This post is a very important one, because it’s time to outline some limits and say it black and white. I’m not officially trained for any mental illnesses, I’m not a psychologist nor a psychiatrist and within SFBT I cannot address every situation. There are several limitations. Although SFBT is reported to work at least as effective as any other therapeutic approach (see Gingerich, W. J. & Peterson, L. T. (2013). Effectiveness of Solution-Focused Brief Therapy: A Systematic Qualitative Review of Controlled Outcome Studies. Research on Social Work Practice, [online version], pp. 1-18 and
Franklin, C., Trepper, T. S., Gingerich, W. J., & McCollum, E. E. (2012). Solution-focused brief therapy: A handbook of evidence-based practice. New York, NY, US: Oxford University Press.)
and may work well with severe difficulties such as drug/alcohol abuse, family violence, anxiousness, etc. (see Langer’s presentation at http://casat.unr.edu/docs/StephenLanger_SolutionFocusedBriefTherapy.pdf for details), there are limits. It may not work with severe mental illnesses such as schizophrenia and bipolar disorder. It is also not appropriate to go into SFBT where one’s life is endangered/at risk.
I’ve been working with students with disabilities at my faculty for over 8 years. I had students with mental difficulties as well and wasn’t “properly” trained nor prepared for that. Did that prevent me from meeting them? It could, but I didn’t think about that back then. Also, I was one of the few who was there for them, as we don’t have any support centre for students with disabilities at our faculty as mentioned in one of the previous posts. I only wanted to see the student as he/she is. Up until now I had no such case where I couldn’t “deal” with the situation. Because there was no such situation. People didn’t come to me for diagnosis, nor did they come for any kind of assessment or treatment. They came to me because they felt comfortable with me. Because I was their colleague and because (they told me) they didn’t want to be treated or healed. They just wanted to be understood and wanted to get help they asked for, not their doctors/psychiatrists.
You may think these were students with mild mental difficulties. I don’t know, honestly. The students told me they had a diagnosis of depression, anxiety, epilepsy, autism, etc. and had a proof for that as otherwise they would not be granted disability status at the faculty and wouldn’t find me. As I’m not trained in this area and have only very basic knowledge about these mental health conditions*, this info didn’t influence my approach, so it’s up to you to decide how “difficult” their cases were from that point of view. I only had students in front of me and a sensitive ear to focus on what they wanted. I once had a student, who’s had several sort of panic/epilepsy attacks (her doctors and psychiatrists didn’t know for sure what she “had”, so they treated her with all sorts of drugs) and she had these attacks in class. You can imagine the panic she’s caused the teachers and students as well. On the day we were sitting together she told me she had an attack just the day before. I quietly asked myself what I would do if she had one now and of course I would look for help, but still, this didn’t turn me away from her in terms of “I would rather avoid seeing you than let the chance of attack happen while we’re together because I can’t deal with you”. Important to say: our meetings were not about her condition or about me trying to get her better. They were about her studies, but her situation and distress came up, so this is how I know about all this. In fact, I know much more, because she told me things she said nobody would listen to. And she was thankful for my non-judgemental response. Still I hear from her every now and then and I dare to think she considers me friends.
It would be different however, if she told me information that could be harmful to herself or others. Then it would be my duty to talk to someone who is trained in this area. But in this case that didn’t happen.
So dear reader, there are limits when it comes to safety and risk. Sometimes you have to react as a human being and do the right thing (like call 911 or refer the client to someone who’s trained to deal with these situations. In my eight years of practice fortunately I didn’t have a situation where I would have to do something like that, but such situation may come and it is necessary to be alert. One situation I may overlook may cause real harm.
On the other hand, I agree with one of my colleagues who made a comment when we addressed issues of risk when discussing launching Brief Coaching for our students. She said she’s been treated for depression she didn’t have and she was uncomfortable with being a “patient” where all she needed was an understanding ear. She found that in someone who was far from being trained for this, but it worked for her. Luckily. So due to one situation in which I may overlook some important signs of risk, should I give up the rest, where the outcomes may be outstanding in positive terms? What do you think?
* During my time working as a disability coordinator, of course I had to participate on courses and familiarize myself with all sorts of disabilities in terms of basic do’s and don’ts so I would be able to recognize and act accordingly. But I didn’t spend years on training/studying it. So please don’t get me wrong and do bear in mind, that training is very important. Kind of sensibilization training so that you can get an idea what it means to have for example dyslexia and you don’t confuse it with being lazy (and similar common mistakes made when pre-judging and making too fast presumptions and conclusions).