Solution Focused Brief Therapy

• Steve De Shazer & Insoo Kim Berg

• Seeks solutions and doesn’t seek to understand underlying problems

• Usually implemented in a brief model 

Key Concepts

• • Peoples complains involve behavior that stems from their view of the world + negative cognitions 

  • Clients are the expert

  • Assumes that clients are doing the best they can at any given time

  • Relies on resources and skills that clients already have

  • Small changes lead to bigger changes, goal is to until hope and garner awareness of positive change

  • Change is constant, things cannot not change

  • A Future-Oriented Focus

    • A therapist only needs limited information to resolve a problem

    • Focused on present and future and does not have regard for the past 

  • Strengths-Based Orientation

    • People have what they need to make changes, they just might be aware of their skills or how to effectively use them

    • Therapists, then, help clients become aware and use their strengths 

  • A Focus on Solutions

    • Solutions are a critical aspect of SFBT so considerable time is spent identifying strategies that are the most likely to succeed 

    • One way to find solutions is to identify what is already working for a client

      • Exceptions to the problem reveal strengths

The Therapeutic Process

• • • • Clients are aware from the beginning of the brief nature of this model. Average of 3-5 sessions, and usually less than 10

      • This model is also conducive to longer time between sessions and more flexible scheduling which allows clients time to practice suggested stratgies 

      • Stages of SFBT

        • Identifying a solvable complaint: Finding a goal that is within the clients control. Often, change language is used. Foundational skills are used to understand the client’s situation in clear and specific terms

        • Establishing goals: usually three forms

          1. 1. Changing the doing 

             2. Changing the viewing or frame of reference

             3. Accessing resource, solutions, strengths 

             4. Miracle Question & Exception questions are used 

        • Designing an intervention: creativity is relied on

          1. 1. Mindmaps: outlines of sessions that T’s use to focus on goal organization

        • Strategic Tasks: also known as solution prescriptions are used to promote change

          1. 1. Usually written down 

             2. Motivation is assessed 

        • Positive new behaviors and changes are identified and emphasized when client returns after having a specifi task

          1. 1. What changes did they notice?

             2. How did things go differently?

             3. Problem viewed as external to the client

        • Stabilization: gradually shift a clients perspective in a more hopeful direction

        • Termination: recognizes that clients might return 

          1. 1. Not just resolving immediate issues, but helps clients develop confidence and access their strengths 

      • Therapeutic Goals

        • Clients have the capacity to define their own goals which becomes the focus of therapy. The T job is to create an atmosphere that encourages change

        • Clients are given time to fully share their experience between jumping to focus on goals

      • Therapist’s Function & Role

        • Therapist adopts a ‘not-knowing’ perspective that puts the client in the seat of expert 

        • Therapist listens, has a warm tone of voice, uses metaphorical stories, and embedded suggestions into conversation 

        • Therapist ask questions, gather information, ask more questions to help client identify change or goals

        • EARS

          1. 1. Elicit exceptions

             2. Amplify exceptions

             3. Reinforced client successes

             4. Start again 

      • Relationship between Therapist and Client

        • Collaborative + egalitarian 

        • Three types of therapeutic relationships can exist between T and client

          1. 1. Clients are visitors or window shoppers. They have not presented a clear complaint and expect change. T should only give compliments

             2. Clients are complainants who have concerns and expect change, but for others and not in themselves. T should suggest observation tasks to help people become more aware of themselves. 

             3. Clients are customers who want to take next steps to find solutions. T can suggest action tasks and expect they will be completed. 

Therapeutic Techniques & Procedures

• • • • Some techniques are particular to SFBT, but they also pull from cognitive and behavioral techniques

      • Pre-Therapy Changes: 

        • Ask clients what changes they have already made or noticed between scheduling and having their first session. 

        • Highlight positive changes between therapy even begins is a great first step to show clients they have the resources in themselves they need

      • Formula First Session Tasks (FFST)

        • Used between first and second sessions as homework

        • Ask clients to observe and reflect on what is currently going well in their life. During second session, ask clients to reflect on what they noticed and changes they want to see

        • This is asked after the client has fully shared their concern

        • This illustrates that change inevitable

      • Miracle Question

        • Helps clients to imagine their concern being resolved

      • Exception Questions

        • Identify when the problem is not present and how clients cope

        • Negativity can distract from the SFBT model so T encourage clients to have a more positive focus

        • If client can’t come up with exceptions T can probe 

          1. 1. Ask for a prediction of an exception

             2. Use questions like ‘what else, tell me more, when doesn’t this happen’

      • Scaling Question

        • Establishes a baseline of progress 

        • Can help clients identify goals or exceptions

        • Help clients focus on change

      • Solution Talk

        • Problem-free talk

        • T must choose their words carefully to increase hope and optimism 

        • Use open questions

        • When, NOT IF

        • Focus on coping behavior

        • Reinforce and notice strengths

        • Create hypotheticals

      • Preferred Future

        • Asking questions about the future that focus on life where their issue is not present

        • What will you notice when the problem is better?

        • How will things be different when..

        • What will you be doing instead..

        • Use HOW and WHEN and future oriented verbs

      • Therapist Feedback to Client

        • This happens during the end of the session alongside the summary. T can provide affirmations/compliments and suggest a task (homework)

      • Solution Prescriptions

        • Tasks designed to help people discover ways to resolve their concerns

        • Common prescriptions

          1. Do one thing different

          2. Continue doing the one thing that has been successful

          3. Notice time when the problem is slightly less and what you did to do that

Application & Current Use

• • • • Integrates well with theories that take a phenomenological approach (Person Centered Gestalt) as well as CBT, REBT, Adlerian, Reality

      • Counseling Applications

        • Depression, Anxiety, Substance Use

        • Increasingly used in crisis situation including domestic violence and suicidality

        • Applicable across environments: schools, CMH, CPS, inpatient

      • Multicultural Groups

        • SFBT focuses on personal frames of reference and therefore is culturally respectful 

        • Easily individualized with a focus on empowerment

Evaluation 

• • • • Limitations

        • Problem definitions must be carefully co-created to avoid prematurely focusing on a problem and missing something of greater importance

        • Perpetuates the misconception the brief therapy is all clients need

• Strengths

• Used widely in a variety of contexts 

• Provided T with powerful interventions