Solution Focused Brief Therapy

100 Key Points and Techniques

Harvey Ratner, Evan George, Chris Iveson

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781136299605
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Solution Focused Brief Therapy: 100 Key Points and Techniques provides a concise and jargon-free guide to the thinking and practice of this exciting approach, which enables people to make changes in their lives quickly and effectively. It covers:

• The history and background to solution focused practice
• The philosophical underpinnings of the approach
• Techniques and practices
• Specific applications to work with children and adolescents, (including school-based work) families, and adults
• How to deal with difficult situations
• Organisational applications including supervision, coaching and leadership.
• Frequently asked questions

This book is an invaluable resource for all therapists and counsellors, whether in training or practice. It will also be essential for any professional whose job it is to help people make changes in their lives, and will therefore be of interest to social workers, probation officers, psychiatric staff, doctors, and teachers, as well as those working in organisations as coaches and managers.

Part 1
BACKGROUND

1
What is Solution Focused Brief Therapy?

Solution Focused Brief Therapy (SFBT) is an approach to enabling people to build change in their lives in the shortest possible time. It believes that change comes from two principle sources: from encouraging people to describe their preferred future – what their lives will be like should the therapy be successful – and from detailing the skills and resources they have already demonstrated – those instances of success in the present and the past. From these descriptions, clients are able to make adjustments to what they do in their lives.

SFBT is a method for talking with clients. It holds the view that the way clients talk about their lives, the words and the language they use, can help them to make useful changes, and therefore SFBT is a language for, as one commentator put it, clients literally talking themselves out of their problems (Miller 1997: 214).

The BRIEF team, known initially as the Brief Therapy Practice, was the first team in the UK to practise SFBT. At that time, in the late 1980s, the approach seemed radically different. The idea that problems could be solved even when the therapist does not know the specifics of what is being complained about, and that clients ‘have got what it takes’, seemed naive to many. If we add to that the expectation that clients would only need an average of three to four sessions, the approach that emerged was an invitation to ridicule.

However, from the perspective of the second decade of the twenty-first century, many of the core tenets of the approach have long been taken up and adopted by other therapy approaches such that the distinctive features of the approach are no longer obvious. It has even been suggested that it is easier now to say what SFBT is not rather than what it is (McKergow and Korman 2009). For example, while practitioners of most approaches today will say they use future focused questions with their clients and may even use the so-called Miracle Question (regarded by many as the most famous invention of those who first devised the model), it is still usual for practitioners to say that they regard it as essential that clients be encouraged to talk about their problems at the outset and that the development of a problem formulation is an essential part of the process. Solution focused practitioners recognize that clients expect to be able to talk about their problems in therapy but do not encourage them to do so and often deliberately divert the client towards ‘solution talk’ (Berg and de Shazer 1993). Furthermore, some approaches will expect to end the session with the therapist providing the client with advice on what they should do next, or at least some sort of homework task for them to practise to solve their problem. While some solution focused therapists will give simple tasks to their clients, these are rarely more than asking a client to notice changes in their lives before the next session. There is an almost complete absence from the approach of giving advice. Insoo Kim Berg, one of the founders of the approach, was fond of advising therapists to ‘leave no footprints in their clients’ lives’, meaning to intervene as little as possible and as briefly as possible. The ‘intervention’ is the interview itself, and nothing more.

In summary, SFBT is a time-sensitive approach to exploring with clients how they would like their lives to be as a result of the therapy, and examining the skills and resources they have for getting there. It is not about the therapist assessing the type of problem the client has and/or providing the solution to the client’s problem. It has to come from the client.

Today, it is possible to talk of ‘brief therapy approaches’, approaches based on a variety of models as diverse as psycho-dynamic or cognitive behavioural therapy. The only connecting factor might seem to be the deliberate intention to intervene briefly – a pre-existing approach has been taken and ways found to deliver it in a more time-efficient manner.

However, there are also therapies originally designed to be brief. The Brief Therapy Center at the Mental Research Institute (MRI) in Palo Alto, California was established in 1967 with that express aim, and their clients are told at the outset that they will receive a maximum of ten sessions. The Brief Family Therapy Center (BFTC) was established in Milwaukee in 1977 as ‘an MRI of the midwest’ (Nunnally et al. 1985: 77), and from their own synthesis of the work of the MRI, the work of the hypnotherapist Milton Erickson, and family therapy methods, they came to develop SFBT. While they did not retain the ten-session limit of the MRI, they noted from their follow-up studies that by its very nature ‘solution focused therapy’ is brief. Subsequently, they stated that ‘it is important to define brief therapy in terms other than time constraints because across the board clients tend to stay in therapy for only 6 to 10 sessions regardless of the therapist’s plans or orientation. Therefore, we draw a distinction between (a) brief therapy defined by time constraints and (b) brief therapy defined as a way of solving human problems’ (de Shazer et al. 1986: 207). The solution focused approach is, therefore, part of a particular brief therapy tradition with distinctive methods and philosophy.

2
The origins of Solution Focused Brief Therapy (1): Milton Erickson

Milton Erickson was a psychiatrist and hypnotherapist who died in 1980. Erickson wrote little about his work but has been the inspiration for many therapists and schools of therapy: Ericksonian hypnotherapy, neuro-linguistic programming (NLP), and many aspects of family therapy all owe much to Erickson who always claimed to have no theory.

Ericksonian stories abound but the best collection is to be found in Jay Haley’s Uncommon Therapy (Haley 1973). The extent of his influence on SFBT can be seen in de Shazer’s early writings. For example, he quotes Erickson as saying,

in rendering him [the patient] aid, there should be full respect for and utilization of whatever the patient presents. Emphasis should be placed more on what the patient does in the present and will do in the future than on mere understanding of why some long-past event occurred. The sine qua non of psychotherapy should be the present and the future adjustment of the patient.

(de Shazer 1985: 78)

de Shazer went on to describe Erickson’s crystal ball technique, which encouraged clients, under hypnosis, to hallucinate the successful overcoming of their problems, and this was clearly a precursor to the ‘Miracle Question’ that invited clients to imagine ‘life without the problem’. de Shazer commented that

these ideas are utilized to create a therapy situation in which the patient could respond effectively psychologically to desired therapeutic goals as actualities already achieved … As I see it, the principles behind this [crystal ball] technique form the foundation for therapy based on solutions rather than problems.

(de Shazer 1985: 81)

de Shazer noted that Erickson appeared to approach each patient with an expectation that change is not only possible but inevitable (1985: 78) and he linked this to Buddhist thought: change is a continual process and stability is only an illusion.

In summary, the elements of Erickson’s practice that came to matter most to the development of brief therapy were:

• utilizing what the client brings
• non-normative (i.e. not prescriptive of what people should do)
• not interested in the client’s past, or in developing insight
• crystal ball technique
• setting tasks
• therapist is responsible for success or failure of the therapy.

3
Origins (2): family therapy and the Brief Therapy Center at the Mental Research Institute in Palo Alto

The Mental Research Institute (MRI) was established by psychiatrist and early family therapist Don Jackson in 1959, and the Institute became famous for developing ideas and researching communication and therapy. In 1967, a centre was set up there to practise brief therapy, from which a new school of family therapy – strategic family therapy – was to emerge.

The team at the centre, led by John Weakland, Paul Watzlawick, and Dick Fisch, were interested in patterns of communication, particularly around problems, and notions to do with homeostasis that were thought to gauge how systems change or resist change. Their interest in the patterns of interaction around the identified client led to a novel view about problem formation:

One of this group’s most influential ideas was the notion that problems develop from and are maintained by the way that, under certain circumstances, particular, and often quite normal, life difficulties become perceived and subsequently tackled. Guided by reason, logic, tradition or ‘common sense’, various attempted solutions are applied (which can include a denial of the difficulty) which either have little or no effect or, alternatively, can exacerbate the situation […] Therapy is focused on changing the ‘attempted solutions’, on stopping or even reversing the usual approach, however logical or correct it appears to be.

(Cade 2007: 39–40)

Under Erickson’s influence, the MRI team made no attempt to understand the problem and its ‘underlying causes’. Instead, they accepted the problem at face value, looking at what was happening in the here and now around the problem and seeking to influence the client(s) to change their behaviour. They did not engage in formal hypnotic work but studied Erickson’s use of language to learn how to frame tasks that would influence the client in the direction of change. For example, they would often suggest to clients that they ‘go slow’ in making changes (Weakland et al. 1974), telling them that, for example, now might not be the time to risk making changes that could, if anything, make matters worse; the paradoxical effect was often to spur the client on to make more changes. They developed the technique known as ‘reframing’, in which the problem or problematic behaviour is given a surprisingly different description to encourage the client to see herself in a different light (Watzlawick et al. 1974: 95). In an unusual case of a man who had a pronounced stammer and yet wanted to succeed as a salesman, his ‘attempted solution’ – trying to stammer less – was exacerbating the stress he felt and making things worse. They encouraged him to view his disability as an advantage, a way of capturing the attention of would-be customers who are put off by

the usual fast, high-pressure sales talk … he was especially instructed to maintain a high level of stammering, even if in the course of his work, for reasons quite unknown to him, he should begin to feel a little more at ease and therefore less and less likely to stammer spontaneously.

(Watzlawick et al. 1974: 94–95)

The MRI offered clients a maximum of ten sessions. If clients made sufficient progress in fewer than the ten, they could keep the remaining sessions ‘in the bank’ to draw on if needed in future. They reported excellent outcome figures for their work (Weakland et al. 1974).

4
Origins (3): the Brief Family Therapy Center in Milwaukee and the birth of a new approach

The story of SFBT starts, appropriately, with John Weakland at the MRI. He had befriended a young therapist and former saxophone player, Steve de Shazer, who was living in Palo Alto and had done some work at the MRI – it is probable that de Shazer did some training there. Weakland introduced de Shazer to another trainee, Insoo Kim Berg, and the pair married and decided to set up a brief therapy centre in de Shazer’s home town of Milwaukee. In time, the pair gathered around them a team of talented and diverse therapists and researchers. In a footnote to an article, de Shazer (1989: 227) said of the title they gave their centre, ‘what else could a group of therapists, half “brief” therapists and half “family” therapists, call their institute?’ Although many of their early papers were published in the family therapy press, it is clear that de Shazer identified himself as a brief therapist and that the initial work of the team was very close to that of the MRI. In time, the sheer creativity of the group led to the development of new ideas, and they were also open to whatever thinking was fresh at the time, such as the work of Don Norum, a social worker in Milwaukee who wrote a paper (which was rejected by Family Process in 1979) called ‘The Family has the Solution’ (Norum 2000).

The early approach they used was oriented towards identifying the patterns of behaviour around the problem, and working out tasks that could be given to clients to influence them towards change. Attention was also paid to what would constitute minimal goals for therapy, and techniques such as the aforementioned crystal ball technique of Erickson (although used without hypnosis) were seen to raise ‘expectations for a future without the complaint’ (de Shazer 1985: 84). Akin to the family therapy technique of circular questioning, they adopted ‘other person perspective’ questions that invite the client to see themselves as others see them and to look at the impact of their changed behaviour on others and vice versa. The place of Erickson in their thinking is evidenced by their use of his ideas about utilization to find ways of developing cooperation with clients, and de Shazer proposed that a client’s resistance be seen as the client’s unique way of attempting to cooperate; in 1984, he brought this idea to fruition in a paper called ‘The Death of Resistance’.

In the same paper, de Shazer referred to a task that the team had developed: ‘between now and the next time we meet, we would like you to observe, so that you can describe to us next time, what happens in your family that you want to continue to have happen’ (de Shazer 1984: 15). Elsewhere (DeJong and Berg 2008) we learn that it was when faced by a family who had listed 23 different family problems, and the therapy team didn’t know where to start, that they decided to give this task. The result was that the family returned to report a number of things they had noticed and, moreover, some of these things seemed new to them, so they had made progress and didn’t need further therapy. The team began experimenting with giving the same task to other clients, and found the same result. Consequently, in 1984, they undertook a research study in which therapists were asked to give this task, dubbed The First Session Formula Task (FSFT), to every client; the outcome was staggering. What was particularly impressive to the team was that it broke the ‘rule’ that the therapeutic task should be constructed to fit with the client’s specific problem presentation. Instead, here was a generic task that was being given to clients regardless of the presenting problem. When de Shazer and Kim Berg presented on SFBT for the first time in London (presentation organized by BRIEF in 1990), de Shazer said that it was out of this task that the whole of the solution focused approach to brief therapy was developed. It led directly to the notion of ‘exceptions to the rule’, which, de Shazer suggested, are times when clients are overcoming their problems but ‘these exceptions frequently slip by unnoticed because these differences are not seen as differences t...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Contents
• Preface
• Part 1 Background
• Part 2 Features of Solution Focused Interviewing
• Part 3 Getting Started
• Part 4 Establishing A Contract
• Part 5 The Client's Preferred Future
• Part 6 When Has it Already Happened? Instances of Success
• Part 7 Measuring Progress: Using Scale Questions
• Part 8 Coping Questions: When Times are Tough
• Part 9 Ending Sessions
• Part 10 Conducting Follow-Up Sessions
• Part 11 Ending the Work
• Part 12 Assessment and Safeguarding
• Part 13 Children, Families, Schools, and Groupwork
• Part 14 Work With Adults
• Part 15 Supervision, Coaching, and Organizational Applications
• Part 16 Frequently Asked Questions
• References