Humanistic, narrative and solution-focused models
The person-centred conditions, narrative therapy including with Aboriginal and Torres Strait Islander clients, and solution-focused brief therapy.
Quick check
Answer each one in your own words, then open the model answer to compare. Signed in, your answers are kept and marked, and the plan uses them.
1.After several sessions with a 28-year-old woman whose hospital discharge letters describe her as "non-compliant" and "chaotic", a psychologist working narratively considers writing to her between sessions. Her GP asks instead for a summary of the diagnosis and treatment plan. What does the psychologist write, and to whom?
Model answer
The two moves are to write the GP the clinical summary asked for, or to write the client a therapeutic letter and give the GP a brief factual update. Both letters can be written, but they are different documents. A therapeutic letter is written with the client, in her own words, and records the unique outcomes, her own knowledge and the people who stand with her, so that it counters the problem-saturated descriptions in her notes. The GP's summary is a clinical record and is not the place for it, and the client is told what the GP will be sent.
2.A 42-year-old man referred for his drinking says in the first session that "the grog" takes him over and that it is not really him who shouts at his children. The psychologist works narratively. Does the psychologist take up his externalising of the drinking as it stands?
Model answer
The two moves are to externalise "the grog" as he has offered it, or to hold back from externalising something he is responsible for. The second is right, with care for the alliance. Externalising the drinking as a force that acts on him risks moving him away from responsibility for the effects on his children, which is the caution narrative therapists themselves raise. The psychologist can externalise the ideas that back the drinking, such as what a man does after work, and keep mapping what the drinking has cost his children and him, so that the alternative story is built on the times he took responsibility.
3.In a fourth session a 50-year-old man says, "You keep nodding and saying you understand, but you don't." The psychologist feels stung and is unsure whether to apologise or to explain what she meant. What does she do?
Model answer
The two moves are to reassure him that she does understand, or to take his comment as accurate information and ask what she has missed. The second is right. The conditions only help if they are communicated by the psychologist and perceived by the client, so his perception is the evidence that matters, and warmth as a technique reads as a role. Genuineness here means acknowledging the misreading and taking responsibility for it, then asking him to say what it is like for him, from his frame of reference rather than hers.
4.A 36-year-old woman in crisis after a family breakdown says nothing has gone right for months and that she sometimes thinks the children would be better off without her. Her psychologist works in a solution-focused way. What comes first?
Model answer
The two moves are to ask a coping question about how she has kept getting the children to school, or to assess her risk of suicide. The risk assessment comes first. The guideline has risk assessed at the outset of the service and whenever it emerges, whatever the model, and a thought that the children would be better off without her is a risk statement that needs direct questions about suicidal thinking, plans and means. Once her safety is understood, the coping question is a good next move, because it draws out what she is already doing that works rather than offering encouragement from the psychologist's vantage point.
5.An Aboriginal community organisation asks a psychologist to help after a young man from the community dies in custody. Individual grief counselling has been offered and few people have come. What does the psychologist offer?
Model answer
The two moves are to offer individual counselling again, with better access, or to ask the community how it wants to respond and offer collective narrative practice. The second is right. Aboriginal families in this position have described what helped: renaming a story of personal guilt as one of injustice, listening teams reflecting their stories back so that people reclaimed pride, and the caring and sharing of community connection. The psychologist works with the organisation to design a gathering rather than deciding the format, and brings in Aboriginal practitioners and Elders to lead it.