# Hope in Action: Solution-Focused Conversations About Suicide 1st edition by Fiske, Heather (2008) #[[psychotherapy]] #solution-focus #book ## Chapter 2: Putting Principles into Practice: Asking Useful Questions All questions are leading questions (Hoyt & Berg, 1998. P 209) and where are we leading clients to focus on? Using the "tap on shoulder" idea, can we focus on what the client *has did* instead of what he *has not done* ? ## BEGINNINGS **Therapy is two people trying to make sense of what one of them wants. Reminded me of [[202009071534 Notes Reading Wittgenstein and Psychotherapy. From Paradox to wonder. John M. Heaton]] on *making sense*** #language Therapy is really just people talking , trying to figure out what the hell one of them wants. (attributed to John Weakland, in de Shazer, Berg, & Miller, 1995). page 38 **Know what client want is critical. So we know what can make a difference.** Knowing what clients want is critical. As early as possible in our conversations, often well before developing specific goals, we need at least a general idea of what can make a difference. Only when we know what clients want can we provide help that will be relavant, important, and salient to them; that may shift their thoughts or their actions, their "viewing" or their "doing" of problems. - page 38 **Suicide is a means to and end rather than the actual goal. Suicidal behavior is people trying to solve a problem. So we can take a collaborative approach to help patient solve their problem** Shneidman (1993) saw suicidal people as trying to solve a problem. Other suicidologists have echoed his view of sucide as problem solving behavior (e.g Chiles & Strosahl, 2005; Michel & Valach 2001)... from this perspective, suicide is a means to an end rather than the actual goal. This understanding allows the clinician to collaborate with clients who are suicidal. **See suicide as one of the attempted solution to a problem, and ask what other possible attempted solutions is possible?** By taking suicide as an attempted solution to a problem (but only one of the many) you reduce blame for the client and value the difficult nature of their situation. You invite the client to wonder if this is the only valid solution... By investigating alternative solutions to the problem, and a different map for reaching their overall goal... you help client feel valued and open up options. (Hawkes, Marsh, & Wilgosh, 1998, p. 103) ### OPENING QUESTIONS **Asking opening questions, such as "what are your best hopes for this session?", we can listen to the client's desires. Even if they are telling problem stories.** Even if clients respond - as in fact they often do - by relating their problems stories, they are talking about them *in the context of something that they want or hope to change*. The therapist can reinforce this possibility even in the course of listening and empathizing. - p 40 In page 41, the table on Shifting Assumptions listed that when clients see a problem, we can use language to suggest or reframe that as something else. This reminded me of [[202009071534 Notes Reading Wittgenstein and Psychotherapy. From Paradox to wonder. John M. Heaton#Aporia]] - on how Bolzano first see that the root of problems are in our assumptions of how things must be. Focus on clarifying what is said, and context of it being said. ![[Screenshot 2020-09-10 at 8.29.22 PM.png]] ## BALANCING ACKNOWLEDGEMENT AND POSSIBILITY **Life is not simple. It will be authentic to reflect life's complexities and often competing views, pulls even in therapy session. Among life's complexities, there are possibilities as well. It's never black or white.** I shall advocate a synthesis of the extremes: the richer therapeutic narrative is the one that embraces both the positive and the negative, allowing each its due salience and proper role ... the aim of the intervention is thus to make room for a more complex narrative and for options that would have been banned out of existence by a more simplistic frame of mind. (Omer, 1998, pp 414-415) Sometimes the most effective moments of therapy occur when you as the therapist are able to model an acceptance of these competing forces. (Chiles & Strosahl, 2005, p. 99) **We need to attend to the client first, before they can move.** One of the mistakes I made when i first began trying to incorporate solution-focused attitudes and methods in my practice was to give short shrift to clients' problem stories in my hurry to get to solutions. Fortunately, the process is resilient. My clients quickly taught me that I must listen fully, before even the most artful solution-building questions could be useful. p 42 **Therapy is about empathic listening and reflecting. (This reminded me to not filter, to distort what has been expressed, not to have a preferred emotions, thoughts or views, because i am not comfortable about it.)** #counselling #[[psychotherapy]] (10 Sep 2020 [[Systemic Thinking]] [[supervision]]. Session with 85 year old lady) Clients need to tell us their stories, and to know from us that they have been heard. Reflecting, and empathic listening is the heart and soul of helping conversations. p42 LANGUAGE USE EXPANDING POSSIBILITIES FOR CHANGE "EXCEPTIONS" EXAMPLES OF EXCEPTION-SEEKING QUESTIONS EXAMPLES OF FOLLOW-UP QUESTIONS FOR AMPLIFYING EXCEPTION REASONS FOR LIVING EXAMPLES OF QUESTIONS ABOUT REASONS FOR LIVING PRESESSION CHANGE COPING QUESTIONS PROTECTIVE FACTORS RESPONDING TO AND UTILIZING EXCEPTIONS A BETTER FUTURE: THE MIRACLE QUESTION "YOU ASK THEM WHAT?" DETAILS, DETAILS, DETAILS MIRACLE PICTURE EXCEPTIONS GOALS "MAKING NUMBERS TALK" EXAMPLES OF SCALING QUESTIONS ABOUT RISK AND SAFETY OTHER QUANTITATIVE QUESTIONS COMPLIMENTS MESSAGES: THERAPIST-TO-CLIENT FEEDBACK COMPLIMENTS BRIDGES TO SUGGESTIONS "HOMEWORK" SUGGESTIONS READINESS FOR CHANGE EXAMPLES OF SUGGESTIONS FOR CLIENT SAFETY PLANNING A NOTE ON NO-SUICIDE CONTRACTING EVALUATIONS: CLIENT-TO-THERAPIST FEEDBACK EXAMPLES OF EVALUATION QUESTIONS CONSOLIDATING AND MAINTAINING POSITIVE CHANGE CONCRETE REMINDERS EXAMPLES OF MAINTENANCE QUESTIONS TERMINATION EXAMPLES OF READINESS FOR TERMINATION QUESTIONS PUTTING IT ALL TOGETHER: THOUGHTS ON "FLOW" EXAMPLES OF POSSIBLE QUESTION SEQUENCES CONCLUSION: VOICE OF EXPERIENCE