completed a monthly electronic diary survey over a 2-yaer period, generating 79,181 reported activities and momentary happiness scores. The results show that happiness increase when elder combine effort social, physical, cognitive and household activities which is positive related relationship.
Besides, participation in social activities mediated the direct relationship between extraversion and happiness. Furthermore, individuals who score high on extraversion derive greater happiness from social activities compared with low extravert counterparts. It is pointed out that the idea of personality is important in identifying which types of activities will improve the well-being of elders (Eysenck, 1981). In this case, Mr. Poon is not willing to join elderly centers because he thought they were just for women and there were lots of gossip. Also, he does not want to stay at the park to chat and play chess there like the others elders. Then, his wife invitation on playing mahjong and shopping is refused by him because he though this is wasting his time. There are many chances to let him to involve in different kind of social activities but he refused all. He is lack of motivation to try new things but he at least has his own thought on his wants. Continuity Theory
Stated at the continuity theory, elders and society fare best when elders continue a consistent level of activity throughout their lives (Atchley, 2000). Atchley(1989) has first proposed a model of retirement that includes six phases. Then, he further extend to eight phases to explain which are the preretirement phase, the honeymoon phase, immediate retirement routine, rest and relaxation, the disenchantment phase, the reorientation phase, the stability phase, and the terminal phase. This model can help to explain Mr. Poon’s situation. According to the model, the second phase is the honeymoon phase. This phase is occurs when the elder is actually retired. One will enjoy a lot on the free time. The elder can do whatever they want, such as doing gardening, travelling, or something wanted to do for years. At the beginning, Mr. Poon does enjoy having morning tea, gathering with old friends, and travelling around with his wife which he desired to do before.
But now he is complaining about nothing to do in his daily time which means he is going through the disenchantment phase. In this phase, retiree begins to feel depressed about life and lack of things to do (Meleis, 2010). After the traveling, cleaning and doing the things most desired, elders may get tired and bored. A year later he is starting to feel that he is lack of things to do and he does not have particulars interests or own social network. Intervention goal
With the above theories, they assist us to know more about the elderly on how aging affected them. Furthermore, they can show that if the elderly continue a consistent level of activity and actively participate throughout their lives, elders will easier adapt to their aging. Although during the first section the SFP Social worker will work together with the client to build up their solution, initial intervention goals are needed to let us more focus on what solutions can help with the client to solve the problem and close to their desire outcome. With the above theories, it may help Mr. Poon to solve his problem by letting him to do more activities. Developing at least one interest may be one of the methods to improve his retirement life. The suggested intervention goals may be following: 1.Develop at least one interest that he and his wife both like to increase their number of communication. A)Mr. Poon will have an interest to utilize his time.
B)Mr. Poon will develop a closer relationship with his wife by having common interest.
Solution-focused Practice is suitable for his case to change his retirement life. It is encompassing basic rules and assumptions about change, interaction and goal setting (Walter and Peller, 1992). Solution-focused practice seeks to use clients’ own life experiences and strengths in finding a path towards desired future (De Jong and Berg, 2008).Social worker will act as an enabler (Karla 2011) to empower clients in finding solutions. It is assumed that clients have their own ability to find solution to solve the problem. The client is the experts of their experiences. They can find the best fit solution to self-determinate. With preliminary information of Mr. Poon, it is noticed that he wants to change his boring and meaningless retired life. The solution-focus practice will be best fit for his wishes. The therapeutic goal is to stop to failed attempt problem solving by thinking outside of the box. De Jong and Berg (2008, pp.17-18) have identified five stages in the solution-building process which are: 1)Describe the problem
2)Develop well formulated goals
4)End-of session feedback
5)Evaluate client progress
It does not have time limited in the sense of offering contracts for a fixed numbers of sessions. De Shazer (1996) reports that, on average, clients at the Brief Family Therapy Centre where in Milwaukeee who required for three sessions for counseling. Furthermore Cade and O’ Hanlon (1993) state that therapy should end as soon as possible. In addition, this guideline is just providing us a general idea of how we can do on each whole practice. Ground Rules
Before we start with using Mr. Poon case as an illustration, it is important to remember three ground rules by de Shazer (1997). These few general rules and series assumptions are to let social workers to work with clients to meet their goals. Hoyt (1996 P.28) lists the rules that he learnt from his conversations with de Shazer: 1.If it ain’t broke, don’t fix it.
2.Once you know what works, do more of it.
3.If it doesn’t work, don’t do it again; does something different. Based on these three ground rules, the aim of this therapy is to continuously let client to do what is working for them and to try new things instead of doing something they feel is not working.
In the first phase, let clients talk with the social worker about the problem that brought them to seek help but not about the root cause. If the social worker concentrates on clients’ problem or what they do wrong, it will have the potential of causing an iatrogenic effect. To begin with the session, I
will ask Mr. Poon what he would like to be called. He responds ‘Old Poon (老潘 OP) is fine, that is what all my old friends call me.’ I then ask OP what he likes to do during his spare time. After a few minutes of polite conversation, I explain to OP what we are going to do in today session which will consist of talking for about 45 minutes. Then, we will take a short break and I will leave the room for few minutes and come back with some suggestions for him. OP agrees to the proposed plan of the session.
I begin to ask OP, ‘What are you hoping to accomplish by coming to see me today?’(Stage 1 Describe the problem) OP Responds by telling how is his retirement life and how boring and meaningless it is. He is staying at home every day. He goes out to have morning tea with his wife in the morning. Then, he goes back home and watch TV to use up the time for a while. OP says the trouble started when he gets back home. The house is just four walls to him and nothing he can do in the house. Therefore, sometimes he walks aimlessly on the street. He says he really does not want to be like other elders in the parks who chatted and played chess there or join the elderly centers. Both of these are too wasting his time and the elderly centers are too much gossip which he does not like. I ask Op if he walks aimlessly on street has worked to change your retirement life which he replies ‘no’. Op is recently trying to do some cooking at home but his wife uses to do all the cooking for him. She would ask him to keep away from the kitchen. He realizes that he does not have much interest. Questioning Strategies
There are totally three general types of questioning strategies which are goal questions, exception questions and scaling questions. These questioning strategies will all be illustrated. The goal questions help the client to move from very large ideas about their future to smaller more manageable goal. The most common goal question is the miracle question, which asks: ‘suppose that one night there is a miracle and while you are sleeping the problem that brought you into therapy is solved: How would you know? What would be different?’(de Shazer and Berg 1988, P.5). This is one of the typical types of questioning strategies of solution focused practice to help clients to develop his goal. It normally uses in stage 2 (Development well formulated goals) I state, ‘I can see that your retirement life is lack of excitement and that you really want to change the way you are (reflection of content) Now I would like to ask you a little bit of a wired question. Suppose that one night there is a miracle and while you are sleeping the problem that brought you to see in to me is solved: How would you know? What will be different?’ Then OP replied, ‘I guess I will feel happier, have a better appetite, and have more conversation with my wife while staying at home. I will go out more often but not aimlessly and repeatedly do the same things every day.’
I respond, ‘That’s great! Tell me if your retirement life is actually like what you said what would you be doing?’ OP responds, ‘Maybe I find something to do to enrich my life like learning some new stuff or develop some interests’. I then ask OP to describe what this would look like if this was to happen. OP replies: ‘Well, I guess I would not complain about how boring my retirement life is. I would have my own interests and new friends. I can often hang out with my friends who have the same interest as me. We can work together to practice our interest. Also, maybe find some interest that I and my wife both like. Then, we can have more conversation at home rather than I just facing the four walls [laughing]. My wife likes eating different cuisines. I am more of an Italian cuisine fan. She did try to make some Italian food to me but it tasted really bad. [Pause] I think I would like to have my own interests and a new social network while my wife can participate in one of the interests and have more topics to share and talk.’ In stage 3 (Explore exceptions), the exception question will commonly use. The exception questions ‘are used by worker to discover a client’s present and past success in relation to the client’s goal’ (de Jong and Miller, 1995, P. 731-732)which may ask: ‘you mentioned that if your miracle happened, you and your wife would have better communication and that you would be able to talk openly with each other. Are there times when this is already happening?’
I respond, ‘it sounds like there are a lot of things that would be different. But the biggest thing is that you will have own interests and network and most importantly you can closer your relationship with your wife?’ OP confirms, ‘That sound right’. I then inquire, ‘Are there times now that you two are worked together to do something you both like or something you particularly want to know more?’ OP replies ‘Recently, we watched TV together. The TV is playing a cookery show. Each participant can have HKD$300,000 to open up a restaurant within one month. If the participant can earn the much money among the all, the one can have two years free rent as a gift. Then, we just keep on talking if us what we are going to do and what we won’t. It is really happy and enjoyable that we have a common thought.’ To further explore exceptions to the problem, I ask, ‘Apart from this, have there been other times like that?’ OP says ‘Um [pause], Yes [pause], but I can’t remember when it happened. I guess quite a long time ago [laugh].’ I then ask OP, ‘Tell me, during that happy time, what were you doing differently?’ OP paused and then answered, ‘Well, I think I actively talk with my wife. I asked what her view was and what she thought about the program. She did the same. We both like eating and cooking a lot [laugh].’ I response, ‘you do know well about your wife, is that you want to have a closer yours relationship by developing an interest with your wife which is something related to food by coming to see me?’
OP replies ‘Yes, I would love to have a closer relationship with my wife. Furthermore, scaling questions is generally used to provide a way for the client and the social worker to track the client’s progress towards meeting her or his goals. Clients are asked to rate some aspect of their life from 0 to 10, with 0 representing the problem or situation at its worst and 10 representing the absence of the problem. Example: On a scale from 0 to 10, where 0 represents the problem at its worst and 10 represents the absence of the problem, where do you find yourself today? In order to further explore OP’s goals, I ask “OK. This sounds like a good goal. So on scale 0 to 10, where 0 is the goal not happening and 10 is the goal absolutely happening where would you rate how close you and your wife are? OP response a 5, then I ask what he will do to move from 5 to 6 on the scale. OP replies, ‘I guess we should join some cooking lesson together.’ This help to affirm G position and response. In stage 4(End-of section feedback), I go out for few minutes and then come back with some feedbacks which are: 1)Restate the situation and problem
2)Suggest him to join any type of cooking lesson with his wife 3)Notice the relationship between him and his wife while they getting alone and report back next session( which is a week later) In stage 5(Evaluate client progress), after a week, I met OP again and started the session by asking, ‘so what has been different since the last time we met?’ OP stated he has found different kind of cooking lesson to his wife and his wife agreed to learn Italian cuisine with him. After the lesson, they bought the same ingredients to home and cooked for the whole family. During the process, they have communicated more and shared their feel. Once time, his wife even suggested learning Tai Chi. I affirm OP’s current position and positive experience by asking what do he think he did to help make this happen? He thought that it is because of joining this cooking lesson. It let his wife thinks that he is willing to try new things and his wife dares to propose suggestions. Before, they would just say ‘whatever’ for anything and do not care for anything. Now, they do express themselves more and give out their own opinions.
I affirm Op’s accomplishments by saying he did well and readdress the scaling of OP’s goal by first remaining him he has rate his goal at 5 at the last session and asking him where he is now on the scale. He responded with 7. I met 1 more sections with OP. In this session, he rated himself at 9. OP reported that things are going much better. Now he has his interests on cooking and Tai Chi with his wife. When they are facing a problem on learning, they always solve the difficulties together. Therefore, they talk a lot more than before. They not only talk about their interest, but also things happen in their daily life. They share everything happened and give out advise to each other. When he gets back home, he is no longer only facing with four walls. His noticed that his wife is always there for him, before he just forgot he can spend more time with his wife. Most importantly, he regain weight and sleep much better than before. Evaluation and conclusion
In the SFP mainly use the scaling questions as an evaluation. This provides a way for the client and the social worker to track the client’s progress towards meeting her or his goals during each session. It is the most effective and easy way to do in SFP. But there is some limitation on this method. Although clients are the experts of themselves, they may not have the same scaling as the social workers do. Therefore, the social workers should work with clients to define clear what should reach to attain on what scale. For instance, if OP can talk about his feeling twice a day with his wife, it is on scale 6. A more concrete example is needed to ensure the clients have the same scaling with the social worker to track the effectiveness of the practice. Client Satisfaction Questionnaire, also, is one of the common methods to use as an evaluation. The purpose of CSQ is to determine clients’ satisfaction with the social services he or she has received and to improve the social workers counseling skill by the clients’ feedback. Overall of the SFP, it is very successful to solve the problem of Mr. Poon. He does not feel his retirement life is boring and meaningless any more. In addition, his wife can accompany with him to make his life more fun and happy. Furthermore, he regains weight and sleeps well after all the session. Strengths and limitations of using SFP
There are identified strengths and limitations to utilizing solution-focused practice in social work. The strengths include the following: •SFP focuses on clients’ strengths (Greene & Lee 2011). The method seeks to identify clients’ strengths or past success at overcoming with the presenting problem. The goal of the work together is to utilize the clients’ strengths and resources to move them towards their preferred future. In OP case, he can turn the example of his successful talk with his wife into his goal and change his desired future. •Solution-focused practice techniques and questions can be used in combination with other methods. For example, the miracle question and exception questions are often found to be used in crisis intervention and scaling questions are often found to be used in motivational interviewing. SFP can use alone or combine with other approaches. In OP case, these questioning strategies can let me easier to explore his thought and the development of goal. The limitations include the following:
•SFP focuses more on solutions rather than the problem (Walsh, 2010). Critics of SFP argue that by not focusing on clients’ problems, social workers may miss some important information that may useful to help clients move towards their goals. In addition, some clients expect to talk with social workers about their problems. As a result, some clients may not make complete or leave the practice of a solution-focused social worker. In fact, it is truth that clients are finding us to solve the problem not finding the solution. It, also, the same as OP purpose. Ethical and cultural
According to Lee (2003) solution-focused practice represents an approach to practice that respects and honors cultural differences and cultural values. Sometimes social workers may not agree with the clients solution is the best one in their mind. It is important that social worker must be open to the goals that client establish for themselves and not attempt to persuade or push clients to select goals that they do not find to be meaningful. The goals that they want are their preferred futures and client defined goals. Therefore, social workers should stand at the clients’ view to think instead of putting their own thought to the clients. While other approaches the social worker being the expert, SFP views clients as the expert and their life experiences as potential solutions. SFP social workers are in the client’s interested context of a client’s situations as the client describes her or his life in her or his own language. SFP social workers seek out client’s strengths and resources in helping clients search for solutions. If important to the client, cultural practices may use in the formation of goals and solutions. Especially in the Chinese culture, in Chinese culture most of the men will consider seeking help as a loser. A successful man should able to solve the problem by himself instead of asking for a hand. Also, the elder have a higher social status. They may not accept our suggestions if they are involuntary clients. Recommendation
Although solutions are the focus and problems are inferior, social workers should listen to clients if they want to discuss their problems. In listening to problems, social workers should attempt to move clients into looking at solutions versus dwelling on failed attempts to solve the problem. SFP is one of the fast and effective approaches to help clients find solution by themselves and empower clients. Facing the large amount of aging population, it may be one ways to help more needed clients. Other approaches are more time consuming. Therefore, SFP should promote more to the public and let more clients to get benefit from it.