Solution-Focused Therapy

A Quick Definition…

“Solution-Focused Brief Therapy (SFBT) is a future oriented, goal-directed approach to brief therapy that uses questions designed to identify exceptions (times when the problem does not occur or could occur less in the client’s life), solutions (a description of what life will be like when the problem is gone or resolved), and scales which are used to measure the client’s current level of progress toward a solution and reveal the behaviors needed to achieve or maintain future progress.” (page 287)

Solution-Focused therapy was developed by Insoo Kim Berg & Steve de Shazer at the Mental Research Institute (Corey, 2015).  It is a brief therapy that represents a postmodern, social constructivist perspective.  This brief, goal-oriented focuses the client’s attention on the solution rather than examining the problem (Metcalf, 2011). Instead of focusing on reliving the past, it focuses on changes to create in the client’s desires for the future.   Since reality is conceived as a constructed, rather than absolute concept, the client is the expert not the therapist. It is for this reason that the therapist’s role is collaborative in nature, and involves redirecting the client toward possibility.   The primary goal of Solution Focused Therapy is empowerment for client in whom emotions are validated in a brief and highly structured context (Metcalf, 2011).

    Focused on the present.

    Postmodern social-constructionist perspective.

    Practical, aimed at uncovering solutions.

    Goal-orientation optimistic perspective.

    Theoretical Assumptions

    Client’s have the resources and capacity to change.
    Problem-focused thinking prevents change
    Change is a continuous process therapists aim to magnify.
    It is unnecessary to know the problem to solve it.
    Clients define the goals.
    Client’s often present one side of themselves in life.
    Rapid change is possible when identifying the “other side of the coin.”
    Client’s can be trusted to solve their own problems.
    There is no right or wrong way of seeing things.

    The Therapeutic Process

    Overview of Steps

    According to a textbook titled “Theory and Practice of Counseling” solution-focused therapy involves the following steps: (1) determine the client’s goals for therapy, (2) figure out what is working in the client’s life, (3) determine new approaches for what isn’t working, (4) keep therapy brief, pragmatic and goal focused, (Corey, 2015, p. 380).   In contrast, my old course textbook, provides the following description of the solution-focused therapy process (Metcalf, 2011):

    STEP #1: BUILD RAPPORT

    “My name is ____. As we begin talking, it would help me to get to know if you would tell me more about yourself and what you appreciate about each other, (Metcalf, 2011, p. 299).”

    STEP #2: UNDERSTANDING THE PROBLEM

    Listen to the client describe their problem and the change they attempt to accomplish.  “How do you explain your ability to ______ during this time? (Metcalf, 2011, p. 299).”

    STEP #3: ASSESSMENT

    In Solution-Focused Therapy, assessment doesn’t involve an examination of the problem, its cause and historical context.  Instead, assessment focuses on actionable solution and the possibility for change. “Could you describe the times when the problem occurred less? (Metcalf, 2011, p. 299).”

    STEP #4: DEFINING GOALS

    The Miracle Question:Suppose tonight while you sleep, a miracle occurs. When you wake up tomorrow, what will be different?, (Metcalf, 2011, p. 299).”  

    STEP #5: AMPLIFY CHANGE

    Whenever you hear exceptions to the problems at hand examine this further in order to develop a clearer understanding of the solution. “What difference did that make for you? (Metcalf, 2011, p. 299).”  

    STEP #6:  TERMINATION

    Each week, ask the clients whether they wish to come back, and if so, when. This puts them in charge of therapy. “What did we do during our time together that you found helpful, if anything? (Metcalf, 2011, p. 299).”  

    How Change Happens

    “Solution-focused therapists view clients as wanting to change, (Sharf, 2015, p. 457).”  Rather than diagnosing or focusing on aspects of the problem, solution-focused therapists aim at making small changes step-by-step.  Change happens through a strategic focus on how to promote solutions to one’s problems.  Helping clients find exceptions to their complaints can help them focus on possibility for change rather than continuing to focus on the problem (Metcalf, 2011).

    Assessment

    “Unlike many other therapies, solution-focused therapy is not concerned with making diagnostic categorizations; rather the therapist assesses openness to change, (Sharf, 2015, p. 457).”  This entails examining the client’s motivations to change as well as any obstacles or barriers that might be present. One tool useful in this assessment are “…mindmaps…diagrams or outlines of…..the goals and solutions to problems, (Sharf, 2015, p. 457).”

    Therapeutic Goals

    “The solution-focused therapist believes people have the ability to define meaningful personal goals and that they have the resources required to solve their problems.  Goals are unique each client and are constructed by the client, (Corey, 2015, p. 381).”   Goals must be, clear, concrete, specific and measurable, (Sharf, 2015).  Techniques useful in defining one’s goals include miracle and exception finding questions. According to solution-focused therapists, well-defined goals have the following characteristics:

    Well-defined goals should be stated positively in client’s language (Sharf, 2015).
    Well-defined goals are action-oriented (Sharf, 2015).
    Well-defined goals are “structured in the here and now, (Sharf, 2015).”
    Well-defined goals are “attainable, concrete & specific, (Sharf, 2015).”  
    Well-define goals entail actions that are controllable by the client (Sharf, 2015).

    Therapist Role

    “Clients are much more likely to fully participate in the therapeutic process if they perceive themselves as determining the direction and purpose of the conversation, (Corey, 2015, p. 382).”  A collaborative relationship develops based on the fact that therapists are experts in the change process while clients act as experts of their own life experiences.   A mutually respectful dialogue develops, involving an open inquiry involving an exploration of goals and solutions.

    Techniques & Procedures

    Questions

    “Questions are designed to help clients focus on exceptions and make presuppositions about future actions while building a positive outlook and encouraging achievement, (Metcalf, 2011, p. 295).”  There are three types of questions:

    Exception Questions

    Solution-Focused Therapy is based on uncovering exceptions to an individual’s experiences of the problem.  These exceptions are times when the problem did not unfold as expected.  Exception questions are utilized in therapy to further understand this powerful exception-related experience.  The goal is to engage in change-talk and develop a clearer view of the solution to one’s problems

    “Tell me about a time when the problems you’re experience don’t happen?”

    The Miracle Question

    With the miracle question the therapist asks: “If a miracle question happened and the problem you have was solved overnight, how would you know it was solved, what would be different?” (Corey, 2015, p. 384).”  The purpose of this question is to allow the client to begin considering hypothetical solutions to their problem.

    “Imagine…a miracle happens and the problems we’ve been talking about disappear….what would the…signs [this] happened? (Sharf, 2015, p. 460).”

    Scaling Questions

    “Scaling questions ask the client where they feel they are on a scale of 1 to 10 (Metcalf, 2011, p. 296).”  These questions are useful in determining a client’s progress towards their goal.  “This kind of assessment offers clients hope that change is inevitable.  It is not a matter of if change will occur, but when it will happen. (Corey, 2011, p. 384).”

    “On a scale of one to ten…where would you say you are today? (Sharf, 2015, p. 460).”

    Interview Techniques

    “Interview techniques serve to validate concerns and assist clients in experiencing significant shifts in their thinking about their situation, (Metcalf, 2011, p. 296).”   The mindset utilized during an interview centers around the idea that the client is the “expert”.  This therapy method has a positive orientation that considers clients willing and capable of change.  It is a problem-free perspective that focuses on promoting change and clarifying solutions to one’s problem.  Corey, (2015) describes compliments as a technique that encourages clients and helps them open up to change.

    The Message

    “Many solution-focused therapists will stop the session 5 to 10 minutes early to give the client a written message as feedback about the session, (Sharf, 2015, p. 462).”  The purpose of this message is to summarize the client’s achievements, while providing an overview of change still needed.

    Strengths & Weaknesses

    One strength of Solution Focused Therapy, is its pragmatic and brief nature. These two qualities are especially attractive in light of the influence of managed care and popularity of brief therapy.   Additionally, as a logical and easy-to-understand approach, it is easy to explain and provides quick solutions for clients.

    The weaknesses associated with Solution Focused Therapy can be understood in terms its one-sided perspective. As Metcalf (2011) explains Solution Focused Therapy sees individuals as creators of their reality, and in this respect the experts. Clients are never viewed as “never pathological or resistant” (Metcalf, 2011, p291) in Solution Focused Therapy. In mental health, pathology refers to the causes and effects of psychological disorder.   As mental health professionals, it seems impossible to do our job if we are unable to attend to the presence of a psychological disorder.

    Additionally, Solutions Focused Therapy has its limits from a cultural perspective. For example, this method may not be a good fit for individuals with a cultural background that includes a collectivist orientation. This is because Solution Focused Therapy excludes generational patterns, family history and past experience as relevant factors to its overall approach (Metcalf, 2011).

    References

    Corey, G. (2015). Theory and practice of counseling and psychotherapy. Retrieved from: http://bk.unesa.ac.id/wp-content/uploads/2015/09/Theory_and_Practice_of_Counseling.pdf
    Metcalf, L, (2011). Marriage and family therapy: A practice oriented approach. New York: Springer Publishing Company
    Rosenthal, H. (2005). Vital Information and Review Questions for the NCE and State Counseling Exams. Routledge.
    Sharf, R. S. (2015). Theories of psychotherapy & counseling: Concepts and cases. Cengage Learning.

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