Case Example: Amanda

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Amanda is a 28-year-old, single mother of a 2-year-old daughter who is seeking addiction counseling on an outpatient basis. Amanda indicates that she has been drinking and smoking cannabis since she was in high school and now' finds that she’s having trouble stopping. She explains that just about every weekend, she’ll go out with her friends and they usually end up drinking at a local bar and then will usually go over to one of her friend’s apartments where they smoke cannabis. Amanda is quick to point out that she is not foolish enough to drive, and instead w'ill take an Uber or Lyft home. She also points out that she does not drink or get high around her 2-year-old daughter, whom she drops off at her parents when she’s going out “partying” on the weekend. Amanda is worried because she feels she is “in a rut” that she can’t get out of and nearly every weekend is spent getting high with her friends, no matter what time of year it is. The following is an excerpt from Amanda’s session with Jennifer, who is a Solution-Focused addictions counselor.

COUNSELOR: Hello Amanda, I’m glad you could make the appointment today. Did you have any problems finding my office?

AMANDA: No, the directions you gave me were very helpful.

Jennifer then goes over some basic ground rules with Jennifer, such as confidentiality and duty to warn and she has Amanda sign an Informed Consent form.

COUNSELOR: So, tell me what brings you here today? What would you like to work on?

AMANDA: Well, like I mentioned to you on the phone when we set up today’s appointment, I’ve been struggling with trying to stay away from drinking and smoking pot, which 1 do just about every weekend.

COUNSELOR: You said,“just about every weekend,” does that mean there are times when you don’t drink or smoke pot?

Jennifer asks this question as a means of “Exception Finding" or instances when Amanda doesn’t drink or get high on weekends.

AMANDA: Yes there have been a few weekends when I didn’t go out. Like the weekend of my daughter, Suzies birthday. I didn’t go out at all that weekend because we had her “kid” party on Saturday and then her relatives/adult party on Sunday.

COUNSELOR: What was that weekend like for you? Did you miss going out with your friends?

AMANDA: No,not really. I did enjoy planning Suzies party and it was so incredible to see her get so excited opening her presents. I felt really good about hosting both parties for her.

COUNSELOR: So, you can go without drinking or drugging when you have something more important or more fun to do?

AMANDA: Yeah, I guess so ... I didn’t think of it that way, but you’re right. I really didn’t feel like I missed anything. Every weekend when I go out partying, is just like the last one, you know “same old, same old.”

COUNSELOR: With the weekend coming up, what do you have planned?

AMANDA: I’m supposed to meet up with Cathy and then we’re going over to the Roadhouse (a local bar) where her boyfriend’s band is playing this Friday night. She wanted everyone to go to help support his band.

COUNSELOR: How are you feeling about going out on Friday?

AMANDA: Well I work all week and there are some Fridays when I’m too tired to go out and would just like to stay home.

Jennifer asks a “Scaling Question”

COUNSELOR: On a scale from 1 to 10 with 1 being “not important at all” and 10 being Very important,” how important would it be for you to go to the Roadside on Friday? Also using the same scale, how important would it be for you to stay home with Suzie on Friday?

AMANDA: I would give going out with friends about a 5 and staying home with Suzie this Friday about an 8.

COUNSELOR: So, it sounds like you’re leaning more towards staying home with Suzie? What would help to make that a relaxing and fun evening?

AMANDA: Suzie loves pizza, so we would order a pizza and then watch one of her favorite movies.

Jennifer introduces the Miracle Question.

COUNSELOR: That sounds like a relaxing evening. I’m going to give you a scenario and then ask you a strange question.This requires creativity and imagination. Are you willing to give this a try?

AMANDA: Sure, why not?

COUNSELOR: Okay. You can keep your eyes open or closed whichever is more comfortable for you. I’d like you to imagine that when you go to bed tonight, that during the night a miracle takes place. The miracle is that all of the conflict that you’ve been having regarding drinking and smoking pot, miraculously disappears, so that when you wake up in the morning, you’re no longer troubled by urges to drink or smoke.

My question is, when you wake up tomorrow, how would you know the miracle occurred during the night?

AMANDA: Wow that’s a tough one. I think the first thing I’d notice is that I’m totally at peace with myself. I’d be thinking clearly, not hungover or dreading going to work. I’d look forward to doing things rather than moping around.

COUNSELOR: Anything else you’d notice?

AMANDA: I think I’d really have a different attitude. Like just feeling better about myself. I don’t know, like being more at peace with myself

This brief case illustration provides you with a glimpse into what a Solution-Focused session might look like. Amanda comes into counseling looking for a solution to her dilemma of going out partying with her friends every weekend. She describes her situation as being in a “rut” or being stuck in a pattern of behavior that she is troubled with. Solution-Focused Therapy is a perfect approach to use with Amanda because she is seeking change.

Summary

The Solution-Focused model is essentially a change model which focuses on the goals that clients want to attain once the problems he or she is experiencing are no longer impeding their progress or aspirations. This model evolved out of concerns that traditional substance use disorders model and counseling placed too much emphasis on the 3 Ds (i.e. Disease, Denial and Dysfunction).Therefore, instead of viewing the role of counselors as being able to break down client denial of having a disease which had created dysfunction or unmanageability in his or her lives, SFT focuses instead at a future point in time when the problems no longer exist. Several useful techniques have evolved out of the SFT approach such as “the miracle question,” scaling questions and exception finding questions.

References

Berg, I.K. (1990a). Solution-focused therapy: An interview with Insoo Kim Berg. In J. Carlson, & J. A. Lewis, Addiction counseling series. Videotape series. Boston, MA: Allyn & Bacon.

Berg, I.K. (1990b). Goal negotiation with mandated clients. Milwaukee, WI: The Brief Family Therapy Center.

Berg, I.K. (1992,June 19—20). Working briefly with the chemically dependent person:A Solution-Focused approach. Workshop booklet. Ardmore, PA: Institute for Advanced Clinical Training. Inc.

Berg, I.K., & Miller, S.D. (1991). The 5-Step Treatment Model. From Working with the problem drinker: A Solution-Focused approach. Milwaukee, WI: The Brief Family Therapy Center.

Curran, RJ., Muthen, B.O., & Harford, T.C. (1998). The influence of changes in marital status on developmental trajectories of alcohol use in young adults. Journal of Studies on Alcohol, 59(6), 647-658.

Miller, S.D., & Berg, I.K. (1995). The Miracle Method: A radically new approach to problem drinking. New York:W.W. Norton.

Misch,D.A. (2007).“Natural Recovery”from alcohol abuse among college students.Journal of American College Health, 55(4), 215-218.

O’Malley, RM. (2004). Maturing out of problematic alcohol use. Alcohol Research & Health, 28(4), 202-204.

Perkinson, R. (2017). Chemical dependency counseling: A practical guide (5th edn). Oakland, CA: Sage Publications.

Robbins, L. (1979). Addict careers. In R. Dupont. A. Goldstein, & J. O’Donnell (Eds). Handbook on drug abuse (p. 332). Rockville, MD: National Institute on Drug Abuse.

Case Example: Amanda

Summary

Recommended Reading and Resources

References