Solution Focused Therapy (Solutiono Focused Therapy Standpoint ( Every…
Solution Focused Therapy
Differences with many psychotherapies
- Present and Future more important than Past
- Instead of making the “Problem” part of the person’s life smaller, it focuses on making the “non-Problem” part bigger.
- It is a systemic/relational therapy – it understands that a change in one person will have effects on others.
Healthy Future Self
(without the problem/s)
- What will I/we be?
- What will I/we do?
- How will my/our relationships be?
- What will life look like?
Healthy Present Self
- What am I already doing right
- What are the Exceptionsto problem/s (Michael White calls these Unique Outcomes)
- What aspects of life/family/self are already OK
Healthy Past Self
- How did I manage this problem (or similar ones) in the past?
- What coping strategies did I have, that I could import into the present and the future?
- What was healthy/strong/worthwhile about me/my family in the past?
- Preferred future
- Coping Questions
- Identifying resources: What’s already working and doesn’t need to change (keep asking “What else?”)
- Scaling Questions
- Meet the person: client is more than the sum of their problems
- Problem free talk: about their work, hobbies, or some other topic on which they have knowledge or expertise
- Don’t minimise problem: show respect for their struggle (All problems are “tough problems”)
- Areas of competence: transferable skills and resources. Listen out for Exceptions, strengths, survival, courage, humour, hope, perseverance, etc
- Personal responsibility and agency: “How Did You Manageto do that?” “What helped you to achieve that?” “How did you cope?” “What qualities did it take to do that?” etc
- External Resources (supportive relationships, etc)
What’s already working
- Always ask about Exceptions (Unique Outcomes)– i.e. when problem doesn’t happen, or happens less, or bothers them less.
- “How did you manage to ...?” “What would it take for you to do that again/more often?”
- “It sounds like things have been really tough for you recently/for a long time. How do you manage to cope?”
- “How have you managed to stop things getting worse?”
- important when people think they are not coping... because they are actually coping in some way; others have "real" (not psychological) problems - also important to ask about coping
- What doesn’t need to change? (What do you value and want to keep in yourself/your life/your relationships?)
- De Shazer and Berg called this the Formula First Session Task, because they originally developed it as a first-session intervention used for every client (hence “formula”). Later, instead of using it in the first session, they asked clients to do this before the first session, when they phoned to make the first appointment.
- Miracle question:
- “Let’s imagine that tonight while you’re asleep, a miracle happens and all your problems disappear – just like that! . . . But you’re asleep so you don’t know that this miracle has happened . . . When you wake up tomorrow morning, what is the first thing that will give you a clue that this miracle has happened?”
- NB: Miracle Question needs at least 20 minutes to really explore – and often fills an hour
- Exploring and expanding the “Miracle”
- How will others notice?
- How will they behave?
- How will you respond? And how will they respond to that?
- At the end of the day (after the "miracle"), what will you be proudest and most pleased about having done differently?
- Shifting from negative to positive: "when you resist the urge to ..., what will you be doing instead? When you are no longer feeling anxious, what will you be feeling instead?
- General to specific: “How will you know that…?” “What will you be doing that will tell others..?” Who will be the 1st to notice you’re moving forward?”
Goals in Solution Focused Therapy:
- Positiverather than negative (“Clean lungs” rather than “not smoking”)
- Significant to client; client’s own idea (not Therapist’s suggestion)
- Expressed in terms of observable behavioural change(“when you feel happier, what will you be doing? What will others notice?”)
What difference outcomes will make to client and to others:
- “So you’ll be seeing more of your children after you’ve stopped using heroin. What difference will that make to you? What difference will it make to them?”
- It is sometimes good to have a long-term (not necessarily achievable) goal; and
- A very small step (achievable within 24 hours) on the way to that goal
- “On a scale of 1 to 10, where 10 is the day after the Miracle (or where you and your life are exactly the way you want it to be), and 1 is the worst you ever felt (or the day before you decided to come for therapy), where are you now?”
- Elicit every strength, resource, action, hope, etc. which makes it “as high as” the number they chose (even if the number is minus 5!)
- Keep asking, “What else?”
- Usually 10 is “the day after the Miracle” or “the way you’d really want life to be like”, so it is quite general.
- Sometimes it is useful to Name the scale, eg. 1 = when your child was taken into care. 10 = when Social Services takes your child off the At Risk Register
- When more than one person in the room:
- So, you see things as at 4 on the scale and your Dad/wife/Social Worker sees it as 5. What do you think s/he can see, that you can’t see?
- (ask the person with the lower score what the other can see; only bring in the higher scorer afterwards, or if the lower scorer is very stuck)
- Identify small achievable noticeable signs of change: “You are at 4. How will you know when you are at 4½? (This effectively challenges All-or-Nothing thinking, e.g. Depressed/Happy or Shy/Outgoing)
- Identify acceptable end point: “Where on the scale do you need to be before stopping therapy?” “What will that look like?” “What will you be doing that’s different?”
- How confident are you that things will change (or: that you can change)? where 1 is no confidence at all, and 10 is absolute certainty
- What gives you that confidence?
- What else?
- What else?
- Particularly useful when a person scored low on the first question
Commitment and motivation scale
- (1 is “I cant be bothered to do anything to change”; 10 is “I’ll do whatever it takes to change”)
- What gives you that motivation?
- What else?
- What else?
- Should be genuine and specific
- may include
- Validate and acknowledge difficulties
- Name Resources: skills, strengths, abilities
- What’s already going well: pre-therapy change, evidence of motivation, preferred future, exceptions, coping, etc.
- Be specific (not “you are intelligent”; instead “The way you figured out what to do regarding [problem or situation] was very intelligent”
- Don’t overwhelm – be selective. Choose just a few points from the above possibilities.
Identifying patients/cliets as "Visitory", "complainants" or "customers"*De Shazer and Berg define 3 stages:
- Visitor: "There is no problem" --> cant be engaged in therapy
- Complainant: "There is a problem; it isn't me"
- Customer: "I am part of the problem, and part of the solution"
- These are not statis categories
- If we can turn a visitor into a complainant, we can intervene. If we cannot, just give a compliment
- Our questions, and their own reflection between sessions may turn complainants into customers
- customers are well-motivated and easier to work with
- “Doing” task – mainly for “customers”
- non-specific behavioural suggestions (“so today you are at 2 on the scale. One day this week, pretend you are at 3”) Thus clients find their own solutions
- “Observing” task – mainly for “complainant”
- Look out for times when things are at 2½ instead of at 2 like today)
- Interactive tasks (when more than one person in the room):
- “One day this week, each of you pretend to be one point higher on the scale. Don’t tell each other which day it is. Let the other person guess.” (thus each person is constantly looking out for positive signs of change in the other)
- What’s been better?
- How did you manage to achieve that? (even if they report change in another person –as long as question sounds sensible. Reinforces patient’s sense of power and agency)
- What did others notice?
- What have you learned?
- [how will you know when you no longer need to come for therapy?]
If things are the same or worse:
- Is there anything that hasn’t worsened (so much)?
- How have you coped?
- Scaling Questions
- NB: de Shazer and Berg never asked whether they have done their Tasks (“if they havent done it, it was the wrong Task”)
Beliefs and Principles
Ellicit Healthy Self
- Elicit competence
- What are they good at
- What do they know how to do
- Wlicit clarity and reflection (through asking questions)
- How do you think you managed to do that?
- What would it mean if this happened
- Elicit problem-free self (Exceptions part and present; problem-free future)
- Scaling questins (these encourage small changes and discourage all-or-nothing thinking)
How we talk influences how we thinkhow we talk has a big impact on others, e.g. instead of saying "if your no longer depressed" saying "when your no longer depressed" ...
- Co-construct new narrative: deframe (shaking and questioning their definition of themselves or the problem), reframe (having a new discription or new definition)
- Avoid labels, or deconstruct them (when they already "have" them)
- Use of humour (when it is appropriate), laughing with the patient
- Use of language to enhance rapport and optimism
- Assume problem-free times
- Assume improvement will happen
- no inferences about problem'S origin or purpose
- knowing (or hypothesising) why problem arose, or what function is serves, is neither necessary nor sufficient to resolve the problem
- object of therapy is only to meet client's goals (expressed as observable behavioural change)
Duration of therapy
- Client decides how long and how often to attend
- They may come back at any time after termination
- May re-negotiate goal(s)
- Each session treated as potentially the last
Problem to solution
- New viewing and new doing from first session (new way of seeing the problem; setting different tasks as in other therapies)
- Problems are maintained by repetitive self-reinforcing personal and interpersonal behavioural sequences intended to solve the problem ("false solutions anti-problems")
- Breaking these sewuences is sufficient to enable change:
- Break pattern - do something different
- "The shorter you want therapy to be, the smaller the steps you take" (de Shazer). This avoids failure and "resistance" - change has often side effects,
- Nonconfrontation (and non-collusion)
- Meet client's world view
- Do not confront or blame
- Do hold accountabe - especially for change (still seeing the person as accountable for change)
Tips for therapists
- "If it's working, do more of it. If it isn't, do something different"
- Check out with patient (patiet as supervisor) - "does this makes sense?" "are you finding this useful?"
- "Resistance' is clinet's unique way of helping theri therapist" - of helpig the therapist to do something different, telling them that whta they are doing at the moment is useless