Lecture 7 solution focused therapy

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Brief overview of Solution focused therapy

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  • Insoo Kim BergAs the center gained notoriety, more therapists wanted to study there. Insoo Kim Berg happened to be one of them. Berg, a psychotherapist who was raised in Korea and moved to the United States in 1957, was dissatisfied with traditional therapy methods. As a beginning therapist, she found her “failures” with clients perplexing. She noticed that although some families dropped out of therapy prematurely, they still referred their friends and family to her. She became curious about what she might have done right with those families. Gradually, she created an approach for clients who wanted to solve their problems right away, not next month or next year.Eventually, Berg stumbled on the (then meager) literature on brief therapy, which motivated her to attend postgraduate school at the Family Institute of Chicago and the Menninger Foundation. After graduate school, she arrived at the MRI. She found that the brief therapy model made sense to her, and she was enticed by its pragmatic approach. While there, she met Steve de Shazer, whom she later married, and together they began questioning some tenets of the MRI approach. They became more intrigued by the role of solutions in therapy than the role of problems. Their interest in solutions eventually led to the for-mation of solution-focused therapy (SFT) and the Brief Family Therapy Center (BFTC) in Milwaukee, Wisconsin.Insoo Berg wrote on various applications of SFT, including that of social services, sub-stance abuse, school applications, and solution-focused work with children. She was well known for her training, which won the hearts of her participants by her warm smile and enthusiasm about the model. Her work took her around the world to work with clinicians, agencies, and schools. Insoo Kim Berg passed away at the age of 72 in 2007.Steve de ShazerSteve de Shazer was one of the most prominent figures in the SFBT approach, which he devel-oped with his wife, Insoo Kim Berg. Upon moving from the MRI in California where Berg and de Shazer met, the two set up what they called “the MRI of the Midwest,” where with a group of like-minded colleagues they developed the ways of thinking and the practices that became known as the solution-focused approach. This approach was based on the assump-tion of preexisting abilities, on client strengths and resources, and on the certainty that there have invariably been exceptions already to the behaviors, ideas, feelings, and interactions associated with problems. Therapy would be focused on an amplification of these exceptions and on helping clients through techniques such as the miracle question and scaling questions to build a detailed picture of how their future could be different. It was not seen as necessary to explore problems or their origins unless the client particularly wished to do so.De Shazer was the author of many chapters and articles and of five books: Patterns of Brief Therapy(1982), Keys to Solutions in Brief Therapy(1985), Clues: Investigating Solutions in Brief Therapy(1988), Putting Differences to Work(1991), and Words Were Originally Magic(1994). Each book demonstrated a stage in the development of the thinking behind and the practicing of the approach (Cade, 2005).Steve de Shazer was a pioneer in the field of family therapy and was in fact often referred to in his later years as the “Grand Old Man of Family Therapy.” An iconoclast and creative genius known for his minimalist philosophy and view of the process of change as an inevi-table and dynamic part of everyday life, he was known for reversing the traditional psycho-therapy interview process by asking clients to describe a detailed resolution of the problem that brought them into therapy, thereby shifting the focus of treatment from problems to solutions. (Trepper et al., 2006)Prior to his untimely death in September 2005, de Shazer and his colleagues completed writing the text More Than Miracles: The State of the Art of Solution-Focused Brief Therapy(Trepper et al., 2006
  • Lecture 7 solution focused therapy

    1. 1. Lecture 7 Solution Focused Brief Therapy Systemic comparative Kevin Standish Newham College University Centre
    2. 2. 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
    3. 3. 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
    4. 4. 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
    5. 5. 1. THE CORE CONCEPTS OF SOLUTION FOCUSED THERAPY (SFBT)
    6. 6. 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
    7. 7. 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
    8. 8. 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.
    9. 9. 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.
    10. 10. 2. CONCEPTUALISATION OF PROBLEMS IN SFBT
    11. 11. 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.
    12. 12. 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
    13. 13. 3. THERAPEUTIC GOALS IN SFBT
    14. 14. 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
    15. 15. 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.
    16. 16. 4. THERAPIST ROLE IN SFBT
    17. 17. 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.
    18. 18. 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.
    19. 19. 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.
    20. 20. 5. SFBT INTERVENTIONS
    21. 21. Skills overview
    22. 22. 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
    23. 23. Ask questions about. . . Client's story Client's strengths Client's resources Client's exceptions Relationships Self-esteem issues
    24. 24. Typical First Session    Opening: Social introductions, structure session Collect Complaints - Problem Rank Complaints   (What’s 1st, 2nd, 3rd) Discuss Exceptions
    25. 25. 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?
    26. 26. Session structure • • • • • • Miracle question process Exceptions / pre-session changes Identify Goals Scales: situation now, willingness, confidence Anything else/ Break Message
    27. 27. 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)
    28. 28. SFBT Interventions Miracle question • Amplifying what the client wants • Concrete, behavioral, measurable terms • Realistic terms
    29. 29. SFBT Interventions 1. 2. 3. 4. 5. Not knowing Complementing strengths Scaling questions Exception questions Coping questions
    30. 30. SFBT Interventions 1. Not Knowing • Clients experts • General attitude communicating an abundant, genuine curiosity • Micro practice skills
    31. 31. 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
    32. 32. 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?
    33. 33. 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?
    34. 34. 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
    35. 35. SFBT Interventions Miracle question • Amplifying what the client wants • Formatting the question • Concrete, behavioral, measurable terms • Realistic terms
    36. 36. SFBT Interventions Coping Questions • Tailored to help client from feeling overwhelmed • A method for exploring exceptions • Finding the clients strengths
    37. 37. 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
    38. 38. 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?
    39. 39. 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
    40. 40. 6. EVALUATION OF SFBT
    41. 41. 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.
    42. 42. 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.
    43. 43. 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.
    44. 44. 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.
    45. 45. 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.
    46. 46. 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.
    47. 47. 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.

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