Solution focused brief therapy

Solution focused brief therapy (SFBT), often referred to as simply 'solution focused therapy' or 'brief therapy', is a type of talking therapy that is based upon social constructionist philosophy. It focuses on what clients want to achieve through therapy rather than on the problem(s) that made them seek help. The approach does not focus on the past, but instead, focuses on the present and future. The therapist/counselor uses respectful curiosity to invite the client to envision their preferred future and then therapist and client start attending to any moves towards it whether these are small increments or large changes. To support this, questions are asked about the client’s story, strengths and resources, and about exceptions to the problem.

Solution focused therapists believe that change is constant. By helping people identify the things that they wish to have changed in their life and also to attend to those things that are currently happening that they wish to continue to have happen, SFBT therapists help their clients to construct a concrete vision of a preferred future for themselves. The SFBT therapist then helps the client to identify times in their current life that are closer to this future, and examines what is different on these occasions. By bringing these small successes to their awareness, and helping them to repeat these successful things they do when the problem is not there or less severe, the therapists helps the client move towards the preferred future they have identified.

One way of understanding the practice of SFBT is displayed through the acronym MECSTAT, which stands for Miracle questions, Exception questions, Coping questions, Scaling questions, Time-out, Accolades and Task.

Questions

The Miracle Question The miracle question is a method of questioning that a coach, therapist, or counselor uses to aid the client to envision how the future will be different when the problem is no longer present. Also, this may help to establish goals.

A traditional version of the miracle question would go like this:

“I am going to ask you a rather strange question [pause]. The strange question is this: [pause] After we talk, you will go back to your work (home, school) and you will do whatever you need to do the rest of today, such as taking care of the children, cooking dinner, watching TV, giving the children a bath, and so on. It will become time to go to bed. Everybody in your household is quiet, and you are sleeping in peace. In the middle of the night, a miracle happens and the problem that prompted you to talk to me today is solved! But because this happens while you are sleeping, you have no way of knowing that there was an overnight miracle that solved the problem. [pause] So, when you wake up tomorrow morning, what might be the small change that will make you say to yourself, ‘Wow, something must have happened—the problem is gone!’”

Whilst relatively easy to state, the miracle question requires considerable skill to ask well. The question must be asked slowly with close attention to the person's non-verbal communication to ensure that the pace matches the person's ability to follow the question. Initial responses frequently include a sense of "I don't know." To ask the question well this should be met with respectful silence to give the person time to fully absorb the question.

Once the miracle day has been thoroughly explored the worker can follow this with scales, on a scale where 0 = worst things have ever been and 10 = the miracle day where are you now? Where would it need to be for you to know that you didn't need to see me any more? What will be the first things that will let you know you are 1 point higher. In this way the miracle question is not so much a question as a series of questions.

There are many different versions of the miracle question depending on the context and the client.

In a specific situation, the counselor may ask,

"If you woke up tomorrow, and a miracle happened so that you no longer easily lost your temper, what would you see differently?" What would the first signs be that the miracle occurred?"

The client (a child) may respond by saying,

"I would not get upset when somebody calls me names."

The counselor wants the client to develop positive goals, or what they will do, rather than what they will not do—to better ensure success. So, the counselor may ask the client, "What will you be doing instead when someone calls you names?"

Scaling Questions Scaling questions are tools that are used to identify useful differences for the client and may help to establish goals as well. The poles of a scale can be defined in a bespoke way each time the question is asked, but typically range from "the worst the problem has ever been" (zero or one) to "the best things could ever possibly be" (ten). The client is asked to rate their current position on the scale, and questions are then used to help the client identify resources (e.g. "what's stopping you from slipping one point lower down the scale?"), exceptions (e.g. "on a day when you are one point higher on the scale, what would tell you that it was a 'one point higher' day?") and to describe a preferred future (e.g. "where on the scale would be good enough? What would a day at that point on the scale look like?")

Exception Seeking Questions Proponents of SFBT insist that there are always times when the problem is less severe or absent for the client. The counselor seeks to encourage the client to describe what different circumstances exist in that case, or what the client did differently. The goal is for the client to repeat what has worked in the past, and to help them gain confidence in making improvements for the future.

Coping questions Coping questions are designed to elicit information about client resources that will have gone unnoticed by them. Even the most hopeless story has within it examples of coping that can be drawn out: "I can see that things have been really difficult for you, yet I am struck by the fact that, even so, you manage to get up each morning and do everything necessary to get the kids off to school. How do you do that?" Genuine curiosity and admiration can help to highlight strengths without appearing to contradict the clients view of reality. The initial summary "I can see that things have been really difficult for you" is for them true and validates their story. The second part "you manage to get up each morning etc.", is also a truism, but one that counters the problem focused narrative. Undeniably, they cope and coping questions start to gently and supportively challenge the problem-focused narrative.

Problem-free talk In solution-focused therapy, problem-free talk can be a useful technique for identifying resources to help the person relax, or be more assertive, for example. Solution focused therapists will talk about seemingly irrelevant life experiences such as leisure activities, meeting with friends, relaxing and managing conflict. The therapist can also gather information on the client's values and beliefs and their strengths. From this discussion the therapist can use these strengths and resources to move the therapy forward. For example; if a client wants to be more assertive it may be that under certain life situations they are assertive. This strength from one part of their life can then be transferred to the area with the current problem. Or if a client is struggling with their child because the child gets aggressive and calls the parent names and the parent continually retaliates and also gets angry, then perhaps they have an area of their life where they remain calm even under pressure; or maybe they have trained a dog successfully that now behaves and can identify that it was the way they spoke to the dog that made the difference and if they put boundaries in place using the same firm tonality the child might listen.

Dan Jones, in his Becoming a Brief Therapist book writes:

'...it is in the problem free areas you find most of the resources to help the client. It also relaxes them and helps build rapport, and it can give you ideas to use for treatment...Everybody has natural resources that can be utilised. These might be events...or talk about friends or family...The idea behind accessing resources is that it gives you something to work with that you can use to help the client to achieve their goal...Even negative beliefs and opinions can be utilised as resources '

Resources

A key task in SFBT is to help clients identify and attend to their skills, abilities, and external resources (e.g. social networks). This process not only helps to construct a narrative of the client as a competent individual, but also aims to help the client identify new ways of bringing these resources to bear upon the problem. Resources can be identified by the client and the worker will achieve this by empowering the client to identify their own resources through use of scaling questions, problem-free talk, or during exception-seeking.

Resources can be Internal: the client's skills, strengths, qualities, beliefs that are useful to them and their capacities.

Or, External: Supportive relationships such as, partners, family, friends, faith or religious groups and also support groups.

History of Solution Focused Brief Therapy

Solution Focused Brief Therapy is one of a family of approaches, known as systems therapies, that have been developed over the past 50 years or so, first in the USA, and eventually evolving around the world, including Europe. The title SFBT, and the specific steps involved in its practice, are attributed to husband and wife Steve de Shazer and Insoo Kim Berg and their team at The Brief Family Therapy Center in Milwaukee, USA. Core members of this team were Eve Lipchik, Wallace Gingerich, Elam Nunnally, Alex Molnar, and Michele Weiner-Davis. Their work in the early 1980s built on that of a number of other innovators, among them Milton Erickson, and the group at the Mental Research Institute at Palo Alto – Gregory Bateson, Donald deAvila Jackson, Paul Watzlawick, John Weakland, Virginia Satir, Jay Haley, Richard Fisch, Janet Beavin Bavelas and others.

The concept of brief therapy was independently discovered by several therapists in their own practices over several decades (notably Milton Erickson), was described by authors such as Haley in the 1950s, and became popularized in the 1960s and 1970s. Richard Bandler, John Grinder and Stephen R Lankton have also been credited, at least in part, with the inspiration for and popularization of brief therapy, particularly through their work with Milton Erickson. While Jay Hayley and the team at the Mental Research Institute at Palo Alto aimed to uncover the principles that underpinned Erickson's approach to brief therapy, John Grinder and Richard Bandler provided practical guidelines for the application of some of the hypnotic techniques of Erickson.

Solution Focused Brief Therapy has branched out in numerous spectrums - indeed, the approach is now known in other fields as simply Solution Focus or Solutions Oriented Therapy. Most notably, the field of Addiction Counseling has begun to utilize SFBT as an effective means to treat problem drinking. Johns Hopkins University, the Center for Solutions in Cando, ND, and notable others, have implemented SFBT as part of their program, wherein they utilize this therapy as part of a partial hospitalization and residential treatment facility for both adolescents and adults.

The field of Christian Pastoral counseling has also seen Solution Focused Brief Therapy make inroads into its practices where it is referred to as Solution Focused Pastoral Counseling or Brief Pastoral Counseling.

Solution-Focused counseling

Solution-Focused counseling is a solution focused brief therapy model. Various similar, yet distinct, models have been referred to as solution-focused counseling. For example, Jeffrey Guterman developed a solution-focused approach to counseling in the 1990s. This model is an integration of solution-focused principles and techniques, postmodern theories, and a strategic approach to eclecticism.

Solution-Focused consulting

Solution-Focused consulting is an approach to organizational change management that is built upon the principles and practices of Solution-Focused therapy. While therapy is for individuals and families, Solution-Focused consulting is being used as a change process for organizational groups of every size, from small teams to large business units.

Solution-Focused hypnotherapy

A contemporary therapy linking the solution focused brief therapy model back to the hypnotherapy of Milton H Erickson the hypnotherapist who inspired Steve de Shazer and Insoo Kim Berg. Solution Focused Hypnotherapy (SFH) adopts practical, modern strategies that include the best of Solution Focused Brief Therapy (SFBT), Cognitive Behavioural Therapy (CBT), Neuro-Linguistic Programming (NLP) and direct hypnosis. Within the last ten years the number of hypnotherapists who have been trained in this approach in the UK has greatly increased, and their primary origin can be found in Bristol, at the Clifton Practice (Clifton Practice Hypnotherapy Training, CPHT), where Hypnotherapist (possibly the most experienced in the UK) and Senior Lecturer David Newton has been developing and championing the use of SFH since 1996. CPHT has now developed nationally throughout England, with plans for new schools in Birmingham and Aberdeen (March 2013).

See also

• Brief therapy
• Family therapy
• Narrative therapy
• Response based therapy
• Solution focused Social Work

References

• Berg, Insoo Kim and S.deShazer: Making numbers talk: Language in therapy. In S. Friedman (Ed.), "The new language of change: Constructive collaboration in psychotherapy." New York:Guilford, 1993.
• Berg, Insoo Kim, "Family based services: A solution-focused approach." New York:Norton. 1994.
• Berg, Insoo Kim; "Solution-Focused Therapy: An Interview with Insoo Kim Berg." Psychotherapy.net, 2003.
• Cade, B., and W.H. O’Hanlon: A Brief Guide to Brief Therapy. W.W. Norton & Co 1993.
• De Jong, Peter and Insoo Kim Berg Interviewing for Solutions Brooks Cole Publishers, 2nd edition 2002
• Denborough, D.; Family Therapy: Exploring the Field's Past, Present and Possible Futures. Adelaide, South Australia: Dulwich Centre Publications, 2001.
• de Shazer, Steve: Clues; Investigating Solutions in Brief Therapy. W.W. Norton & Co 1988
• George,E., C.Iveson, H. Ratner; Problem to solution; brief therapy with individuals and families. BT Press, 1990.
• Greenberg, Gail R., Keren Ganshorn and Alanna Danilkewic. 2001. Solution-focused therapy; A counseling model for busy family physicians. "Canadian Family Physician," 47 (November): 2289-2295.
• Guterman, J.T. (2006). Mastering the Art of Solution-Focused Counseling. Alexandria, VA: American Counseling Association. ISBN 1-55620-267-9
• Guterman, J.T., Mecias, A., Ainbinder, D.L. (2005). Solution-focused treatment of migraine headache. The Family Journal: Counseling and Therapy for Couples and Families, 13, 195-198.
• Guterman, J.T. (1996). Doing mental health counseling: A social constructionist re-vision. Journal of Mental Health Counseling, 18, 228-252.
• Guterman, J. T. (1994). A social constructionist position for mental health counseling. Journal of Mental Health Counseling, 16, 226-244.
• Hubble, M.A., B.L. Duncan, S.D. Miller; The Heart and Soul of Change; what works in therapy. American Psychological Association, 1999.
• Miller, S.D., M.A. Hubble, B.L. Duncan; Handbook of Solution-focused brief therapy. Jossey-Bass Publishers, 1996.
• Murphy, J.J. (1997). Solution-focused counseling in middle and high schools. American Counseling Association: Alexandria, VA.
• O’Connell, B.; Solution Focused Therapy. Sage, 1998.
• O’Hanlon, Bill, and S. Beadle; A Field Guide to PossibilityLand: possibility therapy methods. BT Press 1996.
• O'Hanlon, Bill and M. Weiner-Davis: "In Search of Solutions: A New Direction in Psychotherapy." WW Norton & CO. New York 1989
• Simon, Joel K. & Nelson, Thorana S. (2007). Solution-focused brief practice with long-term clients in mental health services: "I'm more than my label". New York: Taylor & Francis.
• Simon, Joel K. (2009). Solution focused practice in end-of-life and grief counseling. New York: Springer Publication.
• Talmon, M.; Single Session Therapy; maximizing the effect of the first (and often only) therapeutic encounter. Jossey-Bass Publishers, 1990.
• Trepper, Terry S., Eric E. McCollum, Peter De Jong, Harry Korman, Wallace Gingerich, and Cynthia Franklin. 2010. "Solution focused therapy treatment manual for working with individuals." [Hammond, IN?]: Research Committee of the Solution Focused Brief Therapy Association.
• Ziegler, P. and T. Hiller: Recreating Partnership: A Solution-Oriented, Collaborative Approach to Couples Therapy. W.W.

Norton 2001.

External links

• Solution Focused Brief Therapy Association
• Social Construction Therapies Network
• The Association for Solution Focused Hypnotherapy
• UK Association of Solution Focused Practitioners