Innovations

Innovations in Brief Narrative Therapy

Practice 

Brief Narrative therapy brings a narrative therapy philosophy and practice into time-sensitive counseling arenas such as walk-in therapy clinics and other forms of single session and brief services. It creates a non-pathologizing, collaborative, and competency-oriented way of working with people in brief settings. The aim is to make the most of every single session providing therapeutic conversations to people when they need it. It is based on the principle of “when all the time you have is now”, therefore promoting the facilitation of a meaningful, useful conversation immediately. This is a departure from more traditional practices of assessment and information gathering dominating the initial contacts people have with the helping system.

Narrative therapy is an excellent fit with these time-sensitive services as it offers a clear philosophy and practices for in creating an impactful, novel, and meaningful conversation in every session, whether it is one or several sessions. Brief therapeutic encounters can shift how people view problems and themselves, expanding and changing stories, making it possible for them to see ways forward in their lives. People are invited to see themselves as experts in their own lives, with many skills, competencies, abilities, beliefs, values, and commitments that will assist them to reduce the influence of problems in their lives. People consistently report experiencing ‘aha’ moments in brief therapy sessions that ripple forward in their lives, creating lasting change.


Service 

Walk-in Therapy: 
The walk-in therapy clinic is a unique way of offering therapeutic conversation opportunities to people that is truly client centred as it is there for them to use when they choose, with no more required than to walk in. There is no pre-screening, intake or phone call needed; just show up! When service delivery occurs at a walk-in clinic, there are no missed appointments or cancellations. Clinics maximize staff time, are easy to find and access, and professionals are immediately available to clients. People can walk in with no appointment required and are seen for a single session of competency-based therapy at their chosen moment of need. Clients are provided with reassurance that immediate help will be available if needed in the future as they can re-access the walk-in clinic if needed in the future.

The benefits a walk-in clinic offers are:
• Quick & easy access to a therapy session without complex referral processes
• Creates an accessible service for population groups that might not otherwise seek services
• Diverts people away from hospital emergency rooms, reducing pressure on health care systems
• Counseling with trained brief therapists/counselors
• An opportunity for a competency-oriented therapeutic conversation
• May include an intake/referral function
• May often be a single session
• Helps people with immediate concerns while keeping many people off waitlists
• Can be accessed as needed over time
• Efficient, effective service with good clinical outcomes

For details of this and other brief services innovations, go to the policy ready paper "No More, No Less: Brief Mental Health Services for Children and Youth", at excellencechildandyouth.ca/resources-hbu/policy-ready-papers.
Theoretical

Karen Young has been published in many chapters in books and papers in journals. See Publications
Research

The Brief Services Evaluation Project

Team Leader: Karen Young M.S.W., R.S.W.
Lead research team: Dr. Surbhi Bhanot-Mahotra Ph.D., Jim Duvall M.Ed., R.S.W., and Dr. Nancy Cohen Ph.D.

With funding from the Ontario Centre of Excellence, Reach Out Centre for Kids and the Hincks Dellcrest Centre, worked together with 5 partner organizations to design the very first in Ontario comprehensive look at the effects of brief therapy/walk-in therapy for clients. The evaluation partnership spanned multiple organizations, multiple ways to deliver brief services, and multiple therapeutic approaches for brief therapy, across a client age-range from 0 to 24 years.

This evaluation examined outcomes from a sample of Ontario's brief service delivery mechanisms: walk-in clinics at Reach Out Centre for Kids, the collaboratively run What's Up Clinic based in Toronto (East Metro, Oolagen, Yorktown, Hincks-Dellcrest), Point in Time brief services in Haliburton, and Youth Services Bureau walk-in clinic in Ottawa. All serve children and youth 0-18 (some to age 24) and their families. 

The evaluation addressed the following questions:  
1) Do clients benefit from participating in a single therapy session? If so, what positive outcomes are achieved?
2) Are the benefit(s) from a single session maintained after 3 months?
3) What kinds of presenting problems are the clients experiencing who access these services? 
  
Our methodology included a pre-test immediately prior to the brief therapy session, a post-test immediately after the session, and then a three-month post-test. The surveys used included one designed by the research team, one previously designed and published questionnaire, and one standardized measure that had been widely used. As well, key informant interviews were conducted with 3 therapists from each partner organization to determine how their thinking about brief services may have changed from their work at a walk-in clinic or brief service.

Questionnaire items were designed to measure:
• The issues that brought a client to walk-in
• Clients’ understanding of the issue that brought them to walk-in, 
• Clients’ perceptions of their own skills, strengths, and problem-solving abilities,
• Clients’ knowledge of their social supports and community resources,
• The severity of the problem/issues
• Clients’ coping skills
• The presence and effects of aha moments

For a summary of the outcomes from this project please contact Karen Young at kareny@rockonline.ca.


The Narrative Therapy Re-visiting Project - Principle researcher: Karen Young - Co-researcher: Scot Cooper

This research project reflects narrative ways of thinking and practicing and how they might shape research. The re-visiting project centred the voice of the therapy participant over the professional voice. This qualitative research was published in the Journal of Systemic Therapies (Young, K., & Cooper, S., 2008) bringing to the forefront the personal thoughts of the participants in single sessions of therapy about what was meaningful and useful in therapeutic conversations. This moves away from solely interpreted understandings of professionals and toward co-composed understandings between professionals and therapy participants. In a follow-up meeting, persons who had come for a single session of therapy returned to re-visit the session recording, meeting with a researcher to de-construct and transcribe what was important to the person in the session and the effects on their lives of these moments. All of the sessions took place at a walk-in therapy clinic and in single session brief therapy; therefore the feedback is about brief narrative practices.  

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