Solution Focused Harm Reduction: Working effectively with people who misuse substances

By Seán Foy

This is the first book to explain the many synergies between solution focused brief therapy (SFBT) and harm reduction (HR). Seán Foy discusses how these two approaches are complementary and when used in conjunction, create a novel way of approaching addiction work. The book covers several detailed case studies examining how the concepts and theories of both approaches are intertwined to enhance and deepen the work undertaken with people who misuse and abuse substances. It will be of great interest to scholars of psychotherapy, social work, social care, addiction, nursing and health care, as well as to practitioners seeking a clearer understanding of solution focused brief therapy and harm reduction and how to apply these to case work with problematic drinkers and drug users.

• Language: English
• Publisher: Palgrave Macmillan
• Release date: Jan 30, 2018
• ISBN: 9783319723358

Book preview

© The Author(s) 2017

Seán FoySolution Focused Harm Reductionhttps://doi.org/10.1007/978-3-319-72335-8_1

1. Introduction

Seán Foy¹ 

(1)

The Learning Curve Institute, Westport, Mayo, Ireland

Abstract

In this chapter, we will provide some information on our journey into using SFBT and HR as a modality. The chapter will also set out the aims of the book and there is also a description of each chapters content.

Keywords

Harm reductionSolution focused brief therapyWet serviceAddictionNational Addiction CentreNational University of Ireland Galway (NUIG)University of the North of LondonCollege of Staten Island

The twin themes of this book—Harm Reduction (HR) and Solution Focused Brief Therapy (SFBT)—are themes which just a few short decades ago would have seemed like deliberate challenges to the prevailing orthodoxy of substance-misuse therapy: an orthodoxy that considered total abstinence as the optimum if not the sole valid goal of treatment, and that also considered lengthy and intensive therapy to be a necessity where positive outcomes were concerned. Over recent decades, however, due to a greater acceptance of research evidence and a more pragmatic approach by policy makers, both HR and brief therapeutic interventions for substance misusers have gained widespread acceptance. My aim in this book is to look at how HR and brief therapeutic interventions can be successfully combined in working with complex substance-misuse problems in clients who might previously have been considered virtually impossible to manage by health and social services. I intend to do this by drawing on the research and training literature on these themes while also drawing extensively on my practice experience in this field.

My journey to becoming a clinical psychologist has been one with many interesting diversions along the way: I have worked as a cleaner, a construction worker, a customer service agent with an airline, a bartender and a waiter. I also worked in an amusement park and in a pizza joint. In 2014, I finally achieved the end result of working as a clinical psychologist.

When I was 17 years old, I went to live in New York. I am originally from a small West of Ireland town and the journey to New York was made via a short stop working on the buildings in London. This was not because I loved working on the buildings in London but because I did not have the money to travel directly from Ireland to New York. I had failed my final exams in secondary school (high school) and was heading to work abroad as there was, at that time (the 1980s), very little work available in Ireland. Don’t misunderstand me here, I did not leave Ireland reluctantly, I was very happy to be travelling and New York as a destination seemed as exotic as it got. While living in New York I began studying psychology at the College of Staten Island and worked odd jobs to keep everything going. While in New York I became aware of the homeless population and always had a desire to assist in some way. My financial situation at the time meant that I could not finish my degree as a foreign student, so I was forced to leave New York and return to London. I returned, initially to the building trade where I worked for approximately one year. After this I began to work with people who were experiencing homelessness and I found that I really loved it. It was challenging and demanding but it was also amazingly rewarding. I really felt that what I was doing had meaning. It was so practical and it was a job I relished. Throughout my stay in London (approx. ten years) I worked within the homeless population services, and during that time I qualified with an addiction qualification (via the National Addiction Centre ) and a degree in social work (University of North London). When I returned to Ireland in 2000, I began working within a substance-misuse team and worked there for over 11 years. During that time I gained qualifications in counselling and psychotherapy and a Master’s in Addiction and I finally finished my degree in psychology. In 2011, I was accepted onto the Clinical Psychology programme at NUI Galway and I completed this in 2014. The reason I am explaining this to you, the reader, is not that you will sit back and say "gosh isn’t he a great guy", it’s more that; for me, it’s important that the reader can place me and where I am coming from. I do not consider myself to be an expert, as I don’t feel as if I know everything, which of course I don’t; but I have a body of experience that I hope to share with you throughout this book.

I have always been attracted to people who have a positive, realistic attitude. I often think of the glass half-full/half-empty scenario. If we choose to view the glass as half empty, this will have an impact on how we view life. If we view it as half full, life feels a little better. The reality is that the water is exactly at the 50% mark. How we view it and the way in which we choose to engage with that glass of water can determine our futures. I am not saying that there are not times when things are very difficult, there are. If you have lived a life, you have encountered pain as well as joy. We can focus on the pain or look to the knowledge we learned by experiencing it. We can look out for and comment on our ability for dealing with the pain. Ask ourselves, "How did we survive?" This approach to life has always been a positive thing for me.

The first time I was introduced to SFBT was when I was studying at the National Addiction Centre in London in the early 1990s. The approach, I thought, was a really nice one but I immediately felt it wouldn’t work with the client group I worked with. At the time I was working with people who were both alcohol dependent and homeless. I had been working with people who were experiencing homelessness for a few years at that stage and had worked in outreach teams and also direct access hostels for the homeless. At the exact moment I discovered SFBT, I was working in a residential setting where people were allowed to consume alcohol on the premises (often referred to as a wet house): essentially an HR residential unit for alcohol-dependent users.

My journey into HR work also began in the early 1990s when I first began to work with people who were experiencing homelessness. At first I found the approach almost counter-intuitive, as I felt that the best course of action for people who were addicted to a substance was to just stop. This view point did not take into consideration what the actual people I was working with wanted. I feel I always worked in a respectful way with people and always respected their wishes, including continued active drug use, but somewhere, initially at least, I felt that I should be doing something else in relation to a person’s drug use. However, this changed when I actually began to work with active drug and alcohol users and began to apply the theory and practice of HR to my work. I found the approach to be humanistic and focused on the wishes of the client. I began to feel the approach had merit. This practical approach was assisted greatly by my first qualification in addiction which I also began in the early 1990s. This application of theory to practice has always been a fascination with me. It may be that at heart I am a practical person. I often say to myself if there is a way to work that works, let us work it. Initially I began to work with alcohol-dependent clients and began to apply some of the strategies of HR to the work I was undertaking. This I could see was a respectful and evidenced way of working.

At the wet service I was working in, a large number of my clients were men and women over the age of 40 who felt unwilling or unable to stop drinking. Most had tried unsuccessfully to cut down or stop and our aim was to provide three square meals a day, ensure access to health care, key work people in order to identify and hopefully meet their unique needs and adopt an HR approach to their alcohol misuse.

I thought SFBT was a really good idea but there was no way it would work with the people I worked with. I was wrong. Looking back, I am unsure as to why I felt it wouldn’t work but I was pretty sure this SFBT thing wouldn’t work with my client group. Eventually, I began to use aspects of SFBT in my work and I was amazed at how the two approaches of HR and SFBT were a perfect fit for the work I was doing. I initially did not come to SFBT with the attitude that the approach would change my work or the lives of the people I worked with. I struggled with it and I kept thinking Yeah, it’s a really simple way of working but it just won’t work with the people I work with. I was intrigued though that there was an approach which seemed to be worth a shot. I was convinced that if it did actually work in any way with the client group I was working with, it deserved more study. Eventually, I was challenged by a colleague on the course I was doing to ask the miracle question ¹ of a client I worked with, and the result of this interaction has led to a love affair with the approach over the past 25 years. I hope to share that journey with you throughout this book and to demonstrate how both approaches can be interwoven in delivering interventions to people who are experiencing substance-related problems. It took me a while to appreciate how good this blended approach using SFBT and HR was. However, there was a Eureka moment and since then I have been realising more benefits to the clients I work with when practising SFBT and HR.

Given the prevalence of addiction in society and the fact that addiction is treatable, many therapists and students may feel insecure or unprepared to work with clients who have addiction issues. This book is aimed at assisting those who are interested in new and emerging ideas and theories on addiction work. Also, it aims to inform students who are looking to deepen their understanding and knowledge of working with people who are encountering problematic substance misuse. This book is not solely aimed at addiction specialists but rather at the broader cohort of health or service professionals who may encounter substance-misuse issues in their client groups. This book seeks to provide a clearer understanding of SFBT and HR and how to apply these theories and practices to actual casework with problematic substance misusers.

I have organised the chapters in this book in a manner that guides the reader through the theory and practice of SFBT and HR.

In Chap. 2, I will discuss the origins of SFBT and the basic concepts of the approach while also presenting an overview of the skills required to practice. The chapter will describe the unique contribution SFBT makes to therapy, its ethos and philosophy and how, although the concepts and tools appear simple, it doesn’t mean they are easy to put into practice. I will also include the narrative of my own journey with SFBT, as it was not a straightforward one.

In Chap. 3, I will provide an explanation of HR, from its historical beginnings to its current applications within various settings. This chapter will provide definitions of HR and outline the key principles of this approach. It will outline how HR is currently used, not just in addiction services but also in other areas of health care and promotion. The chapter will explore the common arguments for and against HR, how it is implemented and some real-life examples of HR being used within addiction services. The aim of this chapter is to introduce the reader to the concept of HR, while looking at the prevalence of addiction and how the definitions of addiction are being expanded.

In Chap. 4, I will discuss developments over the past decades in relation to the way in which alcohol and drug problems are conceptualised and managed. The way in which certain drugs and certain drug users are portrayed in the media and the knock-on effect in relation to law and policy will be discussed. The chapter also provides the reader with an overview of the explanation of the various approaches taken when working within addiction. The purpose of this chapter is to present an account of some of the more popular treatment modalities and also look at how SFBT and HR when combined are an effective approach to take when working with people who misuse substances.

In Chap. 5, I will discuss the application of SFBT and HR to people who misuse substances (case studies). The chapter will build on the preceding chapters of SFBT and HR and the differing approaches to addiction which exist. The case studies in this chapter will give examples of cases where the two approaches were combined and describe why this blending worked.

In Chap. 6, the final chapter, I will outline the similarities between HR and SFBT, how they complement each other and the strengths-based attributes which each modality provides. This chapter will be the conclusion of the book, drawing together the themes of the book and it will highlight how an understanding of HR can inform and strengthen the SFBT approach and vice versa. Finally, this chapter will outline, for professionals, students and researchers, how using a strengths-based approach to working with problematic drug users is client centred, humanistic and spirit lifting.

Footnotes

1

The miracle question is a key component of SFBT and will be discussed in detail in Chap. 2.

© The Author(s) 2017

Seán FoySolution Focused Harm Reductionhttps://doi.org/10.1007/978-3-319-72335-8_2

2. Solution Focused Brief Therapy: An Introduction

Seán Foy¹ 

(1)

The Learning Curve Institute, Westport, Mayo, Ireland

Abstract

In