March 16, 2020
Welcome to What’s Better This Week? Episode 6: How to Be Solutions Focused in a Crisis (Special COVID-19 Episode).
With everything going on with COVID-19/the Novel Corona Virus, I figured a Special Episode might be helpful, whether for yourself, or as an intervention when working with patients and clients who may very well view this as a crisis well beyond their capacity to cope (especially if their traditional services are being interrupted, or you’re providing services over the phone). Unlike a “traditional” SFBT appointment, I have used the following very often in Crisis Appointments, both in person, and over the phone (and, to be honest, sometimes with myself!).
When a patient presents dysregulated and in crisis, it behoves us to take a Solution Focused approach with them (for all of the reasons that we are SFBT counselors). Also because SFBT is usually the most effective approach at providing an immediate experiment that our patients and clients can leave with to proactively work on whatever it was that brought them into our office in the first place. However, dysregulation usually requires a different approach than a traditional appointment, so while not necessarily Solution Focused, I find it helpful to start the session (in person or on the phone) by asking my patients to join me in taking three deep breathes (slowly in through the nose, and then slowly out through the mouth). Good….now again…and now one more, slowly. The reason is because many of my patients will often begin restricting their breathe when dysregulated, or anxious, or in a panic, and it’s important we work to decrease the physiological symptoms of flight, fight, or freeze (those times when we don’t have Behavioral Ownership).
In a crisis, I will adjust my opening question of “What’s better this week” to instead be: “have things gotten better, stayed the same, or gotten worse?” If this is a patient I have never met with, I will adjust the time frame. Maybe I’ll ask “since yesterday? Last week? Last month?” If I’m working with myself as my own patient (yes, you can use this with yourself) I will often ask “since you last had a moment to reflect?” Then it’s time to listen reflectively. If things have gotten better, we want to respond with a reflection, validate, and then ask them “how did you make that happen?” If things have stayed the same, again, we want to respond with a reflective statement, validate, and ask them “how have you managed to make sure that things have stayed balanced? That’s really hard work to do sometimes? How did you make it happen? What coping skills have you been using?” If our patient, client, or ourselves respond with “things have gotten worse! So much worse!” then we want to respond with a reflective statement, validation, and ask them how they’ve been coping with that. Almost universally the response I get when I ask a patient “how have you been coping with that” when they tell me that things have gotten worse is “but I haven’t been coping!” and generally I’ll reply with “Nonsense, you’re here! You made it to my office! I see that you’re largely in one piece! To my knowledge you didn’t assassinate an Arch Duke and start a World War, so, somehow, you’re coping, maybe we just have to figure out how…let’s think…maybe if you describe what you’ve been doing, we can figure out how you’ve been coping together…” Then validate, validate, validate.
After this, I will ask my usual scaling question of “on a scale from 1-10, where 1 is everything in the world is awful, like Zombies, and not even the cool ones, but the gross ones, and 10 is everything in the entire universe is amazing, like unicorns are just farting rainbows and glitter…where would you put yourself right now in this moment?” I will then work the scale with the patient in half steps (for those not used to scaling questions, that’s okay, we’ll be covering scaling sometime in the next three weeks). I will only ask for a half step because in a crisis a whole step is usually too much. I will generally make a point to say “if we had to take not a big, giant whole step, but a really doable, pragmatic, half step to get to whatever number is a half step up, what would that first step look like…okay so to be a 3.5 you would need to feel more relaxed…and what’s worked for you in the past is coloring…so I wonder if today you could find some time to color, maybe have a cup of tea…I think that does sound like a lovely idea…and it sounds like that’s something that’s in our control…”
Finally, I will conduct the (very brief) lethality assessment of asking (“do you have any thoughts, plans, or intents of harming yourself or others?”) because asking directly is the best way of finding out. I will then ask them if they’re ready to schedule an appointment with me, or with their primary counselor, re-confirm their experiment (“coloring and tea.”) and walk them down to the waiting room.
Ten to fifteen minutes of reflective listening, validation, pragmatic action steps that can be taken today that are within the control of our patients and clients followed by a brief assessment for lethality.
Thank you for listening. Please tune in again this Sunday, as we continue forward together down our solutions focused path. Comments, constructive criticism, feedback, and questions can be sent to email@example.com
. Yes we’re on Social Media @WBTWCast on all of the platforms you’d think to look at. I’m @TheMattSchwartz, and it’s time for bed.
The music you’re listening to in the background today is Boston Landing on “Blue Dot Sessions" generously shared through a creative commons license. Please find more of their music at www.sessions.blue
, that’s w-w-w- dot s-e-s-s-i-o-n-s- dot b-l-u-e. I’ll see you next Sunday with more; until then, make good choices.