Solution Focused Brief TherapySolution Focused Brief Therapy

Steve de Shazer Steve de Shazer & Insoo Kim Berg& Insoo Kim BergO'Hanlon O'Hanlon

"Solution Behaviour" not "Problem Behaviour""Solution Behaviour" not "Problem Behaviour"

Social ConstructionistSocial Constructionist

Focus on what clients want to achieve Focus on what clients want to achieve

Doesn't focus on problemsDoesn't focus on problems

Doesn't focus on pastDoesn't focus on past

How Brief a Therapy?How Brief a Therapy?

Aim for 5 sessionsAim for 5 sessions

45 mins each session45 mins each session

Rarely beyond 8 sessions Rarely beyond 8 sessions

Sometimes 1 session enoughSometimes 1 session enough

Any improvements after 3 sessions?Increase Any improvements after 3 sessions?Increase gap between sessions as time goes ongap between sessions as time goes on

Solution Focused Brief TherapySolution Focused Brief Therapy

Principle 1Principle 1

Nobody's perfect all the time - even in their Nobody's perfect all the time - even in their problemsproblems

What can these "exceptions" tell usWhat can these "exceptions" tell us

Things people ordinarily do can contribute to Things people ordinarily do can contribute to solution solution

Solution Focused Brief TherapySolution Focused Brief Therapy

Principle 2Principle 2

Knowing where you wish to be makes getting there Knowing where you wish to be makes getting there easiereasier

Problems cloud our view of futureProblems cloud our view of future

Lose sight of what we want apart from ending Lose sight of what we want apart from ending problemproblem

Clearer it becomes, greater chance of making Clearer it becomes, greater chance of making solutionsolution

Basic Assumptions Clients have resources and strengths to

resolve complaints Change is constant The therapist’s job is to identify and amplify

change It is usually unnecessary to know much

about the complaint in order to resolve it. It’s not necessary to know the cause or

function of a complaint to resolve it.

Basic Assumptions continued

A small change is all that is necessary. A change in one part of the system can affect

change in another. Clients define goals There is no one right way to view things.

Different views may be valid. Focus on what is possible and changeable,

rather than what is impossible and intractable.

3 types of Clients Visitors: no complaints, along for the

ride; complimented and given no tasks Complainants: going along to placate

and appease; complain, distant, observant, and expectant - given observational and thinking tasks

Customers: Do Something – want to change; given behavioural tasks

Solution Focused Brief TherapySolution Focused Brief Therapy

Ask questions about. . . Ask questions about. . .

Client's storyClient's story

Client's strengthsClient's strengths

Client's resourcesClient's resources

Client's exceptionsClient's exceptions

RelationshipsRelationships

Self-esteem issuesSelf-esteem issues

Resources & Resources & ToolsTools

Miracle QuestionMiracle Question

ScalingScaling

Exception-seeking questionsException-seeking questions

Coping questionsCoping questions

Problem-free talkProblem-free talk

Typical First Session Opening: Social introductions,

structure session Collect Complaints - Problem Rank Complaints

(What’s 1st, 2nd, 3rd) Discuss Exceptions

"Best hopes of our work together?"Best hopes of our work together?"

Miracle questionMiracle question

"Tell me about when the problem is not there""Tell me about when the problem is not there"

"What would others notice about you?"What would others notice about you?

Typical First SessionTypical First Sessioncontinued...continued...

Find out what client wants from sessionsFind out what client wants from sessions

Find out small details of life if problems Find out small details of life if problems solvedsolved

What do they already do that is successful What do they already do that is successful

What might change by taking a small step What might change by taking a small step towards hopetowards hope

Session Structure Miracle question process Exceptions / pre-session changes Identify Goals Scales: situation now, willingness,

confidence Anything else/ Break Message

Subsequent Sessions Less Time on Complaint(s) More Time on Exceptions & Solutions

Opening: What’s different this week from last Exceptions: elicit, recognise, discuss, amplify Scaling: Accentuate any improvements

Therapeutic Break – time for reflection & consider task for next week

Compliments & Summary Tasks & Homework

Five Useful Questions The Miracle (Magic Wand) Question Has anything been better since the last

appointment? What’s changed? What’s better?

Can you think of a time in the past (month / year / ever) that you did not have this problem? What would have to happen for that to

occur more often? Scaling Questions 1 – 10 With all of that going on, how do you manage

to cope?

Coping QuestionCoping Question

Identify clent resources they dont even acknowledgeIdentify clent resources they dont even acknowledge

Can be used even in most pessimistic situationsCan be used even in most pessimistic situations

Genuine curiosity helpsGenuine curiosity helps

Genuine admiration for client helpsGenuine admiration for client helps

Helps identify referred futureHelps identify referred future

Ensure client doesn't feel you're contradicting themEnsure client doesn't feel you're contradicting them

"Despite all the problems you still work. How you do it?""Despite all the problems you still work. How you do it?"

De Shazer’s MiracleSuppose that one night, while you are

asleep, there is a miracle and the problem that brought you here is solved. However, because you are asleep you don't know that the miracle has already happened. When you wake up in the morning, what will be different that will tell you that the miracle has taken place? What else?

(1988)

O’Hanlon’s Videotape Question Let’s say that a few weeks or

months of time had elapsed, and your problem had been resolved. If you and I were to watch a videotape of your life in the future, what would you be doing on the tape that would show that things were better? (1987)

Scaling

Scale of 1 – 10 1 is the worst it’s ever been 10 is after the miracle has happened

Where are you now? Where do you need to be? What will help you move up one point? How can you keep yourself at that point?

Exception Questions Tell me about the times when (the

complaint) does not occur, or occurs less than at other times.

When does your partner listen to you? Tell me about the days when you wake up

more full of life. When are the times you manage to get

everything done at work?

Comparing PCT and SFBT

1. PCT because historically it is a fundamental therapuetic approach has influencedmost approaches that have followed. Even CBT is now delivered from anempathetic relationship, albeit asymetric. SFBT is no different it draws on empathyand the relationship too.2. Most therapists now integrate different elements into their practice thereforecomparisons are based on unrealistic ideal types.

Similarities

1. Both are client centred and value the client as the author of their own lives.

2. Both emphasise client talk and see therapist utterances as having locutionary force e,g. metaphor paraphrasing and the miracle question, What and how something is said is important for both.

3. Both are minimally directive especially compared to behavioural oriented therapies e.g. CBT and DBT.

4. Both value the here and now in contast to psychoanalytic approaches.

5. Both rely on tentative dialogue as opposed to direct challenge.

6. Both focus on the clients frame of reference.

Differences

1. In later Rogerian therapy there was/is an ultimate counselling/existential goal ie to become a fully self actualised being. SFBT is more concerned with short medium term goals focused on more effective adaption or coping.

2. The above is based on philosophical differences related to the nature of reality. For SFBT it is socially constructed and relative. For Rogers scientific truth was possible and differences of world view were temporary not eternal.

3. PCT therapists tend to reflect and paraphrase whereas SFBT therapists would use questioning more to draw out the clients thoughts and emphasise positives.

Differences

4. SFBT will use reinforcing techniques for behaviours and attitudes it sees as positive (within the frame reference) e.g. the therapist compliments the alcoholic for drinking less.

5. SFBT is short 5-8 45min sessions. In theory PCT can be for as long as the client wishes with the proviso that the therapist can end if they believe it unproductive.

6. Possibly, PCT can “allow” acceptance of immutables such as death and inequality whereas SFBT is about amplifying hope in order to better cope.

Useful ReferencesUseful ReferencesBerg, I. K. (1991) Family Preservation: A Brief Therapy Workbook. Berg, I. K. (1991) Family Preservation: A Brief Therapy Workbook. London: BT Press.London: BT Press.

Berg, I.K. & Miller, S. (1992) Working with the Problem Drinker: A Solution Berg, I.K. & Miller, S. (1992) Working with the Problem Drinker: A Solution Focused Approach. New York: Norton.Focused Approach. New York: Norton.

de Shazer, S. (1985) Keys to Solution in Brief Therapy. New York: Norton.de Shazer, S. (1985) Keys to Solution in Brief Therapy. New York: Norton.

George, E., Iveson, C. & Ratner, H. (1999) Problem to Solution: Brief George, E., Iveson, C. & Ratner, H. (1999) Problem to Solution: Brief Therapy with Individuals and Families. London: BT Press.Therapy with Individuals and Families. London: BT Press.

Hawkes, D., Marsh, T. & Wilgosh, R. (1998) Solution-Focused Therapy: A Hawkes, D., Marsh, T. & Wilgosh, R. (1998) Solution-Focused Therapy: A Handbook for Health Care Professionals. Oxford: Butterworth–Handbook for Health Care Professionals. Oxford: Butterworth–Heinemann.Heinemann.

Hoyt, M. F. (1984) Single session solutions. In Constructive Hoyt, M. F. (1984) Single session solutions. In Constructive

Therapies (ed. M. F. Hoyt). New York: GuilfordTherapies (ed. M. F. Hoyt). New York: Guilford..

Useful ReferencesUseful ReferencesJacob, F. (2001) Solution-Focused Recovery from Eating Distress. London: Jacob, F. (2001) Solution-Focused Recovery from Eating Distress. London: BT Press.BT Press.

Lethem, J. (1994) Moved to Tears, Moved to Action: Brief Therapy with Lethem, J. (1994) Moved to Tears, Moved to Action: Brief Therapy with Women and Children.London: BT Press.Women and Children.London: BT Press.

MacDonald, A. J. (1994) Brief therapy in adult psychiatry. Journal of Family MacDonald, A. J. (1994) Brief therapy in adult psychiatry. Journal of Family Therapy, 16, 415–426.Therapy, 16, 415–426.

O'Connell, B. (1998) Solution-Focused Therapy.London: Sage.O'Connell, B. (1998) Solution-Focused Therapy.London: Sage.

Rhodes, J. & Ajmal, Y. (1995) Solution-Focused Thinking in Rhodes, J. & Ajmal, Y. (1995) Solution-Focused Thinking in Schools. London: BT Press.Schools. London: BT Press.

Sharry, J. (2001) Solution Focused Groupwork. London: Sage.Sharry, J. (2001) Solution Focused Groupwork. London: Sage.

Talmon, M. (1993) Single Session Solutions. New York: Addison-Werlely.Talmon, M. (1993) Single Session Solutions. New York: Addison-Werlely.