Solution Focused Therapy for Depression
|✅ Paper Type: Free Essay||✅ Subject: Psychology|
|✅ Wordcount: 4943 words||✅ Published: 8th Feb 2020|
Depression is not only a disorder that affects adults but affects adolescents as well. This disorder can be described as being the most common disorder among adolescents. This disorder has a high risk of suicide among those who have Depression (Thapar, A., Collishaw, S., Pine, D. S., & Thapar, A. K., 2012). These individuals frequently have loss of interest in activities and hobbies that they once enjoyed or an overwhelming sense of sadness. They may lack the energy to complete tasks throughout the day or become easily fatigued. Lowered confidence and affect are in correspondent of this disorder. These individuals may present more physical symptoms like a change in appetite or sleep, and the possibility of displaying self-harm behaviors that include cutting, burning, and misuse of substances (Thapar, A., Collishaw, S., Pine, D. S., & Thapar, A. K., 2012). The various symptoms that are attached often are a cause for impairment within the individual’s life. Some examples of these impairments not only include social impairment due to the lack of interest that they once or shared with their friends and they become more easily exhausted. This then affects their ability to maintain the same lifestyle they once had and are unable to relate with their friends who can still do those activities.
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The etiology of depression has many different ideas as to why these adolescents are at a higher susceptibility with the onset of this disorder. It has been supported and identified that genetics and environment have played an important factor at the beginning of Depression (Saveanu, R. V., & Nemeroff, C. B., 2012). Having a parent who has had depression will raise their child’s chance of three or four times more likely to acquire it. This demonstrates that there becomes a strong genetic component to this disorder when someone in the immediate family has this disorder (Thapar, A., Collishaw, S., Pine, D. S., & Thapar, A. K., 2012). Being a part of a stressful environment and being exposed to childhood traumas increases odds as well. These stressful or traumas can include; being bullied, an injury, loss, abuse, and or poverty. Puberty appears to increase the risk of depression and gender differences (Davey, C. G., Yücel, M., & Allen, N. B., 2008). This is the period of these adolescents’ lives where their hormones are changing, and their brain is still developing which then makes them more susceptible to developing depression. There tends to be a noticeably higher risk for girls than boys for the onset of this disorder. These adolescents become more aware of the social dynamic in their lives and self-awareness or appearances due to their bodies constantly changing (Davey, C. G., Yücel, M., & Allen, N. B., 2008). There are many different factors that contribute to the development of these adolescents.
Similar family dynamics are often common among those who are facing the same problem or disorder. Families who present a more aggressive or uninvolved approach to their parenting style escalates the possibility of the development of this disorder. Adolescents are at a time in their life where they are constantly looking for appreciation and approval from their parents. With the approval creates the opportunity to foster these adolescent’s self-confidence and self-worth. Those parents who are less frequent with praising and positive statements have been associated with the development of this disorder (Gaté, M. A., Watkins, E. R., Simmons, J. G., Byrne, M. L., Schwartz, O. S., Whittle, S., … & Allen, N. B., 2013). The style of parent does not provide the chance for these adolescents to grow safely and learn how to regulate their emotions with parents who are more aggressive or uninvolved. Then these children become unable to identify and learn how to cope with such strong emotions. When these children will be faced with tough situations later in life, they will not know how to react putting them at a higher risk. As well as children who have parents who were diagnosed with depression in their life (Clark, M. S., Jansen, K. L., & Anthony Cloy, J., 2012). Being exposed to adverse effects within their life and their ability for resiliency has a huge influence on whether they become more prone to developing the onset of depression. Adolescents are at a crucial part in their development where their brain and bodies are changing. This age is attuned to being highly aware of their social surrounding and their own appearance due to their body changing (Thapar, A., Collishaw, S., Pine, D. S., & Thapar, A. K., 2012). These youths become hypersensitivity of what others think about them or what they think about themselves. This can cause an altar or distorted view of themselves and can cause lowered self-esteem and self-worth.
When depression is present the family dynamic often changes. The family is often the ones who are having a hard time trying to accept that their child is suffering from a disorder. Families are often in denial that their child even has anything or that they are fine. There may even be more conflict among both adolescent and the family when the child’s part is shifting, and expectations are being made. With this, there is an increased stress around the family on the idea of what this disorder is and how it affects the adolescent (Sheeber, L., Hops, H., & Davis, B., 2001). This is often from the adolescent separating themselves from everyone they love because of this disorder. The symptoms that coincide with the disorder is a loss of interest and a persistent state of hopelessness or lack the energy to obtain the idea of how they should act around others. Thus, creating an undeniable stressor among the family witnessing this happening (Sheeber, L., Hops, H., & Davis, B., 2001). With stressors that are inevitable occurrences, it is far too common for families to avoid what is happening in hopes for the problem to disappear (Timko, C., Cronkite, R., & Moos, R., 2010). The youth who are struggling with depression are unable to manage the stressors due to the symptoms that follow this disorder affecting their ability to cope and cause cognitive distortions.
The evidence-based intervention that was utilized throughout the meeting with the client within placement was Solution-Focused Therapy (SFT). This is a type of therapy model that tends to try and have the client focus more on the exceptions which are the good parts that are happening where the problem does not exist. This is to focus more on the strengths of the client and to show them that they are able to find their own solution to their problem. The idea is that the problem itself is unimportant in order to solve and work towards a goal (Lightfoot Jr, J. M., 2014). The clients who are being provided SFT will be asked to identify and create their own goals that they want to work towards with these sessions. This is to help with the engagement in sessions for clients to have them identify what they want rather than having the therapist choose for them (Lightfoot Jr, J. M., 2014). Allowing the client to decide on what they want to talk about during the session and then having the therapist follow the clients lead. This is to provide them with their own power and teach them that they have the ability to provide their own change.
This is a model that believes that the client is their own expert of their life and they can take charge of their change. Clients are able to decide what they want to discuss when in session and what they want to work towards. They will be asked to come up with their own goals and they are asked to define them in more obtainable goals with the help of the therapist. This often means to identify smaller steps that are needed first in order to reach the end goal. These goals are more realistic, reachable, and feasible within a shorter span of time to provide an increased positive outcome (Lightfoot Jr, J. M., 2014). Having clients realize that they are able to do the small steps that they came up with will lead to added positive behavior. By this, it teaches the clients that they are the proficient or skillful and have control within their own life.
Within this model, there are strengths that make this a suitable option to apply during the session. As stated previously SFT does not revolve around the presenting problem as other models do and this is the major feature of this model. SFT is very solution orientated and aims to show the client that there will be positive outcomes with the solution focus talk. This is being able to put more emphasis on the future and the positives (Lightfoot Jr, J. M., 2014). Having these clients create their own goals can be seen as an additional strength. Allowing the clients to direct their own sessions and what they want from treatment can be empowering. Having clients create their goals is to help improve their engagement during treatment. As the goals are often roughly what the clients desire rather than having the therapist decide on what their goal should be (Lightfoot Jr, J. M., 2014). This generates variety among the kind of goals that are created and are very unique per client. SFT is shown to be effective in terms of offering a positive outcome for clients. A systematic review states that out of 43 different studies that were used for the cross-analysis state that around 73% described that SFT provided a substantial positive value. SFT has been seen to generate a positive assistance for those who are suffering from Depression (Gingerich, W. J., & Peterson, L. T., 2013). This demonstrates that this type of model offers multiple strengths that benefit the client with strong supporting evidence that this has been effective with other clients.
With every model comes weaknesses as not every model works for everyone. This is a very positive orientated model to mainly focus on the future and how can you get closer to your goal. Not everyone can relate to this and will like this style of thinking and processing. There are clients who want to go to therapy to talk about their past and their problems (Lightfoot Jr, J. M., 2014). These clients want to take the time to really explore more and understand how to process the problem that brought them there. This model also looks to the client as their own expert and some clients may not want that and may view it as unhelpful (Lightfoot Jr, J. M., 2014). These clients may be looking for a therapist to be the expert and to help them rather than them helping themselves. This then becomes a problem for the client and for the therapist as they both are expecting something different.
Part 2: Working with a client and Family that exhibit the problem
The client is a 12-year-old male in middle school. Parents were the ones who referred the client to counseling to receive services. The client was presenting signs of possible depression with the intent to seriously harm himself. He had symptoms that related to depression that included; sadness, loss of hope, loss of interest, lack of energy, and suicidality. He had expressed to a friend that he was to kill himself. The client had previously faced a constant 5 months’ worth of bullying at the middle school. He also recently had broken up with a girlfriend that he had strong feelings for. The client was struggling in school in terms of his grades and socially. My client only wanted to play video games at all hours of the night. This then disrupts his motivation to complete his homework and care about his work. The client had lost interest in school when in the previous year had done really well in his classes. As stated previously the client’s grades were really low and the client often had a hard time staying awake in class. His sleeping habits have changed, and the client is unable to feel fully rested. The client does not get enough sleep and says that he is just unable to fall and stay asleep.
The client’s family during the assessment expressed that they have been supportive of the client’s feelings. They stated that they had often asked him about how he was feeling and what is going on in his life. The parents were surprised that their son was feeling so lost and depressed. They stated that they might have been hard on him with his grades this year because they know that he can do better. They have seen him do better and expect more from him. The father discussed that he is unsure if the son is really having feelings of wanting to harm himself. The father said that his feelings might be from him being too hard on the client and pressuring him to do his homework. Father believes that he might be saying such statements to get out of doing his homework and to have his parents stop asking him how he is doing. The father does not fully believe his son and has doubt. The mother voices that she believes her son and that it makes her sad that he is feeling such a way. She does not understand why and what happened to make him feel like that. Both of the parents described taking the time and each has their own time with the client, either on a drive or out to dinner where they try and show him that they support him.
Engagement can be describedas developing a therapeutic relationship with client to help provide the best possible treatment. Engagement becomes the most essential factor with being able to connect with a client. This has often been associated with a positive outcome when it comes to therapy and the interventions that are being provided. Engagement increases a more progressive outcome due to the rapport (Holdsworth, E., Bowen, E., Brown, S., & Howat, D., 2014). There becomes a sense of trust and a judge free area between both client and therapist. To help with the engagement process there have been specific characteristics that are associated with more positive results with treatment. These characteristics included kindheartedness, hopefulness, and offering a sense of humor (Holdsworth, E., Bowen, E., Brown, S., & Howat, D., 2014). Being able to enhance the engagement increases the chances of having the clients attend sessions, be motivated, participate, and having treatment satisfaction.
Engagement with my client came easy. In the beginning, the client was unsure of who he was talking to. With the use of humor and warmth, the client soon became more open and willing to form a therapeutic relationship. Utilizing what the client’s interest was and connect on that level. This allowed him to see that I was trying to truly relate to and understand him. As well as letting the client lead sessions and choose what therapeutic tool he wanted to use. This was to show him that these sessions are for him and what he wants to talk about. The sessions are very client-centered and revolved around what he wants.
A suicide risk assessment was completed for the client with the onsite counselors at the school 2 days before I had received his referral. This assessment was to help examine the different combinations of potential risk factors within the client’s life and to help identify them. When a risk assessment is once completed the goal is to be able to identify whether the client is a low or high risk for suicide or seriously harming themselves (Haney, E. M., et. al., 2012). After the assessment was completed for my 12-year-old client, he was considered as not a harm to himself as this time.
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The referral was then provided to me and I was to have an assessment done with the family. The family was more than willing to come in to complete the assessment to help ensure that their son will receive the support that he needed. The parents were overall supportive parents and very aware of their son’s feelings now. After working with both parents and the son it was clear that this family has a strong bond together. The client stated that his parents are always asking him how he is doing and helping him try to understand his emotions more. In the beginning, the client’s father did not know whether he should fully trust his son because he might be using it as an excuse to get out of his father being hard on him about school. The family’s characteristics came through during the assessment. These can include being open about what was going on in the household and being willing to support their child in any way and form they can. The client’s characteristics include some very similar ones as his parents such as being open to services, being willing to share what is going on in his life and being receptive or participating in sessions. After the assessment comes to the idea of creating a goal or having the client create their own goal. The client’s process was fast as there was not the time to create his own goal. We had discussed working on maintenance as being his main goal due to him being able to identify what makes him happy and how to have him reground himself if he was having thoughts.
Solution Focus Therapy was the main intervention that was utilized during the core phase of treatment. This was the model that followed the assessment due to the organization that I am affiliated with. As this is the type of model that we only use with the client due to the high efficiency and the strengths that are associated with it. This organization trains their interns in this intervention to practice and provide this service to the client as they have preferred this model over others. Solution Focused Therapy is very client-centered and has increased engagement with therapist and client therapeutic relationship (Franklin, C., Zhang, A., Froerer, A., & Johnson, S., 2017). As well as being more solution focused rather than having the client risk getting secondary trauma from revisiting the past pain over and over again. Within this model, there were multiple styles of techniques that are a part of the model that was applied throughout sessions. These techniques included using a strength-based approach with the client (Franklin, C., Zhang, A., Froerer, A., & Johnson, S., 2017). This can be described as taking the time to search for the exceptions or the strengths that they already do to help themselves without even knowing. This is constantly used within a session with a client and with this client. This is a way to help them notice what they do and learn how to empower themselves.
Another technique that is used with all clients and my client is the style of questioning during sessions. These questions are set up in a specific way to allow for solution discussion and to provide hope for future (Franklin, C., Zhang, A., Froerer, A., & Johnson, S., 2017). The style of language that is used is either active or passive depending on the client’s statements. With that then eventually able to identify if the client is a customer or browsers for treatment. This helps us identify what kind of homework the client is able to do. These question styles become very specific to the client and what language they use. An example question that is used is the miracle question which gives the chance for the client to think about the future and when the problem will not happen. The type of language that is used is to help keep the client in a trance about how their future will be. These are the important techniques that are being used with this client. This was where the client had struggled at the beginning with. The style of questions was unique and different but direct for the client to answer. He would become confused and then realize how to answer these questions. As of now the client has learned the style of questions and are more comfortable with such direct solution and client-focused questions. The client is slowly able to identify his own exceptions and how to maintain his own goal.
Termination and Follow up
Due to still meeting with this client the termination process would occur once the client has achieved their goals and has been able to maintain the goals. This also includes the ability to see the improvement that they have made. The therapist will then ask the client after they have been able to maintain their goal on how often the client thinks they need to meet with the therapist. This still allows for it to be client-centered all the way to termination. My client as of right now is meeting his goal of maintenance for a couple sessions currently. We will continue to meet a couple more sessions to ensure that he is still able to maintain the goals set. Then a discussion on the outcome of the client’s performances and letting them know that they are able to maintain their goal. This is to help reinforce this idea that they are capable and provide them with the confidence. Once that discussion occurs the client will be able to decide on how often they would like to meet. This is a termination style that hopes to provide a sense of pride and achievement for themselves (Olivera, J., Challú, L., Gómez Penedo, J. M., & Roussos, A., 2017). This also gives the chance for the client to speak about how he feels about termination and how confident he is feeling.
After talking with my client, I had found out that he thinks his family has noticed his change. He said that he believes this because his parents are smiling’s more and having fun more often with him. Rather than having them on constant worry and watch for my client. I will be contacting the parents in a week to update them about the process of therapy after discussing with my client what he will allow me to share with his parents. When contacting them I will inform them what has been the client’s exceptions including what has been helping him maintain his goal. This is to help ensure that the parents look for his exceptions and his strengths if they have not already done so already. I will ask the parents about their own opinion on what changes they have noticed and what they think about possible termination. Then talking to the client about what they think about possible termination and describing to them what that means. This creates the chance to have a mutually agreed termination and have the chance to retain the therapeutic bond and increases chances of higher satisfaction of treatment (Olivera, J., Challú, L., Gómez Penedo, J. M., & Roussos, A., 2017).
This therapy model, I find it to be very beneficial to the client and the client’s outcome. This is a therapy model that is every client-centered and more personal on their level than other styles. I enjoyed working towards understanding and implementing this model to my very best ability for the clients benefit. SFT is often easy to understand and grasp but becomes very difficult to implement with the client. This is where I was becoming more frustrated with this approach and the style of questioning as I was getting lost in how to find the clients exceptions rather than focus on the problem. I was noticing that it was reflecting onto the clients during the session as I would get stumped and would not know how to follow up with the client.
SFT started to click for me after practicing and realizing that it is going to take time to learn how to implement. With the constant help from my supervisor and reviewing, I was able to make this model work for me and adjust it to my style. Once doing so there is a noticeable change with the therapeutic relationship and what the client wants from sessions. Letting the client know that this is a very client-centered approach and the therapist will follow their lead. This has increased the engagement with the client that I have and their motivation to work towards their own goal they created. SFT takes this client approach and provides the chance for the client to view a more positive aspect of themselves. It offers the chance to really focus on the exceptions where the problem does not happen and show them that these positives are happening daily. Focusing less on the problem to find a solution and more on the future for the client. As well as letting them know that they are their own experts and know what is best for themselves.
Depression is often a more common problem that affects adolescents a lot more than other disorders. This is a problem that generates negative symptoms that include cognitive and somatic symptoms. These can include a feeling of loss of hope or sadness, isolation, increased fatigue, loss of appetite, and suicide ideation. These are just some of the major examples that this disorder creates on these adolescents. These adolescents are often at a higher risk with this disorder because of the constant change going on. Their bodies are constantly changing making them become more aware of themselves and of others. Having a child suffer from such a serve disorder can cause stress as well as avoidance of the problem. As there are so many factors that contribute to this occurring and there is not one underlying reason. Multiple factors play into the development that includes environment and genetics. Solution Focused Therapy was the model that was chosen to be implemented with the client suffering from symptoms that relate to depression. This is an intervention that focuses these youths with a more strength-based talk and to help them seek their own exceptions over time. As well as learning how to work on their own goals and being able to recognize how they are feeling when these exceptions are occurring. Rather than focusing on the problem that had brought them here often becomes unnecessary to create a solution. This model is constantly helping these clients learn how to empower themselves and become their own expert.
- Clark, M. S., Jansen, K. L., & Anthony Cloy, J. (2012). Treatment of childhood and adolescent depression. American family physician, 86(5), 442.
- Davey, C. G., Yücel, M., & Allen, N. B. (2008). The emergence of depression in adolescence: development of the prefrontal cortex and the representation of reward. Neuroscience & Biobehavioral Reviews, 32(1), 1-19.
- Franklin, C., Zhang, A., Froerer, A., & Johnson, S. (2017). Solution focused brief therapy: a systematic review and meta-summary of process research. Journal of Marital and Family Therapy, 43(1), 16-30.
- Gaté, M. A., Watkins, E. R., Simmons, J. G., Byrne, M. L., Schwartz, O. S., Whittle, S., … & Allen, N. B. (2013). Maternal parenting behaviors and adolescent depression: The mediating role of rumination. Journal of Clinical Child & Adolescent Psychology, 42(3), 348-357.
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- Thapar, A., Collishaw, S., Pine, D. S., & Thapar, A. K. (2012). Depression in adolescence. The Lancet, 379(9820), 1056-1067
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- Saveanu, R. V., & Nemeroff, C. B. (2012). Etiology of depression: Genetic and environmental factors. Psychiatric Clinics, 35(1), 51-71.
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