Solution+Focused+Therapy

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 * = Distinguishing Ideas ||= Contributors ||= Theory Conceptualization ||= Therapeutic Process ||= References ||= External Links ||

=I. Distinguishing Ideas = = =

Developed by Steve de Shazer and his colleagues at the Brief Family Therapy Center, Milwaukee in the late 1970s and early 1980s, Solution Focused Therapy (SFT) has emerged as an effective and popular model of brief therapy today. SFT is one of the more recent therapeutic approaches to emerge in the field of counseling psychology. The theoretical underpinnings of SFT are based on the philosophy of Milton Erickson and Jay Haley and share many commonalities with the work of Paul Watzlawick, John Weakland, and their colleagues at the Mental Research Institute (MRI) at Palo Alto, California (Watzlawick, Weakland, & Fisch, 1974; Weakland, Fisch, Watzlawick, & Bodin, 1974). When compared to prevalent models of therapy, SFT takes a different approach to understanding the formation of problems and their subsequent resolution. Solution focused therapists perceive problems as a by product of human interactions that occur between people and not due to any inherent deficits situated within individuals (de Shazer et al., 1986). Therefore, SFT does not subscribe to the disease model that focuses on diagnoses and pathologizing clients. Instead, clients are considered adept at solving their problems at all times since they are viewed as having unique attributes, strengths, values, resources, positive qualities, and abilities essential for successful resolution of problems. The focus on strengths, resources, and solutions instead of client’s problem and pathology in SFT differentiates it from traditional therapies. This is liberating for the therapists because it allows them to take a not-knowing, non-expert stance, while still remaining curious and interested in exploring client strengths and past successful handling of problems in order to help clients resolve their own problems (DeJong & Berg, 2002; Hoffman, 1990). In focusing on clients as experts of their lives, solution focused therapists reinstate the idea that clients hold the key to solving their problems. The therapists act as agents of change by assisting the clients in constructing their own solutions to the identified problem. This frequently entails changing interactions in the context of the situation in which the problem occurs, the perceptions and interpretations associated with the interactions or situation which comprise the problem, or co-construction of alternate, problem-free futures which are acceptable to the clients (de Shazer et al., 1986).

Solution focused therapists engage in solution talk by exploring and building on what is going well in the clients’ lives and this begins as early as the first session. Solution focused therapists believe that it is not necessary to know minute details of the complaints in order to start exploring possible solutions with clients; therefore, sessions are not focused on gathering a detailed past history of complaints and hypothesizing about or explaining why the problem occurs (de Shazer et al., 1986; DeJong & Berg, 2002). The goal of SFT is to utilize the clients’ language to find out what is going well and to continue doing what works. However, this does not imply that the clients cannot talk about their problems since they must engage in solution building. Clients are asked to identify and describe the problem in order to provide information on their perceptions of the problem and how they will know that the problem that brought them to therapy has been resolved (de Shazer et al., 1986; O’ Hanlon, 1993).

 Goals established in SFT are well defined and concrete since well defined goals provide a tangible way to measure the usefulness of therapy for clients and also enable them to anticipate positive change (de Shazer et al., 1986). Asking clients, “How do you think I can be helpful to you today?” allows the therapist to begin focusing on what the clients want from therapy. Goals, frequently set in the first session, are small, behavioral, achievable, and described as presence rather than absence of something (DeJong & Berg, 2002). One of the ways well formed goals are established in SFT is by asking the Miracle Question:  "Now, I want to ask you a strange question. Suppose that while you are sleeping tonight and the entire house is quiet, a miracle happens. The miracle is that the problem which brought you here is solved. However, because you are sleeping, you don’t know that the miracle has happened. So, when you wake up tomorrow morning, what will be different that will tell you that a miracle has happened and the problem which brought you here is solved? (de Shazer, 1988, p. 5)"

 Dejong and Berg (2002) believe that asking clients the miracle question enables them to think about unlimited possibilities, changes the course of the conversation from problem talk to solution talk, and evokes hopefulness about the future. Given that initial responses to the miracle question can be vague or grandiose, therapists may need to follow up with several related questions that help clients describe their more satisfying and problem-free futures in terms that also embody characteristics of well formed goals according to SFT, such as, “What else will you be doing that is different?” or “Who else will notice and how or when will they know that a miracle has happened?”

 Frequently, even before clients come to therapy, they are able to successfully resolve or deal with at least some aspect of the problem. They may also describe occasions when the problem-free futures elicited through the miracle question are already happening. Solution focused therapists ask exception questions to elicit when the problem does not occur and how the clients were able to get the exceptions to happen (de Shazer, 1986; DeJong & Berg, 2002). Small instances, such as, getting out of bed to make it to the appointment in a client who is depressed or a couple is able to agree on what they want to work on when they are having marital problems, may be considered as exceptions to the problems since only a small change is required to have a rippling effect that reverberates through the entire system (de Shazer, 1986).

 Scaling questions are frequently used with great versatility in SFT in order to make abstract concepts like goals, aspirations, perceptions, confidence, motivation, and commitment more concrete, and therefore, more attainable for clients. Scaling questions invite clients to put their observations, impressions, and predictions on a scale of 0 to 10 (DeJong & Berg, 2002). For example, a client may be asked, “On a scale of 0 to 10, where 0 means that you are not at all confident and 10 means that you are absolutely confident, how confident are you that your probation officer will let you off probation early?” and “On that same scale, what will the probation officer see you doing when you are at 8 or 9?” Scaling questions may be used early in therapy to negotiate goals and later, to assess progress in therapy or terminate successfully. For example, “On a scale of 0 to 10 where 0 means you are not able to control your anger and 10 means you are successful in controlling the anger, where are you on that scale now, where do you want to be, and where will you be when therapy can end?”

Major Tenets of Solution Focused Brief Therapy


 * 1) If it isn't broken, don't fix it. This is one of the overarching tenets of SFBT in that if a client has already solved a problem or in the process of resolution then it does not make sense to attempt to intervene. Therapy is required when the problem is present.
 * 2) If it works, do more of it. The role of the therapist is to encourage clients to continue doing what is already working and to support them in the maintenance of these changes.
 * 3) If it's not working, do something different. If an attempted solution does not work then the client is encouraged to explore and try alternative solutions in order to resolve the problem.
 * 4) Small steps can lead to big changes. Clients are encouraged to set small, realistic, behaviorally measured goals. This supports the assumption that small changes lead to other changes in the system. Small steps keep the process of change manageable for clients and allows for progress towards termination of therapy.
 * 5) The solution is not necessarily directly related to the problem. Because SFT is a present and future oriented model, therapy begins by having the client describe what will be different when the problem is solved. This approach focuses on the strengths and resources the client is already using when the problem is less frequent or not present. The goal is to encourage the client to focus on what they will be doing or be able to do when the problem is solved and identify times in their lives when this has already occurred.
 * 6) The language for solution development is different from that needed to describe a problem. Solution focused talk is positive, hopeful; future focused, and sends the message that change can and will happen. On the other hand, problem focused talk is past oriented and tends to imply problems are permanent.
 * 7) No problems happen all the time; there are always exceptions that can be identified. There are times in the client's life when the problem they come to therapy with is absent or less severe. Exploring what it different during those times helps make small changes.
 * 8) <span style="font-family: 'Times New Roman',Times,serif;">The future is both created and negotiable. Change is always happening and clients have the ability and knowledge to change their future behaviors.

=II. Contributors= <span style="font-family: 'Times New Roman',Times,serif;">[|Steve DeShazer], [|Insoo Kim Berg], Bill O'Hanlon, [|Eve Lipchik], [|Michelle Weiner-Davis], John Walter, Jane Peller, Peter DeJong

=III. Theory Conceptualization=

A. Problem Formation
<span style="font-family: 'Times New Roman',Times,serif;">Problems are formed as a result of interaction between people (relationships) and the client views differently a change in circumstances.

B. Problem Maintenance
<span style="font-family: 'Times New Roman',Times,serif;">Problems are also maintained as a result of interaction between people (relationships) and when the clients continue trying the same unsuccessful solutions to their problems.

C. Problem Resolution
<span style="font-family: 'Times New Roman',Times,serif;">Problems are resolved by helping clients utilize strengths and resources that they bring with them to therapy, consequently, helping them to do more of what works. Problems are also resolved by helping clients do something different by changing (the doing of) their interactions or their understanding (the viewing) of the interactions or situation.

=**IV. Therapeutic Process**=

B. Interventions
<span style="font-family: 'Times New Roman',Times,serif; font-size: 10pt;"> In their book, // More than miracles, // de Shazer, Dolan, Korman, Trepper, McCollum, and Berg (2007) described the following as the main SFBT interventions:
 * <span style="font-family: 'Times New Roman',Times,serif;">Look for previous solutions: According to this approach, individuals have solved many of their own problems in the past and have some ideas of how to solve their current problem. A helpful question to ask to highlight these previous solutions is to ask, "Are there times when this is less of a problem for you?"
 * <span style="font-family: 'Times New Roman',Times,serif;">Looking for exceptions: The therapist's role is to find times when the problem could possibly occur, but does not. It is also important to note that an exception is something that occurs instead of the problem, which is unplanned and unconscious to the individual. In order to identify exceptions, the therapist can ask, "What is different about the times that the problem is occurring less?" “When are you already doing some of what you want?”
 * <span style="font-family: 'Times New Roman',Times,serif;">Bridging the exceptions as the goal of therapy: “So, as you continue to do these things, will you think that you are on the beginning of a track to getting what you want out of coming here?”
 * <span style="font-family: 'Times New Roman',Times,serif;">To pursue the goal of continuing to perform the exceptions: “How you keep this going?” or “How do you predict that you will keep this going?” or “How will others know that you are keeping this going?”
 * <span style="font-family: 'Times New Roman',Times,serif;">Focus on the present and future: Problems are solved by focusing more of what the client would prefer, rather than on the past. "How would you like your life to be?" "What will you be doing that you would notice that you are continuing to stay on track" "What would others around you notice that would indicate that you are on making progress?"
 * <span style="font-family: 'Times New Roman',Times,serif;">Compliments: It is important to validate the client and inform them that they are working hard and doing a good job. It is also helpful to take notice of how difficult the clients problem may be and they are continuing to work hard at achieving their goal. This can be achieved by asking the client, "How did you do that?
 * <span style="font-family: 'Times New Roman',Times,serif;">Questions vs. directiveness and interpretations: One of the therapist's role is to ask questions to communicate with the client as opposed to telling them what to do or making interpretations.
 * <span style="font-family: 'Times New Roman',Times,serif;">Nudging: Therapist may prompt the client to do more of what is what is already working with a gentle nudge.
 * <span style="font-family: 'Times New Roman',Times,serif;">Contextual differences: “What is different about the times when the problem doesn’t happen (or you are doing some of what you want)?”
 * <span style="font-family: 'Times New Roman',Times,serif;">Specification (within client’s frame of reference): “What are you doing differently?” or “How are you thinking differently?”
 * <span style="font-family: 'Times New Roman',Times,serif;">Specification (from outside client’s frame of reference): “How are you perceived by others as acting differently?” or “If they think you are acting differently, how then do others act differently with you?”
 * <span style="font-family: 'Times New Roman',Times,serif;">**Specific Interventions:**
 * <span style="font-family: 'Times New Roman',Times,serif;">__Pre-session Change__: Therapist may ask a question eliciting pre-session change, What changes have you notice since you called to set up your appointment?
 * <span style="font-family: 'Times New Roman',Times,serif;">__Solution-focused goals__: The goal should be stated as the solution of the problem by the client. It should be small, concrete, and observable. It is important that the clients describe what they __will__ like to see happening as opposed to what they __will not__ like to see happening.
 * <span style="font-family: 'Times New Roman',Times,serif;">__The miracle question__: “Is any part of the miracle currently happening?”
 * <span style="font-family: 'Times New Roman',Times,serif;">__Scaling Questions__: On a scale from 1 to 10 (or 0 to 10), with 1 being XXXX and 10 being XXXX how would you rate X today?
 * <span style="font-family: 'Times New Roman',Times,serif;">//__Type of scaling questions:__//
 * <span style="font-family: 'Times New Roman',Times,serif;">//Presession change// : 0 represents how things were when client called to make the first appointment, 10 represents the miracle or how things would be if therapy was successful
 * <span style="font-family: 'Times New Roman',Times,serif;">//Tracking progress//: use same question every week to set goals and monitor change
 * <span style="font-family: 'Times New Roman',Times,serif;">//Motivation//: 1 represents not willing to do anything to make change, 10 represents being willing to do whatever it takes to find a solution
 * <span style="font-family: 'Times New Roman',Times,serif;">//Confidence//: 1 represents no confidence that they can change, 10 represents totally sure the changes will happen
 * <span style="font-family: 'Times New Roman',Times,serif;">//Relationships//: 1 represents no confidence that significant other will notice change, 10 represents being sure that others will notice change.
 * <span style="font-family: 'Times New Roman',Times,serif;">__Experiments and tasks:__
 * <span style="font-family: 'Times New Roman',Times,serif;">//Observational//: Suggest that clients pay attention to a particular aspect of their lives that is likely to prove useful in solution building, e.g., notice when you have a better day and what you are doing differently on those days
 * <span style="font-family: 'Times New Roman',Times,serif;">//Formula 1st Session:// “Between now and the next time we meet, we would like you to observe, so you can describe it next time, what happens in your life that you want to continue to have happen.
 * <span style="font-family: 'Times New Roman',Times,serif;">Notice when you overcome the urge to… (for addictions or habitual behavior)
 * <span style="font-family: 'Times New Roman',Times,serif;">//Prediction task:// predict whether the problem will be the same the next day, at the end of the day rate the day and compare to the predication. Think about what may have accounted for the right or wrong prediction.
 * <span style="font-family: 'Times New Roman',Times,serif;">//Behavioral://
 * <span style="font-family: 'Times New Roman',Times,serif;">Do something (specific or not) different and see who notices
 * <span style="font-family: 'Times New Roman',Times,serif;">Do more of what works
 * <span style="font-family: 'Times New Roman',Times,serif;">Do the opposite (of what others expect)
 * <span style="font-family: 'Times New Roman',Times,serif;">Go slow or don’t change
 * <span style="font-family: 'Times New Roman',Times,serif;">Write your thoughts or problems down and then burn it
 * <span style="font-family: 'Times New Roman',Times,serif;">Coin flip: flip a coin to determine which of two ways will be used to address the problem the next day
 * <span style="font-family: 'Times New Roman',Times,serif;">Base tasks on client’s level of commitment to change

C. Assessment Issues

 * <span style="font-family: 'Times New Roman',Times,serif;">Acting in line with this type of therapy model, it would be complementary to pick assessments that mirror the view of positive exceptions to the problem
 * <span style="font-family: 'Times New Roman',Times,serif;">The clinical interview, including SFT techniques such as scaling, would be considered an optimal assessment using this therapy model
 * <span style="font-family: 'Times New Roman',Times,serif;">Types of clients that come for counseling, according to deJong & Berg:
 * <span style="font-family: 'Times New Roman',Times,serif;">Visitor-don't assign a task; just give compliments--state what the clients are doing that is useful for them in their current circumstances
 * <span style="font-family: 'Times New Roman',Times,serif;">Complainant--no exceptions, no goals. Observe what is happening that tells you this problem can be solved
 * <span style="font-family: 'Times New Roman',Times,serif;">Complainant--exceptions, but no goals. "Between now and the next time we meet, pay attention to those time that are better, so that you can describe them to me next time in
 * <span style="font-family: 'Times New Roman',Times,serif;">detail. Try to notice what is different about them and how they happen and who does what to make them happen." -OR- Therapist can add element of prediction, e.g., each night before you go to bed, predict whether or not tomorrow will be the day when….
 * <span style="font-family: 'Times New Roman',Times,serif;">Customer, clear miracle picture but no exception- Compliment on clarity of miracle picture and suggest that client pretend that miracle has happened.
 * <span style="font-family: 'Times New Roman',Times,serif;">Customer, high motivation, no well-formed goals- "Do something different, no matter how strange or weird."
 * <span style="font-family: 'Times New Roman',Times,serif;">Customer, well-formed goals and deliberate exceptions- "Continue to do what is working and pay attention to what else you might be doing, but haven't noticed yet, that makes things better and come back and tell me about it."

D. Treatment Plan
=V. REFERENCES= DeJong, P., & Berg, I. K. (2001). Co-constructing cooperation with mandated clients. //Social Work, 46,// 361-374.

DeJong, P., & Berg, I. K. (2002). //Interviewing for solutions// (2nd ed.). Pacific Grove, CA: Brooks/Cole.

<span style="font-family: 'Times New Roman','serif';"> de Shazer, S. (1984). The death of resistance. //Family Process, 23,// 79-93.

<span style="font-family: 'Times New Roman','serif';"> de Shazer, S. (1988). //Clues: Investigating solutions in brief therapy//. New York: Norton

<span style="font-family: 'Times New Roman','serif';"> de Shazer, S., Berg, I. K., Lipchik, E., Nunnally, E., Molnar, A., Gingerich, W., et al. (1986). Brief therapy: Focused solution development. //Family Process, 25,// 207-222.

<span style="font-family: 'Times New Roman',Times,serif;">de Shazer, S., Dolan, Y., Korman, H., Trepper, T., McCollum, E., & Berg, I. K. (2007). //More than miracles: The state of the art of solution-focused brief therapy.// New York: Haworth.

Lipchik, E. (2002). //Beyond technique in solution-focused therapy: Working with// //emotions and the therapeutic relationship.// New York: Guilford Press.

O’Hanlon, W. H. (1993). Take two people and call them in the morning: Brief solution oriented therapy with depression. In S. Friedman (Ed.). //The New language of change: Constructive collaboration in psychotherapy//. New York: Guilford Press.

Watzlawick, P., Weakland, J., & Fisch, R. (1974). //Change: Principles of problem formation and// //problem resolution//. New York: W. W. Norton

Weakland, J., Fisch, R., Watzlawick, P., & Bodin, A. M. (1974). Brief therapy: Focused problem resolution. //Family Process//, //13//, 141-168.

=VI. External Links= ==