# Solution-Focused Case Management by Robert G. Blundo and Joel Simon #Booknote #solution-focus [[020.300 Solution Focused MOC]] ![[Solution-Focused Case Management - Robert G. Blundo, PhD, LCSW _ Joel Simon, .pdf]] ## Chapter 1: SOLUTION-FOCUSED CASE MANAGEMENT: DEFINITIONS AND MEANINGS **Traditionally, Case managers are the experts deciding what clients' needs and interventions are.** - Traditionally, case management was described as starting with assessment by the worker so that the worker could make the necessary connection with services he or she found necessary for the client (Laurie, 1978). Solution focus case management defined as : The Northwest Brief Therapy Training Center in Olympia, Washington, presents a solution-focused description. Solution-focused management is a powerful, practical, way to achieve positive change with people, teams and organizations. It identifies what is already working and amplifies it to make useful changes. It focuses on what is possible rather than on causes of problems and gets man- agers to stop doing what isn’t working and do something different. Several principles characterize the approach, including simplicity, cooperation, and an emphasis on strengths, resources and abilities of the organization and its members. The focus is on interaction between individuals and teams and holds individuals accountable. Possibilities are explored in the past, present and the future. Exceptions and even small changes are used to achieve desired goals. Every case is seen as different and expertise for achieving solutions is located with the person or team that wants to change or improve. (italics added; Northwest Brief Therapy Training Center, 2014) **Solution-focused focuses on what the client want and desires.** Solution-focused practice shifts the concept of solution to mean what is wanted or desired as explicitly stated by the client. The focus is on taking steps to a better future. **Instead of focusing on the "problem", and understanding what "caused" them, the SF practitioner attend to the client's problem, and then ask "how did you keep going?"** **SF does not ignore problem. The act of talking about solution means that there is a problem** - One of the misconceptions is that by focusing on solutions, we are there- fore ignoring the problem. De Shazer (1991) writes: “The concept ‘problem’ always presupposes the concept of ‘solution.’ In fact, the concept of solu- tion is a precondition essential for the development of a concept of problem” (p. 122). Conversations about solutions imply problems—the two are inter- twined and cannot be separated. **The talking about problem in a way reveal the desired outcomes** - If you describe a better marriage as the outcome of the work together, then the “problem” is with your marriage as you see it in terms of specific details. For example, if I state that I want to be able to spend more time with my spouse, I have given a specific detail to work toward and specified a partic- ular problem to be addressed. By following detailed descriptions of my goals or desired outcomes, as the client, I have revealed possibilities for how I might reach that goal. I am able to identify times when just a part of that goal has been achieved and how it was created. **Start listening out to what is unspoken by the client. What is their desired outcomes, hoped-for futures, listen out for the exceptions.** - Solution building does not focus on problems but focuses on client goals, hoped-for futures, and exceptions to the existence or intensity of the “prob- lem.” The expertise of the worker is in engaging in a conversation with the client in a collaboration of unveiling of potentials, competencies, resources, past successes, and problem exceptions, as well as in being curious about how clients keep going in difficult situations. ### Shifting Into New Ideas 6 **Don't see the client as the "problem"** - The “problem” now justifies the need for the case manager to determine the exact cause, which then requires a certain type of intervention to address the problem. Charles Rapp (1998) describes this phenomena nicely: If alcoholism is defined as the disease of excessive alcohol consump- tion, then the therapeutic approach must be centered on abstinence. Getting an alcoholic [note the new term for the person] to stop drink- ing is the first step in recovery. In this way, alcohol is both the center of the problem and the treatment. Even when someone is successfully sober for long periods of time, alcohol remains a central concern of his or her life. The image of the bottle is as prevalent in sobriety as in drunkenness - This is referred to as the damage model by Wolin and Wolin (1997). This think- ing results in individualizing the problem. The persons themselves are the cause and in need of changing. **Question: Do i also see my patients as having deficits and problematic even though i talk about systemic views? Or do i view the whole system as "problematic"?** - Even though most helping professions talk about the social context, actual practice is directed at the deficits and problematic behaviors of the individual. In this way, the individual is seen as the cause of his or her problem and needs to “own up to it.” **Need to start formulating my patients as people with strengths and possibilities, to adopt a "not knowing", and have curiosities, not to categorise people into boxes.** - As solution-focused case management practitioners, we need to develop a respectful curiosity about the unique abilities people have of being self-correcting. This means a shift from the lens focused upon pathology to that of how people within their life contexts keep going in spite of whatever traumas or difficulties they face - This respectful curiosity from a place of “not-knowing” attention is a shift from the typical categorization of people and problems to being concerned with strengths and possibilities. Exercise: How Our Assumptions Determine How We View the Client Reading two case example, one is "discharged from a psychiatric ward", the other is "Graduated from university", and we quickly have different judgement about the two case. - Research on cognition and social cognition confirms that these ways of thinking, categorizing, and paying selective attention are how we are hard- wired to organize, store, and access information. The material presented in the preceding exercise came from an experiment conducted by Pierce (1987). #Judgement because " This ability to make quick judgments is actually very useful when you are in dangerous circumstances, as many of our ancestors were when hunting and encountering animals and other unknown groups of hunters. In this case, the quicker one could judge the situation, the greater the chance for survival." **Assumptions drive future actions.** **Assumption guide our action, and clients response to those actions, and worker response to those reactions.** - The more we become aware of our potential biases, the more likely we will be able to recognize them and keep them from influencing our listening to and hearing of the client’s life narrative. Solution-focused practice requires the ability to attune to the client’s world without interference from our personal and theoretical lenses. #Biases #Reflection ### Conclusion 11 Question: When i practice empathic listening, do i only attune, affirm and acknowledge #Juliana to the patient's problem, negative feelings and experiences? Have i tried to attune, affirm, acknowledge the patient's strength and possibilities? - Unfortunately, much of what has been written about and considered empathic has focused almost exclusively on the therapist’s identifying and connecting with the client’s negative feelings and personal experi- ences (e.g., clients’ pain or suffering, their despair or feelings of hope- lessness, their present difficulties and the history of the complaint). However, since client strengths and resources contribute greatly to psychotherapy outcome, we would do well to adopt a broader view of empathy, a view that encompasses the light as well as the dark, the hope as well as the despair, the possibility as well as the pain. (Miller, Duncan, & Hubble, 1997, p. 12) ----- ## Chapter 2: Challenging our Assumptions