Solution Focus

by Rob Cumming

Solution focused brief therapy (SFBT) is at first sight a rather minimal set of skills and assumptions about helping people change.  It seems to defy many of the conventions of psychotherapy from the last  hundred years – about the need for long-term work for example - yet it seems to be giving good results in many fields, from mental health through to organisational development.

SFBT was developed through the research programmes of the Brief Family Therapy Centre, Milwaukee, USA. It was named in 1986¹ in a paper whose title gave homage to an earlier paper² by John Weakland and his team from the Mental Research Institute at Palo Alto. That earlier paper had outlined a practice of strategic brief psychotherapy;  both papers refer to the work of pioneers such as Milton Erickson and Jay Haley³. These are the “usual suspects” who show up in the history of many major threads of the strategic and brief psychotherapies and they are very much present in the genealogy of SFBT. If a more profound understanding of SFBT’s origins is what you desire, then the literature of family therapy, particularly Milton Erickson and the Strategic branch of the subject, will reward your study.

SFBT also bears  a family resemblance to other contemporary collaborative and narrative therapies, such as the work of Bill O’Hanlon⁴; Michael White and David Epston⁵; John Walter and Jane Peller⁶; Harlene Anderson and Harry Goolishian⁷.

The upsurge in interest in all these variants of brief therapy has coincided with moves towards cost-effective, accountable psychological interventions in healthcare in the USA and elsewhere. But that is not where these therapies are from, or necessarily what they are for. Yvonne Dolan has written⁸ that brief therapy means doing only what is necessary for healing; a standard which can be applied in any context. It can be very tough to achieve this in work-contexts where time is strictly rationed out.

Fundamentals

SFBT runs on questions. Approaching it as a set of skills, there are specific questions which practitioners  must learn to ask. The questions the therapist has to answer may give a simpler idea of what happens in SFBT.

What does my client want to get as a result of coming along to see me? This involves questioning (such as the Miracle Question) and as far as possible, literal acceptance of the client’s answers. Plenty of detail is always sought; and the outcome desired for the therapy should be richly described, and include differences which therapist and client will notice, and which will make a difference!

The Miracle Question goes something like this: Suppose… we finish up our meeting today, and you go home and eventually you go to bed and go to sleep… and while you are sleeping a miracle happens, and this miracle has the effect of solving the problem which brought you along to see me today. But you’re asleep, so you don’t know this miracle has happened. What will you notice when you wake up, that shows you that the miracle has happened? This can lead to a very detailed description of the preferred future which your client want to move towards. More generically, it’s that word ‘suppose’ which I think is significant. The therapist has to be able to invite the client in to an imagined place where their problems don’t hold sway. Suppose your problem is gone, what specifically would happen then? This can work as a self-help exercise – remembering always to tarry a while in the imagined future and to fully explore what it looks, sounds and feels like, and what other people make of it.

The next question the therapist has to answer is, what is my  client already doing and what have they done recently which might help them to attain their preferred future? This means looking for  exceptions to the rule of their problems. Here the principle is that there are exceptions to every rule. And another principle which guides these conversations is: that if the therapist chooses to talk about, and seek detail of every exceptional thing which the client tells her about, the salience and relevance of these ‘anomalies’ in the client’s story will be greatly increased. Clients can rapidly, visibly change as this becomes real to them, and marginalised successes become central threads of their stories.

Notice that so far we have two activities in therapy - finding out what the client wants, and finding out about times when they have attained at least a little of what they want. That’s two thirds of the approach. The last bit is to find out what bridges the client can build between where they are now and their desired future. You may  seek descriptions of the next small steps towards their goals which the client feels able to take. These can be very small indeed. Maybe some clients will first want to know how they can avoid getting worse! Scaling  questions can come in to this bridge-building process – for example, On a scale of zero to ten where zero is where you first called me, and ten is after the miracle, where are you now? With questions like this you and your client can mark progress, talk about small steps as well as end-points or goals, and talk about what part of the process they want you to help them with.  

What else is involved in solution-focused work? The emphasis on recognising and building on strengths which underpins it, works best when you are also able to truly acknowledge your client’s humanity and their suffering or difficulties.  This is surely an ingredient of all effective therapy – and it is essential in SFBT also. Jingoistic positive thinking does not come in to it.

So, in SFBT we are cultivating a way of thinking which is constructive. Empathy is also essential. ‘Constructive’ means that you seek out competence and capability – however small – and build on that. Nowadays this way of thinking is being incorporated in everything from social work to dog training, so SFBT is in a sense participating in the spirit of the age. Empathy means that you are doing your very best to understand the world from your client’s point of view. When you are doing this, being curious from this perspective, your questions are far more likely to come out well and your client will be  ready to work towards solutions.

Let’s end with a bit of homework. This utilises a scale in a slightly unorthodox way:

Imagine a scale from 0  to 10. And immediately place yourself on that scale.

Now – what does the 10 mean on your scale? What is your scale called? Give yourself a little time to notice these things.

References and Notes

1.  Brief Therapy: Focused Solution Development Steve De Shazer, Insoo Kim Berg, Eve Lipchik, Elam Nunnally, Alex Molnar, Wallace Gingerich, Michele Weiner-Davis. Family Process, 25, pp. 207-222

2.  Brief Therapy: Focused Problem Resolution. John H Weakland, Richard Fisch, Paul Watzlawick, Arthur M Bodin. Family Process, 13, pp. 141-168

3.  Both papers cite Haley, J., Uncommon Therapy: The Psychiatric Techniques of Milton H. Erickson, M.D. Norton, 1973, and Haley, J. (Ed.) Advanced Techniques of Hypnosis and Therapy: Selected Papers of Milton H. Erickson, M.D. Grune and Stratton, 1969.

4.  O’Hanlon, Bill and Bertolino, Bob: Even From A Broken Web: brief, respectful solution-oriented therapy for sexual abuse and trauma. Wiley, 1998.

5.  White, Michael and Epston, David: Narrative Means to Therapeutic Ends. W W Norton, 1990.

6.  Walter, John L. and Peller, Jane E. Recreating Brief Therapy: preferences and possibilities. W W Norton, 2000.

7.  Anderson, Harlene and Goolishian, Harold. The Client is the Expert: a Not-Knowing Approach to Therapy. In McNamee, Sheila and Gergen, Kenneth J., Therapy as Social Construction, pp. 25-39.

8.  Dolan, Yvonne M., Resolving Sexual Abuse: solution-focused therapy and Ericksonian Hypnosis for adult survivors. W W Norton, 1991.

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