 Alrighty, I'd like to welcome everybody to today's presentation on 10 useful brief interventions and brief therapies. And I think there's 11 now because I put in a pretty significant section on solution focus counseling because I left that one out the last time we did this presentation. So we're going to go through the stages of change model because that's one of the foundations of brief therapy is making sure that we're tailoring our interventions to somebody's level of readiness for change. So to go over the goals of brief intervention and the components will identify essential knowledge and skills when to use it, different approaches and different components. And then we're going to briefly talk about different types of brief approaches, including cognitive behavioral cognitive processing, trauma focused behavioral, which cognitive processing and trauma focused behavioral are both brief ish strategies 12 to 16 sessions that you can use with trauma clients. So that's a good one to have in your arsenal. Brief strategic brief humanistic brief psychodynamic brief family therapy and time limited group therapy. All right, so who can use brief interventions is not just for counselors. Brief interventions are designed to really help somebody who might be, you know, somewhat motivated to change to change something specific. So primary care physicians can use it to increase medication compliance treatment compliance, smoking cessation, get somebody to go to treatment, you know, whatever substance abuse treatment providers, we use it a lot, emergency department staff members, nurses, social workers, health educators, health educators go in and they say, you know, you need to eat a healthy diet or you need to be getting a certain amount of sleep every day. Well, if people are presented that information in a way that helps them see the need for it, and we use the brief intervention tools, then we're going to be more likely to increase the chances that somebody's going to change their behavior. Teachers, EAP counselors, crisis hotline workers and clergy can all use it to because brief interventions are just that we're using something, some sort of tool in order to rapidly change someone's behavior in some way, shape or form, you know, that's basically what it comes down to. It's not complicated. It's a brief therapy as it reduces no show rates. If somebody comes into counseling and or health education or whatever they're coming into, and they start having positive experiences, they start experiencing benefits from jump. Guess what? They're going to come back. And instead of having that long drawn out, you know, I don't know how many more sessions I've got to come before I see improvement, they're seeing improvement and their treatment sessions, you know, brief tends to be eight to 12, maybe 16 sessions. So you're not seeing a person for a super long time. Most people can commit to 10 or 12 sessions and say, yes, I can be here every week for for 10 or 12 weeks. When you start getting out to six months, you know, that's 24 weeks, a little harder to commit because life happens. It increases treatment engagement because brief therapies by their very nature are interactive and they're active. It's not something you're just going to sit by and let's talk about things. And humanistic and Rogerian processes are definitely useful for developing rapport and useful in some situations. But if we're talking about brief therapy, we're going to do more than just clear out the blockages. We're going to really help somebody propel themselves forward towards making change. It increases compliance and self-efficacy because they see that this is working. They see that things are happening and they see that they're doing things to make things happen. And wow, you know, I can feel better. I can accomplish this. It can reduce aggression and isolation because, you know, when people start feeling happier and more efficacious, they tend to be a little less grumpy. So great. And when they're less grumpy, other people want to be around them and they may have more energy to be around other people. And it's also an interim for clients on waiting lists because, you know, a lot of times in counseling, whether it's mental health counseling or substance abuse, there's a waiting list. So what do you tell that person who says, I really need help now? Well, you got to wait in four or six weeks. We'll probably have an opening for you. Well, that doesn't do them any good. They need help right now. So brief therapy says, OK, let's look at what's one thing you can do right now to start helping you feel better. We're not going to relieve your depression. You know, that's huge. That's lots of stuff involved in that. But we're going to look at what's one thing we can help you do to start relieving that depression today. Goals of brief interventions are to make measurable changes in specific target behaviors. So if we're talking about depression, we want someone to have more energy. If we're talking about smoking cessation, we want to see somebody smoke less. Preferably not smoke at all. But depending on the approach you're taking, we want to see that reduction. If we're talking about interpersonal skills, maybe you're seeing a couple and they fight, quote, constantly, well, let's define what constantly is. How often are you really fighting? And let's see if we can start reducing, putting some interventions in there, to reduce the frequency with which you're arguing. Is it going to solve the marital problems? No. We're looking at one thing. Let's see how we can approve this one thing. Because if they're not fighting, quote, constantly, guess what? Other things are going to start to improve. And the tools they use in order to not argue are probably going to benefit them and improve in communication and other things in their relationship. So we're just going to look at one thing. But we're going to recognize that any positive change in the system, in the person, is probably going to have a positive change that reverberates. We want to help the client demonstrate a new understanding and knowledge of the problems and issues. We want to help them figure out what's causing this, what's going on here, what strings might I be able to pull? I tell clients that sometimes mental health or mental illness are like a blanket. And it's a woven blanket. And no matter where you start, you start pulling a string. Or if you have a sweater, we've all done that every once in a while. We have a little hang string. We start pulling, and then we're like, oh, crap. Regardless, when you start pulling that string, whatever string you start pulling on, you're unraveling that blanket. Eventually, you're going to unravel the whole thing. You don't have to start at one end or the other. So let's pick a string to pull. And let's start unraveling that blanket that's oppressive on you right now. We want to help clients improve their personal relationships and resolve other identified problems. When they come in, we say, what's going on with you right now? What are your presenting issues? What are the three biggest issues facing you right now? Let's identify some practical things that we can really dig our teeth into. Brief interventions are either problem-focused or solution-focused. I like solution-focused. But they target the symptom or the presenting issue and not what's behind it. We're not going to do a bunch of psychodynamic stuff. We're going to look at, if you're fighting with your spouse, what's causing that? Are you having difficulty communicating? What might be causing that behavior right now, that symptom, that fighting? And what can you do? So instead of fighting, when you come in and he says something that just kind of rubs you the wrong way, instead of fighting with that person, what can you do? Can you walk away? That would be a more helpful solution. And you can either focus on the problem, which is we're fighting all the time or I'm depressed, or you can focus on the solution. If this problem weren't there, what do you hope to happen? Instead of fighting all the time, what would you like to be different? So if you were able to peacefully communicate, what would that look like? And how can we start moving towards that? If you weren't depressed, if you didn't feel blah all the time and apathetic, how would you feel? And OK, you'd feel happy. So what makes you feel that way? So we want to focus on the solution here. What is it that you're working towards? Let's start creating that plan. Brief interventions use interventions appropriate to the stages of change. So if somebody is ready to change some things, but not others, and most of us are in that place, when we start saying, we want to get healthy. Well, that's great. I love to exercise. Don't mind exercising at all. So I want to get healthy. I'm going to start going to the gym, no problem. I want to get healthy. I want to start eating healthier. Great, no problem. I want to get healthy. I need to cut back on my soda. Oh, wait, wait. Whoa there, no. So I am in pre-contemplation when it comes to cutting down the amount of soda I drink every day. I recognize that. So using the same interventions to get me to cut down on my soda are not going to be the same as interventions you might use to get me to go to the gym, which I'm already motivated to do. Brief interventions clearly define goals related to a specific change or behavior. So for exercise, I'm going to go to the gym four times a week for cutting down soda. I might consider taking a week where I don't drink soda and seeing how I feel. That's a little bit different. That's different than saying I'm not going to drink soda anymore. If we're talking about depression and somebody just feeling apathetic and not feeling like they can get out of bed, we might be able to encourage them to take steps, but they may not be ready to do certain other things. They may not be motivated to start changing their eating patterns or changing their sleeping patterns. That's one that some people are really willing to either jump right in there and start sleeping better so they can have more energy. Or they're like, no, I like staying up until 2 in the morning. So I'm not seeing how that's a big deal and I'm not ready to change that. OK, in brief interventions, if they're not ready to change that, we can provide some education, but we want to focus on the positive things, those strings that they're ready to start pulling. Goals should be understandable to both the client and clinician and produce immediate results. Now, obviously, it's not necessarily going to happen right in your office, but that week when they start doing something, we want them to experience immediate results. So if Jane comes home and the first thing that happens when she walks in the door is she and her husband start kind of bickering at each other, that's the one thing she wants to change right now. So we talk with her about what might help change that, what might be a different response you could do, and have her try that and see how that works. And I generally have people identify three different things that they could do instead of what they're doing because I don't know which one of those is going to work. It may not work to walk away. It may not work to take a deep breath and paraphrase. We've got to give the person some response options that they can choose from. Brief therapy is highly active, empathic, and sometimes directive. So we don't want to just tell people this is what you need to do. We want to say, what do you think might help you solve this problem? What's worked in the past? Use some of those solution-focused questions and then encourage them, OK, over the next week, I want you to try these three things. So sometimes they need a little push to, OK, now I know what I need to do. It's a matter of doing it. Responsibility for change is placed on the client. I can't make them do anything. So it's up to them to want to change. So if I'm throwing out suggestions and just kind of spitballing things and they're not buying into it, we're not making any progress. So I need to make sure that we've got a good therapeutic alliance and they're ready to take some of those suggestions or take some of those ideas that they had and put them into action. I need to help them increase their motivation to achieve whatever this goal this is. Early in the process, the focus is to help the client have experiences that enhance self-efficacy and confidence that changes possible. So regardless of the problem, they're coming in and think of it as like a staircase. And the first step is not going to be the panacea. That's not the cure. That's a little bit better. I'm getting over the flu right now and I kind of use a Likert scale to figure out where I'm at. My whole family's getting over it. And I'm like, OK, on a scale of one to five, one being how you felt on Monday and five being ready to go back to martial arts or the gym, where are you at right now? And they can give me an idea and I would say, OK, what needs to happen to move to the next level? So we can do that with clients as well. Termination is discussed from the beginning. We want clients to realize that they are in control. They are empowered to make changes in their own life. They don't need to come see us forever. We're giving them tools so they know how to solve this problem, henceforth and forevermore. We're not creating a dependency and we're setting them up so they can take charge. And you want to use measurable outcomes. That way you can point to things that are changing. Because sometimes people are just having a bad day and they're like, it doesn't feel like I'm making any progress. And you can look back and go, well, you may not have made as much progress as you wanted. But when you came in, you were sleeping 17 hours a day. And you said, when you were awake, you were crying most of that time. And now you're sleeping 11 hours a day and you're not crying every single day. So yes, you're still crying occasionally. And yes, you still have pretty significant fatigue. But you have made some progress. So we want to make sure they have something objective they can look back at. Brief interventions. We want to find at least one measurable change. So things we can target, time management. If somebody says they're, oh my gosh, I am so stressed. I don't feel like I can get anything done. I fail at everything I do, yada, yada. If we can look from an objective standpoint and say, maybe time management might be an issue, or maybe that might help, then we might throw that out there as a suggestion. Do you think it would be helpful to manage your time better so you don't feel like you're being pulled six ways till Sunday? We can help them expand their support system because we all need somebody to lean on occasionally. We can look at improving social skills. Do they feel like they've got good relationships? And if they improved their relationship skills, do they think it would improve their situation? We can help them change unhelpful thoughts, identify those cognitive distortions and help them see that using those cognitive distortions may be keeping them stuck and unhappy or feeling like the sky is gonna fall. We can help them improve health behaviors. We know that good nutrition provides the body, the building blocks to make the neurotransmitters to keep you healthy and happy. We know that quality sleep enables the brain to rest and rebalance and that as quality sleep goes down depressive symptoms and anxiety symptoms tend to go up regardless of the age group. We can help them identify vulnerabilities, help them realize what are their triggers? If what goes on, what happens that makes them more likely to have this problem whether it's fighting with their spouse or being depressed or crying, what things make that more likely? If it's been cloudy for a bunch of days, maybe they've got some seasonal effective stuff. If they're not getting enough sleep, if they haven't eaten well, particular holidays, have them identify triggers and vulnerabilities that may predispose them to whatever this problem is so they can figure out how to prevent them and then the ones they can't prevent, like cloudy days, how do you mitigate that? Can you get bright light therapy? What can you do so it doesn't weigh on you as much? Vocational issues, we spend a lot of time at work. So one thing you may look at is helping people figure out how they can be happier at work. Encourage support group attendants, have them look at the concepts of forgiveness and acceptance that they tend to be very resentful and angry at the world, helping them stay in the here and now. Sometimes people who are worried a lot or who are depressed, they spend a lot of time either in regret or anxiety, which the future and the past, instead of in the here and now and appreciating what they have in the present. We can help them identify triggers for the mood or behavior and ways to cope with high risk or triggering situations. So if they know that there are certain things that trigger their mood, let's talk about ways to cope with that particular situation. Goal setting with brief intervention should be specific, like we just talked about. Those are very specific goals. It's not depression. It is looking at some of the components that are causing some of the symptoms. Specific, measurable, achievable in eight to 10 weeks. You don't wanna have something that's gonna take a year. They should be realistic for that person. Are they going to be deliriously happy in eight to 10 weeks? Probably not. Where do you wanna be? What do you want it to look like in eight to 10 weeks? And time limited, which comes back to the eight to 10 weeks. We want them to see that there's going to be progress. It's kinda like when you go to the gym. You hope that when you start working out in two or three months, you're gonna see some progress. Hopefully sooner than that, but you want to be able to say it's time limited before, until I start seeing some progress. And then things keep going from there. The purpose of brief interventions are not to cure anything. It's to reduce the likelihood of damage or additional problems from the current issue. So if they're depressed, we're not going to cure the depression with brief interventions necessarily. But we can help them keep that depression from negatively impacting their family, from negatively impacting their work, their health, their self-esteem or causing other problems such as guilt because they're just too depressed to get up and do anything. One of the big components of brief interventions is the frames model, providing feedback. Let's give them some objective feedback about what's going on, about the behavior, about the symptom. If they come to your office and they are depressed, what does that mean? Are they expecting to be deliriously happy all the time? That's like people who are expecting to be pain-free 365 days a year. It doesn't happen that way. I don't care if you are 10 or if you are 50. You're gonna have aches and pains once in a while. So providing feedback about normative data and what's realistic and what's going on with them and maybe what you think might be contributing to whatever's going on. Responsibility for the identification of future goals for health, activities, hobbies, relationships, et cetera. That's placed on the client. So we're gonna say, what do you think needs to change in order for you to achieve your goals? If we just tell them, do this, they may or may not buy in, but then when they have a similar problem in the future, they're not going to have the experience of solving that problem and figuring out, okay, what do I need to do to make things better? They're just gonna come back and go, okay, tell me what to do, Doc. You know, you can, but that's not empowering them. We want to have them take responsibility for the identification of the pros and the cons of the current behavior in terms of self, family, and community. No matter what behavior it is, it's being maintained by some reinforcers somewhere. There's something going on that's maintaining it. So we wanna look at what are any possible benefits? What are the drawbacks? Let's highlight some of those drawbacks and to help you get motivated for change. Doing the decisional balance exercises, motivational interviewing 101. We wanna help them look at the consequences of staying the same, reasons to change, and sensible strategies for change. We want them to build on something, just like when you go on a diet, most of the time it's not recommended that you just go cold turkey and cut out most everything because you're probably not going to maintain that weight loss. When people stop smoking, we wanna help them identify sensible strategies to do it. So it's a lifelong habit or lifestyle change. It's not just a hiccup in time because a hiccup in time means they're gonna have the problem again. We wanna provide advice about what might help. We know some strategies, let's throw those out there. They're the expert on themselves. They can say that'll work or no, that won't work. Provide a menu of options, express empathy because change is hard. And they've probably tried to change before they've even come into our office. And we wanna recognize that. And they may be going, I don't know if this is gonna work. I don't know if I can do it. And that apprehension, we need to be there to go, it's hard and I'm with you every step of the way and we're gonna work together to figure out a plan. And we wanna help them see that they can be effective. We wanna help them see, when have you been effective in the past at solving this problem? Even if for a short period of time. You came, you had the courage to come here today. So that took a lot of energy, effort and strength. You can do this. So stages of change. As I said, if somebody's not ready to change, your interventions are gonna be very different. You're gonna be helping them kind of start to try to consider the fact that there might be a problem. How's that for hedging? We wanna provide information, linking the problems with current behaviors, such as their thoughts or reactions. So if somebody's having, they're arguing a lot and they don't see it's a problem. They came from a family that argued a lot, they argue a lot, they just don't see a problem. Well, we might be able to help them see, help them identify whether arguing a lot is having a negative impact, for example, on their children or on their energy levels. Or what could they be doing with that time if they weren't spending it arguing? So we provide education about that. You can use motivational interviewing and have them list five ways that their problem, whatever brought them to counseling that day, has impacted their family, their work, their health, et cetera. And you can also solicit family or peer commentary specifically about the client. If you've got collateral sources, you can use that information. If you don't, you can say, what would your mom say? What would your best friends say? And see if they can step out in themselves to identify what other people's perspectives might be. In pre-contemplation, there's a lot of reasons people may say, you know, this is not a problem I'm willing to work on. I don't see where it's a big deal. They could be reluctant. So we wanna increase their knowledge of the problem and the personal impact, open their eyes to it. The rebellious pre-contemplator doesn't wanna lose control. They don't want you telling them what to do. Thank you very much. And they will decide when they're ready to change. Okay, you know, we wanna shift energy from fear of losing control to improving the next moment. So we wanna say, you know, I can't make you do anything. And you're the expert on you. I see that you've got a handle on this right now. So, you know, whatever brought you here today, if it was your wife, your spouse told you you had to come. You know, what do you think would help her feel more at ease about the current situation? And what do you think you can do in order to make things a little bit better? And the resigned pre-contemplator may have just tried so many times to quit smoking or quit drinking or start exercising or whatever it is that they just, they don't wanna try again. They don't wanna be let down again. So we wanna highlight their successes and their strengths. In pre-contemplation, it's like being outside in the summer and thinking, you know, there's a pool over there, but I'm not that hot yet. I'm fine, I don't need to jump in the pool. There's no problem. In contemplation, we'll stick with that same metaphor, you start thinking it's getting a little hot out here, but you're looking around going, but I'm not, I don't wanna mess with all that splashing and cold water and stuff. I'm good. So in contemplation, the person's starting to see that there might be an issue, but they're not ready to take any action yet. So we wanna help them increase their awareness of the problem, explore and address ambivalence by using decisional balance exercises. Address anxiety and grief about change. Yeah, grief, because you know what? When they have to change something, when you have to give something up, even if it's you start going to the gym, so you've gotta give up sitting on the couch and watching Netflix marathons, that's a change. Helping people adjust to that. And you know, sometimes it's a grief thing. Sometimes they're like, I wanna watch Netflix. And helping them figure out how to negotiate that and become okay with this new lifestyle. And help clients visualize change. You know, what would things be like if you were a non-smoker? What would things be like if you woke up in the morning and you actually wanted to get out of bed? In preparation, just like it sounds, the person realizes there's a problem and they're thinking about going to get in that pool because it's getting pretty uncomfortable. But they're not ready to jump right in because they know just like treatment is hard. Jumping in a cold pool can be really unpleasant. So they're not ready to do anything yet. So we can help them identify the benefits of treatment. We see that they're motivated. We see that they're thinking about change. Let's talk about what the benefits of treatment are. You know, what do you have to lose to talk about it? Identify and address fears and apprehensions. Give the client a list of options for treatment. You know, there are a lot of different ways, smoking cessation, for example. There are medications, there are talk therapies, there's acupuncture, there's a whole bunch of evidence-based practices that the person can potentially explore. Clarify goals and strategies by helping them identify and address barriers to change. If you start going to treatment, what may make you drop out? Or when you've started going in the past, what has happened that sort of changed your course? Highlight strengths and past successful strategies so they can go, you know, I can do this. Garner social support. We want them to have somebody on the outside that's their cheerleader, because we're not there 24-7. We're there one hour a week. Envision change and find motivating stories from others. Help them identify other people who've gone through something similar and succeeded. Identify motivations in each area. Emotional, what's gonna make them feel better. Mental, why is this the right thing to do? Physical, how is this gonna help them feel better? Social, how might this improve their relationships? And environmental, kind of everything else. How could it, what are some other benefits of this? Increase self-efficacy and hardiness. Help them realize they can do it. And hardiness is C3, commitment, control, and challenge. Help them realize that their life is multifaceted. There are, you know, 20 things that make their life rich and meaningful. This one thing over here may be going crappy right now, but they can be committed to those other 19 things while they're working on this one thing over here. Help them see that they have control over those other 19 things. And the parts of this 20th thing that they do have control over. And help them see this change as a challenge, not a hurdle, not something that's insurmountable, but it's a challenge. Let's see how well you can do this. Let's see how quickly you can do this. Let's see what works. And encourage a spirit of inquiry instead of one of inquisition, so to speak. In action, the person is tired of being sick and tired. If they're at the pool, they're tired of being hot. And they're ready to get in the pool. And they may jump in, you know, so they're taking that dive. Now what happens after that determines whether they stay in the pool until, you know, you warm up a little bit and it's less uncomfortable, or they jump right back out. So in this stage, we need to help the client implement the plan successfully. And help them ensure motivation and progress is maintained, you know, because as it gets hard, they may start going, you know what, it wasn't that big of a deal after all. This is really unpleasant. Most of us have had that experience with the gym once in a while. We want to help them be able to say, all right, I've got to get through this and it will get easier. Help them identify triggers and how they could cause relapse and how to deal with them. You know, what might trigger you going back to that old behavior? Provide practical tools in each session and role play the application. So as you say, well, if you and your spouse are bickering constantly, let's try a couple of different things. You know, I'll play your spouse, you play you and let's see what happens. Address obstacles. What could keep you from staying the course? You know, it could be finances, it could be childcare, it could be schedules at work, you know, help them identify those and plan for them ahead of time and acknowledge the client's feelings and experiences as a normal part of recovery. In the maintenance stage, they've done the hard work. Now it's a matter of keeping those goals. It's like after you lose weight, you need to keep it off. After you get in shape, you know, you can run that 5K in 24 minutes. Great, you know, now you need to maintain that. So when the race comes up, you can, you know, knock it out of the park. So help people enjoy their successes, take a step back, look how far they've come. Stay mindful of continuing to do what they've been doing and not fall back into old habits and remind them that life happens and they're going to need to make minor adjustments as needed and help them figure out or learn how to do that. In relapse, you know, that's when the pool was too cold, they just couldn't stick it out, so they jumped out and they said, you know what, I'd rather be hot, thanks. Relapse means falling back into old ways of thinking and acting. It's not a requirement for recovery and this is with addiction, depression, anything. The earlier you catch a relapse, the better and it's an opportunity for learning about what triggered it. You know, you were going along fine and then all of a sudden you had a major depressive episode. Where did that come from? Well, let's look back, because hindsight's 2020 and we can probably see some things that changed from when you were doing well to when the relapse triggered and we can figure out how to prevent that in the future. A good relapse prevention plan will have strategies for identifying early relapse warning signs. You know, when you're starting to go down that slippery slope, what happens? Do you withdraw? Do you get more irritable? Do you start stress eating? Do you quit going to the gym? What kinds of signs do people around you see that indicate that, you know, things may be getting ready to go south? Help them figure out what those are and plan for solutions, ways to address those. In maintenance, we wanna help by reassuring, evaluating present actions and redefining their long-term recovery plans. So look back and look forward and go, okay, here we are, where are we going? Educate about the relapsing nature of mental health and addictive disorders. Addiction, anxiety, depression, bipolar, you know, these are all things that may have a resurgence. So it's not a failure. We wanna recognize what causes it and try to help you adjust to it and mitigate it as much as possible. Develop a list of circumstances that require a return to treatment. Review the problems that emerge that were not addressed. And develop strategies for identifying and coping with high-risk situations. So thinking about anger. If somebody tends to get irritable when they go to family reunions and they've got a family reunion coming up for the holidays, well, how can we, what strategies can you use to deal with that high-risk situation? Teach the client how to capitalize on their personal strengths. None of us is perfect at everything. So we wanna figure out what are your strengths? What do you bring to the table? And, you know, what you don't have, the wonderful thing is your friends probably do. You know, you surround yourself with people that have your complimentary traits. It's great that way. Emphasize client's self-sufficiency. They can do this. It's not us doing it for them. They are able. Help them develop a plan for support, including family as they define it, may not be blood relatives, and community support. Where can they go in their community for recreation, for, you know, any sort of support needs that they may require? And that may just mean going to the library. Where I came from in Florida, we had one part of the library was dedicated to children and parents. And there were rows of books that were just on parenting and discipline and sleeping and all that kind of stuff for parents to read. But the rest of the area had bean bags and things for kids to do. And it wasn't a quiet area, by any means, of the library. But it was a place where parents could go and get a little bit of respite, you know, so they weren't sitting at home all by themselves with their 18-month-old who was bouncing off the walls and could get a little bit of, you know, support and encouragement. So encourage people to be aware of the resources in their community. Prepare the client to maintain positive change through difficult times. Identify potential stressors and challenges. Prepare for changes to the environment. You know, as you, you know, get better, get healthier, get more energy, you may wanna make changes. So what's gonna happen when you make those changes? If you wanna start traveling or something, great. Let's anticipate any challenges that might come from traveling. At the end of treatment, ask the client to look into the future and describe where he intends to be six months or a year from now. Brief therapy is not appropriate for everybody. It can be appropriate for people with dual diagnosis issues as long as those issues are well-controlled. You wanna have somebody who is oriented to time and place, you know, they need to be fully detoxed and able to cognitively participate. The range and severity of presenting problems is gonna be your clinical judgment whether brief therapy is going to be appropriate. Obviously, we're not gonna use brief as the only modality with somebody who is severely clinically depressed. If they have substance dependence, brief therapy is probably not going to be the be all end all treatment. It may be something we can use while they're on a waiting list. But if they've been using substances for 20 years, 10 weeks of brief therapy ain't gonna take them to recovery, 99.99% of the time. The availability of familial and community supports. If they have a lot of support, brief therapy is a lot easier than if they are an island unto themselves. The level and type of influence from peers, family and community kinda goes with those supports. If they've got a nurturing environment of some sort that they can draw on, score. You know, their brief therapy can be really effective. If they don't, they may need more intensive assistance. Previous treatment or attempts at recovery. If they've learned some skills along the way, brief therapy can be really helpful. If they've tried brief before and it hasn't worked at all, then obviously we don't wanna repeat the same thing. But we can look at things and tools they've gained from the past and use those in brief therapy. We can enhance those. The clarity of the client's short and long-term goals. If they're not clear on any of this stuff, it's gonna be hard to figure out where they're sustained to pull. If they don't believe in the value of brief therapy, then they're not gonna buy in. If they don't buy in, you're gonna have no motivation. And the number of clients needing treatment. Brief therapy, you can obviously get a lot more clients through the system, so to speak, than with longer-term therapy. But it may not be clinically appropriate for every client that comes through your doors. If they have a need for longer-term treatment, you'll know this because they failed previous shorter treatments. They may have multiple concurrent problems that need to be addressed right now. Severe substance use, psychoses, cognitive inability to focus, long-term history of relapse, many unsuccessful treatment episodes, low levels of social support, and serious consequences related to relapse. So even if they've only relapsed once or twice, if they've relapsed and that's ended up in a hospitalization in the ICU or a suicide attempt, you know, they probably need something more intensive than brief interventions. So how do we do this brief stuff? In the opening session, you wanna produce rapid engagement. Let's develop some rapport. Identify, focus on, and prioritize problems. Let's get down to business. We're not gonna spend a lot of time talking about the past and this and that. We're gonna talk about what are your presenting issues, what do you hope needs to be different? And let's prioritize those. And that kind of takes some clients off guard right away who may be expecting to sit down and tell you about their mother as the old Freudian saying goes. But we wanna help them see that we want you to start feeling better now. Let's figure out what we can do to get you on the road and everything will come full circle. Work with the client to develop possible solutions. Don't just give them. Ask them what has worked. What do they think would work? Do they have a friend who's gone through something? What worked for them? Negotiate the plan with the client. So ask them, okay, for the next week, how about if you try this and see if that works for them. And make it so it's in manageable chunks there. Remember that time limited. Most people can say, I can try anything for a week. They may not be able to say, I don't think I can do that forever. But they can do anything for a week. Okay, well, let's try it for a week. Elicit client concerns and solutions to the problem. If somebody tells me, you can't drink caffeine for the next week. Oh, yeah, right. So I might say to them, that's not gonna happen. I'm gonna get headaches. I'm not gonna be able to function in the morning. That's just not how things work around here. And so that would be my concern. My solutions would be to switch to decaf. Cut down, maybe go 50-50. Be prepared to have some aspirin or something on hand to handle the headaches. Trying to figure out how to deal with that if for some reason I was gonna try to go cold turkey without caffeine for a week. And I was habitually drinking caffeine prior to that. Understand the client's expectations. What do they want to have happen? Because what they want to have happen is what needs to happen. It doesn't matter what I want. Explain the structural framework and rationale of brief therapy. A website video, if you do brief therapy as a great portion of your practice. Putting a video on the website so clients can learn about it ahead of time will help them come in more prepared for what the first session's gonna look like. And then make referrals. Out the door running. I wanna make sure that they've got something to do. They feel like they're going to start making progress on remedying whatever this issue is and that they have the resources to do it at the end of that first session. When we do assess. And yeah, you still gotta do an assessment. You wanna ask about current use patterns. Are they using substances? Do they have history of substance use? Something to be aware of because that can be a confounding factor, especially if that's not the reason they're seeing you. Consequences of substance use or their current issue. Consequences of their depression or their fighting. Any coexisting psychiatric disorders. Bipolar, depression, PTSD. What major medical issues might be going on? Because medical issues can serve to be a triggering factor for depression and anxiety and chronic pain and poor sleep. And we wanna look at it from a biopsychosocial perspective. Information about education and employment. Are they happy where they work? Do they feel stuck? Do they feel trapped? Are they financially strapped? Support mechanisms. What support do you have that we can draw on in treatment? Client's strengths and situational advantages. Previous treatment. What's worked? What didn't? Because we don't wanna repeat that. And family history of substance abuse disorders and psychological disorders. This gives us the information we need to put together an integrated summary to try to figure out what might be causing their presenting issue. So we can make suggestions about those tangible goals that it might help you start feeling better if we worked on this area or this area. Each one of those areas may be an episode of brief therapy. So brief therapy models. Cognitive behavioral assumes that problems are caused by deficient coping skills. Choosing not to use the coping skills you have, which probably means they're not effective anyway, or are inhibited from doing so for some reason. So what prevents you from using that skill? What prevents you from counting to 10 instead of screaming at your spouse? Why are you choosing to scream at your spouse? And that may be the reward. That may actually get the spouse's attention who doesn't usually pay attention to them. So we wanna look at what's maintaining that behavior. CBT helps clients recognize situations which are likely to trigger or worsen the problem and address those. Identify unhelpful thoughts maintaining their problem. Find ways of avoiding those situations and cope more effectively. Core elements include a functional analysis, looking at what led up to the problem, screaming at your spouse, getting depressed, whatever it is, the consequences of the behavior, and the benefits and the drawbacks. What were the positive and negative consequences of the behavior? What makes it likely that you might respond that way again? What makes it likely that you wanna choose something else? Coping skills training, relapse prevention planning. And it's important to remember though that cognitive behavioral is generally not appropriate for people who are psychotic or have bipolar disorders that are not stabilized on medication. They have to be cognitively present. If they have no stable living arrangements or are not medically stable, there may be too much other stuff going on to really focus on CBT at the moment. Think Maslow's hierarchy. That bottom level is your biological needs. We need to get somebody stable before they can focus. The initial session of brief CBT therapy explores the reasons why the client's seeking treatment. The extent to which the motivation for treatment is intrinsic. Do they wanna change? Versus they're being told they have to be here. Areas of concern that the client and significant others may have about the problem. Situations in which the problem's worse. Consequences that are experienced because of the situation. And then this is all done within three major steps. Establishing rapport, educating the client, and then asking the client to describe a recent event that triggered some negative feelings in order to illustrate the CBT process. Cognitive processing therapy is a manualized therapy used by clinicians to help people recover from PTSD and includes elements of cognitive behavioral therapy in its process. It conceptualizes post-traumatic stress disorder as a disorder of non-recovery in which the person's beliefs about the causes and consequences of the trauma produce strong negative emotions, which prevent accurate processing of the traumatic memory and the emotions resulting from the event. So cognitive processing therapy is exactly what it sounds like. You go back, you look at the event, and you reprocess it, retell that story, looking at it through a more objective, well-rounded lens instead of having that laser focus. For essential parts, educating the patient about the specific post-traumatic stress disorder symptoms and the way treatment can help. Exploring the connection between thoughts and feelings, that whole cognitive behavioral thing, imparting lessons to the patient to help him or her develop skills to challenge or question his or her own thoughts. Are these thoughts based on feelings or facts? Helping the patient to recognize changes in his or her beliefs that happened after going through the trauma. So how did that event change you? How does it change how you interact with people or how safe you feel in the world? The structure of CBT is generally 12, 50 minute structured sessions, typically conducted once or twice weekly. Patients complete out-of-session practice assignments to complement what's done in. Another one is trauma-focused cognitive behavioral therapy. And the medical school at the University of South Carolina has a wonderful training program on this, but I'm briefly hit. It aims to address the needs of children and adults with PTSD, depression, anxiety, and behavioral difficulties related to traumatic life events. The goal of trauma-focused cognitive behavioral is to provide psychoeducation to both the child and caregivers and help them to identify and cope with emotions, thoughts, and behaviors. The major practice of trauma-focused cognitive behavioral are denoted by the practice acronym, psychoeducation and parenting skills, relaxation, affective expression and regulation, cognitive coping, trauma narrative development and processing, in vivo, gradual exposure, conjoined parent-child sessions, and enhancing safety and future development. Now, the course from the University of South Carolina's medical school can be found at this link, and it provides free CEUs, so you might as well jump on that too. It focuses, solution-focused brief therapy focuses on solutions instead of problems. It starts with the miracle question, using compliments to highlight strengths and successes and build self-efficacy. Focus on what people are doing well. It encourages clients to identify previous solutions and build on those. It uses present and future-focused questions. Instead of talking about, well, what did you do back then? You wanna ask the client, what are you gonna be doing in the next week that's gonna indicate you're continuing to make progress? What do you anticipate doing next week that is a result of your continued progress? Use scaling questions, such as on a scale of one to five, what is your confidence that treatment's gonna work? And help them increase their confidence. What would help you move from a three to a four in your confidence that this will work? And you can use the scaling question in terms of change. You know, on a scale of one to five, one being, I got no problem, five being, where do I sign up to change? Where are you in terms of readiness for change? What are you, how willing and ready and motivated are you? Other questions you can ask, what would you like to achieve today? Notice it says today, not in our sessions, but what would you like to achieve today? How will you know later that this meeting has been successful? Are there times when this problem's not happening and what's going on then, what's different? Before this problem existed, what was different? What have you found helpful in managing this situation in the past? You know, you've probably been trying to do things on your own. So what have you found that's worked? Considering how depressed and overwhelmed you feel right now, how is it that you were able to get out of bed this morning and make it to our appointment? How did you do that? That helps them see, you know, I did that. How will others know when you start to change of the thinking we've done here today? What's been helpful? What would you like to see yourself doing differently between now and this time next week? And use the word when rather than if, instead of saying if you start getting better, is when you start getting better. If things start to improve, says it may or may not. If you say when things start to improve, what's going to be different? That keeps that motivation going. Brief strategic interactional therapies focus on the individual strengths. The relationship to the therapist is essential and interventions are based on client self-determination with the community serving as a resource rather than an obstacle. So we wanna help them reach out to those resources. We wanna define situations that contribute to the problem in terms meaningful to the client. You know, what things are gonna help you start feeling better? What things do you think are causing this? Identify steps needed to address the problem. Heal the family system so it can support change. Maintain behaviors that will help support recovery and respond to situations in which the client has relapsed. And again, that can be mood disorders, addiction, et cetera. So this is obviously based on a family therapy model, but it encourages the person to reach out and tap into those resources. Brief humanistic and existential therapy emphasizes understanding the human experience and focusing on the client rather than the symptom. Psychological problems are the result of inhibited ability to make authentic, meaningful, and self-directed choices about how to live. Therefore, in the initial session, you build an alliance developing therapeutic rapport and creating that climate of change, emphasize the client's freedom of choice, and articulate expectations and goals of therapy. How are we going to reach your goals in eight to 10 weeks? And then help them identify what is it that you want to do, not what your mama wants you to do, not what your spouse wants you to do, what is it that you want to do? Let's get authentic for a moment. A psychodynamic approach enables the client to examine stuff from their past, which led to desire to use substances, their depression, their anxiety, or their relationship problems. In brief psychodynamic therapy, we work with the client's perceptions of reality. We ask questions and we sidestep rather than confronting defenses. So if we start running into yes, buts, okay, we're gonna back off of that for a second and maybe come at it from a different direction. We wanna help them look at their perceptions. We wanna help them look at the way their reality is right now and how that's informed by stuff in their past. We can't change the past, but we can help them figure out how to change how the past impacts their present and their future. Brief family therapy believes that interactions with family set the patterns and dynamics for many people's problems. Family member interactions can either perpetuate or resolve the problem. So it's important to figure out who's gonna be involved in the treatment process and what may be going on in that family area where they're living, whoever's living there, that may be maintaining the problem or might be able to help solve the problem. Family therapy offers an opportunity to focus on the expectations of change within the family. What does change look like in the family? Test new patterns of behavior. Teach how a family system supports symptoms and maintains needed roles. So we wanna look at, why might this be going on? If you've got a child that's regularly acting out, how might the family system be supporting that behavior by maybe not disciplining or only sporadically disciplining the behavior or whatever? So we're gonna look at what part the family plays in maintaining and correcting the behavior. We wanna elicit the strengths of every family member and explore the meaning of the problem within the family. And that gets a little abstract sometimes, but it helps people start seeing that it's not just them, not just the identified patient, but everybody plays a part, may have played a part in the problem, but everybody plays a part in the recovery process. The initial section clarifies the nature of the problem and identifies the family's goals with open-ended questions such as, what's y'all's goal in coming here? Educate the family about what is needed to participate effectively in the therapeutic process. Understand key biosocial issues related to the problem. So if they're stressed, if both parents are working two jobs, any sorts of things like that, we wanna understand that that may be causing some of the strife and stress in the family or if junior has a substance use issue or who knows. Provide feedback to the family on what was said, demonstrating whose goals are similar or different. So we wanna really draw after we do that assessment, we wanna draw it all together and go, okay, this is what I heard. When they hear it coming back, they may be like, oh, you're right, I heard that too. And prioritize directions for change or if the direction is sufficiently clear already, get to work. Brief family therapy is appropriate for families who are able to benefit from teaching and communication to better understand some aspect to the problem. So we need a family that's on board. It's not gonna work if you've only got one or two people in the family on board. And time-limited group therapy. Groups can help reduce denial and process ambivalence. It can facilitate acceptance of the problem because people don't feel like they're the only one. It can help them in identifying exacerbating and mitigating factors, because you're gonna talk about that in group. And when John starts talking about something that happened to him last week that made his depression worse, Sam might go, you know what? I never thought about that, but you're right. Valentine's Day really does make my depression worse or whatever it is. So you might be able to help people identify exacerbating and mitigating factors. Mitigating is what do you do to make it better? So John might start talking about training for a marathon and Sam might go, I'm not sure, but it sounds like you're loving it, so can't hurt. Provide a wealth of coping strategies and resources. Increase motivation for change. Treat co-occurring conditions. Increase the capacity to recognize, anticipate and cope with situations. Cause in a group, you know, you're hearing different situations constantly, so people are becoming more aware and they're going, oh yeah, that happens to me too. Provide a warm environment that provides social acceptance and support and it helps people explore whether they believe they have the ability to choose effective actions. So they start talking about, can I do this? Do I have a choice? Brief therapy is a cost-effective technique that can help engage clients in the preparation phase. Not great for pre-contemplation. If they don't think they've got a problem, brief therapy's not gonna do a lot. But once they get to preparation, they're starting to think about making a change. It's like getting ready to go on a vacation if you think of therapy as your vacation. Preparation is making the travel arrangements and packing your bags. So brief therapy can help there. Enhances treatment compliance, improves outcomes, increases success and client efficacy, reduces cost per patient expenses because you're seeing them 10 times, not 30 times. And it can be used for a variety of issues to help clients accomplish specific, measurable, achievable, realistic, and time-limited goals. If we can help clients learn nothing else but how to set and achieve smart goals and how to increase and maintain motivation, yeah, those are two big things, but if we can help them do that, they are gonna be so much further along than when they came in. And brief therapy can be implemented in group or individual settings in multiple different places, you know, doctor's offices, health educators at school, clergy. There's a lot of different settings where brief therapy can be used or brief interventions can be used to help people start moving toward a happier, healthier life. Essential characteristics of brief interventions, specific focus, enhanced experiencing. So people are in that session thinking about, you know, role-playing, if I do this differently, what's gonna be different? So they're really focused on that experience. Highly interactive, useful with clients who are moderate to high functioning. There's an emphasis on readiness for change and the impact of the intervention. I wanna know how did that go? I wanna know what happened and we're gonna build on the momentum. So that is brief therapy in a very, very small, you know, nutshell to give you some ideas of techniques that might fit. And my goal for providing the different types was to help you find one that might fit with your theoretical orientation so you can learn a little bit more about it and you might be able to get some brief tools in your toolbox in order to be able to use with your clients. Alrighty, everybody, have an amazing day and I will see you tomorrow. Oh, I forgot to ask, I'm sorry, are there any questions? Alrighty then, on that note, everybody have an amazing day and I will see you tomorrow.