Brief overview of Solution focused therapy

1. Lecture 7 Solution Focused Brief
Therapy
Systemic comparative
Kevin Standish
Newham College University Centre

3. Learning Outcomes
1. Describe the core concepts of Solution
Focused Therapy (SFBT)
2. Conceptualisation of problems in SFBT
3. Therapeutic goals in SFBT
4. Therapist role in SFBT
5. SFBT interventions
6. Evaluation of SFBT

4. Back ground to Solution Focused
Therapy (SFBT)
• Founders : Steve de Shazer, Insoo Kim Berg, and the
Brief Therapy Center in Milwaukee
• greatly influenced by Milton Erickson who believed
that everyone possessed the skills and abilities to solve
their own problems and that small changes could lead
to bigger changes.
• Gregory Bateson played an influential role in the
development of the solution-focused model.
• Others include: Don Jackson, Jay Haley, John
Weakland, and Bill Fry, the Mental Research Institute
(MRI) Paul Watzlawick, Richard Fisch, and Janet Beavin

5. Core Founders
• Steve de Shazer (died 2005)
• Insoo Kim Berg (Died
2007)
SFBT :a future-focused, goal-directed approach to brief
therapy that uses questions designed to identify
exceptions, solutions, and scales, which are used both
to measure the client’s progress toward a solution and
reveal the behaviours needed to achieve or maintain
further progress

6. 1. THE CORE CONCEPTS OF SOLUTION
FOCUSED THERAPY (SFBT)

7. Core concepts of SFBT
• Takes a distinctly postmodern approach,
whereby therapists dismissed the notion that
examining the past was necessary and began
to focus on the future.
• According to the postmodern view, there are
no fixed truths or realities: the truth or reality
is whatever the client presents.
• In other words, the postmodern view places
the client as the expert, not the therapist

8. Core concepts of SFBT
• social constructionism has heavily influenced the
solution-focused approach: the therapist should
take a “not- knowing stance” (de Shazer, 1988).
• This means the therapist enters the therapy
session not knowing what the client should do to
solve his or her problem.
• language can be a tool for creating change in
therapy by conjuring up new descriptions or
meanings for the client

9. the main assumptions SFBT
1. Clients have strengths and resources.
2. The relationship between therapist and client
has therapeutic value.
3. Change happens all the time.
4. A small change will generate larger change.
5. Rapid change is possible.

10. the main assumptions SFBT
6. The focus is on the present and the future.
7. Clear goals are essential.
8. The attempted solution may be part of the
problem.
9. The focus is on people not problems.
10.‘Resistance’ is a function of the relationship.
11. Knowing the cause of the problem is not
necessary to do effective therapy.

11. 2. CONCEPTUALISATION OF PROBLEMS
IN SFBT

12. Conceptualisation of problems
1. SFBT is focused on finding solutions not
problems and therefore does not look at a
person in the sense of being maladjusted.
2. It is behavior that causes maladjustment and
not the innate qualities of the person.
3. The client’s narrative determines much about
the repeated patterns of dysfunctional
behavior.

13. Three Types of Narratives
1.Progressive: Indicates that clients are
moving forward and acting on goals.
2.Stability: Indicates client’s are keeping
the status quo.
3.Regressive: Indicates client’s are
retreating from goals

14. 3. THERAPEUTIC GOALS IN SFBT

15. How Brief a Therapy?
• Aim for 5 sessions
• 45 mins each session
• Rarely beyond 8 sessions
• Sometimes 1 session enough
• Any improvements after 3 sessions?
• Increase gap between sessions as time goes on

16. Basic Rules and Assumptions
about Goals
– ―If it ain’t broke, don’t fix it‖: The client
determines the goals of counseling, not the
therapist.
– ―Once you know what works, do more of it‖:
This helps the client see positive behaviors
and reinforces proactive behaviors.
– ―If it’s broke, do something to fix it. If it
doesn’t work, don’t do it again‖: If it is not
working there is no need to try it again.

17. 4. THERAPIST ROLE IN SFBT

18. Therapist role in SFBT
The Counseling Process
Three types of clients:
1. Customers: These clients are active and want to do something
about their situation.
2. Complainant: These clients don’t want to do anything themselves
but want someone or something else to change.
3. Visitor: A client who does not know or cannot verbalize his or her
complaint or problem.
Counselor/client relationship:
1. Customer—Seller;
2. Complainant—Listener;
3. Visitor—Host.

19. Therapist role in SFBT
– Focus on what is right and what is working.
– Every problem has exceptions that can be
turned into solutions.
– Little changes lead to bigger changes.
– Goals are always set in positive terms.
– People do want to change for the better.

20. Therapist role in SFBT
– People are highly susceptible and dependent.
– Don’t ask a client to do something that he or she has
not succeeded at before.
– Avoid analyzing the problem.
– Be efficient! Don’t look for problems or solutions that
won’t work.
– Be a survivor not a victim.
– Focus on the present and the future, not the past.

21. 5. SFBT INTERVENTIONS

22. Skills overview

23. Core Tenets of SFBT
• If it’s not broken, don’t fix it
• Look for exceptions
• Asking questions rather than telling clients what
to do
• Future is negotiated and created
• Complements
• Gentle nudging to do more of what is working
• Change is constant and inevitable
• The solution is not always directly related to the
problem

24. Ask questions about. . .
Client's story
Client's strengths
Client's resources
Client's exceptions
Relationships
Self-esteem issues

25. Typical First Session



Opening: Social introductions, structure
session
Collect Complaints - Problem
Rank Complaints


(What’s 1st, 2nd, 3rd)
Discuss Exceptions

26. Typical First session
Find out what client wants from sessions
"Best hopes of our work together?"
Find out small details of life if problems solved
Miracle question
What do they already do that is successful
"Tell me about when the problem is not there"
What might change by taking a small step towards hope
• "What would others notice about you?

27. Session structure
•
•
•
•
•
•
Miracle question process
Exceptions / pre-session changes
Identify Goals
Scales: situation now, willingness, confidence
Anything else/ Break
Message

28. De Shazer’s Miracle Question
Suppose that one night, while you are
asleep, there is a miracle and the
problem that brought you here is solved.
However, because you are asleep you
don't know that the miracle has already
happened. When you wake up in the
morning, what will be different that will
tell you that the miracle has taken place?
What else?
(1988)

29. SFBT Interventions
Miracle question
• Amplifying what the client wants
• Concrete, behavioral, measurable terms
• Realistic terms

30. SFBT Interventions
1.
2.
3.
4.
5.
Not knowing
Complementing strengths
Scaling questions
Exception questions
Coping questions

31. SFBT Interventions
1. Not Knowing
• Clients experts
• General attitude communicating an
abundant, genuine curiosity
• Micro practice skills

32. SFBT Interventions
2. Complementing Strengths
• Strengths perspective
• Building rapport and giving hope
• Direct complements: positive evaluation or
reaction
• Indirect complements: a question implying
something positive

33. SFBT Interventions
Scaling Questions
 Scale of 1 – 10
 1 is the worst it’s ever been
 10 is after the miracle has happened
 Where are you now?
 Where do you need to be?
 What will help you move up one point?
 How can you keep yourself at that point?

34. SFBT Interventions
Exception Questions
 Tell me about the times when (the complaint)
does not occur, or occurs less than at other
times.
 When does your partner listen to you?
 Tell me about the days when you wake up
more full of life.
 When are the times you manage to get
everything done at work?

35. SFBT Interventions
Exploring Exceptions
• Problem description vs. exceptions
• Increase awareness of current/past successes
• Turning past solutions into present solutions
• Finding out specifics
• Creating a plan

36. SFBT Interventions
Miracle question
• Amplifying what the client wants
• Formatting the question
• Concrete, behavioral, measurable terms
• Realistic terms

37. SFBT Interventions
Coping Questions
• Tailored to help client from feeling
overwhelmed
• A method for exploring exceptions
• Finding the clients strengths

38. Types of Coping Questions
• Identify client
acknowledge
resources
they
do
not
even
• Can be used even in most pessimistic situations
• Genuine curiosity helps
• Genuine admiration for client helps
• Helps identify referred future
• Ensure client doesn't feel you're contradicting them
"Despite all the problems you still work. How you do

39. Other Useful Questions




Has anything been better since the last
appointment? What’s changed? What’s
better?
Can you think of a time in the past (month /
year / ever) that you did not have this
problem?
 What would have to happen for that to
occur more often?
Scaling Questions 1 – 10
With all of that going on, how do you manage
to cope?

40. M.E.C.S.T.A.T.
• A basic understanding of the SFBT treatment
approach is embodied in the
acronym: M.E.C.S.T.A.T.
• M – Miracle Questions
E – Exception Questions
C – Coping Questions
S – Scaling Questions
T – Time-Out
A – Accolades
T – Task

42. 6. EVALUATION OF SFBT

43. Advantages of SFBT
– Fits in nicely with managed care and the
pressure to provide effective counseling in
a briefer time frame.
– Emphasizes the positive attributes in
clients.
– It can be used effectively with a variety of
clients and issues.

44. Disadvantages of SFBT
– Critics say it is too simplistic and does not have enough
empirical research to support it.
– It may be contraindicated with dependent clients.
– It may not adequately address clients with serious
mental issues.
– It may not develop the counselor/client relationship in
enough depth to be therapeutic.

45. SFBT with Diverse Populations
– It does not attend to many multicultural tenets (e.g. understanding the
client within his or her culture and worldview.)
– It does not attend to the fact that problems may indeed be out of the
client’s ability to change them because the problems are system
bound.
– It works well for clients and cultures who like a fast, nononsense, down-to-earth approach and who are not interested in the
cognitive, behavioral or affective components of a problem.
– But because the client is seen as the expert, it can work well for some
clients of other cultures.

47. Comparing PCT and SFBT
1. PCT because historically it is a fundamental therapuetic approach has influenced
most approaches that have fol owed. Even CBT is now delivered from an
empathetic relationship, albeit asymetric. SFBT is no different it draws on empathy
and the relationship too.
2. Most therapists now integrate different elements into their practice therefore
comparisons are based on unrealistic ideal types.

48. Similarities
• 1. Both are client centred and value the client as the author of
their own lives.
• 2. Both emphasise client talk and see therapist utterances as
having locutionary force e,g. metaphor paraphrasing and the
miracle question, What and how something is said is important
for both.
• 3. Both are minimally directive especially compared to
behavioural oriented therapies e.g. CBT and DBT.
• 4. Both value the here and now in contast to psychoanalytic
approaches.
• 5. Both rely on tentative dialogue as opposed to direct
challenge.
• 6. Both focus on the clients frame of reference.

49. Differences
• 1. In later Rogerian therapy there was/is an ultimate
counselling/existential goal ie to become a fully self actualised
being. SFBT is more concerned with short medium term goals
focused on more effective adaption or coping.
• 2. The above is based on philosophical differences related to the
nature of reality. For SFBT it is socially constructed and relative.
For Rogers scientific truth was possible and differences of world
view were temporary not eternal.
• 3. PCT therapists tend to reflect and paraphrase whereas SFBT
therapists would use questioning more to draw out the clients
thoughts and emphasise positives.

50. Differences
• 4. SFBT will use reinforcing techniques for behaviours
and attitudes it sees as positive (within the frame
reference) e.g. the therapist compliments the alcoholic
for drinking less.
• 5. SFBT is short 5-8 45min sessions. In theory PCT can be
for as long as the client wishes with the proviso that the
therapist can end if they believe it unproductive.
• 6. Possibly, PCT can “allow” acceptance of immutables
such as death and inequality whereas SFBT is about
amplifying hope in order to better cope.