Welcome to What’s Better This Week? Episode 6: How to Be Solutions Focused in a Crisis (Special COVID-19 Episode).
With everything going on with COVID-19/the Novel Corona Virus, I figured a Special Episode might be helpful, whether for yourself, or as an intervention when working with patients and clients who may very well view this as a crisis well beyond their capacity to cope (especially if their traditional services are being interrupted, or you’re providing services over the phone). Unlike a “traditional” SFBT appointment, I have used the following very often in Crisis Appointments, both in person, and over the phone (and, to be honest, sometimes with myself!).
When a patient presents dysregulated and in crisis, it behoves us to take a Solution Focused approach with them (for all of the reasons that we are SFBT counselors). Also because SFBT is usually the most effective approach at providing an immediate experiment that our patients and clients can leave with to proactively work on whatever it was that brought them into our office in the first place. However, dysregulation usually requires a different approach than a traditional appointment, so while not necessarily Solution Focused, I find it helpful to start the session (in person or on the phone) by asking my patients to join me in taking three deep breathes (slowly in through the nose, and then slowly out through the mouth). Good….now again…and now one more, slowly. The reason is because many of my patients will often begin restricting their breathe when dysregulated, or anxious, or in a panic, and it’s important we work to decrease the physiological symptoms of flight, fight, or freeze (those times when we don’t have Behavioral Ownership).
In a crisis, I will adjust my opening question of “What’s better this week” to instead be: “have things gotten better, stayed the same, or gotten worse?” If this is a patient I have never met with, I will adjust the time frame. Maybe I’ll ask “since yesterday? Last week? Last month?” If I’m working with myself as my own patient (yes, you can use this with yourself) I will often ask “since you last had a moment to reflect?” Then it’s time to listen reflectively. If things have gotten better, we want to respond with a reflection, validate, and then ask them “how did you make that happen?” If things have stayed the same, again, we want to respond with a reflective statement, validate, and ask them “how have you managed to make sure that things have stayed balanced? That’s really hard work to do sometimes? How did you make it happen? What coping skills have you been using?” If our patient, client, or ourselves respond with “things have gotten worse! So much worse!” then we want to respond with a reflective statement, validation, and ask them how they’ve been coping with that. Almost universally the response I get when I ask a patient “how have you been coping with that” when they tell me that things have gotten worse is “but I haven’t been coping!” and generally I’ll reply with “Nonsense, you’re here! You made it to my office! I see that you’re largely in one piece! To my knowledge you didn’t assassinate an Arch Duke and start a World War, so, somehow, you’re coping, maybe we just have to figure out how…let’s think…maybe if you describe what you’ve been doing, we can figure out how you’ve been coping together…” Then validate, validate, validate.
After this, I will ask my usual scaling question of “on a scale from 1-10, where 1 is everything in the world is awful, like Zombies, and not even the cool ones, but the gross ones, and 10 is everything in the entire universe is amazing, like unicorns are just farting rainbows and glitter…where would you put yourself right now in this moment?” I will then work the scale with the pati