Brief Solution-Focused Counseling: A Practical Effective Strategy for Dealing with Wait Lists in Community-Based Mental Health Services
Mireau, Ruth, Inch, Roxanne, Social Work
Community-based mental health services are funded by the provincial government in most Canadian provinces and, in Saskatchewan, are provided through local health regions as a part of the public health care system. Resource allocation in public mental health has not matched the demand for service, resulting in waiting lists, a problem faced by many social workers working in publicly funded mental health services. In this article, we describe our efforts to apply evidence-based practice strategies to our clinical setting. A strengths-based brief solution-focused counseling (BSFC) model was used to increase the number of clients served. The program was evaluated to ensure that clients continued to benefit from the counseling being offered, despite the reduction in number of sessions being offered. We discuss the challenges faced by social workers who introduce evaluation tools in a clinical setting. We believe this article can serve as a model for social workers who plan to explore clinical challenges and then evaluate their interventions.
Wait List Dynamics and Statistics
Wait lists result when demand for service outstrips resources (Brown, Parker, & Godding, 2002), challenging practitioners to "struggle continuously with how to serve our clients most effectively and efficiently" (Pinkerton, 1996, p. 315). Waiting lists have an unacceptable cost to clients (McGurran & Noseworthy, 2002; Smith & Hadorn, 2002) and to counselors (Douglas, 2001). Clients on wait lists experience more problems and experience lower motivation and poorer outcomes as the waiting period lengthens (Brown et al., 2002; Douglas, 2001; Job, 1999; Jones, Lucey, & Wadland, 2000; McGurran & Noseworthy, 2002). In contrast, clients who have very short waits prior to their first appointments are more likely to show up for their appointments (James & Milne, 1997). In mental health, no standards have been set for acceptable waiting times (Brown et al., 2002; Job, 1999), though evidence indicates that client motivation starts to diminish two weeks after they request service (Hicks & Hickman, 1994). Counselors who are aware of the pressure of wait lists also report discomfort, anxiety, and dissonance (Douglas, 2001). Our solution has been to provide a specific model of brief counseling to clients.
What Is Brief Solution-Focused Counseling?
There are many brief counseling approaches (Carlson & Sperry, 2000) that use a variety of theoretical models, most of which have been described in the literature as effective when evaluated with standardized questionnaires (Bloom, Yeager, & Roberts, 2004; Vonk & Thyer, 1999). In the Adult Counseling Program, we use a solution-focused (Berg & Dolan, 2001 ; DeJong 8: Berg, 2002; de Shazer, 1988; O'Hanlon & Weiner-Davis, 2003; Stalker, Levene, & Coady, 1999), strengths-based (Blundo, 2001; Saleebey, 2002) model.
In addition to being strengths-based, BSFC uses the positive expectations of therapists to affect client success. In BSFC there is no right way for clients to do things, and rapid change is possible (DeJong & Berg, 2002; de Shazer, 1988; O'Hanlon & Weiner-Davis, 2003), which often occurs within the first four to eight sessions of counseling (Howard, Lueger, Martinovich, & Lutz, 1996; Hubble, Duncan, & Miller, 1999).
Counselors who use this method make a conscious use of time by engaging the client quickly and keeping the client focused on goals and priorities. Though the therapy moves quickly, it is essential to develop a relationship with the client, as the therapeutic relationship has been strongly connected to success in therapy (Asay & Lambert, 1999; Duncan, Miller, & Sparks, 2004). The counselor works cooperatively with the client to create solutions built on strengths rather than on solving problems and curing illnesses (DeJong & Berg, 2002; de Shazer, 1988; Graybeal, 2001; McQuaide & Ehrenreich, 1997; Saleebey, 2002). …