An Overview of Strengths-Based Theory and Practice in Uniting Care Burnside
This overview is based on a literature review written by Dianne Nixon for the purpose of promoting discussion within UnitingCare Burnside on the incorporation of strengths-based approaches into all aspects of Burnside’s work. (The material in the original literature review is partly based on work done for a Commonwealth Parents and Domestic Violence (PADV) project on strengths-based approaches in domestic violence situations, also prepared by Dianne Nixon, Social Justice and Research, 2001). A full transcript of the ‘Strengths-based Practice in UnitingCare Burnside’ paper is available from Social Justice and Research.
Theoretical Framework
In strengths-based approaches it is argued that traditional problem solving approaches are based upon the medical model, involving an initial diagnosis or assessment, followed by professional treatment, of an illness (De Jong and Berg, 1998). Therapists following a strengths-based model believe it is more appropriate to actively focus on identifying and building upon client strengths. The focus in counselling or groups is therefore on the identification of these strengths, in collaboration with the client, rather than an extensive focus on the problem / abuse, or illness.
Saleebey (1992) identifies the following assumptions as underlying strengths-based work:
§ Respecting client strengths
§ Clients have many strengths
§ Client motivation is based on fostering client strengths
§ The worker is collaborator with the client
§ Avoiding the victim mindset, and
§ Any environment is full of resources
Saleebey argues that the use of strength-based approaches 'requires a deep belief in the necessity of democracy and the contingent capacity of people to participate in the decisions and actions that define their world' (ibid:8). A strength-based approach therefore supports social action and the addressing of inequalities in society, reflecting a belief in the client’s strengths and contributions to society, rather than a focus on their problems. Saleebey firmly places strengths-based work as a political statement as much as a therapeutic approach.
Strengths based approaches such as ‘Narrative’, ‘Solution-focused’, and ‘Appreciative Inquiry’ seek to enhance the competence of the client. A wide range of therapeutic techniques may be used which endeavour to rewrite the victim’s ‘life script’, for example, from that of victim, to that of courageous survivor who is working to overcome the effects of child sexual abuse (White and Epston, 1989).
In these approaches, the worker encourages the service user to see that they are not the problem. Notions of pathology, dysfunction, or diagnostic labels suggest that problems are part of people. This leaves them unable to experience themselves as having any personal agency in finding the solution (De Jong & Berg, 1998).
Parton & O'Byrne (2000) have described a strengths-based approach in social work through examining the post-modern themes of constructivism. The Constructivist movement developed in the last part of the 20th Century, with the basic belief that children and adults construct their versions of reality from their own unique experiences (Nixon & Gould, 1999). It assumes that how we perceive things is mediated by culture, language, and subjective meaning, and that human experience reflects a dynamic interplay between events and the meanings we attach to them. We constantly shape our reality and negotiate its meaning as a social process. What is 'real' is what we believe to be so and what others may choose to agree with (Gergen, in Saleebey 1981:21). It is opposed to the scientific model of knowledge, whereby reality can be measured, tested, and objectively verified. Problems therefore reflect not what we are looking at, but who is doing the looking.
Parton & Byrne (200:24) summarize the underlying assumptions of this approach as:
§ practitioners must develop a critical stance towards assumed ways of understanding the world, including their own assumptions
§ Categories and concepts commonly used to understand the world are seen as culturally and historically specific, and therefore meaning varies over time and place. Practitioners should not assume that their ways of understanding are necessarily the same as others' and are any nearer the truth;
§ Knowledge of the world is developed between people in their daily interactions such that practitioners should be centrally concerned with the social processes carrying these changes, and how the knowledge can be changed, and
§ The social world is the product of social processes. There cannot be any given, determined nature of the world 'out there' and no hidden essences inside people that make them what they are. No-one is intrinsically ‘evil’ and no situation lacks strengths.
Different methodologies that use a strengths-based approach
Any way of working with others can use a strengths-based approach, however there are a few approaches, outlined below, which have been specifically developed on a strengths-based philosophy, and are commonly associated with this approach. Nevertheless using a strengths-based approach should not be seen as limited to these therapeutic and group approaches.
Solution-Focused Brief Therapy
‘Solution Focused Brief’ therapy has a central philosophy that clients bring with them strengths and capacities they can access and develop to make their lives more satisfactory (Corcoran 2000:468). The client is the expert and the therapist is responsible for developing a collaborative context and helping the client articulate desired changes.
The working principles of Solution Focused intervention include the following:
§ People are in a constant process of making sense of their experience. Beliefs about self and others, values, expectations, societal prescriptions serve to keep people from noticing information about themselves, others or relationships that would allow them to move forward.
§ People experience problems as problems and generally want things to be better, and the persistence of difficulties does not imply addiction. It is unhelpful to think in terms of resistance or denial. People’s potential for change is limited by their awareness of other possibilities, and this awareness needs to be developed by the worker.
§ Problems do not indicate pathology. Problems are seen as occurring within the context of human interaction. Problem patterns include both behaviour and perceptions.
§ People have tried to solve their problems, but the attempts have failed to bring about the desired relief. These attempted solutions frequently lead people to focus more on the problem, and how they feel stuck, than to focus on alternate solutions.
§ People have within them a wealth of resources both known and unknown to them. One of the main effects of problems, and peoples’ experience of them is to blind them from noticing their strengths and capabilities, or the solution-orientated behaviour that already exists.
§ The problem is the problem. The person is not the problem. Notions of pathology, dysfunction and diagnostic labels suggest that problems are part of people, which leaves them unable to experience themselves as having any personal agency in finding the solution.
§ Change is constant and, in fact, inevitable. Snowball effect...small change can lead to bigger and bigger change. The best changes are those identified by the client rather than the therapist, and they can be framed as part of a process of small steps.
§ Every problem-dominated pattern includes examples of exceptions that serve as hints towards solutions.
§ New and beneficial meanings can be constructed for at least some aspects of the client's complaint. The problem can be redefined in a way that promotes the identification of existing solution-behaviour.
§ “If it works, don’t fix it”. In fact, encourage the client to do more of it. If it’s not working do something else.
§ Effective therapy can be done even when the therapist cannot describe exactly what the problem is, or when clients don’t agree on the definition of the problem. It is more important to know what will be different when the problem is solved.
Solution focused approaches emphasize the importance of ‘well formed goals’, the characteristics of which include:
§ Stated in positive terms
§ In a process form
§ In the here and now
§ As specific as possible
§ Within the client’s control
§ In plain language
(De Jong, P. & Berg, I.S., 1998)
Narrative Therapy
Narrative therapy believes that problems arise because people are induced by our culture into subscribing to narrow and self-defeating views of themselves and the world. Narrative therapies complete the process of widening the circle of culpability for problems (Schwarz, 1999:263). White and Epson 1990 (in Etchison 2000:61) state that narrative therapy is based on the idea that problems are manufactured in social, cultural and political contexts. Thus change occurs by exploring how language is used to construct and maintain problems (Cowley & Springen, 1995, in Etchison, 2000:61). Experiences are collapsed into narrative structures or stories to give a frame of reference for understanding and making experiences understandable.
Omer (1993,1994, in Parton & O'Byrne, 2000:161) identified 4 elements in narrative therapy that are particularly valuable, though not of universal effectiveness. They are:
§ Use of client's narratives
§ Validating the seriousness of problems
§ Externalizing the problem to make the client a hero/heroine
§ Developing options for a new character.
The worker and the client therefore re-construct the client's story together. As Parton & O'Byrne state (2000:162) 'No two solutions will ever be the same and we cannot tell what any particular solution will look like until it is built, though they may be built in a similar manner.' The basic assumption of narrative therapy is that service users have the resources that are needed and also know how to get what they want, but it is only by talking about it do they get to know what they know (Parton & O'Byrne 2000:162).
Appreciative Inquiry
Appreciative Inquiry is an approach that extends strengths-based concepts into organizational group learning. The approach can be used to plan for and create change by looking for what works within a group, and build on these to create new ways of working together.
The approach is built on the following principles:
§ Inquiry into what is possible should begin with appreciation. The primary task is to describe and explain those exceptional moments, which give energy to the group and activate member's competencies and energies.
§ Inquiry into what's possible should be applicable. Study should lead to the creation of knowledge that can be used, applied, and validated in action.
§ Inquiry into what is possible should be provocative. A group is capable of becoming more than it is at any given moment, and learning how to determine its own future.
§ Inquiry into the human potential in the group should be collaborative. This assumes an inseparable relationship between the process of inquiry and its content.
Hammond (1996) argues strongly that in order to adopt a strength-based approach in groups, the 'language of deficit' must be actively replaced, in order to address unconscious sets of assumptions that create individual frames of reference. In order to apply ‘Appreciative Inquiry’ to organisational group learning, Hammond suggested the following process:
§ clearly identify the topic
§ generate the questions from within the group
§ explore and gather existing information from within the group
§ present and combine this information to create new a new information base for future action.
E valuating Strengths-Based Approaches
Evaluations and studies of outcomes of strengths-based approaches in therapeutic settings are limited in their validity by their general lack of control groups, which means there is no real comparison point to measure results from. In general, evaluations suggest that this way of working is at least as effective as others, even though it tends to have shorter involvement in people's lives (Parton & O'Byrne, 2000). The authors cite ongoing research by de Shazer's team (ibid:153) to argue that the studies suggest that not only is the effect maintained over time, but it actually tends to increase its impact rather than wash out.
Sundman’s research in ‘Solution Focussed Brief’ therapy in Finland showed that there were no significant changes in goal achievement, but in line with solution focused orientation there were increases in positive statements, goal focusing, and shared views between therapists and their clients. (Sundman 1997:159). Clients and therapists ‘felt better’ even though the problem remained the same as the control group, but solutions focused clients were more focused towards their goals and more engaged in problem solving with the therapist. The process, but not necessarily the outcomes, was successful.
McKeel (1996, in Miller, Hubble & Duncan) in an overview of evaluations and research on Solution Focussed Brief therapy argues that evidence is building that this approach can be effective for a wide range of clinical presentations, including severe and chronic problems. However, the author admits that knowledge on which interventions and approaches, currently used under the umbrella of Solution Focussed Brief therapy, are most effective is poorly researched. McKeel urges practitioners to use a research and development strategy when exploring new or untested interventions. The author outlines this strategy as similar to a small research study, where new approaches are tested over a number of interventions and then evaluated and assessed using standard questions which include client input.
The following general points can be made from existing research and evaluations of strengths-based therapeutic programs, mainly solution-focused brief therapy:
§ At a one-year follow-up, 64% of clients were shown to have improved in their problem-solving approaches. However those with longstanding problems do less well. Equal outcomes found for all social classes (Macdonald, 1997)
§ For solution-focused parenting groups, improvement was shown on the Parenting Skills Inventory, no change on Family Strengths assessment (Zimmerman et al, 1996)
§ Research suggests that brief therapy is an effective treatment for a broad range of client problems such as depression, suicide, sleep problems, eating disorders, parent-child conflict, marital/ relationship/ sexual problems, sexual abuse, family violence and self-esteem problems (de Jong & Berg, 1998).
§ The number of sessions a client attends and whether they accomplish their treatment goals seem related. The highest success rate is where clients attend four or more sessions, the lowest when they attend below three sessions (Macdonald, 1997)
§ In their evaluations of brief therapy counselling, clients nominate their relationship with their therapist as more influential to treatment success than any specific technique their therapist uses (Shilts, Rambo & Hernandez, 1997; Metcalf et al, 1996). Qualities included respectfulness, time to listen, and the care and concern the therapist showed
In one study (Sunderman 1997, in Parton & O'Byrne p.155) of a social work team in Helinski using solution-focused work, a comparison group was used. While no significant differences were found with the comparison group in terms of goal achievement, the service users were more satisfied, more goal focused and more engaged with workers in joint problem-solving i.e. the work was more collaborative.