Men & Trauma: 5 Dynamic, Solution-Focused Questions to Use in Therapy

7 09 2017

Guest Author:

Daniel Lawson, LMHC, CASAC

man in therapy

 

 

 

 

 

 

“I am not what happened to me, I am what I choose to become.” –  Karl Jung

Jung penned these words in 1965, and I find myself returning to them often in my work. The intention of this blog post is to provide clinicians with tangible and pragmatic tools to enhance treatment effectiveness with men who have with trauma histories.  As a solution-orientated therapist, the tools I use are questions.

My hope is that in using these questions effectively with the men you serve, they become more of who they are, and less of who they aren’t.

QUESTION 1: “What has been the greatest accomplishment of your life?”

Whenever I do an initial intake, I spend at least five to ten minutes at the beginning of the appointment with this question.  Asking your client about what they have achieved, builds awareness of their patterns of success.  This also helps the client feel at ease and competent.

Naturally, this question also helps men build confidence.  Confidence in many ways is a requirement for successful goal formulation.  Confidence also decreases men’s fears about treatment and making change.

Sometimes, the client may respond saying that they have not achieved anything great in their life.  As the therapist, it’s important to add, “not yet.”  If a client gives that response, it becomes a very appropriate time to talk about goals and ask, “Well, what would you like to say someday is one of your great achievements?”

QUESTION 2:  “What helped you survive?”

Often times our work as a therapist is to reframe the experience of our client.  This question alters the client’s perception from a place of being a “victim” to being a “survivor.”  This creates different expectations and also allows the client to see that in fact they have done something valuable.  It may also allow them to see other strengths that they possess as well as ways to build upon them.

It is important to note that male trauma survivors may habitually destroy their own self-worth, abusing themselves and ruminating on past failures. This question subtly harnesses the power of positive blame, demanding the client to take responsibility for their success and good decisions.

QUESTION 3: “How do you think other people have gotten through something similar to you?”

One crucial element in maintaining the therapeutic relationship and achieving positive treatment outcomes is respecting the client’s theory of change.  This question begins a conversation about what the client believes about their diagnosis/prognosis and their preferred method for recovery.  This also empowers male clients, offering them a way to collaborate and contribute to their own treatment process.

Sometimes the answers clients give reveal the client has very little hope in therapy in general.  In those cases, it becomes more important to explore ways to increase hope before more recommendations are made.

Clinicians can also use this as an opportunity to task clients to do some “research” and identify people who have recovered from similar situations.  Stories of others’ success increase hope and motivation for change.

 QUESTION 4: “Since this all happened, when have you felt at your best?”

Traumatic experiences can alter our observational skills.  Often times, periods when symptoms are less intense (or absent) remain outside of our client’s awareness.  If a client has no clearly defined goal, or they seem to “complain” habitually in session, it is very useful to provide the client with observational tasks.

This question increases the client’s awareness of what is working in their life and has a meditative quality, allowing them to be more present for greater periods of time.  It also enhances confidence and hope that may set the groundwork for the client to begin communicating about future goals for therapy.  Remember that attention is a limited resource, so whatever your client focuses on gets bigger.

 QUESTION 5:  “Who do you feel closest to in your life?”

David W. Smith coined the term “Friendless American Male” during the 1980’s recognizing the consequences associated with disconnected men.  Many healthy men prefer to connect and socialize with each other through experience rather than dialogue.  In building a positive post-traumatic identity, men can benefit from the company and friendship with other men.

This question helps to identity places of support and connection already in place in the client’s life.  Each client is different and therefore patterns and preferences for connection may be vastly different.  However, this is a respectful way to enhance the client’s support network and enhance their awareness of their process of connection. Once recognized, it may be replicated.

Sometimes, clients may respond saying that they are close to no one in their life.  In those cases, it may be useful to ask them if there was anyone they were close to in their past. If so, how did they go about that process?

CONCLUSION

Remember that all people are patterns that persist.  Change the pattern you focus on, change the life you lead.  Have the courage to ask better questions with your clients.  Our lives are the answers the questions we ask.  Better questions can mean a better life for your clients.

SELECT RESOURCES

Post Traumatic Success: Positive Psychology and Solution-Focused Strategies to Help Clients Survive and Thrive by Fredrike Bannink 2014 (book)

101 Solution-Focused Questions for Help with Trauma by Fredrike Bannink  2015 (book)

American Psychological Association “10 Factors of Resilience”

Based on TIP 56: Addressing the Specific Behavioral Health Needs of Men KAP Keys for Clinicians (SAMHSA)   

 TIP 56: A Treatment  Improvement Protocol Addressing the Specific Behavioral Health Needs of Men 

 Grit: The Power of Passion and Purpose by Angela Duckworth (book)

Essential Research Findings in Counseling and Psychotherapy, the Facts are Friendly by Mick Cooper (book)

Video-“Facts are Friendly Pt 1” – Mick Cooper

Video-“Facts are Friendly Pt 2” – Mick Cooper

Video-“Facts are Friendly Pt 3”  – Mick Cooper

1001 Solution-Focused Questions by Fredrike Bannink (book)

Quick Steps to Resolving Trauma by Bill O’Hanlon (book)

BRIEF, an SF training institute in London

ICCE, a worldwide community dedicated to promoting excellence in behavioral healthcare services

Pennsylvania University  Positive Psychology Center (Seligman)

Penn University with positive psychology questionnaires (VIA Character Strengths Survey)

 Author Bio: Daniel Lawson, LMHC, CASAC, works in private practice in Buffalo, NY. He specializes in working with men to overcome issues with relationships, depression, anxiety, substance abuse, death of a child, childhood trauma, or feelings of anger. Dan is a passionate, eclectic practitioner and bases his practice heavily on a solution-focused approach to therapy.  As a result, many of his clients see the results they are looking for in less than six sessions. Dan also uses DBT, positive psychology, mindfulness, CBT, existential, motivational interviewing, and narrative therapy. When working with men, he focuses on restoring hope and connecting them to their ability to do what it takes to heal. In every session, clients leave with a plan to begin improving their life. In addition, Dan also specializes in supporting Catholic men and woman. He effectively combines his faith with his psychological training to provide therapy deeply rooted in Catholic Theology and Philosophy. Dan is a balanced professional and works effectively with his clients regardless of their spiritual/religious beliefs.  Prior to starting a private practice, Dan worked at Horizon Health Services for ten years. In addition to his clinical experience, Dan has experience in training provision and clinical supervision services.  Visit his websites for information at:

http://catholictherapysolutions.com

www.counselorscorner.net/clinicians.html

 

 

 





Got Barriers? Improving Access to Mental Health Care for Children & Adolescents

23 01 2015

Guest author:

Melanie Washington, LMSW, MPH, PhD candidate

  Child concerns on a corkboard

If it were not for social work interventions I had as a child, my life trajectory may have been completely different.  I am eternally grateful for those individuals who, with moderate intervention, helped to shape the individual that I am today and be a part of what facilitated the passion that I have for mental health care for children and adolescents.  With my life experiences, both personally and professionally, I fervently believe that every child deserves the opportunity to have mental health treatment, therefore it is my hope through my future work we will be able to figure out solutions to help increase access to mental health care for all children.

I had my first interaction with a social worker in second grade.  I was fortunate to have parents who recognized the struggle that I was having and were unconcerned about the stigma of seeking mental health treatment.  In general, I was an irritable, angry, and strong willed child, with a low sense of self-worth (it wasn’t until I was an adult that I was diagnosed with depression and learned that this is often how depression presents in young children).  However, at school, I was shy and quiet, allowing myself to be walked on by my peers and then I would come home and take it out on my family, verbally and physically.  It was through family and individual work that I was able to start making improvements and gaining more confidence in myself.

Then in sixth grade, I became well acquainted with the school social worker who assisted me in dealing with tremendous challenges and stress at home (although this time I was not the cause of it).  Her assistance and support shaped not only my personal trajectory, but also my career.

After obtaining my bachelors in social work, I worked as an intake coordinator in an outpatient mental health clinic for children and adolescents; I saw the heartache and immense challenges caregiver’s face in attempting to access treatment for their children.  Therefore, I made the decision to go back to school to become a researcher to find solutions to this issue.  I have also begun working on an exciting new grant funding a white paper exploring the issues of access to child and adolescent mental health care in Western New York.

Why is this issue important?

  • Children globally (1 out of 4) have at least one diagnosable mental health disorder.
  • There are not enough child mental health providers to meet the current needs within the population.
  • The World Health Organization has estimated a 50% increase in childhood mental health needs by 2020.

Closed Road with signs

Potential (and too often) Real Barriers:

  • Financial barriers:
    • Insurance coverage- plan may not include mental health services, minimal number of visits allowed, therapists may not be “in network”, may have high deductible plan
    • No insurance
    • Co-pays and families without money to pay the co-pay
    • Sliding fee scales- if they are offered, still may not be low enough for families to afford the payment
  • Geographic barriers: There may not be any clinics in the communities in which individuals live. If a child is below the age of 5, the family may have to travel further distances to find a therapist willing to see children under this age
  • Transportation barriers: Does the family own a car? Can they afford gas? If not, do they have access to Medicaid funded transportation or have money to take the bus? Is your clinic on a bus line? How many bus transfers would might families have to take to get to the office? Is there enough time for the family to take the bus to the appointment after they get out of work? Is the family ashamed or embarrassed to tell you that they don’t have the adequate transportation to access services?
  • Organizational barriers:
    • Hours of operation: Do the clinic hours of operation provide enough flexibility for days, evenings and weekend appointments or does the schedule of therapy create a barrier to access?
    • Does the clinic engage in practices of double booking that can cause people to wait past their appointment time when both appointments show up as scheduled and someone has to wait? These delays may not be tolerable for the children and adolescent or their family due to behavioral and schedule needs (such as the last bus leaves before their appointment ends).
    • Is there enough diversity in the sex and race/ethnicity of therapists so that families have a choice of someone they feel comfortable with?
    • Are there therapists who have appropriate specializations to work with diverse clientele in a clinic as well as evidence-based treatment skills to provide effective treatment?
    • Is the organization trauma-informed and trauma-sensitive so that people seen feel safe and welcome, and are not re-traumatized through service provision?
  • Availability of services:
    • Is a family able to easily obtain an appointment when they first call? If not, what does the process entail for a family to get one? How long do they have to wait for the first appointment? How are they treated by the person who handles the initial contact with the agency? Does the family feel cared for, engaged and that their social or cultural differences will be recognized and understood?
    • If an appointment is given, is it within a reasonable period of time?
    • Are there therapists available to take on new clients?
    • Are there delays or interruption in service being provided- for example if an agency has a high turnover rate, how long to families have to wait to see a new therapist when their current one leaves, and what impact might that disruption in services have on the child?
  • Lack of awareness and willingness to access care:
    • Caregivers may not recognize the signs that a child or adolescent needs mental health treatment. Or they feel there is a stigma related to this. How to we help educate them?
    • Caregiver may be unsure about how to access care, who to ask, and how to navigate the mental health system. Their primary physician also may not be knowledgeable about how to assist them. How do we help them find access to care?
    • Fear: Caregivers may be fearful that if their child does need mental health care that they will be blamed for their child’s behavior or that their child will be taken away from them. Social workers are often equated with Child Protection Services and the myth that CPS only takes away children from families. How do we educate families that therapists can help?

  Kids enjoying family timeThere are many barriers faced by families as they attempt to obtain mental health services for their children.  Yet I passionately believe we also have also have the ability to create some solutions for children and adolescents, their families, mental health care organizations, and the research and policy community.

Possible Solutions for Families:

  • Take action! If you are concerned about your child, talk to their primary care doctor or school social workers.
  • Keep a positive attitude: Help is available and the sooner mental health issues receive effective interventions, the healthier the outcome will be for the child and family.
  • Don’t worry: Getting mental health help for your child does not mean you are a bad parent!
  • Communicate (there is a questions at the end of this post to ask of different providers) with your child’s providers and advocate for them if you do not like the way services are provided. (There is a link at the end of this post on the family resource page with 25 ways to advocate for your child.)

 Possible Solutions for Organizations:

  • Improve engagement and retention of clients by following Trauma-informed Care (TIC) principles and educate all staff at the clinic, from the receptionist to the director on TIC. (Refer to the resource section at the end of this post.)
  • Review and adjust, if needed, clinic hours of operation to ensure they meet the needs of family schedules.
  • Attempt to hire a diverse group of individuals and provide training in cultural competency.
  • Advance the education of your workforce to enhance their skills in treatment provision including evidence-based treatments
  • Include access to services in agency strategic planning.
  • Review and adjust, if needed, your intake process. For example: is there a way to streamline it and make it more family friendly, decrease the waiting times for services, etc.?
  • Review and adjust, if needed, scheduling so that clinicians can see their clients at the time that their appointments are scheduled.
  • Pursue grants or a charitable fund to assist families who are unable to cover the cost of services, bus passes to get to the clinic, and other needs that create barriers to access.
  • Consider, if possible, performing home or school visits for families who have transportation issues.

Possible Large System Solutions:

  • Enhanced integration of physical and mental healthcare
    • Mental health screenings in pediatric clinics, starting from birth
    • Having mental health professionals on staff so that a child or adolescent screens positive they are able to see someone immediately, in addition to providing regular treatment
  • Enhanced integration of mental health clinics into schools or increase of therapists within schools who are able to provide regular psychotherapy, as opposed to crisis management
  • Evaluate tele-mental health: To assist with families to who have transportation issues or may not have easy geographic access to a mental health clinic. Yes, billable regulations need to be investigated and policy advocacy may be part of this with funding bodies.

 Resources:

New York Child and Adolescent Psychiatry for Primary Care

25 ways to advocate for your child

Questions for caregivers to ask providers

SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach

US Dept. of Health & Human Services. Access to Adolescent Health. Access to Mental Health Care

American Psychological Association. Strengthening the Child and Adolescent Mental Health Workforce

American Psychological Association. Increasing Access and Coordination of Quality Mental Health Services for Children and Adolescents

Photo Credits

Closed Road with Signs

Child Concerns on a Cork Board

Piggy Ride Time, Kids Enjoying








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