Using Solution Focused Brief Therapy and Mindfulness Therapy: Is it Effective? (Dissertation Sample)

Using Solution Focused Brief Therapy and Mindfulness Therapy: Is it Effective? DISSERTATION PROSPECTUS Presented in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Counseling in
 the Adrian Dominican School of Education of Barry University
 by 
Josephine L. Rodriguez, L.M.F.T, L.M.H.C, NCC, Doctoral Candidate ***** Barry University 2015 Area of Specialization: Marital, Couple, and Family Counseling/Therapy ABSTRACT International and U.S guidelines often recommend the use of anti-depressants to treat recurrent mental issues such as depressive disorder. However, the current pharmacological interventions are often associated with a series of negative side effects that often prevent patient compliance and reduce efficacy. As a result, alternative effective therapies are being sought by mental health practitioners. The Mindfulness Based Cognitive Therapy (MBCT), developed by Segal, Williams and Teasdale is a variant of cognitive Behavioral Therapy (CBT) and is a form of psychotherapy intervention known to prevent relapse, especially in patients with major depressive disorder. MBCT may be effective in reducing depression, although further research is needed to test the outcomes of this type of psychotherapy. Solution-Focused Brief Therapy (SFBT) is a goal oriented therapy technique that targets the desired outcome of therapy as solution rather than focusing on the just negative symptoms. Both approaches are characterized by a series of strength, limitations and assumptions. It means that application of either MBCT or SFBT may be ineffective at times due to the limitations. Thus, the qualitative study will explore the benefits and dynamic of therapists who combine MBCT Mindful Therapy along with SFBT in order to test whether this approach is considered effective by therapists who utilize these approaches to reduce patient relapse and increase self management. CHAPTER 1: INTRODUCTION Background information In traditional counseling approaches for depressive disorder, a client with mental health issues is encouraged to open up to a stranger (the counselor) in ways that are different and more therapeutic than talking with friends or family members (Sharf, 2012). During talk therapy, the counselor affords a client quality time to talk, weep, and reflect. In simple terms, both the clients and the counselor get an opportunity to examine the presented problem in a different but respectful and encouraging manner. This aims at making the client feel better by providing an easier way to cope with the problem and at the same time feel happier. Powered by counseling, clients are able to think optimistically and improve their life coping skills. Further, counselors do not only help people recover from enduring psychological problems, but also prevent depression from reoccurring. From a broader perspective, different counseling interventions are based in theory and are used to treat diverse problems (Daniel, Abby and Shannon, 2013). They include Solution Focused Brief Therapy (SFBT), Cognitive Based Therapy (CBT), and Mindfulness Based Cognitive Therapy (MBCT) among others. Additionally, some patients are placed on pharmacological interventions (anti-depressants), which can complicate therapy due to their unintended side-effects. Further, depending on the specifics of the client’s condition, a counselor may choose to combine different approaches. This study will explore the effectiveness of integrating Mindfulness Therapy with Solution Focused Brief Therapy derived from counselors’ experience. Background of the Problem Psychiatric disorders such as Major Depressive Disorder (MDD), which are characterized by high rates of relapse and/or recurrence, triggered the invention of psychological interventions (Grossman et al., 2004). Relapse refers to a return of symptoms which suit the full syndrome criteria for an episode that occurs during remission period but prior to recovery (Hardeveld et al., 2010). The term remission denotes the period in which a person no longer meets syndrome criteria for the disorder and has no minimal symptoms. Recurrence, on the other hand, refers to appearance of a new episode of major depressive disorder. A study conducted in 2010 affirmed a recurrence rate of 85% observed in out-patients suffering from major depressive disorder for 15 years of follow-up (Hardeveld et al., 2010). The same study uncovered that recurrence risk increases by 16% after every successive episode (Hardeveld et al., 2010). Notably, psychiatric disorders are associated with massive psychological, social and economic burdens. Further, relapse or recurrence prevention is very critical. Consequently, maintenance treatment featuring antidepressant medication is the commonly used preventive strategy for relapse. International guidelines recommend that clients suffering from recurrent psychiatric disorders should take antidepressant medication for more than two years after remission. A meta-analysis conducted in University of Amsterdam founded that antidepressant medication (mADM) significantly reduces relapse or recurrence rates compared to placebo (Segal et al., 2010). Nonetheless, despite the mADM effectiveness as a preventive strategy, it is characterized by a series of disadvantages. To begin with, since significant numbers of clients are reluctant to use mADM for the recommended period, adherence is low. Further, just like in most pharmacological interventions, clients under mADM treatment experience upsetting side effects. Most importantly, several clients prefer psychological treatment over pharmacological intervention. Additionally, the mADM effects come to an end after discontinuation, whereas psychotherapeutic approaches such as MBCT are characterized by long-term and valuable effects (Segal et al., 2010). The term intervention refers to actions performed to bring about change in human life such as modifying behaviors. Currently, a series of psychological interventions directed towards different types of problems exist. For instance, psychotherapy is commonly used to treat mental disorders. From a broader perspective, psychological interventions alleviate symptoms through targeting the root cause of a problem. The interventions are tailored towards promoting healthy emotions, habits and attitudes rather than treating a particular condition (The British Psychological Society & the Royal College of Psychiatrists, 2011). Still, in the psychological interventions narrative, Segal, Williams & Teasdale, (2013) developed Mindfulness Therapy aimed at preventing relapse. Mindfulness Therapy is a contemporary restructuring of the customs surrounding ancient meditation associated with Buddhism. Through facilitating control of mind, Mindfulness Therapy helps in dealing with the problems attached to daily challenges. In tough situations such as loss of loved ones, people experience very strong emotions such as sadness. At times, such long lasting emotions incapacitate the victim. In other cases, obstructive thoughts such as “I wish I knew” accompany strong emotions. These thoughts further perpetuate powerful emotions resulting in loss of mind control (Michael et al, 2014). Consequently, Mindfulness-Based Cognitive Therapy aims at creating awareness of thoughts and bodily feelings, which in turn is helpful in handling daily emotions and troubles. Just like any other part of the body, understanding how the brain works as well as training it to perform better is very effective to persons suffering from depression. Mindfulness Therapy does not seek to either change or eliminate depressive symptoms, but rather to connect them in diverse ways. In simple terms, Mindfulness Therapy attends to a client’s condition in a more accepting and composed attitude. The term cognitive reactivity denotes negative thinking and behaviors reactivated during stress periods (Steven, 2015). Research by Daniel et al (2013) indicates negative cognitive reactivity lowers client’s moods, which in turn can result in recurrence of depression. Notably, there is a strong connection between cognitive reactivity and rumination. The term rumination denotes recurrent thinking about depressive symptoms, including their causes and repercussions. The condition is a significant factor attributed to cognitive vulnerability at the beginning of the relapse in depression. Consequently, Mindfulness Therapy recognizes such cognitive and behavioral changes. On top of cognitive reactivity and rumination, self-compassion, or self-management, Mindfulness Therapy protects against depression. Self-compassion is a combination of self-kindness, common humanity, and mindfulness. Self-kindness means being kind and understanding towards oneself in times of pain. Similarly, common humanity denotes perceiving individual experience as part of larger human experience. Mindfulness means holding hurting feelings and thoughts in an impartial consciousness (Daniel and Jason, 2015). From a broader perspective, a physiological approach to psychiatric disorders and associated complications such as substance abuse aims at reducing relapse chances, easing withdrawal symptoms, and improving behavioral skills. Both Cognitive Behavioral Therapy (CBT) and family therapy have the most research evidence for treating problems related to substance abuse (Becvar, 2012). On the same narrative, Solution Focused Brief Therapy is a common psychological intervention that develops a vision for the client’s future as well as determining the skills, resources, and abilities that can be easily enhanced to obtain the desired outcome (Bavelas, 2011). Solution Focused Brief Therapy (SFBT) is grounded on two premises. First, the therapy acknowledges that human beings face a lot of problems. Consequently, no one has the ability to perfectly attend to problems surrounding them as required. ‘Exceptions’ is a term used by DeShazer and Berg to...