Treatment Plan and Therapy Case Study

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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.

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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….....

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