“Problem talk creates problems--solution talk creates solutions.” (Steve de Shazer)
Solution-Focused Brief Therapy (SFBT) is a goal-directed & future-focused approach to brief therapy. Solution-Focused therapists do not focus on the past, unless there is a lesson for the future. In addition, they do not focus on psychopathology or in labelling people’s problems. “Therefore long episodes of history-taking, repetitiously wallowing around in the negative pool of problem talk and the creation of stigma are deliberately avoided and generally discouraged by keeping the client focused on needs and solutions” (Mental Health Practice).
SFBT therapists do not concentrate on problems or their causes. Instead, the therapists gets the individual to think about hopes and achievements. In SFBT attention is focused on goals rather than obstacles & strengths rather than weaknesses. “Solution-focused therapists do not make diagnoses, try to promote insight, or analyze the past. Instead they encourage the client to recognize and implement alternatives. They work on the assumption that at the end of any successful psychotherapy, the situation of the client will have changed, so he or she will be doing something different. SFBT therapists start by helping the client think about what that difference would be. Once a solution is identified, client and therapist work toward it step by step.” (Harvard Mental Health Letter)
The miracle question allows clients to imagine how life would be once the problem has disappeared. “Steve de Shazer originally worded the miracle question as follows:
Suppose that one night, while you were asleep, there was a miracle and this problem was solved. How would you know? What would be different? How will your husband know without your saying a word to him about it?
Other solution-focused therapists use similar wording. Peter DeJong and Insoo Kim Berg recommended the following:
Now, I want to ask you a strange question. Suppose that while you are sleeping tonight and the entire house is quiet, a miracle happens. The miracle is that the problem which brought you here is solved. However, because you are sleeping, you don’t know that the miracle has happened. So, when you wake up to tomorrow morning, what will be different that will tell you a miracle has happened and the problem which brought you here is solved?
....When asking the miracle question, or teaching the concept in training seminars, we have learned that the way you ask the question is very important, i.e., you have to ask the question as if you really want to hear the answer and you believe the client has the ability to give a good answer” (More Than Miracles- The state of the Art of Solution-Focused Brief Therapy).
The exception question- In SFBT the exception question is used to discover times in the clients lives when there have been exceptions to the problem. For example there have been times the client did not hit his/her child, resisted the urge to drink, & did not abuse his/her partner. The therapist might ask “when was the last time you managed to do this even a little bit? What could you do to make it happen again?...What have you already done or are you doing that might help you find a solution?” (Harvard Mental Health Letter).
Coping questions- allows the SFBT to obtain information about resources the client may not be aware of. This question can be helpful if the client cannot imagine any change in their circumstances. For example, a woman who is working w/ CPS may have a hard time parenting her children. However, there are times when she gets her children to school on time & makes it to her supervised visits. The therapist can praise the client for coping on that particular day: “I see that things have been really difficult for you, yet somehow you do manage to get up in the morning and get the children off to school. How do you do that?” (Harvard Mental Health Letter).
Scaling questions- The goal of the scaling question is to help the client see his/her progress. The SFBT may ask the client on a scale of 1 to 10 (i.e. 1 is the worst situation & 10 is the solution) where he or she stands today. Other scaling questions are “What has changed, even a little, since the last session? How confident are you that you can advance even one level?” (Harvard Mental Health Letter).
Major Tenets of SFBT: 1. If it isn’t broken, don’t fix it. 2. If it works, do more of it. 3. If it’s not working, do something different. 4. Small steps can lead to big changes. 5. The solution is not necessarily directly related to the problem. 6. The language for solution development is different from that needed to describe a problem. 7. No problems happen all the time; there are always exceptions that can be utilized. 8. The future is both created and negotiable.
One of the things I appreciate about SFBT is that it levels the playing field. In this type of therapy the client does most of the work. The author of More Than Miracles sums this up nicely “It’s easier to be an interested and compassionate companion for someone on the road to change when you don’t feel burdened with the responsibility of their change”.
I seem encounter SFBT each time I set foot in the ER. Whether it be with the college student who comes in w/anxiety attacks and depression to the next pt who comes in w/ suicidal ideations. We have such limited time in the ER, that this modality seems to be one of the most appropriate. Pt who presents w/ anxiety- talking about small steps to change can provide some initial relief. Compartmentalizing the issue at hand can help them to gain a better understanding of what is going on and understand solutions/coping skills that can be utilized in the given moment. Focusing on the here and now (like Gestalt)is sometimes all we have in that limited time and limited space of a tiny little room. The only time I can see this modality not working is with a pt who presents w/ psychotic behaviors and/or intoxicated/high. I feel like you have to be able to have linear thought patterns in order for this therapy to have a positive effect.
When talking about scaling questions, doing confidence questions also may be helpful to both the therapist and client.
Confidence Questions: Example: How confident are you that you can stay at a 6? How do you and other people notice? If client appears too confident i.e. 9-10, a response could be as follows: How would the social worker with_____ rate you?
Goals of Intervention *Finding exceptions to the problems * Identifying helpful resources * Goal Focused *Identifying the attributes of clients *Constructing Solutions
when working with folks with ETOH and drug issues, usimg this and motivational interviewign helps. i admit i have never used the miracle question....
when I was in grad school this was the technique that was most discussd in all my classes. It is interesting that when you reseach many therapists they have this moda,ity as their main technique. I think there is pressure from the insurance folks to use this therory.
I think it is unfortune that there is so much pressure from insurance folks. I am glad I have no interest in having my own private practice.
This is a great theroty and I do use bits and peieces of it at times. Good job katie.
Okay all- I hope to see you wednesday need to figure out daycare pick up through for Ethan.
Kasie- I think you are right about the pressure from insurance companies, but that is why we have to be such advocates for our clients and utilize our time efficiently with them. This is why this modality is such an important componenent to treatment. Just today, in the ER I saw a pt who came in c a/v hallucinations secondary to meth use last night. He acutally thought for awhile (even after coming down off of the drugs) that his hallucinations were valid and real. I had a short time to talk with him once he was coherent and could track in a linear enough pattern to be able to complete an assessment and make a safe plan. I used SFBT during my encounter c him today- utilizing the "exception question" as I moved my conversation towards his sobriety and ways in which he can maintain it (he has used quite frequently and large amounts for a long time now). He was able to come up with a 9 month period of sobriety and was able to briefly identify the coping skills he used during that time and therefore identify ways in which he could stay sober in the future. He was freaked out from these a/v hallucinations as they had never happened before and he was seeking help. With him, I focused on the here and now and goals for the future in terms of him staying sober. It is so helpful to encounter these case examples in my daily practice and then be able to relate it back to what we are learning in group. I really appreciate all of the effort you put in to teaching us all of these modalities Derek... it truly pays off.. thank you!
Great interaction team!. Kasie your analysis about insurances is exactly right! Insurances love brief therapy because it is solution focused and time sensitive. But, should we always cater to this ideology! Don't get me wrong, I think brief therapy is very effective especially when your dealing with time sensitive cases or clients with limited resources whose insurance companies only allow for six sessions. How does brief therapy work with repression or things that are placed in the unconscious mind? or PTSD that is related to repressed sexual abuse or early childhood trauma! My turn to play devils advocate team. However, I am glad you guys respected the theory in it's purist form
Team, Katie M is hosting the discussion this week on Brief Therapy
ReplyDelete“Problem talk creates problems--solution talk creates solutions.” (Steve de Shazer)
ReplyDeleteSolution-Focused Brief Therapy (SFBT) is a goal-directed & future-focused approach to brief therapy. Solution-Focused therapists do not focus on the past, unless there is a lesson for the future. In addition, they do not focus on psychopathology or in labelling people’s problems. “Therefore long episodes of history-taking, repetitiously wallowing around in the negative pool of problem talk and the creation of stigma are deliberately avoided and generally discouraged by keeping the client focused on needs and solutions” (Mental Health Practice).
SFBT therapists do not concentrate on problems or their causes. Instead, the therapists gets the individual to think about hopes and achievements. In SFBT attention is focused on goals rather than obstacles & strengths rather than weaknesses. “Solution-focused therapists do not make diagnoses, try to promote insight, or analyze the past. Instead they encourage the client to recognize and implement alternatives. They work on the assumption that at the end of any successful psychotherapy, the situation of the client will have changed, so he or she will be doing something different. SFBT therapists start by helping the client think about what that difference would be. Once a solution is identified, client and therapist work toward it step by step.” (Harvard Mental Health Letter)
The miracle question allows clients to imagine how life would be once the problem has disappeared. “Steve de Shazer originally worded the miracle question as follows:
Suppose that one night, while you were asleep, there was a miracle and this
problem was solved. How would you know? What would be different? How will your
husband know without your saying a word to him about it?
Other solution-focused therapists use similar wording. Peter DeJong and Insoo Kim Berg recommended the following:
Now, I want to ask you a strange question. Suppose that while you are sleeping
tonight and the entire house is quiet, a miracle happens. The miracle is that the
problem which brought you here is solved. However, because you are sleeping,
you don’t know that the miracle has happened. So, when you wake up to tomorrow
morning, what will be different that will tell you a miracle has happened and the problem
which brought you here is solved?
....When asking the miracle question, or teaching the concept in training seminars, we have learned that the way you ask the question is very important, i.e., you have to ask the question as if you really want to hear the answer and you believe the client has the ability to give a good answer” (More Than Miracles- The state of the Art of Solution-Focused Brief Therapy).
The exception question- In SFBT the exception question is used to discover times in the clients lives when there have been exceptions to the problem. For example there have been times the client did not hit his/her child, resisted the urge to drink, & did not abuse his/her partner. The therapist might ask “when was the last time you managed to do this even a little bit? What could you do to make it happen again?...What have you already done or are you doing that might help you find a solution?” (Harvard Mental Health Letter).
ReplyDeleteCoping questions- allows the SFBT to obtain information about resources the client may not be aware of. This question can be helpful if the client cannot imagine any change in their circumstances. For example, a woman who is working w/ CPS may have a hard time parenting her children. However, there are times when she gets her children to school on time & makes it to her supervised visits. The therapist can praise the client for coping on that particular day: “I see that things have been really difficult for you, yet somehow you do manage to get up in the morning and get the children off to school. How do you do that?” (Harvard Mental Health Letter).
Scaling questions- The goal of the scaling question is to help the client see his/her progress. The SFBT may ask the client on a scale of 1 to 10 (i.e. 1 is the worst situation & 10 is the solution) where he or she stands today. Other scaling questions are “What has changed, even a little, since the last session? How confident are you that you can advance even one level?” (Harvard Mental Health Letter).
Major Tenets of SFBT:
1. If it isn’t broken, don’t fix it.
2. If it works, do more of it.
3. If it’s not working, do something different.
4. Small steps can lead to big changes.
5. The solution is not necessarily directly related to the problem.
6. The language for solution development is different from that needed to describe a problem.
7. No problems happen all the time; there are always exceptions that can be utilized.
8. The future is both created and negotiable.
One of the things I appreciate about SFBT is that it levels the playing field. In this type of therapy the client does most of the work. The author of More Than Miracles sums this up nicely “It’s easier to be an interested and compassionate companion for someone on the road to change when you don’t feel burdened with the responsibility of their change”.
Can you think of a time in your practice when you have used SFBT, or when it might have been useful?
ReplyDeleteKatie M this is incredible work! Great Great Great effort
ReplyDeleteI seem encounter SFBT each time I set foot in the ER. Whether it be with the college student who comes in w/anxiety attacks and depression to the next pt who comes in w/ suicidal ideations. We have such limited time in the ER, that this modality seems to be one of the most appropriate. Pt who presents w/ anxiety- talking about small steps to change can provide some initial relief. Compartmentalizing the issue at hand can help them to gain a better understanding of what is going on and understand solutions/coping skills that can be utilized in the given moment. Focusing on the here and now (like Gestalt)is sometimes all we have in that limited time and limited space of a tiny little room. The only time I can see this modality not working is with a pt who presents w/ psychotic behaviors and/or intoxicated/high. I feel like you have to be able to have linear thought patterns in order for this therapy to have a positive effect.
ReplyDeleteWhen talking about scaling questions, doing confidence questions also may be helpful to both the therapist and client.
ReplyDeleteConfidence Questions:
Example: How confident are you that you can stay at a 6? How do you and other people notice? If client appears too confident i.e. 9-10, a response could be as follows: How would the social worker with_____ rate you?
Goals of Intervention
*Finding exceptions to the problems
* Identifying helpful resources
* Goal Focused
*Identifying the attributes of clients
*Constructing Solutions
when working with folks with ETOH and drug issues, usimg this and motivational interviewign helps. i admit i have never used the miracle question....
when I was in grad school this was the technique that was most discussd in all my classes. It is interesting that when you reseach many therapists they have this moda,ity as their main technique. I think there is pressure from the insurance folks to use this therory.
I think it is unfortune that there is so much pressure from insurance folks. I am glad I have no interest in having my own private practice.
This is a great theroty and I do use bits and peieces of it at times. Good job katie.
Okay all- I hope to see you wednesday need to figure out daycare pick up through for Ethan.
Kasie- I think you are right about the pressure from insurance companies, but that is why we have to be such advocates for our clients and utilize our time efficiently with them. This is why this modality is such an important componenent to treatment. Just today, in the ER I saw a pt who came in c a/v hallucinations secondary to meth use last night. He acutally thought for awhile (even after coming down off of the drugs) that his hallucinations were valid and real. I had a short time to talk with him once he was coherent and could track in a linear enough pattern to be able to complete an assessment and make a safe plan. I used SFBT during my encounter c him today- utilizing the "exception question" as I moved my conversation towards his sobriety and ways in which he can maintain it (he has used quite frequently and large amounts for a long time now). He was able to come up with a 9 month period of sobriety and was able to briefly identify the coping skills he used during that time and therefore identify ways in which he could stay sober in the future. He was freaked out from these a/v hallucinations as they had never happened before and he was seeking help. With him, I focused on the here and now and goals for the future in terms of him staying sober. It is so helpful to encounter these case examples in my daily practice and then be able to relate it back to what we are learning in group. I really appreciate all of the effort you put in to teaching us all of these modalities Derek... it truly pays off.. thank you!
ReplyDeleteGreat interaction team!. Kasie your analysis about insurances is exactly right! Insurances love brief therapy because it is solution focused and time sensitive. But, should we always cater to this ideology! Don't get me wrong, I think brief therapy is very effective especially when your dealing with time sensitive cases or clients with limited resources whose insurance companies only allow for six sessions. How does brief therapy work with repression or things that are placed in the unconscious mind? or PTSD that is related to repressed sexual abuse or early childhood trauma! My turn to play devils advocate team. However, I am glad you guys respected the theory in it's purist form
ReplyDelete