Solution focused brief therapy

Solution-Focused Brief Therapy (SFBT) is rapidly becoming an important way of working with families and individuals, allowing clients to find solutions to their own problems (King & Kellock, 2002). SFBT is one of the most popular and widely used psychotherapy approaches in the world (Trepper et al., 2006; Gingerich & Eisengart, 2000). In general, solution-focused therapists accentuate the positive, look toward the future, and do not focus on the past or the cause of a problem. The language of solutions is more positive and hopeful (Nichols, 2010). I chose this approach for those reasons; I feel it’s important to look for the positive, and use more of what’s already working for a client. I will give a brief history of SFBT, examine the theory, the practiced techniques of SFBT, and lastly I will address my personal likes and dislikes with this approach.

Solution-focused therapy originally developed as a short-term psychotherapy technique at the Brief Family Therapy Center in Milwaukee, Wisconsin in the early 1980’s (Gingerich & Eisengart, 2000). The primary creators of this therapy were Steve de Shazer and Insoo Kim Berg (Nichols, 2009). Solution-Focused Brief Therapy evolved from Brief Family Therapy, SFBT operates opposite that of the current paradigm of problem focused therapy to that of solution focused (Trepper, Dolan, McCollum, & Nelson, 2006). Trepper et al. (2006) states, “…SFBT focuses on client strengths and resiliencies examining previous solutions and exceptions to the problem, and then, through a series of interventions, encouraging clients to do more of those behaviors (pg. 134).” The main therapeutic task is helping the client to imagine how he or she would like things to be different and what it will take to make that happen (Gingerich & Eisengart, 2000). Many of de Shazer’s thoughts for SFBT expand on and incorporate ideas from the work of Milton Erickson. Erickson believed that in most cases a client already has enough resources to resolve the problem faced and that the therapist should be active and directive in embracing these qualities (Ruddick, 2008). Erickson’s focus was on change, and finding the client’s resources (King & Kellock, 2002). Erickson also saw that people may only need a slight shift of perspective to release their potential (Nichols, 2010). The language of SFBT incorporates the suggestion that change is inevitable into therapy from the outset and the range of interventions used in SFBT address the fact that a client has these resources and strength to change (Ruddick, 2008). As stated in King & Kellock (2002); O’Hanlon and Weiner-Davis (1989) further developed techniques for helping clients access their potential to change positively through the use of language techniques. SFBT can be applied to many different family-related problems, as well as, individual counseling. Insoo Kim Berg trained therapists all over the world and authored books and articles applying the solution-focused approach to a variety settings, including alcoholism, marital therapy, and family-based services (Nichols, 2010). A student of de Shazer and Berg since the mid 1980’s, Yvonne Dolan has also been influential in solution-focused therapy and conducts training around the world and is president of the Solution-Focused Brief Therapy Association (Nichols, 2010).

Steve de Shazer held a firm belief in a client’s ability to know what is best for them and effectively plan how to get there, many techniques can be integrated into SFBT as long as this fundamental principle is not violated (Trepper et al., 2006). “Solution-Focused Brief Therapy is different in many ways from traditional approaches to treatment. It is a competency-based model, which minimizes emphasis on past failings and problems, and instead focuses on clients’ strengths and previous successes (Trepper et al., pg.1).” The Solution Focused Therapy Treatment Manual highlights several basic core beliefs to SFBT and they are as follows: (1) based on solution building rather than problem solving, (2) therapeutic focus should be on the client’s desired future rather than on past problems or current conflicts, (3) clients are encouraged to increase the frequency of current useful behaviors, (4) there are exceptions to the problem; no problem happens all the time, (5) therapists help clients find alternatives to current undesired patterns of behavior, cognition, and interaction within the clients’ repertoire or can be constructed by therapist and client in collaboration, (6) assumes solution behaviors already exist for clients, (7) small increments of change lead to large increments of change, (8) clients’ solutions are not necessarily directly related to any identified problem by either client or therapist, and (9) conversational skills required of the therapist to invite the client to build solutions are different from those needed to diagnose and treat problems (Trepper et al.). Therapists view the client as the expert on his or her own life (Sommers-Flanagan & Sommers-Flanagan, 2009). In fact, according to Nichols (2010) de Shazer declared “the death of resistance” by suggesting that when clients don’t follow advice, it’s the clients’ way of telling the therapist that their suggestions don’t fit their way of doing things. Solution-focused interviewers honor the client’s way and use existing strengths and resources from the client’s life (Sommers-Flanagan & Sommers-Flanagan, 2009). Solution-focused therapists do not believe it is necessary to know what causes a problem in order to make it better (Nichols, 2010). There is little attention paid to history taking, diagnosis, or exploration of the problem and what may cause it (Gingerich & Eisengart, 2000). As Nichols (2010) points out, “One of the defining characteristics of family therapy has been its focus on the present, where problems are maintained, rather than search the past for what caused them. Solution-focused therapists prefer to look to the future, where problems can be solved (p.321).” Problems are not seen as evidence of failure, but rather as normal life-cycle complications (Nichols, 2010). Goals of solution-focused therapy are to resolve presenting complaints as quickly as possible. As Miller (1997) points out this is also related to the solution-focused assumption that change is always present in life. Clients are not stuck on their problems and complaints just unable to see that the solutions to their problems are already present in their lives (Miller, 1997). The goals for solution-focuses therapists is never about how families should be structured but only what they want different (Nichols, 2010).

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Most psychotherapy consists of conversations, SFBT includes this as well. Trepper et al. state in the Solution Focused Therapy Treatment Manual that there are three ingredients to these conversations for SFBT, they are: conversations are centered on the client concerns, the conversations involve a therapeutic co-constructing altered or new meanings in clients, and thirdly therapists use a number of specific responding and questioning techniques that invite clients to co-construct their vision of the future. SFBT uses the same process regardless of the concern that the client brings to therapy. Success tends to build on itself, and for this reason solution-focused therapists see modest goals as the beginning of change (Nichols, 2010). Goal-setting is an important component of SFBT, and they are formulated through the solution-focused conversations about what clients want to be different in the future (Trepper et al.).

Solution-focused therapists have two fundamental strategies that are core to their techniques (Nichols, 2010). First is developing well focused goals and second is generating exceptions (Nichols, 2010). Main interventions used in SFBT include the miracle question, exception questions, coping questions, and scaling questions (Harvard Mental Health Letter, 2006). Some clients have troubles formulating any goal at all, this is a way for many clients to do a “virtual rehearsal” of their preferred future and begin to formulate goals (Trepper et al.). As Ruddick (2008) simply states “its function is to clarify the client’s goals or preferred scenario (p. 35).” A common way to state the miracle question can be: Imagine in the middle of the night, while you are sleeping, a miracle happens, and all the troubles that brought you here are ended. When you wake up the next morning, how will you know? What will you be doing different? Who else will know, and how and when will they know? What would indicate to me, your therapist, that you had a miraculous solution (Harvard Mental Health Letter, 2006)? Reactions will vary among clients, and some might seem puzzled. The miracle question to envision unlimited range of possibilities and begins the problem-solving process (Nichols, 2010).

The exception seeking process is all about probing for exceptions to the problem, times when clients don’t have the problem (Nichols, 2010). Exception questions are based on the assumption that clients have already begun to find a solution and they just don’t know it yet (Harvard Mental Health Letter, 2006). The aim is to discover what the exceptions are and get the client to do more of the same making them less exceptional (Harvard Mental Health Letter, 2006). The Solution Focused Therapy Manual notes that it is important to punctuate these exceptions with enthusiasm and support. A possible way to phrase an exception question could be: When in the recent past might the problem have happened but didn’t? What’s different about those times when the problem doesn’t happy (Nichols, 2010)? Again, the importance of exception seeking is to invite the client to recognize that some potential solutions may already be a part of their lives (Nichols, 2010). Coping questions are a variation on exception-finding and they are designed to get more information about resources clients may not realize they possess (Harvard Mental Health Letter, 2006). Coping questions are used when a client reports the problem is not any better, or feels that nothing has changed in their circumstance. In general, the therapist expresses praise and admiration for coping and how the client did it (Harvard Mental Health Letter, 2006). Coping questions can help clients see that simply by coping, they are more resourceful than they believe (Nichols, 2010). Some examples of coping questions might be: How come things aren’t worse? What have you done to keep them from getting worse? Once these questions are answers, therapists are able to build upon them and explore how the client may be able to do more.

Scaling questions are the work horses of SFBT, because they are used so often, and solution focused therapists use them to achieve many different tasks (Miller, 1997). Scaling questions used as an intervention include three major components, according to the Solution Focused Therapy Treatment Manual. First, it is an assessment device. Therapists are able to use it as an ongoing measurement of the client’s progress. Secondly, it shows that the client’s evaluation is more important than the therapist’s. Third, it is a powerful intervention because it focuses dialogue on previous solutions and exceptions (Trepper et al.). Scaling questions were introduced to help therapists and clients talk about and identify concrete behavioral changes and goals with vague topics (Nichols, 2010). The basic scaling questions are: On a scale of 1 to 10, where 10 is the solution and 1 is the worst possible situation, where are you today? How confident are you that you can move up one level? What would be different one level up (Harvard Mental Health Letter, 2006)? By keeping track of progress and noticing small changes that lead to improvement on the scale, this naturally lets clients see that they can do well just by continuing to do the things that are already working and slowly build upon them.

Some other therapeutic techniques that solution-focused therapists use are compliments. According to the Solution Focused Therapy Treatment Manual (Trepper et al.) compliments are an essential part of SFBT, they validate what clients are already doing well and by acknowledging how difficult their problems are encourages the client to change while giving the message that the therapist has been listening. Compliments are used with questions that take the form of “How did you do that?” or any question that invites the clients to describe their successes and helps foster self-confidence (Nichols, 2010).

As with any therapy approach it is important to look at the outcome research. Solution-focused is fairly new, but increasingly used therapeutic approach. In a review of the outcome research by Gingerich & Eisengart (2000) they reviewed all of the research to date on solution-focused therapy. Successful outcomes and high client satisfaction have been reported by practitioners of SFBT, however widespread use and reports of success do not provide adequate basis for ongoing use of SFBT (Gingerich & Eisengart, 2000). Early follow-up studies were done at the Brief Family Therapy Center by de Shazer and they found success rates as high as 82% on follow up of 28 clients. The following year, de Shazer et al. (1986) reported a 72% success rate with a 25% sample of 1,600 cases (Gingerich & Eisengart, 2000). More recent follow up studies have found similar outcomes, at somewhat smaller success rates (Gingerich & Eisengart, 2000). In order to permit causal inferences about the effectiveness of SFBT, controlled studies must be looked at. Controlled studies have begun to appear in the literature, and this is what Gingerich & Eisengart (2000) focused on in their article. As of 1999, Gingerich & Eisengart (2000) identified 15 controlled studies of SFBT according to their criteria and they used standards set for by the APA to critique these studies.