Alternative Approaches: SFBT and Motivational Therapy

The AA/medical model and the traditional cognitive behavioral and psychoeducational therapies have dominated the substance abuse recovery and treatment areas. The more recent solution-focused and motivational therapies are erupting into the forefront of substance abuse treatment. They signal a changing epistemology toward privileging the voice of the client and utilizing his or her existing strengths in the treatment process. The shifting of language from the label patients to the currently preferred term clients is one small indicator of the shift. Cutting-edge therapies do not formally consider the traditional concepts of denial and resistance, and issues of dual diagnosis are considered tangential. The problem is defined by the clients and the solution is presumed to be known by the clients. The therapist acts as a skillful facilitator, positioned to elicit existing client knowledge and resources, using techniques such as the scaling and miracle questions, and largely avoiding pro blem talk. This model has been welcomed by those clients who prefer not giving up their control to a higher power or having to fit their beliefs into a norm for substance abuse treatment and recovery. In this unit, we explore the alternative treatments and their limitations and usefulness.
The unit presents a video called “The Right Path or the Wrong Path: Working with a Teenage Substance Misuser” about a 16-year-old African American girl. The interview was conducted at the Brief Family Therapy Center (BFTC) in Milwaukee, Wisconsin. The sessions and commentary contextualize the solution-focused theory and its philosophy about how change takes place in a therapeutic session. Clearly, the session demonstrates the underlying epistemological difference of SFBT as compared to more the traditional psychotherapeutic theories of cognitive behavioral, psychoeducational, and the AA/medical model evidence-based approaches to treatment.
The textbook and library reading for this unit elaborate on the use of SFBT with people who abuse substances.
Berg, I. K., & Miller, S. D. (1992). Working with the problem drinker: A solution-oriented approach. New York: Norton.
de Shazer, S., Berg, I. K., & Miller, D. The right path or the wrong path: Working with a teenage substance misuser [Video]. Milwaukee, WI: Brief Family Therapy Center (BFTC).
McCollum, E. E., Trepper, T. S., & Smock, S. (2004). Solution-focused brief group therapy for drug abuse: Rationale, content, and approaches. Journal of Family Psychotherapy, 14, 27–42.
To successfully complete this learning unit, you will be expected to:
1. Understand the paradigm shift in thinking from traditional treatment approaches with substance abuse to the collaborative solution-focused brief therapy principally described by Berg and Miller.
2. Understand, describe, and analyze the connections between motivational therapy and solution-focused therapy.
3. Submit your annotated bibliography of 15 peer-reviewed journal articles.

• Learning Activities
Unit 5 Study 1
Studies Readings
Use your Concepts of Chemical Dependency textbook and the Capella library to complete the following:
• Read Chapter 5, “The Alcohol Use Disorders,” pages 46–64. This chapter discusses the scope and complications of alcohol use disorders.
• Read Chapter 6, “Abuse of and Addiction to Barbiturates and Barbiturate-like Compounds,” pages 65–73. This chapter discusses the subjective effects of barbiturates and barbiturate-like drugs.
• Read D’Amico, Osilla, Miles, Ewing, Sullivan, Katz, and Hunter’s 2012 article, “Assessing Motivational Interviewing Integrity for Group Interventions With Adolescents,” from Psychology Of Addictive Behaviors, volume 26, issue 4, pages 994–1000.
• Read the Lewis and Osborne article, “Solution-Focused Counseling and Motivational Therapy: A Consideration of Confluence,” pages 38-48. This article looks at the influence of these therapy approaches over the last two decades.

Unit 5 Discussion 1: 1 page needed with minimum of 250 words and 2 references.
Motivational Interviewing
• You are meeting with the parents, teachers, and school counselors to pitch a motivational interviewing group therapy program for high school teens with alcohol and substance use concerns or use.
• Explain to the adults the principles of motivational interviewing (MI).
• Describe the MI group model and how it differs from the AA model and psychoeducational treatments.
• Predict the questions that the teachers and parents might ask about the approach. Develop and answer five questions of potential concern.
• Do not attend to logistics such as meeting times. Concentrate on theory and practical application to help the adult participants understand how you will help the teens with alcohol substance use issues.
• Cite your sources.


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