Using Solution-Focused Brief Counseling to Provide Injury Support

Transcription

1 The Sport Psychologist, 2004, 18, Human Kinetics Publishers, Inc. Using Solution-Focused Brief Counseling to Provide Injury Support Susan M. Gutkind University of Tennessee, Knoxville Athletes at all levels of competition run the risk of becoming injured through their sport participation, and individuals who work closely with athletes during the rehabilitation process (e.g., coaches, athletic trainers, sport psychology consultants) may be called upon to provide mental and emotional support. One approach that seems well suited as a theoretical framework for injury support is solution-focused brief counseling (SFBC). In this paper, athletes responses to injury are outlined, and several roles of the consultant are identified. Then the basic tenets of SFBC are discussed, and an example showing how SFBC can be used in an injury support setting is provided. Taking warm-up shots before a game, a basketball player comes down wrong and twists her ankle. A gymnast lands a dismount but feels something pop in his back and needs to be helped off the floor. On a hard tackle, a soccer midfielder reaches down to brace her fall and breaks her arm. A figure skater notices that a once nagging, but manageable, pain in his hip is now sharply affecting his ability to perform. The possibility of injury comes with the territory of sports at all levels of competition, and injury is both expected and unexpected. Although athletes understand the potential risks of sport participation, especially in those situations where practice and competition are frequent and demanding, some level of denial ( It won t happen to me ) is necessary for successful performance (Heil, 1993). When injury occurs, however, athletes may need to make cognitive and emotional adjustments as well as physical ones. Those who work closely with athletes during the rehabilitation process, especially athletic trainers and sport psychology consultants, may be called upon to provide mental and emotional support. Although there have been a number of studies devoted to the identification of psychological factors associated with athletic injury (for a comprehensive review of the research in this area, see Williams & Andersen, 1998), few sources exist that provide a theoretical framework for consultants involved with injury support. The author graduated from the Health, PE, and Recreation Department at the University of Tennessee, Knoxville. Present sgutkind@knology.net. 75

2 76 Gutkind One approach that seems well suited for consultants who work with injured athletes is solution-focused brief counseling (SFBC; originally developed by de Shazer et al., 1986). In the present paper, athletes responses to injury and the role of the consultant are explored first. Next, the basic tenets of SFBC are discussed. Finally, an example of how SFBC might be used in injury support situations is provided. Used with conventional techniques such as relaxation, imagery, and goal setting, SFBC provides the athlete with opportunities for positive and achievable change that can enhance the athlete s outlook and sense of efficacy. Athlete Responses to Injury The Psychology of Sport Injury Although some athletes react to an injury as if it were a disaster, others view injury as an opportunity to show courage. Still others see it as a welcome break from the pressure of competition or the disappointment of an unsatisfactory season or performance (Rotella, 1988; Wagman & Khelifa, 1996; Weinberg & Gould, 1995; Williams, Rotella, & Heyman, 1998). Regardless of how athletes interpret injuries, once they occur, athletes immediately face problems that need resolution. Focus and motivation may need to move from the arena to the rehab center (Green, 1993). Heil (1993) noted that the emotional challenge faced by athletes during rehabilitation is largely related to the initial impact of the injury on them. Factors that mediate the impact of injury include general emotional distress (such as fear, anxiety, perceived hopelessness, or catastrophizing thoughts), the body part injured, the amount of pain caused by the injury, the unexpectedness of the event (e.g., occurring at practice, a result of routine play), and the time of injury occurrence relative to the playing season. An athlete who tears an ACL while completing a lay-up during a pregame warm-up in the middle of the season playoffs is likely to be more affected by the injury than someone who breaks the nonshooting hand in a chance collision with an opponent during a summer league game. Early research suggested that athletes reacted to injury by progressing through Kubler-Ross s (1969) stages of grief denial, anger, bargaining, depression, acceptance. The application of thanatological models to athletic injury, however, seems to be somewhat procrustean. More recent theories point to a multitude of potential responses. Athletes may experience a loss of identity (Rotella, 1988; Weinberg & Gould, 1995) as well as decreases in self-esteem (Heil, 1993; Wagman & Khelifa, 1996; Weinberg & Gould, 1995), self-efficacy (Heil, 1993; Ievleva & Orlick, 1993; Magyar & Duda, 2000), or confidence (Magyar & Duda, 2000; Norris, 1998; Weinberg & Gould, 1995). Some athletes may feel guilty ( I let the team down ) or culpable (Heil, 1993) as the reality of the injury sets in. The more the athlete s self-image is tied to sport participation, the more serious the reaction to injury can be (Brewer, Van Raalte, & Linder, 1993). Stress, fear, and anxiety are additional reactions to injury (e.g., Rotella, 1988; Weinberg & Gould, 1995). Stress can lead to increased muscle tension, overarousal, and attentional disruption that can cause setbacks or reinjury. Additionally, Williams and Roepke (1992) reported that some athletes manifest stress or anxiety by creating negative self-talk messages or imagery that impedes recovery. Heil (1993) listed several ways in which stress influences self-concept as well as physical, emotional,

3 Injury Support and Solution-Focused Counseling 77 and social well-being. Stress and anxiety are exacerbated by an athlete s fear of not recovering or of becoming reinjured upon return to the sport. Stress, fear, and anxiety may occur at the immediate onset of the injury or at any point throughout recovery. Therefore, it is important that the rehabilitation plan includes both support and self-management techniques to help the athlete cope with the injury and subsequent rehabilitation. Many factors contribute to the psychological state of an injured athlete, and a model of injury response that includes cognitive, affective, and behavioral components may be more effective than one that primarily emphasizes a grief response (Wagman & Khelifa, 1996; Weinberg & Gould, 1995; Williams & Roepke, 1992; Williams et al., 1998). In Williams et al. s (1998) cognitive appraisal model, injury is considered to be a stress process. That is, the psychological response of the athlete is due to how the athlete interprets or perceives the injury rather than the injury itself. The athlete s cognitive appraisal of the situation affects the emotional response, which in turn affects the athlete s behavioral response (e.g., adherence to rehabilitation). Cognitive appraisals of an event are mediated by personal factors as well as situational/ environmental factors. The former include the athlete s investment in the sport, the degree to which self-identity is entwined with the sport, and the athlete s belief in his or her ability to bring about healing (i.e., self-efficacy; Williams et al., 1998). For example, an athlete who has already had the same injury and rehabilitated successfully is likely to be more realistic in appraising the event if it happens again. Situational factors include the medical prognosis, the recovery progress, the degree to which daily life is affected by the injury, and the social support available. Stress may also influence cognitive appraisal. Athletes in a stressful situation may exaggerate the meaning of the injury, ignore important aspects, or draw inaccurate conclusions even when evidence exists to the contrary (Rotella, 1988). For example, when athletic trainers and coaches are being supportive and optimistic, an athlete personally devastated by an injury might believe that recovery is impossible or that there is no point in working hard despite apparent support. When working with athletes in an injury support setting, it is important to recognize the attitudes and conditions that promote successful recovery. Duda, Smart, and Tappe (1989) as well as Heil (1993) found that rehabilitation adherence was related to athletes perceptions about treatment efficacy, and athletes who had faith in the treatment plan and staff recovered faster. This result was echoed by Ievleva and Orlick (1993), who added that self-efficacy also affects recovery (i.e., athletes who had faith in themselves rehabbed faster). Other keys to effective recovery are positive self-talk (Ievleva & Orlick, 1993; Kolt, 2000; Wagman & Khelifa, 1996; Weinberg & Gould, 1995), goal setting and directedness (Duda et al., 1989; Ievleva & Orlick, 1993; Kolt, 2000; Norris, 1998; Weinberg & Gould, 1995), positive attitude and outlook (Weinberg & Gould, 1995), self-motivation (Kolt, 2000; Norris, 1998; Weinberg & Gould, 1995), and the desire to heal (Ievleva & Orlick, 1995). Social support has also been found to promote successful rehabilitation (Duda et al., 1989; Heil, 1993; Ievleva & Orlick, 1993; Kolt, 2000; Magyar & Duda, 2000; Norris, 1998; Wagman & Khelifa, 1996; Weinberg & Gould, 1995; Williams et al., 1998). This factor includes the athlete s primary social network (coaches, teammates, family, friends) as well as the social support present in the rehabilitation center or training room.

4 78 Gutkind The Role of the Sport Psychology Consultant Because athletes who view injury as a challenge and an opportunity for learning tend to recover more quickly (Heil, 1993; Ievleva & Orlick, 1993; Williams et al., 1998), many of the performance enhancement strategies typically used in mental training can be useful in the injury setting. Williams and Roepke (1992) stated that the consultant must first understand the meaning the athlete places on the injury and the impact the injury has on the athlete s life. Once this assessment has occurred, the consultant can use techniques such as goal setting, relaxation, imagery, and cognitive restructuring to facilitate confidence restoration/enhancement, promote coping strategies (especially for fear and pain management), and provide social/ emotional support. Regardless of the specific treatment techniques used, the goals of psychological intervention are to (a) facilitate the rehabilitation process, (b) maintain the athlete s emotional equilibrium, (c) identify and mobilize existing coping strategies and social support, (d) enhance mental readiness for performance, and (e) promote selfefficacy (Heil, 1993). Solution-focused brief counseling (SFBC; de Shazer et al., 1986; Sklare, 1997) provides a potentially useful framework for assessing the needs of individual athletes at different times throughout the rehabilitation process. Solution-Focused Brief Counseling SFBC is an approach that provides a framework for people to solve their problems. The idea for this method emerged as a result of a counseling technique developed by de Shazer and colleagues (1986), who would ask their clients to notice things that were better in the clients lives in between counseling sessions. Interestingly, they found that nearly all their clients were able to identify several things that were working. Consequently, they developed a Solution-Focused approach to counseling that is designed to meet the needs of clients in a wide variety of situations. The key to SFBC is utilizing what clients bring with them to help them meet their needs in such a way that they can make satisfactory lives for themselves (p. 208). As Sklare (1997) notes, this approach is relatively easy to master and emphasizes problemsolving and client-generated solutions. In addition, change is possible almost immediately (de Shazer et al., 1986, report that many clients notice significant improvement after just one session) making this a highly attractive model for sport psychology consultants working with injured athletes. In the following sections, the main features of the SFBC approach are summarized and examples are given to illustrate how it might be used with injured athletes. Key Principles There are several key principles to SFBC. In essence, the SFBC counselor believes that a client is able to identify the problem, the goals for counseling, and the solutions/steps that can lead to goal achievement. The counselor acknowledges that every problem has identifiable exceptions; that is, there are times in the client s life when the problem is less severe or nonexistent. The counselor and client form a collaborative relationship to identify and enhance these exceptions. Further, the counselor recognizes that any change in the client s life can lead to more changes. Therefore, the goals of SFBC can be small and not necessarily related directly or obviously to the presenting problem (de Shazer et al., 1986; O Connell, 1998;

5 Injury Support and Solution-Focused Counseling 79 Sklare, 1997). Finally, SFBC is future-oriented. The past is explored only to the extent that it provides clues about possible solutions for present problems and to enhance the client s future. The language used in SFBC reflects the principles of the practice. Problemoriented questions are avoided and replaced with solution-based talk (O Connell, 1998). For example, a question like, How can I help you? becomes What would you like to change? Rather than asking, Can you tell me about the problem? the SFBC counselor might ask, What will the future look like without the problem? or, When during this week have things been a little better? By using language that creates an expectation of change, the counselor helps the client identify and move toward a desirable life state. This expectation of change is established at the beginning of the first SFBC session and involves the following steps (de Shazer et al., 1986): 1. Statement of the problem. 2. Establishment of counseling goals. 3. Exploration of exception situations. 4. Identification of possible solutions. 5. Break in consultation (during which the counselor prepares a message for the client). 6. Delivery of the message. Each of these steps is briefly discussed in the following section. Statement of the Problem. Although it may seem strange that the first step of a solution-focused approach involves a problem statement, it is with the client s problem statement that the counselor opens a space for solution talk. As the client shares the concern that prompted counseling, the counselor sets out to establish how the client s life is different when the problem is present (de Shazer et al., 1986; O Connell, 1998). The problem conversation during this first session focuses on the client s changing experience in relation to the problem, with the counselor paying particular attention to the client s strengths, skills, and coping mechanisms. To facilitate this discussion, when clients call to set up the initial appointment, the counselor typically asks them to note any differences that occur between now and the first session. For example, a client who enters counseling because of depression might be asked to identify the behaviors or thoughts that let him or her know he or she was depressed and when and where the depression occurs. By asking specific questions, the counselor is able to identify specific traits of the experience that the client has termed depression. The goal of counseling is not to determine why the client is depressed, but rather to identify ways to diminish or modify the clientidentified traits of the depression. Establishment of Counseling Goals. A cornerstone of SFBC is the use of the miracle question as a means of identifying the small, achievable, specific goals the client will strive to achieve (O Connell, 1998). After the client has identified a problem situation, the counselor asks the miracle question by using the following standard format: Imagine when you go to sleep one night a miracle happens and the problems we ve been talking about disappear. As you were asleep, you did not know the miracle had happened. When you woke up what would be the first signs for you that a miracle had happened? (p. 50)

6 80 Gutkind The miracle question enables the client to generate a detailed picture of what the solution to the problem looks like. This picture of possibility embodies realistic new behaviors and feelings the client would like to have. The client s description is used to define what s/he believes would constitute a more satisfying life. To that end, the counselor persists in asking about the miracle until the client provides a full account of life without the problem. Questions can involve the reactions and feelings of significant others in the client s life as well as the client s reaction to those others and the new, problem-free experience. Exploration of Exception Situations. Once the client identifies the specific goals involved in solving the problem, the counselor asks him or her to think about exceptions to the problem situation. At this point, the client has already noted when the problem occurs, what it looks like, and what life would be like without it (de Shazer et al., 1986; O Connell, 1998). The counselor might then ask, When have you noticed that the miracle has already happened, even if it s only a part of the miracle or it only happened for a little while? This allows the client to discover or remember times when the problem was already being solved. The counselor then asks the client to think about how the nonproblem situation was created. As the client begins to look for the things that he or she was able to do to create the desired goal, self-efficacy is increased and the solution locus of control is internalized. Identification of Possible Solutions. The client s answers to the question, How did you make the miracle happen? become the solutions to the problem and the specific goals of counseling. Scaling is a valuable tool counselors can use to assist clients in identifying where they stand with respect to problem solutions (Sklare, 1997). The counselor restates what the post-miracle life would be like and says, On a scale of 0 to 10, where 10 is the day after the miracle has happened and 0 is the worst that things have ever been, where would you say you are right now? Since clients generally do not answer 0, the counselor uses the rating as an opportunity to discover more about the client s skills and coping mechanisms by asking the question, How are you able to keep from being at 0? Clients who scale themselves at 0 can be asked what they are doing to keep things from getting even worse. The counselor and client then explore the things it would take for the client s life to be just 10% better (i.e. move up one notch on the scale). They then identify a small and realistic change the client could make that would represent a step in the direction of goal achievement. Break in Consultation. In the next step of the session, the counselor prepares a message to give to the client. The counselor, having explained this part of the session beforehand, leaves the room to reflect on the session and write the message. The message begins with a compliment to the client on the strengths and skills the counselor has noted during the session. These compliments are followed by a restatement of the client s goal(s) for counseling. The message concludes with a suggested task the client can do before the next session. Delivery of the Message. In the final step, the counselor returns to the room and presents the written message to the client. Typically, the counselor assigns a standard first session task in which the client is asked to begin noticing things in life that s/he would like to see continue and then report these to the counselor the next time they meet (de Shazer et al., 1986; O Connell, 1998). The session ends with the counselor returning to the room and giving the client the note. Subsequent Sessions. Subsequent sessions are designed to identify things that are better in the client s life, amplify the effects of the things that are better,

7 Injury Support and Solution-Focused Counseling 81 reinforce the methods by which the client brought about these changes, and create new goals as needed (O Connell, 1998). The miracle question and scaling procedure are used throughout the entire counseling process, with a message being written and delivered by the counselor to the client at the end of each session (de Shazer & Berg, 1997). If the client reports no progress between sessions, the counselor asks the client to identify some reasons that things didn t get worse or if there were times when things weren t quite as bad as they were at all the other times. Answers to either question allow the client to generate additional exceptions and future solutions. The client typically has 5-6 sessions with the counselor, often with two or three-week intervals between sessions near the end. Criticisms. One criticism of SFBC is that it is a highly scripted, behaviororiented procedure that allows little room for the counselor to provide emotional support. However, as with all counseling, it is up to the practitioner to determine the pacing that best suits the needs of the client (Butler & Powers, 1996). Within the SFBC framework, the counselor is free to provide time for the client to express pain, frustration, or anger in the form of problem talk. While the counselor may determine that problem-focused language is appropriate even for an entire session or two, the counselor also tests the client s readiness to problem-solve by introducing solution language and listening carefully for the client s response. If the client joins in the solution talk, the counselor continues with it. If not, the counselor provides more problem-based support and tries solution talk again, later. In either case, the client is expected to move between problem and solution language throughout the session. Sport psychology consultants who use SFBC with injured athletes should expect that individuals will need some time to talk about the negative feelings and thoughts that accompany injury. Furthermore, an athlete s progress through rehabilitation may more closely resemble a roller coaster ride than a simple, straightforward progression. Emotions surface, are dealt with, and may surface again later due to any number of reasons (especially since setbacks are a virtual certainty during the course of recovery). An effective sport psychology consultant is receptive to athletes needs while continuing to provide a supportive, solutionfocused setting in which emotional and mental healing can occur. An SFBC Model of Injury Support The ideal SFBC counselor should be skilled at forming relationships quickly and formatting clear, specific goals (de Shazer & Berg, 1997). He or she must be able to stay focused on a specific issue while listening for exceptions, solutions, and strengths. Additionally, the counselor should be driven by the idea that counseling represents the beginning of a process the client must maintain outside the counseling setting. To illustrate the potential of this model for sport psychology consultants, the following examples are provided of injury support sessions the author had as a graduate student consultant in the Women s Athletic Department. Rather than portraying a single session and athlete, the following dialogue represents a composite taken from sessions with several athletes at different times spliced together to illustrate how consultants can use SFBC. Statement of the Problem This conversation occurs after the small talk, introductions, and brief explanations of confidentiality and the counseling process that mark the beginning of any initial

8 82 Gutkind session. The athlete in this case recognized the need for injury support and had come willingly. (Note: At the end of this section, techniques for working with athletes who are unwilling participants and have been referred to counseling by someone else are discussed.) Consultant: So what things would you like to see going a little better as a result of us working together? Athlete: I wish my rehab wasn t so monotonous. I get bored with it. C: So what might rehab be like instead? (We need a positive goal, not a negative one.) A: I d have different exercises I could do sometimes. Something more challenging. I don t think I m making any progress because I ve been doing the same old thing for so long now. C: OK, so something to mix it up a bit and challenge you in rehab. What else would you like to have different? A: I d like to sleep better. C: What would that be like for you? Sleeping better? A: It takes me forever to fall asleep at night. My leg hurts and I have all these things I m thinking about. I wish I could just go to bed and fall asleep. C: So falling asleep faster would make things better for you. What else? A: Well, it seems like I m in a bad mood a lot. At this point, the athlete may need some time to engage in some problem talk about these bad moods. The consultant follows the athlete s lead in determining whether to provide reflective listening or solution talk. When the athlete is ready, the consultant solicits details about what the athlete s bad moods are like and when they occur. Throughout the conversation, the consultant is listening for examples of coping skills ( How do you keep those bad moods from wiping out your whole day? ) and encouraging the athlete to define what it is like to be in a bad mood (problems) compared to being in a good mood (solutions). When it appears that the athlete has identified all the things that could be improved, it is time to determine the goals for counseling. Establishment of Counseling Goals It is not a good idea to ask the Miracle Question at the beginning of the first injury support session because the likely answer ( I ll know the miracle occurred because my injury will be completely healed ) is obvious and serves no useful purpose at this point. Butler and Powers (1996) report making a similar adjustment in their SFBC work with grieving clients. Instead, the consultant asks the question, How do you see yourself after your injury is completely rehabbed? or What are some things about your rehab that you wish were going differently? These questions are in line with the spirit of the Miracle Question, but allow the consultant and athlete to focus more on issues over which the athlete has some control. Once the athlete has identified specific issues for which the Miracle Question is better suited, the consultant can ask the question. In this case, the athlete s bad moods lend themselves well to the miracle question.

9 Injury Support and Solution-Focused Counseling 83 C: So we ve got a few things here that would make things better for you if they were different. There are ways to make changes in all of them. Which one would you like to look at first? A: I think the bad moods bug me the most. I m just not used to being in a bad mood so much. C: I m going to ask you kind of a weird question, but one that I think will be helpful. Imagine that while you re sleeping tonight a miracle happens and the problem with your bad moods is solved. Because you were sleeping, you didn t know the miracle happened. When you woke up, what would be the first signs to you that the miracle had happened? A: I don t know. I d be happier, in a good mood. C: What would you be doing differently when you were feeling happier? A: I d be talking on the phone and being around people. I d be smiling more. (her goal) C: Who would be the first person to notice that things were different for you? A: Probably [her athletic trainer]. C: How would she know? How would she react to you after this miracle? A: She d see me anxious to start rehab and talking to people in the training room. She d probably say, You look like you re in a good mood. C: What would you do if she said that? A: I d say, Yeah, I feel good today. C: Who else would notice that things were different for you? What would they see? The conversation continued while the athlete and consultant together determined, as specifically as possible, what the athlete s picture of the post-miracle mood would be like. In this case, the athlete wanted to be able to talk to people and smile, showing that she was in a good mood. Other topics that were discussed at this point included times it might be OK to be in a bad mood and times when she might want to try to change her mood. Once the vision was complete, the consultant asked the athlete about exceptions to the problem. Exploration of Exception Situations Exceptions provide valuable clues about possible steps the athlete might take to reach the goal. It is important to remember that even the worst, most prevalent problem for an athlete contains moments during which the problem is either less intense or not present at all. By searching for these times, the athlete can discover ways to bring about the desired changes. C: When have you noticed times when it seems like the miracle has already happened, even a little bit? Times you re in a good mood, or your bad mood isn t quite so bad? A: It was pretty good all last Saturday.

10 84 Gutkind C: All right! How d you make that happen? A: I was with my best friend and a couple people who aren t on the team. My mom was here, too. When I got in a bad mood I just told her that it wasn t her and she was OK with it until I was in a good mood again. I was in a good mood when I woke up. I d had a good night s sleep. And then I had a good rehab session. So it was just a good day. In searching for exceptions, the athlete named several possible solutions (friends not on the team, a good night s sleep, good rehab). In the next part of the session, these suggestions were further explored and other possible solutions were identified, which set the stage for making the small change(s) that could lead to a better mood. Identification of Possible Solutions SFBC is based on the notion that small changes lead to bigger changes and to general improvement in a problem situation. At this point in the session, the consultant and athlete identified a possible change that the athlete could initiate. The scaling question was asked in order to provide more solution space to explore. C: So there s times when your moods are better and times when they re worse. On a scale of 0 to 10, where 10 is the day after the miracle and 0 is the worst it s ever been, where would you say you are right now? A: I m about a 5. C: All the way to a 5, huh? Good deal. What keeps you from being a 0? A: Well, I m not always in a bad mood, and sometimes when I get in one I can kind of get out of it. C: Really?! How do you manage to do that? (Reinforce internal locus of control.) A: Usually I just try to get away from everybody and go to sleep. C: Do you do anything else? A: If I can t get away I try to tell people I m in a bad mood, but I don t like having to do that. I don t want to be moody. I don t know, I guess I try to think about when I ll be able to get away. C: So you try to be by yourself when you re in a bad mood, or try to sleep it off, or maybe just think about when it won t be as bad. Based on her responses to the scaling question, the athlete identified several coping strategies (be by herself, go to sleep, tell people she s in a bad mood, think of better times). The consultant then asked what it would take in order to move up just one notch (to a 6). When the athlete was able to name a small, achievable change that would be life enhancing and helpful in reaching the goal that she had established, the session was nearly over. All that remained was the message. Preparing the Message Throughout each session, the consultant takes notes about the athlete s strengths, skills, and coping mechanisms, as well as the goals and steps that would indicate the goals have been met. In SFBC, the counselor leaves the room and writes a message that reflects the client s strengths and encourages a small change. Although

11 Injury Support and Solution-Focused Counseling 85 de Shazer et al. (1986) notes that the time the counselor spends out of the room allows the client to process what has been shared, consultants may want to deliver the message verbally without leaving the room. Writing the message potentially puts the consultant in a one-up position that is inconsistent with the tenor set during the session (i.e., the consultant has consistently deferred to the athlete). A verbal message allows the content to be communicated in a less formal way that may also fit better with the consultant s communication style. However, it is important for the consultant to phrase the message using the athlete s own words and ideas. Whatever the case may be, it is important for the consultant to end the session by affirming the athlete s strengths and by providing both a reminder of the athlete s goals and the steps needed to reach them. Subsequent Sessions The remaining sessions follow the same basic format as the first one. The consultant asks the athlete what things are going better and how the athlete has been able to bring about those good changes. New goals are determined and scaled. The athlete identifies behaviors that could lead to a 10% improvement, and the consultant provides a message that reinforces the athlete s skills and promotes the desired changes. In the second session with this athlete, she reported that she had talked to her athletic trainer and obtained some new exercises for rehab. Additionally, she had talked to her assistant coach, a biking aficionado, and he was going to suggest some different stationary bike workouts for her. This was noteworthy in that she had done it completely on her own. Except for identifying it as a problem, nothing was mentioned about workouts in the first session. At this point, we turned to her primary concern, the bad moods. C: So what things did you notice about your moods that were better this week? A: I really noticed that when I sleep well I m happier. The two days I fell right to sleep I woke up in good moods. (This matches her earlier complaint about not falling asleep.) C: So getting to sleep is important. I remember you mentioned that last week, too. Anything else you noticed? A: It s easier when I m out with my friends. It was harder at practice. Oh, and I had a really good rehab session on Tuesday, that helped. Additional conversation about the improvements she noticed uncovered the fact that it was hard for her to be around the team because the coach didn t like people to be moody at practice. Her good rehab session had involved two other injured athletes who were rehabbing similar injuries. Although she didn t use the term social support, she implied that it played a large role in her positive attitude during that rehab session. The miracle question and scaling helped her identify that hanging out with people not on the team, possibly those who were also rehabbing, was a small change she could make to improve things for her. To address the problem of falling asleep, the consultant introduced her to some progressive relaxation and deep breathing techniques. The athlete agreed to practice them at least once during the day and to try them at night if she had trouble falling asleep. To conclude the session, the consultant gave the athlete a verbal message

12 86 Gutkind that reinforced her initiative in addressing the workout problem. The consultant also suggested that the athlete practice and use the relaxation techniques to see if they helped her sleep and potentially improve her mood. The consultant reiterated that her idea to hang out more with non-team members seemed like a good one and concluded by saying she looked forward to hearing about it during their next session. The remaining sessions involved a combination of SFBC, to help the athlete deal effectively with setbacks in rehab, and traditional mental training techniques designed to help her make the transition back to full competition. Mandated Athletes Sometimes injured athletes are referred to the consultant by the coach or athletic trainer and are not as willing to participate in the counseling sessions. When this happens, it is vital for the consultant to get the athlete invested in the process before attempting any other intervention. Tohn and Oshlag (1996) identify two keys to working with mandated clients. First, the consultant must avoid labeling the athlete resistant or in denial. SFBC is based on the belief that clients know what is best for them. The reluctant athlete is simply acting on this belief in a way that ignores counseling as part of his or her solution set. The consultant can engage the athlete in conversation that shows respect for the athlete s position while still guiding the athlete in the search for solutions and goals. The second key to working with mandated athletes is to work to establish goals that fit the athlete s view of the problem. This may mean finding ways to help the athlete get the athletic trainer, coach, etc. off the athlete s back. The following conversation reflects the process of establishing goals with a reluctant athlete. C: So what would you like to see happening differently as a result of our work here? A: I don t know. The trainer said I had to come. C: What do you think the trainer hopes you ll get out of this? A: Probably wants me to be on time for my rehab sessions. C: What do you want? A: I want her to stop nagging me to come here. C: What would you like to see her doing instead of nagging you? A: Telling me I m doing a good job when I m working at my rehab. Telling me I m making progress. C: What would you have to do for your trainer to tell you those things? A: Just keep working at my rehab. Get there on time and just work on it. C: So if you were getting to rehab on time and working on it that would get your trainer to stop nagging you? That would make things better for you? A: Yeah. The consultant can now work with the athlete to discover details, exceptions, and solutions related to the goal of getting to rehab on time and working on it. Many mandated athletes are worried that they are being forced into psychotherapy. In the words of one, I m hurt, not crazy, and I don t want you crawling around in my head! In such cases, it is helpful to point out to athletes, reluctant or otherwise, that the injury has affected many aspects of their life and

13 Injury Support and Solution-Focused Counseling 87 is certainly not something they planned on or asked for. It makes sense that some parts of being injured are easier to deal with than others. Rather than crawling around in their heads, the consultant should communicate that his or her role is to help the athlete find ways to make things a little bit better. As a final enticement, the consultant might ask the athlete to commit to only five whole-hearted, openminded sessions, after which the athlete can determine whether injury support is being helpful. At that point, the athlete can choose either to continue working with the consultant or to return to the supervision of the training room staff. The author s experience has been that every referred athlete who has allowed herself to engage in the process has found it helpful and most choose to continue counseling beyond the minimum number of sessions. Conclusions and Recommendations There are many benefits to using SFBC that dovetail nicely with the needs of injured athletes. SFBC is based on the idea that athletes are able to solve their own problems, and it provides athletes with many opportunities to enhance their self-efficacy. Focusing on solutions tends to create a more positive rehabilitation climate/mindset and promotes positive cognitive appraisal of the injury as well as a more optimistic outlook. The consultant can pace sessions so that the athlete is able to focus on problem talk, when he or she needs to, while still pursuing solutions. Specific, achievable goals are established regularly, and motivation is enhanced as the athlete continues to meet the goals that are set. Finally, the SFBC model allows for easy integration of traditional mental skills such as relaxation, imagery, and positive self-talk to facilitate the athlete s rehabilitation and return to competition. Because social support is such a valuable part of the recovery process, it is becoming more common for helping professionals to form injury support groups. While SFBC has been successfully used in a variety of group settings (O Connell, 1998; Sklare, 1997), additional research is needed to determine its effectiveness with groups of injured athletes. Further research might also be done to identify the various benefits of written versus verbal messages at the end of a session. Finally, the effectiveness of SFBC with injured male athletes remains to be explored. In the meantime, athletes will continue to experience injury, and sport psychology consultants will continue to try to provide support. For such consultants, a method like SFBC that is positive, goal-oriented, and athlete-driven appears to be a potentially valuable tool for meeting the emotional and mental needs that arise for athletes during the process of rehabilitation and recovery. References Brewer, B.W., Van Raalte, J.L., & Linder, D.E. (1993). Athletic identity: Hercules muscles or Achilles heel. International Journal of Sport Psychology, 24, Butler, W.R. & Powers, K.V. (1996). Solution-focused grief therapy. In S.D. Miller, M.A. Hubble, & B.L. Duncan (Eds.), Handbook of solution-focused brief therapy (pp ). San Francisco: Jossey-Bass Publishers. de Shazer, S. & Berg, I.K. (1997). What works? Remarks on research aspects of solutionfocused therapy. Journal of Family Therapy, 19,

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