Evolving Possibilities

Selected Works of Bill O'Hanlon

Stephanie O'Hanlon, Bob Bertolino

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781134874651
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

First Published in 1999. When we attend a workshop or read a book, we usually encounter the end result of someone's research, theorizing, or contemplation. However, it is often true that the process of reaching that end-point is just as informative as the end-point itself. Evolving Possibilities is just such a look at the process. In a way, it offers a behind-the-scenes look at Bill O'Hanlon's approach to therapy.This book is a collection of twenty essays and articles written or co-written by Bill O'Hanlon. They span a time period from 1986 to the present. The articles are grouped into four different approaches to psychotherapy: Ericksonian/Strategic Approaches, Solution-Oriented Therapy, Possibility Therapy, and Inclusive Therapy. Moving through these four groups of essays, the reader has the unique opportunity to witness the evolution and transformation of a therapist's thoughts regarding a variety of therapeutic issues. The book offers a refreshing, open look at one therapist's attempts to make sense of psychotherapy, including views that have sparked debate within the professional community. By offering a private look into Bill O'Hanlon's public persona, Evolving Possibilities provides the reader with a thought-provoking study in professional development that is of interest to anyone engaged in the pursuit of more effective psychotherapeutic techniques and approaches.

Phase II
Solution-Oriented Therapy

Introduction to Phase II

Bill O'Hanlon

I was warped by Erickson's influence into paying attention to the resources and capabilities my clients had. Erickson viewed everything as an ability, even the ability to experience symptoms. Studying with Bandler and Grinder was also a big influence. They stressed identifying the "best practices" and best moments of clients and others and then finding ways for the clients to use those as solutions when they were faced with future problems. Around this time, I went through the est training. The emphasis in that training of distinguishing between one's stories about events and the events themselves also shaped the development of the solution-oriented approach. I found that my clients had spontaneously begun to tell me more about their resources, strengths, abilities, and solutions, so I thought that there must be something I was doing differently during the assessment and interviewing processes. I met Jim Wilk, an American expatriate living in England, and we told each other about these unusual one-session treatments we had begun to have in our practices. We made a vow to articulate how this could be. Out of that collaboration came a book (Shifting Contexts, Guilford, 1987) and the beginning of the articulation of solution-oriented therapy. I found that therapy naturally became briefer when I was solution oriented. I also found that I didn't have to be quite as clever as when I did primarily Ericksonian, strategic, and interactional therapies. My clients, it turned out, were clever enough to solve their own problems much of the time. This was a great relief to me. I needed to merely be better and better at creating a context in which my clients' competencies emerged and better and better at listening carefully for any hint of solution that I could pursue.

This section contains my writing from the solution-oriented period of my work and thinking. There is some controversy on the origins of solution-based approaches. Steve de Shazer and his colleagues at the Milwaukee Brief Family Therapy Center (BFTC) often write and speak as if they solely derived this approach, but I differ in that writing of the history. It appears the ideas were first and most completely articulated at a presentation given by a therapist named Don Norum in 1978 in Milwaukee. He read a paper called, "Brief Therapy: The Family Has the Solution," in which he argued that it was preferable to ask families about their own solutions, rather than focus on their problems or the therapist's ideas of the solution. He also articulated ideas about clients making positive pretreatment change, which were later reflected and developed in solution-based approaches. (The paper was submitted for publication in Family Process but turned down as "shaky, dubious and unsupported.") It is reported that Steve de Shazer, his wife, Insoo Kim Berg, and others who would later become part of BFTC were present at the lecture and also worked with Don Norum at Family Service, but to my knowledge they have never acknowledged the debt we all owe to this unsung hero. In any case, my idea is that the ideas of solution-focused therapy and the ideas of solution-oriented therapy codeveloped and had mutual influences on each other through the years. Many of my basic ideas that led to this approach were codeveloped directly with Jim Wilk, who took many of these ideas to BFTC when he worked there for a year before the solution-focused model was formally spelled out, and Michele Weiner-Davis, who also worked at BFTC after the model was developed. To be fair and inclusive, I call the generic approach solution-based.

Chapter 9
Solution-Oriented Therapy

A Megatrend in Psychotherapy

Bill O'Hanlon

The otherwise-impossible can be made to happen under the stimulation of a comprehensive plan and program focused on finding solutions instead of attacking a problem. By looking at the best that might be and determining how to get there, problems that might have been formidable are evaporated by the larger vision. (Rouse, 1985, p. 15)

Several years ago, John Naisbitt published his popular book, Megatrends (1982), which detailed some sweeping trends that he saw emerging in our society but were, perhaps, not obvious to others. In a similar manner, I have observed and experienced a "megatrend" in psychotherapy that is detailed in this chapter. Stated simply, psychotherapy is moving away from explanations, problems, and pathology and toward solutions, competence, and abilities.

This megatrend has gradually emerged for me mainly as a result of my practice of "Ericksonian" therapy, that is, therapy in the tradition and spirit of Milton Erickson. Doing Ericksonian therapy has warped me in a particular direction. After some time, I noticed a similar warp in the work of others, most notably the recent work of Mara Selvini Palazzoli and her colleagues at the Nuovo Centro per lo Studio della Famiglia in Milan, Italy, and that of Steve de Shazer and his group at the Brief Family Therapy Center (BFTC) in Milwaukee, Wisconsin. While they are not really Ericksonians, and in some ways work quite differently from the way in which Erickson did, there was something that smelled vaguely familiar in their work. Following that scent led to the articulation of this megatrend for me.

The Pattern that Connects

There is a thread that connects the work of Selvini Palazzoli, de Shazer, and Erickson (and perhaps others with whose work I'm not familiar). Here I describe the work of Palazzoli and de Shazer that shows evidence of this thread.

Milan Invariant Prescription

Mara Selvini Palazzoli is an Italian psychiatrist who became interested in family therapy after she started working with people with anorexia. Her training was biologically and psychoanalytically rooted, but she found these approaches entirely inadequate to the task of treating these patients. The people with anorexia had an annoying habit of dying before their analysis was complete! Dr. Selvini Palazzoli's (1978) book about her work with people with anorexia is recognized as one of the seminal clinical works in the field. In the transition to working systematically, she gathered three psychiatric colleagues who worked as a team observine sessions from behind a one-wav mirror.

After working with people with anorexia for a number of years, the team became bored because they were able to resolve most of the "hopeless" cases with their methods. So they turned their attention to schizophrenia and began to develop similar methods and report similar consistent successes. As was bound to happen, they became quite well known, especially in Europe, and were sought-after speakers and workshop presenters. This eventually led to the splitting of the team across gender lines, with the two men (Boscolo and Cecchin) choosing to do more teaching and training along with their clinical work and the women (Prata and Selvini Palazzoli) choosing to set up their own institute (the Nuovo Centro mentioned previously) to concentrate more on clinical research and practice.

The Nuovo Centro team once treated a family with an anorexic member with whom they were stymied. The 21-year-old eldest daughter, Mary, had made several suicide attempts, nearly succeeding at times. The team saw little hope for curing this case and at best resigned themselves to rescuing the parents from the tyranny of their children, who constantly interfered in the parents' personal lives. Accordingly, they dismissed the children from therapy and saw the parents on their own. They gave the parents a directive that involved them going out together one night, not telling the children where they were going, but only leaving a note telling the children that they would be back at an appointed hour. The resulting disruption in the family system led to some amazing results. The daughter who had been anorexic began to improve dramatically, attending nursing school and becoming active in sports, eventually marrying a widower and becoming a "good, happy wife and loving stepmother."

The team was flabbergasted by these reported changes. How had they come about? In an effort to investigate exactly which part of the intervention had the dramatic impact, they decided to use this intervention with every family that sought their help. They have to date given the intervention to 114 families. The dramatic results in many of these families have led them to develop an invariant prescription (Selvini Palazzoli, 1986). One interesting aspect of this research is that the team is not interested in solution-oriented therapy. Although they have come across a widely applicable solution, they are on a quest to understand why the solution works—they are on their way back to explanation-land.

de Shazer's Skeleton Key Interventions

The recent work of Steve de Shazer has focused on interventions for solutions. In his latest book, Keys to Solution in Brief Therapy (1985), he details several invariant prescriptions that his team has found useful across a wide range of presenting complaints. He writes that he has become more interested in the nature of solutions than in the nature of problems. He gives five skeleton key interventions. They are as follows:

1. The therapist tells the client (or clients) that "between now and the next time we meet, I would like you to observe, so that next time you can describe to me what happens in your (family, life, marriage, relationship) that you want to continue to have happen."
2. The therapist tells the client that he does not know what will help but that the client should do something, anything, different about the problem than what was done before.
3. The therapist tells the client to "pay attention to what you do when you overcome the urge to (binge, drink, yell at your children, get depressed, etc."—whatever the presenting complaint involved).
4. When a client is obsessed with some unhappy event (e.g., the breakup of a relationship), he or she is told to write about the subject for a certain amount of time on odd-numbered days, to read it over on even-numbered days and then burn it. If the obsessive thoughts occur at any other time, he or she is to put them out of mind until the "regular time."
5. Couples or families that have been fighting are told that they should have a structured fight in which each person gets to have his or her say for a set amount of time with no interruptions from the others. They are to toss a coin to see who goes first; then the other people get their turns. If they decide to go another round, they are to spend a certain amount of time in silence between rounds (de Shazer, 1985; de Shazer & Molnar, 1984).

Again, the team reports quite dramatic and impressive clinical results with these interventions. There is something afoot here.

The Birth of a Nation: Identifying the Common Thread

At first blush these interventions seem to be going in the exact opposite direction from Erickson, who emphasized not having an invariant approach to anything, much less clients in therapy. There was something familiar in these reports, however. It was the emphasis that Erickson placed on focusing on solutions rather than on problems. In conversation with Haley and Weakland (Haley, 1985a) in the 1950s, it comes across that Erickson had a solution orientation and Haley and Weakland lived in explanation-land. When they would suggest that getting rid of a symptom would just lead to symptom substitution because the int...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• Preface
• Phase I Ericksonian/Strategic Approaches
• Phase II Solution-Oriented Therapy
• Phase III Possibility Therapy
• Phase IV Inclusive Therapy
• Index