Pathways to Change, Second Edition: Brief Therapy with Difficult Adolescents

305 Pages·2005·1.58 MB·English

by  Matthew D. Selekman MSW

PATHWAYS TO CHANGE
This page intentionally left blank
Pathways to Change
Brief Therapy with Difficult Adolescents
SECOND EDITION
MATTHEW D. SELEKMAN
THEGUILFORDPRESS
NewYork London
© 2005 The Guilford Press
A Division of Guilford Publications, Inc.
72 Spring Street, New York, NY 10012
www.guilford.com
All rights reserved
No part of this book may be reproduced, translated, stored in a retrieval
system, or transmitted, in any form or by any means, electronic, mechanical,
photocopying, microfilming, recording, or otherwise, without written
permission from the Publisher.
Printed in the United States of America
This book is printed on acid-free paper.
Last digit is print number: 9 8 7 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
Selekman, Matthew D., 1957–
Pathways to change : brief therapy with difficult adolescents / Matthew D.
Selekman.—2nd ed.
p. cm.
Includes bibliographical references and index.
ISBN 1-57230-959-8 (trade cloth)
1. Brief psychotherapy for teenagers. I. Title.
RJ504.3.S45 2005
618.92´8914—dc22
2005009476
To the two most special women in my life,
Asa and Hanna, who have been there with
undying support and love, and light up my life
About the Author
MatthewD.Selekman,LCSW,MSW,isacoupleandfamilytherapistin
privatepracticeandthecodirectorofPartnersforCollaborativeSolutions,
aninternationalfamilytherapytrainingandconsultingfirminEvanston,
Illinois.Mr.SelekmanreceivedtheWalterS.RosenberryAwardfromThe
Children’sHospitalinDenver,Colorado,in1999and2000forhissignifi-
cantcontributionstothefieldsofpsychiatryandthebehavioralsciences.
Heistheauthorofnumerousfamilytherapyarticlesandthreeotherpro-
fessionalbooks:LivingontheRazor’sEdge:Solution-OrientedBriefFam-
ily Therapy with Self-Harming Adolescents, Solution-Focused Therapy
with Children: Harnessing Family Strengths for Systemic Change, and
Family Therapy Approaches with Adolescent Substance Abusers. Mr.
Selekmanhaspresentedworkshopsonhissolution-orientedbrieffamily
therapy approach with challenging childrenand adolescents throughout
theUnitedStates,Canada,Mexico,SouthAmerica,Europe,andAustra-
lia.
vi
Preface Preface
Preface
RalphWaldoEmersononcesaid,“Unlessyoutrytodosomethingbeyond
whatyouhavealreadymastered,youwillnevergrow.”Inthisspirit,since
thefirsteditionofPathwaystoChangewaspublishedin1993,Ihavecon-
tinuedtoallowmysolution-orientedbrieffamilytherapymodeltoevolve
considerablyintermsofmodelexpansion,becomingevenmorecollabora-
tive,andcarefullytargetingandinterveninginthemultisystemslevelsof
theadolescent’ssocialecologytoproducelong-lastingsystemicchanges.
Beingadiehardintegrationist,Icontinuetodevelopandlookfornewand
oldtherapeuticideasthatcanlogicallyfittogetherandhelpbuildinmore
therapeuticflexibilityandchoiceswiththerapeuticexperimentsandritu-
als.Anotherimportantdimensiontothissecondandexpandededitionis
myplacingastrongeremphasisontheengagementprocessandrelation-
shipbuildingthroughoutthebook,particularlyinthenewchapters.Our
ability to establish meaningful connections with challenging adolescents
andtheirfamiliesatthestartoftreatmentcangreatlycontributetoposi-
tivetreatment outcomes.Thisissupported bymany psychotherapy out-
comeresearchstudiesthathaveconsistentlydemonstratedhowrelation-
ship factors were highly rated by clients as greatly contributing to their
treatment success (Hubble, Duncan, & Miller, 1999).
ThefirsteditionofPathwaystoChangetheoreticallywasquiteheavy
on the solution-focused brief therapy side (de Shazer, 1988, 1991). Al-
thoughthisimportanttherapeuticapproachhasshownfavorableclinical
results with a wide range of adolescent behavioral difficulties,I came to
discoveroverthepastdecadesomeofitslimitationswithmuchmorecom-
plex adolescent case situations that had experienced multiple treatment
failures.Attimes,instayingtooweddedtothebasicsolution-focusedbrief
therapyapproach(deShazer,1988,1991),Ifoundmyselfnaturallyfavor-
ingthekindsofsolution-determinedstoriesIwantedtocoauthorwithmy
vii
viii Preface
clientsandinadvertentlyminimizingtheirproblem-saturatedtalesofop-
pressionanddemoralizationthatfeaturedchronicdifficultiesandnegative
pasttreatmentexperiences.NylundandCorsiglia(1994)refertothisway
of interviewing and staying true to the base model as “solution-focused
forced” therapy. I still find the practical formulas, decision trees, major
therapeuticcategoriesofquestions,andtasksofthebasicsolution-focused
approachtobequiteusefulinmyclinicalpractice.ButearlierIfoundmy-
selfbecomingtoodependentonthesefeaturesofthemodelfortherapeutic
guidance,robbingmyselfoftheopportunitytotapmyowninventiveness,
creativity, and strengths, or to borrow ideas from other therapeutic ap-
proachesintheinterviewingprocessandwiththerapeuticexperimentse-
lectionanddesign.Anothermajorgapinthebrieftherapyliteratureanda
weaknessofthefirsteditionofPathwaystoChangeisthelackofdiscus-
sion about and sensitivity to social injustice—the cultural, gender, and
widersocietalaggravatingfactorsrelatingtothedevelopmentandmainte-
nance of adolescent difficulties.
Today’syouthareoverscheduled,haveoppressivehomeworkloads,
and are faced with having to make far too many choices about every-
thing,whichislargelyattributabletoourmedia-drivenandconsumerist
culturallandscape;peergrouplifehasbecomemorehigh-pressured,and
youngpeoplearestrugglingtocopewithexcessivelyhighlevelsofstress.
Other than turning to substance abuse or self-harming and eating-dis-
tressedbehaviors,emotionallyvulnerableadolescentsoftenareataloss
formorehealthycopingstrategies.Inthisvolume,Ipresentavarietyof
useful therapeutic coping strategies such as mindfulness meditation
(Hanh, 2001, 2003a), visualization, and disputation skills (Seligman,
2003; Seligman, Reivich, Jaycox, & Gillham, 1995)—to name a few—
that adolescents can easily learn and use to help themselves cope with
stress.
InthisneweditionofPathwaystoChange,readerswillfindmorecre-
ativeandpowerfulwaysofinvolvingtheservicesofkeymembersofthe
adolescent’s social network, such as concerned peers and inspirational
others (Selekman, 2002, 2004) in family therapy. Given the push in the
mentalhealthandjuvenilejusticefieldsfortheuseof“best-practice”em-
piricallyvalidatedtreatmentapproacheswithtroubledyouth,itisimpor-
tant that we become much more familiar with these approaches and see
howwecanincorporatewhatcurrentresearchisindicatingworksinour
clinicalpracticeswithyouthandtheirfamilies.Alongthesesamelines,we
needtobesensitiveto—andmaximize—thefourcommonfactorsorma-
jorelementsthat40yearsofpsychotherapyoutcomeresearchstudieshave
indicated count the most for positive treatment outcomes (Hubble et
al.,1999);theyareextratherapeuticfactors,relationshipfactors,hopeand
expectancy factors, and models and techniques.
Preface ix
Furthermore, the positive psychology movement (Peterson & Selig-
man,2004;Seligman,2002,2003;Keyes&Haidt,2003;Snyder&Lopez,
2002;Fredrickson,2002,2003;Csikszentmihalyi,1990,1997,2003)has
recently produced some groundbreaking research and therapeutic ideas
thatmayeventuallyrevolutionizeourmentalhealthdeliverysystem.Ipre-
sent the innovative multipleintelligencesframework of educational psy-
chologistHowardGardner(1993,1999,2004)anddiscusshowwecanuse
thisframeworkasaguideformatchingwhatwedointheinterviewingpro-
cessandwiththerapeuticexperimentdesignandselectionwiththekeyin-
telligenceareasoftheclients.
Finally,therearethreenewchapters—ontheimprovisationaluseof
self,engaging andcreating possibilitieswithdifficultparents,anddeal-
ingwithno-problemproblemmandatedfamilies—andagreatlyrevised
and expanded chapter on the solution-oriented parenting group. Read-
ers will find these new chapters to be filled with many practical guide-
linesandtherapeutictoolsthatcanbeputtoimmediateusewiththeircli-
ents.
OVERVIEW OF THE BOOK
This book is specifically designed to provide clinicians with the practical
“howto’s”forconductingsolution-orientedbrieffamilytherapywithdiffi-
cult adolescents and their families. Chapter 1 describes how our media-
driven and consumerist cultural landscape and treatment-related system-
aggravatingfactorshavecontributedtohowadolescentsdevelopdifficul-
ties.IdiscussthevariouswaysIhaveexpandedthesolution-orientedbrief
familytherapyapproachbyincorporatinginnovativeideasfromthefields
of psychology and family therapy and integrating what we know works
frompsychotherapyandfamilytherapyoutcomeresearchintoourclinical
practices. Chapter 2 presents helpful assumptions about difficult adoles-
cents,theirfamilies,andbrieftherapy.InChapter3,Ipresentseveralcre-
ativewaystherapistscanusetheirownimprovisationalskillsinsessionsto
createpossibilitieswiththeirmostchallengingadolescentsandtheirfami-
lies.Chapter4discusseshowtoco-createacontextforchange,beginningin
the first family interview. Several categories of therapeutic questions and
guidelines for therapeutic experiment selection and implementation are
presented.
Chapter5presentspracticalguidelinesforengagingandtreatingpar-
entswhoareangryandhostile,highlypessimistic,laissez-faire,ormental
healthandsubstanceabuseimpaired.InChapter6,Ipresent10effective
and empirically based engagement strategies with difficult adolescents.
Chapter 7 provides helpful guidelines for engaging and treating no-