Treatment Plan and Therapy

Solution-Focused Therapy: AIDS and Dying Well

Pattern of Questioning

The pattern of questioning that Berg uses in "Dying Well" begins with effective questioning technique. Berg asks Tanya what she hopes or wants to accomplish before death. It is Tanya's response that she wants to confront her past -- so that she can go home and say goodbye to her mother. Her goal is to "get rid of" the past issues that are keeping her from going home -- namely, the abuse she suffered at the hands of her brothers and father (Berg, 2012). She feels that by confronting this issue she can avoid having a bad encounter with her family if she goes home.

Berg asks Tanya, "What difference will it make?" if she confronts this issue and "gets rid of" the problem she is having about her feelings of hate for her brothers and father. Tanya talks through this issue, trying to make sense of her own feelings as well as the advice given her by the doctors at the clinic where she is tested: it is their advice that she confront her brothers so that she can have a good death; but she does not see the point of doing this because it would just "bring it all up again" and besides "they don't think they did anything wrong," so Tanya says (Berg, 2012).

Berg's pattern of questioning is continuous and in tone it is mainly comforting, as she seeks to be of support to her client and not judgmental. Her method of effective questioning is geared towards helping Tanya to work through her issues by asking herself why they are issues in the first place and what she expects to happen by confronting them. By doing this, Berg is actually helping Tanya to confront them by talking about them and getting them in the open.

Finally Berg transitions to the miracle question method. Berg asks the client what she would do if when she went home, went to sleep, and woke up to find that a miracle had happened and that the problem was no more, that it had mysteriously resolved itself and no longer existed. This is a method of questioning that enables the client to imagine a new sense of self and the world -- and in doing so helps to clear the air and give the client a vision to move towards and embrace. In this manner, Tanya is able to envision a life for herself that is complete, in which she has a supportive family and does not have to feel guilty about her past.

Repetition

The therapist is very repetitious with the client: she repeats a lot of what the client says to show that she is listening and understanding everything she is saying. She also repeats affirmative expressions throughout -- "Mm-hm," and, "Mm," and, "Uh-huh," and, "Yes, I see," and the like.

After every pause, the therapist recounts what the client says, but she also keeps pursuing a line of inquiry, asserting three times within the first 12 minutes of the session that she does not understand why the client wants or needs to do this (go home to confront a family issue so she can say goodbye to her mother before she dies). The therapist is trying to move the client towards a deeper examination of the underlying issues that she is having.

Client's Wants/Needs

The client appears to have gotten what she wanted, which is the opportunity to bury the past, which she does first by confronting the issue and then by imagining a new reality and future for herself in which she can conduct herself according to how she actually wants to be able to live her life. She maintains her sense of reality and awareness of approaching death, but she does not allow herself to be crushed by her problems and issues. She is moving confidently towards her goal of being able to say goodbye.

Outcome

The above happened through a combination of effective questioning and effective listening. The therapist was engaged with the client throughout -- never telling Tanya what to think or do or say or how to feel -- but affirming her responses and repeating them back to her to show sympathy and empathy. She also was able to steer Tanya towards a better self-concept and goal by using the miracle question approach, which enabled the client to project herself into a world where the issue was resolved and her goal attainable. She could envision this and in doing so be a step closer to making it a reality by essentially viewing herself in the role that she wanted to be in.

Other Concepts

Berg used a lot of positive feedback with the client, showing support throughout for her good decisions and accountability -- presenting herself at the clinic for instance, taking care of her body in spite of her situation -- warning her own clients that she had AIDS and trying to protect them in spite of themselves. Some Ericksonian concepts that can be seen here are Brief Therapy -- the act of seeing a client briefly and just once, Lifting the Symptom -- the idea that by nudging the lid off the problem, more can be done in terms of dealing with it, and, of course, solution-focused therapy, which looks at the future and imagines a new one for the client.

Lessons Learned

What I learned from listening to the session was that a lot can be done simply by listening to a patient, repeating what they say, showing empathy and good will, and asking them questions for clarification so that they themselves can focus their thoughts. The miracle question is also a good approach for imagining a new self.

Treatment Plan

A treatment plan that reflects what Berg did and likely would do with this client could include case conceptualization (Gehart, 2014). Case conceptualization in Tanya's case would refer to the map of therapies and obstacles that could be used to treat her and help her achieve her aims. The obstacles for Tanya are multiple -- some impossible to overcome and others quite possible to overcome. The biggest obstacle is death -- her disease has given her six months to live. This obstacles is insurmountable and Tanya has accepted it -- but it has also become, through her acceptance of it, an opportunity to right things in her own life. She is compelled to face issues within that have kept her distant from her family. This distance -- derived from abuse -- is one of the obstacles that can be overcome; in fact, it is the main obstacle to overcome.

A map of the therapies to use in this case would include the following: Brief Therapy and Solution-Oriented Possibility Therapy (n.d.): the duration of the therapy would follow the Ericksonian method of brief therapy, with the intervention occurring in one session, so that the client and therapist can proceed to the work at hand and pry open the issues and obstacles that need to be addressed without any attempts to maneuver around issues. Of course, it would be good for the patient to agree with this timeframe and be comfortable with it. If the client does not wish to have only one session, some adjustments can be made to this portion of the map so that the therapist is more accommodating to the needs of the patient.