In the year 2000 when this blog was first published, a directory of counselors and psychotherapists in New Zealand listed only one practitioner identified as offering Solution Focused Brief Therapy (SFBT). As the directory listed over 300 practitioners in private practice, this suggests that less than 0.3% of our therapists had discovered this very pragmatic approach to psychotherapy. About 10% of the listees at that time offered Narrative Therapy, which is perhaps not surprising given the influence of Michael White and David Epston in Australasia. My internet colleagues of the time estimated that in North America these figures would be the reverse. I revise this blog on the eve of the first NZ SFBT conference, and it would seem, by the interest shown, that there are a lot more practitioners embracing this method.
Both approaches are considered social constructionist, or perhaps strength focused. This is the notion that an objective viewpoint of the world is not available with most of the social realities we deal with daily, and different ‘language games’ or genres of interpretation construct different ‘realities’ or ‘worlds’ to live in. Money for example, works by us all having a tacit agreement that we will treat it as having real value, but as we know the paper and metal it is made of has little value as paper or metal. It is a socially constructed reality. Common to these schools of therapies is the commitment by the therapist to privilege the clients preferred realities, and make no claim as a therapist to be able to distinguish ‘good’ thinking from ‘bad’ (as cognitive-behavioural therapists do in their claims of identifying maladaptive schemas), or ‘rational’ thinking from ‘emotive’ (as rational-emotive therapists do).
The founders of both Narrative therapy and SFBT picked up on an observation made by a group in Palo Alto (Watzlawick, et al) in the 1970’s. Many human difficulties come about not so much because of the problem, but because of the attempted solution. “The problem is not the problem, so much as the attempted solution is the problem”. It is not difficult to envisage how a more positivist mind-set might be enticed by this observation into the endless analysis and discussion of what the ‘real’ problem is, which so characterises most of the dialogue which occurs amongst mental health professionals. The search for the ‘correct’ diagnosis. But if there is no objective viewpoint, what then? Well, both the founders of Narrative therapy and SFBT decided to invest their faith in human resilience, reasoning that in all probability there will be times when the client is moving in the direction of resolving their problems, although they may not have noticed this yet. The task then for the therapist, is to assist the client in recognising their own solutions (no matter how small they may initially be) to their difficulties.
As most people know who have even a passing knowledge of Narrative therapy, White & Epston set about doing this by developing a modern version of the ancient discourse of ‘demon possession’ – that is, externalising the problem as some sort of ‘entity’, constructed by social-historical discourses, which has taken over people’s lives. This immediately creates space between the person and the problem, breaks up the debilitating effects which occur when people identify with a problem, and allows a conversation to develop around when the person has resisted, avoided, or escaped from the ‘demon’ (or even reduced it’s powers to control their life – say in people with chronic pain). The person may then be invited to reflect upon whom the audience might be (either real or imagined) to their heroic skills; and the preferred sense of identity entailed by this.
Now whereas Narrative therapy conversations may spend some time deconstructing the ‘demon’ (on the grounds that generally speaking ‘demons’ thrive in the dark and need to be drawn into the light of day), perhaps by discovering that ‘anorexia’ say is rooted in discourses relating to feminine virtue and fashionable appearance in the market place for a particular client, or that domestic violence is rooted in discourses that invite men to be ‘cannon fodder’ for war; SFBT eschews almost all talk about the problem. SFBT writers frequently claim that problem talk and solution talk are often quite incommensurable. Steve de Shazer, one of the founders of SFBT illustrates this point with the tale (in Clues) of the Japanese coastal farmer who, whilst working in the rice field high above the village, saw a monstrous tidal wave rapidly approaching. She would not have been heard had she yelled, and there wasn’t time to run to the village and warn them. So she set the rice fields on fire. The villagers of course rushed to save the crop, and were spared a certain death from the tidal wave. A solution can occur without knowing about the problem. However we are so enamoured at times in analysing problems that we miss the solutions that are occurring right under our noses. Harry Korman (1996) has gone as far as to claim that the kinds of questions needed to formulate a diagnosis or understanding of the problem and the kinds of questions needed in order to help things change are mutually exclusive. But in saying that it is worth noting that some solution focused therapists have drawn criticism at times because of their zeal in doggedly pursuing client’s strengths and solution talk, and not spending enough time listening to the clients enunciation of their problem. But if solution focused therapists don’t get lured into becoming solution forced therapists then SFBT has much to commend it.
Rather than seeing themselves visited by clients with problems seeking help, as most therapists do, SFBT-ers more frequently regard themselves as visited by people with solutions seeking expression. As such they may take the first opportunity, such as when the client rings to make an appointment, to set in motion solution or change thinking, by saying for example: “Some people have noticed that things start to get better as soon as they have made an appointment, and even before they see someone for the first time; I wonder if you could keep note of any improvements that occur between now and when we meet”. Or else during the first session SF therapists ask the client what improvements have occurred since they made the appointment. There is some research to suggest that between 15 to 30% of people make some improvement before the first session; and when therapists ask about this possibility in a presuppositional manner the figure starts to climb towards 60% (Allgood, et al 1995; Howard et al 1986; Lawson, 1994; McKeel & Weiner-Davis, 1995).
Like Narrative therapists the SFBT-er is sensitive to those moments in the clients problem-saturated narrative when the problem could have occurred but didn’t. The exceptions to the dominant tale of problems. If you think about it, you will recognise that problem-focused thinking tends to be oriented towards the past, trying to analyse what happened, and then trying to effect change now – a style of thinking which has characterised most psychotherapies. By contrast solution-focused thinking is future oriented, and so SFBT-ers assume that clients are competent at conceptualising a desirable and satisfying future, and then, perhaps with help, figuring out which of their strengths and resources they can draw upon to get there (or are using now and could do more of). To assist them in this endeavour Steve de Shazer has come up with a question which is central to SFBT. It is called the Miracle Question:
Let’s imagine … that tonight, while you are asleep … a miracle happens … and all the problems that brought you here are solved. … because you are asleep, you don’t know this miracle is happening … so, tomorrow morning, how will you know that the miracle happened? What will be different that will tell you that the miracle happened? (p.5, 1988)
On the internet list for SFBT, which is one of the most active and helpful bulletin boards for therapists, Steve has commented that he has never asked the miracle question in the same way twice. Because the question has a “let’s pretend” quality to it, it allows answers to emerge which don’t get caught up in the “yes, buts” generated by any current feelings of hopelessness. By pursuing the question in detail a concrete picture of the solution and goals of therapy emerge; and what’s more this focus on the future seems to begin generating in clients an experience of themselves as competent and successful as they imagine themselves there in detail. It has not answered the question of what problem they want solved, but it does, often with a seemingly miraculous quality, allow the client to jump from complaint to solution.
The client further talks him- or herself into the solution by exploring further exception questions about when parts of the miracle have already occurred. If you like, SFBT is a rhetorical process which encourages people to talk themselves into solutions on the assumption that people’s lives are continuously changing and the solutions are already present as exceptions to the problem saturated stories. As the solutions are already happening it must be the client that is doing it, which in turn allows the therapist to embrace an ethic central to the constructionist therapies – all change for the better is attributed to the client, and all failure to enhance recognition of change is attributable to the therapist. A far cry from those therapies which talk of client resistance.
Having established the goals through a detailed examination of the answer to the miracle question and the exploration of any other exceptions, the therapist then asks the client scaling questions. The client is asked to rank on a scale of 1 to 10 where they are in terms of the goals, or how much of the preferred behaviour is happening, etc. Whereas questions which ask whether a problem is present or not, or whether a solution is present or not, invite constructions of fixed states, scaling questions invite constructions of process. “On a scale of 1 to 10, rank how much you resist the temptation to nag”, is a far more useful question than asking whether you resist the temptation to nag or not. (But it must be noted this (nagging) is a negative goal, and sfbt therapists prefer positive goals such as “I will be using more play to bring about change in my partner”.) Scaling questions are only limited, it seems, by the therapists creativity. “If 0 was where you were when you first sought this appointment, where are you now?” “What would you need to do to move half a point higher?” “If 10 stands for your preparedness to do anything to solve this problem, where are you now?” “Which of your friends or family will notice first that you have moved 1 point up the scale?”
The session ends with the therapist assigning homework, again solution focused work. “Until we meet next time I want you to pay attention to things you do or that happen in your life that you would like to continue to have happen in the future when the problem is solved. Note them in such a way that you can tell me about it next time.” (This task is called the formula first session task (FFST)). Or alternatively, “Until we meet next time I want you to pay attention to what you do when you resist the urge to do drugs (drink, binge etc.). Note it in such a way that you can tell me about it next time.” Compared to clients in a behavioural therapy problem focused homework assignment Jordan and Quinn (1994) found that SFBT clients assigned a FFST were more likely to report improvements in their problem, more likely to expect their therapy would be successful, and more likely to rate their first session as productive and positive. The difference rests, I believe, on the authorship of the solutions.
The second, and subsequent sessions begin with a review of changes and the FFST assignment. One of the blessings of SFBT is that it has evolved in an academic environment of greater acceptance by the researchers, than narrative therapy has in the Southern hemisphere. As a result there is a considerable body of research validating not only it’s overall effectiveness in a considerable number of settings, but also the effectiveness of various elements of it’s strategy (McKeel 1996; McDonald, 2011). This is of some importance for those working in environments of mangled care, where third parties are demanding only the use of empirically validated treatments. Not only that, but SFBT is one of the leaders, along with other constructionist approaches, in promoting that change in therapy is mostly related to perceptions of clients themselves as agents of change, and this factor accounts for 40% of observed change according to 40 years of outcome research.
Allgood, S. M., Parham, K. B., Salts, C. J., & Smith, T. A. (1995). The association between pretreatment change and unplanned termination in family therapy. The American Journal of Family Therapy, 23,
de Shazer, S. (1988). Clues: Investigating solutions in brief therapy. New York: Norton.
Howard, K. I., Lopta, S. M., Krause, M. S., & Orlinsky, D. E. (1986). The dose-effect relationship in psychotherapy. American Psychologist, 41, 159-164.
Jordan, K. B., & Quinn, W. H. (1994). Session two outcome of the formula first session task in problem- and solution-focused approaches. The American Journal of Family Therapy, 22, 3-16.
Korman, H. (1996). On the ethics of constructing realities. Contemporary Family Therapy, 19(1),
Lawson, D. (1994). Identifying pretreatment change. Journal of Counseling and Development, 72, 244-248.
McDonald, A.J. (2011). Solution-focused Brief Therapy: A Handbook of Evidence-Based Practice. New York: Oxford University Press.
McKeel, A. J. (1996). A clinician’s guide to research on solution-focused therapy. In S. D. Miller, M. A. Hubble, & B. L. Duncan (Eds.), Handbook of solution-focused brief therapy (pp. 251-271).
McKeel, A. J., & Weiner-Davis, M. (1995). Presuppositional questions and pretreatment change: A further analysis. Unpublished manuscript
Videos – There are a wide range of youtube videos on sfbt!
A Reminder Card – which may be useful to adapt to your style
Customers, Visitors, Complainers, and Prisoners.
At one time Steve de Shazer identified 3 classes of people who come to your clinic. However this classification system got picked up a little too readily by those of us with a diagnostic background; and we found ourselves reverting back to bad habits, and blaming the client for not improving (as diagnosticians are highly prone to do). So the idea was largely dropped. However you will at times hear sfbt therapists using these terms, so I add the here for those new to this school. Now some time later, in the early 1990s, Daphne Hewson, from McQuarrie University in NSW added a fourth class.
Customers: These are people who clearly express that they have a difficulty and are prepared to do almost anything to solve it. The task for SFBT therapists is to assist people reach goals, BUT only if that’s what they want at the moment. That moment is when they are customers. At other times they can be thought of as:
Visitors: People who don’t have any problem they want help with. You’ll certainly get no answer to the miracle question from these folk. Sometimes it is useful to ask who has asked them to come and see you, and why they think they did that. There is no need to convince them that you are yet another fool who doesn’t understand that they want no help at this point in time. You can give them compliments for any competences they might choose to tell you about, and offer them the possibility of an appointment in the future should they ever have a problem they want assistance with.
Complainers: People who come in and complain about various situations but when asked directly if they want help with one of these situations, refuse it. It is very easy to turn a complainer into a visitor – just tell them they ought to change or that they should take responsibility for some behaviour. Not a recommended course of action. Some therapists are willing to be a paid ear for complainers for an extended period of time, but I don’t think they should call that listening therapy, especially if there is a community of concern surrounding that individual, and they think the person is getting therapy. However on occasion complainers will become customers for a while and genuinely seek help for a problem. Sometimes sharing stories of others who have consulted you with similar complaints may invite the individual to become a customer. Sometimes asking them to pay attention to desirable behaviours in others about whom they are complaining, may lead them to reflect on their own behaviour and become a customer.
Prisoners: This is Daphne Hewson’s addition. People who are forced to see you by some mandate. You may wish to review your code of ethics about this. Daphne Hewson first introduced me to this term at a workshop on supervision, where choice of supervisor is not available and one is forced into supervision by the mangled care organization one finds oneself in. Prisoners are I suppose, a sub-group of visitors, and as such are not desiring help at this point in time. Some may be invited to become customers if asked if they would like some help to get out of “prison”.