Reading B

Introduction

Solution-focused brief therapy (SFBT) is a future-focused, goal orientated therapeutic approach to brief therapy developed initially by Steve de Shazer and Insoo Kim Berg at the Brief Family Therapy Center in Milwaukee in the early 1980s. SFBT is an optimistic, antideterministic, future-oriented approach based on the assumption that clients have the ability to change quickly and can create a problem-free language as they strive for a new reality (Neukrug, 2016).

Key Concepts

Unique Focus of SFBT

The solution-focused philosophy rests on the assumption that people can become mired in unresolved past conflicts and blocked when they focus on past or present problems rather than on future solutions. Solution-focused brief therapy differs from traditional therapies by eschewing the past in favor of both the present and the future (Franklin, Trepper, Gingerich, & McCollum, 2012). Therapists focus on what is possible, and they have little or no interest in gaining an understanding of how the problem emerged. Behavior change is viewed as the most effective approach to assisting people in enhancing their lives. De Shazer (1988, 1991) suggests that it is not necessary to know the cause of a problem to solve it and that there is no necessary relationship between the causes of problems and their solutions. Assessing problems is not necessary for change to occur. If knowing and understanding problems are unimportant, so is searching for “right” or absolute solutions. Any person might consider multiple solutions, and what is right for one person may not be right for others.

It is within the scope of SFBT practice to allow for some discussion of presenting problems to validate clients’ experience and to let them describe their pain, struggles, and frustrations (Murphy, 2013, 2015). However, this brief exploration differs from the lengthy discourse into the history and causes of problems common to some other types of therapy. In solution-focused brief therapy, clients choose the goals they wish to accomplish; little attention is given to diagnosis, history taking, or exploring the emergence of the problem (O’Hanlon & Weiner-Davis, 2003).

Positive Orientation

Solution-focused brief therapy is grounded on the optimistic assumption that people are healthy and competent and have the ability to construct solutions that can enhance their lives. An underlying assumption of SFBT is that we already have the ability to resolve the challenges life brings us, but at times we lose our sense of direction or our awareness of our competencies. Regardless of what shape clients are in when they enter therapy, solution-focused therapists believe clients are competent. The therapist’s role is to help clients recognise the competencies they already possess and apply them toward solutions. The essence of therapy involves building on clients’ hope and optimism by creating positive expectations that change is possible. Solution-focused brief therapy has parallels with positive psychology, which concentrates on what is right and what is working for people rather than dwelling on deficits, weaknesses, and problems (Murphy, 2015). By emphasizing positive dimensions, clients quickly become involved in resolving their problems, which makes this a very empowering approach.

Because clients often come to therapy in a “problem-orientated” state, even the few solutions they have considered are wrapped in the power of the problem orientation. Clients often have a story that is rooted in a deterministic view that what has happened in their past will certainly shape their future. Solution-focused practitioners counter this negative client presentation with optimistic conversations that highlight a belief in achievable and usable goals. Therapists can be instrumental in assisting clients in making a shift from a fixed problem state to a world with new possibilities. One of the goals of SFBT is to shift clients’ perceptions by reframing what White and Epston (1990) refer to as clients’ problem-saturated stories through the counselor’s skilful use of language.

Looking for What is Working

The emphasis of SFBT is to focus on what is working in clients’ lives, which stands in stark contrast to the traditional models of therapy that tend to be problem-focused. Individuals bring stories to therapy, some of which are used to justify the client’s belief that life can’t be changed or, worse, that life is moving them further and further away from their goals. Solution-focused brief therapists assist clients in paying attention to the exceptions to their problem patterns, or their instances of success. They promote hope by helping clients discover exceptions, or times when the problem is less intrusive in their life (Metcalf, 2001). SFBT focuses on finding out what people are doing that is working and then helping them apply this knowledge to eliminate problems in the shortest amount of time possible. Identifying what is working and encouraging clients to replicate these patterns is extremely important (Murphy, 2015). A key theme of SFBT is, When you know what is working, do more of it. If something is not working, try something different (Hoyt, 2015).

There are various ways to assist clients in thinking about what has worked for them. De Shazer (1991) prefers to engage clients in conversations that lead to progressive narratives whereby people create situations in which they can make steady gains toward their goals. De Shazer might say, “Tell me about times when you felt a little better and when things were going your way.” It is in these stories of life worth living that the power of problems is deconstructed and new solutions are manifest and made possible.

Basic Assumptions Guiding Practice

Walter and Peller (1992, 2000) think of solution-focused therapy as a model that explains how people change and how they can reach their goals. Here are some of their basic assumptions about solution-focused therapy:

• Individuals who come to therapy do have the capability of behaving effectively, even though this effectiveness may be temporarily blocked by negative cognitions. Problem-focused thinking prevents people from recognising effective ways they have dealt with problems.
• There are advantages to a positive focus on solutions and on the future. If clients can reorient themselves in the direction of their strengths using solution-talk, there is a good chance therapy can be brief.
• There are exceptions to every problem, or times when the problem was absent. By talking about these exceptions, clients can get clues to effective solutions and can gain control over what had seemed to be an insurmountable personal difficulty. Rapid changes are possible when clients identify exceptions to their problems and begin to organize their thinking around these exceptions instead of around the problem.
• Clients often present only one side of themselves. Solution-focused therapists invite clients to examine another side of the story they are presenting.
• No problem is constant, and change is inevitable. What people need to do is become aware of any positive changes that are happening. Small changes pave the way for larger changes, and these changes are often all that is needed to resolve the problems clients bring to counseling (Guterman, 2013).
• Clients are doing their best to make change happen. Therapists should adopt a cooperative stance with clients rather than devising strategies to control resistive patterns. When therapists find ways to cooperate with people, resistance does not occur.
• Clients can be trusted in their intention to solve their problems. Therapists assume that clients want to change, can change, and will change under cooperative and empowering therapeutic conditions. There are no “right” solutions to specific problems that can be applied to all people. Each individual is unique and so, too, is each solution.

Characteristics of Brief Therapy

The average length of therapy is three to eight sessions, with the most common length being only one session (Hoyt, 2015). The main goal of brief therapy is to help clients efficiently resolve problems and to move forward as quickly as possible. Some of the defining characteristics of brief therapy include the following (Hoyt, 2009, 2011, 2015):

• Rapid working alliance between therapist and client
• Clear specification of achievable treatment goals
• Clear division of responsibilities between client and therapist, with active client participation and a high level of therapist activity
• Emphasis on client’s strengths, competencies, and adaptive capacities
• Expectation that change is possible and realistic and that improvement can occur in the immediate future
• Here-and-now orientation with a primary focus on current functioning in thinking, feeling, and behaving
• Specific, integrated, pragmatic, and eclectic techniques
• Periodic assessment of progress toward goals and outcomes
• Time sensitive, including making the most of each session and ending therapy as soon as possible

The core task is for SFBT practitioners to learn how to rapidly and systematically identify problems, create a collaborative relationship with clients, and intervene with a range of specific methods. Because most therapy is time-limited, therapists should learn to practice brief therapy well (Hoyt, 2011).

The Therapeutic Process

The therapeutic process rests on the foundation that clients are the experts on their own lives and often have a good sense of what has or has not worked in the past and what might work in the future. Solution-focused counseling assumes a collaborative approach with clients in contrast to the educative stance that is typically associated with most traditional models of therapy. If clients are involved in the therapeutic process from beginning to end, the chances are increased that therapy will be successful. In short, collaborative and cooperative relationships tend to be more effective than hierarchical relationships in therapy.

De Shazer (1991) believes clients can generally build solutions to their problems without any assessment of the nature of their problems. Given this framework, the structure of solution building differs greatly from traditional approaches to problem solving as can be seen in this brief description of the steps involved (De Jong & Berg, 2013):

1. Clients are given an opportunity to describe their problems. The therapist listens respectfully and carefully as clients answer the therapist's question, “How can I be useful to you?”
2. The therapist works with clients in developing well-formed goals as soon as possible. The question is posed, “What will be different in your life when your problems are solved?”
3. The therapist asks clients about those times when their problems were not present or when the problems were less severe. Clients are assisted in exploring these exceptions, with special emphasis on what they did to make these events happen.
4. At the end of each solution-building conversation, the therapist offers clients summary feedback, provides encouragement, and suggests what clients might observe or do before the next session to further solve their problem.
5. The therapist and clients evaluate the progress being made in reaching satisfactory solutions by using a ratings scale. Clients are asked what needs to be done before they see their problem as being solved and also what their next step will be.

Therapeutic Goals

SFBT reflects some basic notions about change, about interaction, and about reaching goals. The solution-focused therapist believes people have the ability to define meaningful personal goals and that they have the resources required to solve their problems. Goals are unique to each client and are constructed by the client to create a richer future (Prochaska & Norcross, 2014). A lack of clarity regarding client preferences, goals, and desired outcomes can result in a rift between therapist and client. During the early phase of therapy, it is important that clients be given the opportunity to express what they want from therapy and what concerns they are willing to explore. From the first contact with clients, the therapist strives to create a climate that will facilitate change and encourage clients to think in terms of a range of possibilities.

Solution-focused therapists concentrate on small, realistic, achievable changes that can lead to additional positive outcomes. Because success tends to build upon itself, modest goals are viewed as the beginning of change. The therapist looks for ways to amplify the client’s movement in the desired direction as quickly as possible (Hoyt, 2015).Solution-focused therapists use questions such as these that presuppose change, posit multiple answers, and remain goal-directed and future-orientated: “What did you do, and what has changed since last time?” or “What did you notice that went better?” (Bubenzer & West, 1993).

Murphy (2015) emphasizes the importance of assisting clients in creating well-defined goals that are (1) stated positively in the client’s language; (2) are action-oriented; (3) are structured in the here and now; (4) are attainable, concrete, specific, and measurable; and (5) are controlled by the client. Counselors should not too rigidly impose an agenda of getting precise goals before clients have a chance to express their concerns. Clients must feel that their concerns are heard and understood before they can formulate meaningful personal goals. In a therapist’s zeal to be solution-focused, it is possible to get lost in the mechanics of therapy and not attend sufficiently to the interpersonal aspects. Therapists need to be mindful of not becoming overly technique driven at the expense of the therapeutic alliance.

Solution-orientated therapy offers several forms of goals: changing the viewing of a situation or a frame of reference, changing the doing of the problematic situation, and tapping client strengths and resources (O’Hanlon & Weiner-Davis, 2003). Therapists note the language they use, so they can increase their clients’ hope and optimism and their openness to possibilities and change. Clients are encouraged to engage in change or solution-talk, rather than problem-talk, on the assumption that what we talk about most will be what we produce. Talking about problems can produce ongoing problems. Talk about change can produce change.

Therapist’s Function and Role

Solution-focused practitioners believe that every client is motivated in the sense that he or she wants something as a consequence of meeting with a therapist (George, Iveson, & Ratner, 2015). Clients are much more likely to fully participate in the therapeutic process if they perceive themselves as determining the direction and purpose of the conversation. Much of what the therapeutic process is about involves clients’ thinking about their future and what they want to be different in their lives. Consistent with the postmodern and social constructionist perspective, solution-focused brief therapists adopt a not knowing position to put clients in the position of being the experts about their own lives. Therapists do not assume that by virtue of their expert frame of reference they know the significance of the client’s actions and experiences (Anderson & Goolishian, 1992). This model casts the role and function of a therapist in quite a different light from traditionally orientated therapists who view themselves as experts in assessment and treatment. The therapist-as-expert is replaced by the client-as-expert, especially when it comes to what the client wants in life and in therapy. It is important that therapists actually believe that their clients are the true experts on their own lives. Although therapists have expertise in the process of change, clients are the experts on what they want changed. Clients will have their own ways of building their preferred futures, even if this is often not clear to them when they begin therapy. The therapist’s task is to point clients in the direction of change without dictating what to change (George et al., 2015; Guterman, 2013).

Therapists strive to create a climate of mutual respect, dialogue, and affirmation in which clients experience the freedom to create, explore, and co-author their evolving stories. A key therapeutic task consists of helping clients imagine how they would like life to be different and what it would take to make this transformation happen. One of the functions of the therapist is to ask questions and, based on the answers, generate further questions. Examples of some useful questions are “What do you hope to gain from coming here?” “If you were to make the changes you desire, how would that make a difference in your life?” and “What steps can you take now that will lead to these changes?”

The Therapeutic Relationship

The quality of the relationship between therapist and client is a determining factor in the outcomes of SFBT, so relationship building or engagement is a basic step in SFBT. The attitude of the therapist is crucial to the effectiveness of the therapeutic process. It is essential to create a sense of trust so clients will return for further sessions and will follow through on homework suggestions. The therapeutic process works best when clients become actively involved, when they experience a positive relationship with the therapist, and when counseling addresses what clients see as being important (Murphy, 2015). One way of creating an effective therapeutic partnership is for the therapist to show clients how they can use the strengths and resources they already have to construct solutions. Clients are encouraged to do something different and to be creative in thinking about ways to deal with their present and future concerns.

De Shazer (1988) has described three kinds of relationships that may develop between therapists and their clients:

1. Customer: the client and therapist jointly identify a problem and a solution to work toward. The client realizes that to attain his or her goals, personal effort will be required.
2. Complainant: the client describes a problem but is not able or willing to assume a role in constructing a solution, believing that a solution is dependent on someone else’s actions. In this situation, the client generally expects the therapist to change the other person to whom the client attributes the problem.
3. Visitor: the client comes to therapy because someone else (a spouse, parent, teacher, or probation officer) thinks the client has a problem. This client may not agree that he or she has a problem and may be unable to identify anything to explore in therapy.

De Jong and Berg (2013) recommend using caution so that therapists do not box clients into static identities. These three roles are only starting points for conversation. Rather than categorizing clients, therapists can reflect on the kinds of relationships that are developing between their clients and themselves. For example, clients who tend to place the cause of their problems on another person or persons in their lives (complainants) may be helped by skilled intervention to begin to see their own role in their problems and the necessity for taking active steps in creating solutions. How the therapist responds to different behaviors of clients has a lot to do with bringing about a shift in the relationship. In short, both complainants and visitors have the capacity for becoming customers.