Solution Focused Therapy
June 23rd 2007 03:53
Solution focused brief therapy is an approach to counselling that is brief and effective. Research shows it to bring about lasting change on average in less than 5 sessions and in up to 83% of referrals. It can be brief because it is future-focused and because it works with the strengths of those who come by making the best use of their resources, and it can bring about lasting change precisely because it aims to build solutions rather than solve problems.
People come to the Brief Therapy Practice with an enormously diverse range of troubles including stress, depression, anxiety, sleep-problems, drug and alcohol problems, relationship difficulties with both children and partners, histories of abuse and oppression, pain, mental health problems and work-related concerns. On the basis of the research evidence the Practice will work with anyone who thinks that solution focused brief therapy could be of help in his or her life.
Solution-focused treatment begins from the observation that most psychological problems are present only intermittently. People with panic disorder obviously do not spend every minute of every day in a panic; even depression fluctuates in severity. Solution-focused therapy tries to help the patient notice when symptoms are diminished or absent and use this knowledge as a foundation for recovery. If a patient insists that the symptoms are constant and unrelieved, the therapist works with him or her to find exceptions and make the exceptions more frequent, predictable, and controllable. In other words, therapy builds on working solutions already available to the patient.
Solution focused brief therapy is a simple idea but not easy to put into practice. It consists of only three basic questions which, if they can be answered, often lead to dramatic change. The task of the therapist is to ask the questions in a way that leads the client to discover the answers and this requires considerable skill.
Three Basic Questions
Three basic questions underpin solution focused brief therapy:
What are your best hopes from this therapy?
What would your day-to-day-life look like if these hopes were realised?
What are you already doing and have done in the past that might contribute to these hopes being realised
Best Hopes – negotiating the contract
The basic rule of negotiation between professional and client (whatever the professional service being offered) is to put the client's agenda first. "How can I help you?" being one of the most common starting points. A solution focused negotiation will often begin with "What are your best hopes from this meeting?" Clients will respond across a continuum: "I would like to have a better relationship with my children" and "To get you out of my life!" representing different ends. Traditionally the former response would be seen as characterising motivation and the latter resistance. A solution focused response would see them as equally motivated. "So if this meeting helped towards getting us out of your life would that mean it had been useful?" is a response that accepts the client's starting point without closing down potential for agreement. "Let's imagine that this begins to happen – you begin to get on with your life as a person, as a parent in a way that is totally right for you and also okay for 'the authorities', what do you think you'll start to see that is different?" With this question the professional accepts the legitimacy of the client's wishes, makes no attempt to impose an agenda of 'the authority', and legitimately requires merely that the client acts within 'the law' (in its most general sense). If this outcome is achieved then the client will be doing things their way and because they are within what is permissible the authorities will no longer need to be involved. A win-win outcome.
A Preferred Future – What's the first thing you would notice?
After negotiating an agreed goal eliciting a detailed description of its realisation is a key task. For the client above a detailed picture of a day going well is likely to be included in the first meeting. The more detailed and concrete this description the more likely is the client to do. The point of these interviews is to keep the descriptions ordinary, mundane and small scale so no part of them is beyond the client's ability. In this instance two scenarios are explored. These are continued into the day. Many professionals are already adept at eliciting detailed descriptions of problem behaviour. Solution focused practitioners use the same skills to describe potential and sought after future behaviour rather than actual and unwanted past behaviour.
What are you already doing? The history of the preferred future.
The third skill involves discovering what is already working and the often hidden resources at the client's disposal. A useful 'rule-of-thumb here is the more problems a client's has had to face and survive the more hidden resources they are likely to have. In this sequence an exception to the normal problem behaviour is discovered and explored in a way that is likely to lead to more.
Solution focused conversations: using scales
Solution focused conversations look (and are) very simple but they are not easy to conduct. Many of the assumptions that drive them are contrary to the usual assumptions that govern conversations with clients. To begin with there is no intrinsic need to know and understand the problem. Instead the assumption is that knowing what to do next is more helpful than knowing why what you did yesterday was wrong. Another assumption is that no one is perfect and therefore no one can do their problem perfectly. This means that whatever the problem there will always be exceptions and these exceptions contain the seeds of alternative ways forward.
One of the most useful frameworks for solution focused conversations and one that keeps professional and customer on track is the 0–10 scale where 10 represents the hoped for outcome (i.e. the presence of what is desired rather than the absence of what is not) and 0 its opposite. The client's position on the scale allows for questions about how they are at that point rather than lower, how they improved things if they are higher than they have been in the past and what might tell them they are moving up the scale towards their desired goals. These scales can be constructed verbally but they can also be drawn (as mountains, stairs, ladders etc.), built (with chairs, toys, bricks etc.) and so provide the simplest and most concrete of structures for conversations about future hopes, past achievements and current strengths.
People come to the Brief Therapy Practice with an enormously diverse range of troubles including stress, depression, anxiety, sleep-problems, drug and alcohol problems, relationship difficulties with both children and partners, histories of abuse and oppression, pain, mental health problems and work-related concerns. On the basis of the research evidence the Practice will work with anyone who thinks that solution focused brief therapy could be of help in his or her life.
Solution-focused treatment begins from the observation that most psychological problems are present only intermittently. People with panic disorder obviously do not spend every minute of every day in a panic; even depression fluctuates in severity. Solution-focused therapy tries to help the patient notice when symptoms are diminished or absent and use this knowledge as a foundation for recovery. If a patient insists that the symptoms are constant and unrelieved, the therapist works with him or her to find exceptions and make the exceptions more frequent, predictable, and controllable. In other words, therapy builds on working solutions already available to the patient.
Solution focused brief therapy is a simple idea but not easy to put into practice. It consists of only three basic questions which, if they can be answered, often lead to dramatic change. The task of the therapist is to ask the questions in a way that leads the client to discover the answers and this requires considerable skill.
Three Basic Questions
Three basic questions underpin solution focused brief therapy:
What are your best hopes from this therapy?
What would your day-to-day-life look like if these hopes were realised?
What are you already doing and have done in the past that might contribute to these hopes being realised
Best Hopes – negotiating the contract
The basic rule of negotiation between professional and client (whatever the professional service being offered) is to put the client's agenda first. "How can I help you?" being one of the most common starting points. A solution focused negotiation will often begin with "What are your best hopes from this meeting?" Clients will respond across a continuum: "I would like to have a better relationship with my children" and "To get you out of my life!" representing different ends. Traditionally the former response would be seen as characterising motivation and the latter resistance. A solution focused response would see them as equally motivated. "So if this meeting helped towards getting us out of your life would that mean it had been useful?" is a response that accepts the client's starting point without closing down potential for agreement. "Let's imagine that this begins to happen – you begin to get on with your life as a person, as a parent in a way that is totally right for you and also okay for 'the authorities', what do you think you'll start to see that is different?" With this question the professional accepts the legitimacy of the client's wishes, makes no attempt to impose an agenda of 'the authority', and legitimately requires merely that the client acts within 'the law' (in its most general sense). If this outcome is achieved then the client will be doing things their way and because they are within what is permissible the authorities will no longer need to be involved. A win-win outcome.
A Preferred Future – What's the first thing you would notice?
After negotiating an agreed goal eliciting a detailed description of its realisation is a key task. For the client above a detailed picture of a day going well is likely to be included in the first meeting. The more detailed and concrete this description the more likely is the client to do. The point of these interviews is to keep the descriptions ordinary, mundane and small scale so no part of them is beyond the client's ability. In this instance two scenarios are explored. These are continued into the day. Many professionals are already adept at eliciting detailed descriptions of problem behaviour. Solution focused practitioners use the same skills to describe potential and sought after future behaviour rather than actual and unwanted past behaviour.
What are you already doing? The history of the preferred future.
The third skill involves discovering what is already working and the often hidden resources at the client's disposal. A useful 'rule-of-thumb here is the more problems a client's has had to face and survive the more hidden resources they are likely to have. In this sequence an exception to the normal problem behaviour is discovered and explored in a way that is likely to lead to more.
Solution focused conversations: using scales
Solution focused conversations look (and are) very simple but they are not easy to conduct. Many of the assumptions that drive them are contrary to the usual assumptions that govern conversations with clients. To begin with there is no intrinsic need to know and understand the problem. Instead the assumption is that knowing what to do next is more helpful than knowing why what you did yesterday was wrong. Another assumption is that no one is perfect and therefore no one can do their problem perfectly. This means that whatever the problem there will always be exceptions and these exceptions contain the seeds of alternative ways forward.
One of the most useful frameworks for solution focused conversations and one that keeps professional and customer on track is the 0–10 scale where 10 represents the hoped for outcome (i.e. the presence of what is desired rather than the absence of what is not) and 0 its opposite. The client's position on the scale allows for questions about how they are at that point rather than lower, how they improved things if they are higher than they have been in the past and what might tell them they are moving up the scale towards their desired goals. These scales can be constructed verbally but they can also be drawn (as mountains, stairs, ladders etc.), built (with chairs, toys, bricks etc.) and so provide the simplest and most concrete of structures for conversations about future hopes, past achievements and current strengths.
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