Introducing Solution Focused Therapy in Nepal
By Claudia van Zuiden and Sujen Maharjan
Keywords: Mental health; solution focused approach in Nepal; post trauma supervision
This paper will discuss how Claudia van Zuiden introduced solution focused brief therapy in Nepal, how she continued to deliver follow up workshops which included post trauma solution focused supervision and wellbeing plan, and includes a link to transcription of an interview held by Sujen Maharjan. During the interview Sujen and Claudia discussed how Claudia got into this technique, what inspired her to do social work in Nepal and what does she thinks about politics in Nepal; such as the idea if politics could be done in a solution-focused way? The paper also explores the outcomes of her work in Nepal and what the next steps will be in training others in SF interventions in Nepal and what needs to be done to be able to facilitate this.
Claudia van Zuiden is a solution focused practitioner, coach and workshop facilitator. Claudia has been a solution focused brief therapy practitioner since 2001 and is the CEO and founder of Solution Ways, a solution focused practice in Aberdeenshire, Scotland, United Kingdom. Claudia also works part-time in the community as a psychiatric support worker as part of a mental health team and has completed the COSCA modules 1,2,3,4 in counseling skills and completed training in solution focused brief therapy at Robert Gordon University at Aberdeen, Scotland, UK.
Over the last few years, Claudia has been invited to speak about ‘The Application of SBTF in Developing Countries” at international solution-focused practice conferences, such as at Herriot Watt University (2012), the World Conference of Solution Focused Practitioners, Barbizon Palace, Amsterdam (2014) and the Playfield Institute, NHS Fyve, Scotland, UK (2014).
Her workshops in solution-focused approach interventions have helped health professionals, students, youth workers, teachers, guidance teachers, volunteers and classroom assistants to practice and develop an understanding of the application of solution focused brief therapy and its approach. Claudia facilitates solution-focused practice workshops in the UK and abroad.
In 2011 and 2012 Claudia introduced and facilitated training in ‘The Application of SFBT Intervention Skills’ in Nepal. In June 2015 she went back to Nepal and delivered two workshops in post trauma support in a solution focused approach, which included a supervision model and a presentation of a wellbeing plan for health- and social work professionals, students and volunteers.
What is SOLUTION FOCUSED BRIEF THERAPY?
Solution focused brief therapy (SFBT), is often referred to as simply ‘solution focused therapy’ or ‘brief therapy’, is a type of talking or counselling psychotherapy that was developed in the 1980s by Steve de Shazer and Insoo Kim Berg, of MiIwaukee, USA and is now being used in many countries worldwide. SFBT focuses on what clients want to achieve through therapy, rather than on the problem(s) that made them seek help. Solution-focused brief therapy is an approach to psychotherapy based on solution-building rather than problem-solving.
The focus in the therapeutic session will be on enhancing the client’s resources, skills, competences, strengths and possibilities. The therapist and client will be working together towards the client’s preferred future or goal.
The approach has been successfully utilised for over a decade in many settings including alcohol and drug addictions, sexual abuse, violent relationships, depression, anxiety and phobias, and many other settings where people consider they have a problem (DeShazer et al, 2007).
Claudia believes that SFBT can be helpful in countries where there are very few mental health resources available and where there is a lack of funding for counseling support.
In May 2010, the Himalayan Times published that, according to Dr. Sherchan, director of Mental Hospital, “Around thirteen per cent of illnesses are related to mental diseases”. The major challenge is that less than one percent of health care expenditure in Nepal goes to mental health. Across the whole country, there are estimated to be around 440 in-patient beds for people with mental illness (combining both governmental, 112 and private hospital facilities, 327); which amounts to 1.5 beds per 100,000 population. No separate in-patient service is available for children with mental illness in Nepal. ((Luitel et al, 2015).
Many health professionals in developing countries are dealing with the same financial problem resulting in not being able to facilitate critically required training in the mental health sector. As mentioned by Subrath Shrestha; “ Depression is an unseen pain of the communities struggling with poverty, and is clearly noteworthy that poverty is a deep root cause of depression. For these reasons, poverty needs to be addressed to alleviate depression and the associated, mental health disorders”. (Shrestha, 2008).
Claudia’s aim is to share the application of solution focused interventions approach in developing countries, such as Nepal for free. The solution focused approach can provide mental health support in a few sessions to people who suffer from depression and other mental health needs as opposed to offering a lengthy counselling therapeutic intervention program. A. J. McKeel mentions that “In a study of 275 cases receiving SFBT, De Jong and Berg (1998) report that the average number of sessions was 2.9 and a Johnson & Shaha’s (1996) study reports the average number of sessions of clients receiving SFBT was 4.77.” (McKeel, 1996).
Claudia has visited Nepal several times for the last fifteen years and has been, on a small scale, involved in certain projects in relation to childcare, cessation of human trafficking and women empowerment support programs. Claudia has also been studying Buddhism for more than twenty five years.
Claudia strives to promote awareness to go beyond the stigma of mental health and to promote positive and empowering tools and skills for people who have little access to mental health supportive resources in developing countries, such as Nepal.
As a qualified Solution Focused Practitioner, Claudia believes that training people in Solution Focused interventions can benefit counsellors and those who work in the mental health support and in the psychosocial sector, to learn and develop an additional professional skill.
Clients with mental health needs often are not much aware or made aware of their own expertise, strengths and capabilities. Solution-focused approach interventions aim to, by asking certain skilful questions, empower people and to bring awareness of, and elicit, skills and strengths that people already have and have used in the past. By interviewing clients in a solution-focused manner, professionals can also find out much about finding solutions to a problem that a client brings to a session. By applying these simple, however seldom easy, questions and coming from a ‘not knowing’ and inquisitive stance, professionals are able to find out what and who is around in the supportive social environment of the clients too. Discussing and exploring the options of support in the clients’ social environment and how this has been helpful in the past for the clients, clients can explore ways of how this can be beneficial to them in the present moment also. Or clients can determine more of other resources available that can help them to take small steps towards their preferred future. At times, during therapeutic sessions with clients, we can find that there is little or no supportive social environment available. In this case, by a way to find a possible solution is by exploring what can be helpful to the clients instead and how the clients can make use of these possible resources. If there are no other resources available at all, we can explore other ways, applying a solution focused approach, which could prove to be helpful to the clients. Therapists will continue to focus on finding solutions, during sessions, rather than spending too much time on discussing the problem.
Small steps can lead to big changes. During sessions, Claudia finds that when we aim to stay focused on a solution for positive outcome, there is a sense of hope created for the client, rather than a sense of despair. Claudia finds that this sense of hope is likely to inspire and encourage clients to keep exploring solutions, whether the clients are working together with a therapist, with any other support, or on their own behalf.
One of the strengths of a solution focused intervention session is that it can empower the clients. The solution-focused approach way of inquiry can lead to clients finding their own solutions to the problem instead of a possible elimination of the empowerment of the clients, by professionals telling clients what to do or not to do. These type of inquiry also explores how the clients can cope best with their problems if the problem is not likely to be solved, for example if the clients have lost a loved one and finds it hard to live without this person.
At times, Claudia has found that by exploring small changes that could help the clients to cope better with the problem and how to apply these in their lives, the clients’ perception of the problem often changes or they seem somehow, to find hope to be able to cope better with the situation/problem in the future.
Through the experiences and dialogues Claudia had in Nepal over the last few years with staff at orphanages, children in orphanages, people who have suffered from depression and friends who have recovered from depression, Claudia felt the solution focused interventions could be a helpful technique to share as its origin has some similarities with Buddhist philosophy. The Buddha taught the concept of impermanence; everything is in a continuous flux of change, nothing stays the same. The same understanding is held in solution focused therapy. A problem is not always there the same for the client as such. Clients seem to sometimes to be able to cope better or the problem is not happening as much. By using the solution focused approach during therapeutic interventions, there is an exploration of what the clients are doing differently that makes the problem smaller or non-existent and what else is happening or can happen that can facilitate change. By exploring these in depth with the clients, often the solution to the problem can be found. On the basis of these findings, therapeutic discussions of how to apply these will follow.
In Nepal, Claudia had observed a prevalent presence of a ‘ mindfulness culture’, based on widespread Buddhism and Hinduism traditions in Nepal. One could argue that parts of mindfulness are present in a solution focused brief therapy (sfbt) session, based on the suggestions of therapeutic tasks such as ‘noticing when things are different or up the scale’. The ‘noticing’ could be similarly interpreted as the ‘observing and noticing, without judging’ keynotes of the mindfulness approach.
Scaling questions are used in sfbt to measure if where clients are in therapy. One way of using the scaling questions is by ‘1’ on the scale being when the clients are furthest away of not needing therapy and ‘10’ being not needing therapy. Often at the end of a session a client is suggested a task by the therapist. This task is often a ‘noticing when things are a bit higher on the scale’ task. Based on those two findings, Claudia wanted to explore if sfbt could be a therapeutic intervention that could help quite a few people in a short period of time. Hence, she contacted and suggested the training to a few organisations in Nepal.
The first workshops were held in Department of Psychology, Tribhuvan University on 26 and 28 April 2011. It was organized on invitation by Sujen Man Maharjan on behalf of the Central Association of Psychology Students (CAPS) and supported by Central Department of Psychology. Eighteen participants took actively part in a two day workshop. The participants included the psychology students from Tribhuvan University, counseling students from CPSSC, and counselors from TPO Nepal and Saathi Nepal.
Claudia also held a workshop for the Nepal Mental Health Foundation and to the staff at the Himalayan Healers Project, both in Lazimpat, Kathmandu, Nepal, in May that year.
The feedback has been very positive, to the extent that some of the workshop participants are now sharing the technique with other institutions. Claudia is researching the effect of the solution focused interventions by evaluating how much is being used of the technique by the workshop participants and aims to continue facilitating the training workshops in Nepal.
How to skillfully apply solution focused therapeutic interventions can be equally taught to untrained mental health staff, however it is helpful if the trainee has some background in mental health support. The solution focused approach can also be applied in the business sector, at schools and volunteer organisations. Claudia facilitates team building workshops and steering group meetings by using the solution focused approach in a variety of business and volunteer organisation settings.
In comparison to general health services, globally there is still little financial support for mental health promotion available. Mental health affects both body and mind and therefore affects people’s role in society and how relate to the world. Offering therapeutic support to people in a solution focused manner, can help to create healthier communities. Claudia aims to make people more aware of the solution focused therapy technique and continues to train and offer therapy consultations. Claudia believes the solution focused therapeutic approach is a healthy approach as it empowers and helps people to have a healthy input in finding solutions to their problems.
Claudia encourages others to share the solution focused approach and to bring forth other techniques that offer a positive outlook for people who need mental health.
In Claudia’s personal experience, applying solution focused approaches helps her to focus on living a positive and satisfying lifestyle. This applies to her work and personal life. She believes that the application of a solution focused orientation can be highly beneficial for personal and professional development in any country and culture.
How did Claudia feel and learn from her work in Nepal?
After reading the article such as ‘Poor and Depressed’ by Surbrath Shrestha (2008) and talking to people in Nepal about the lack of mental health support in Nepal, she decided offer to facilitate workshops in SFBT techniques in Nepal.
Based on the research outcome that an average of 4-5 sessions in solution focused therapeutic interventions is needed to facilitate positive change for clients, utilising the solution focused approach in countries where there is little mental health support seems to be part of offering a solution for improvement in this field. The feedback forms received from the participants after the workshops have been 100% positive, which again indicated that this technique resonates with the Nepalese mindset and can be applied in clinical settings in Nepal too.
The evolution forms used for feedback reflected a 100% yes on the question if participants think they are and will continue to apply all or some of the solution focused approach in their work. Requests are continuing to be made for further training in this technique. The outcome of all the workshops have been very satisfying and positive and Claudia learned that participants of the workshops could very much relate to sfbt technique as some participants are stating that the sfbt origins, such as the application of the practical aspects of positive psychology originates from Eastern philosophy.
Follow up workshops and post trauma interventions:
Claudia is aiming to continue to share the theory and application of SFBT skills in Nepal and other countries where there is a need for the development in mental health support and where support of governments in this sector is limited. Claudia continues to raise funds to be able to share the workshops free of charge in developing countries. She was able to deliver a follow up workshop at the Nepal Mental Health Foundation, Kathmandu,Nepal again in November 2012. This workshop was well received by 25 participants.
In June 2015, just a month after the first big earth quake that had hit Nepal that year, she went back to Nepal and delivered two workshops in post trauma support in a solution focused approach, which included a supervision model and a presentation of a wellbeing plan for health- and social work professionals, care-givers, students and volunteers. Both workshops were delivered in Lazimpat. Both were attended by 15 participants on both days. One participant came all the way from Pokhara, and stated to already use the solution focused approach with clients in his work and was very pleased to learn the technique in solution focused supervision. The second day of the workshops Prof. Shishir Subba and Mrs Usha Subba attended the workshop. Prof. Shishir Subba stated the fundamental importance of supervision and of looking after one’s own wellbeing, especially when one works in the caring profession. It had become known that one of the counselors had committed suicide the previous week due to acute traumatic stress.
The workshops participants engaged all positively and enthusiastically during both workshops. Role play scenarios were practiced where participants could apply possible scenarios they could come across in their workplace and in the outreach programs. Feedbacks of the workshops again were 100% positive and because of this outcome, a resource centre for solution practice has been established in ‘Mandala Spa and Training Centre’, Lazimpat, Nepal. Participants will have an opportunity to meet regularly and practice solution focused approach interventions and facilitate supervision sessions with other practitioners. To maintain communication and to share published papers and other relevant solution focused approach literature, Claudia has created a Facebook group for Solution Focused Practice in Nepal and there soon will be an online solution focused practice in Nepal resource centre, which is being created and will be hosted by Sujen Maharjan, psychologist.
As Bhattarai in the Nepal News Desk mentions: “The temblors that struck Nepal on April 25 and May 12, as well as countless aftershocks, have caused profound psychological disturbance. With only about a hundred psychiatrists and a few hundred counselors, the nation is struggling to respond to a massive outbreak of anxiety disorders and depression.” Although there is so much mental health support still needed in Nepal, Claudia feels satisfied with the outcome of being part of the development of the solution focused approach in Nepal and it has become known to her that more and more people are already getting familiar with the solution focused f approach and are applying it in their work. She strongly believes that the approach will develop strongly in therapeutic settings. Due to the high standards of resilience and enthusiasm she witnessed of the participants of the workshops and hearing of their many professional success stories, Claudia believes that she was successfully able to deliver another tool for a variety of therapeutic approaches already being used in the workplace in Nepal.
Claudia also offered solution focused approach counselling when she was in Nepal and offered Reiki training and trained trainers in the Reiki practice as she finds that numerous social- and health professionals work in a holistic approach.
Claudia raised money last year, which helped to pay some of her flight and again offered all workshops for free.
• Bhattarai. T., 2015. Earthquakes Highlight Lack of Mental Health Care In Nepal, Nepal News Desk. (online) http://www.globalpressjournal.com/asia/nepal/earthquakes-highlight-lack-mental-health-care-nepal#sthash.VTqxRvRr.dpuf [Accessed 10th July 2015].
• deShazer, S., Dolan with Harry Korman, Terry Trepper, Eric McCollum, Insoo Kim Berg, “More than Miracles, The State of the Art of Solution-Focused Brief Therapy“, The Haworth Press, 2007, p.13.
• Luitel et al., 2015. Mental health care in Nepal: current situation and challenges for development of a district mental health care plan. Conflict and health. (on line) http://www.conflictandhealth.com/content/9/1/3 [Accessed 10th July 2015].
• Mental experts seek equal legal provisions Himalayan News Service. (online), http://www.thehimalayantimes.com/fullNews.php?headline=Mental+experts+seek+equal+legal+provisions&NewsID=245129 [Accessed 3rd September 2010].
• Maharjan, S., 2011. Positive Mental Health Training .(online), http://sujenman.wordpress.com/2011/10/21/positive-mental-health-training/#comment-333 [Accessed 7th November 2011].
Maharjan, S., 2012. Claudia Van Zuiden on Solution Focused Therapy in Nepal https://sujenman.wordpress.com/2012/06/09/claudia-van-zuiden-on-solution-focused-therapy-in-nepal/ [Accessed 14th July 2015].
• McKeel, A. J. (1996). A clinician’s guide to research on solution-focused therapy. In S. D. Miller, M. A. Hubble, & B. L. Duncan (Eds.), Handbook of solution-focused brief therapy. Updated. (online) http://www.solutionsdoc.co.uk/mckeel.htm [Accessed 10th July 2015].
• Shrestha, S., 2008 Poor and Depressed, NewsFront, (online) http://himalaya.socanth.cam.ac.uk/collections/journals/newsfront/pdf/Newsfront_049.pdf [Accessed 7th November 2011].
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