McLeod, J. (2019). Narrative approaches to therapy. In An introduction to counselling and psychotherapy: Theory, research and practice (6th ed.) (pp. 221-225). McGraw Hill.
Solution- focused brief therapy is mainly associated with the work of Steve de Shazer (1940-2005) at the Brief Family Therapy Centre in Milwaukee, and a group of colleagues and collaborators, including Insoo Kim Berg (Berg and Kelly 2000; Miller and Berg 1995), Yvonne Dolan (1991) and Bill O’Hanlan (O’Hanlan and Weiner-Davis 1989; Rowan and O’Hanlan 1999). De Shazer was strongly influenced by the theory and research carried out at the Mental Research Institute (MRI) in Palo Alto, California. The Palo Alto group were the first, during the 1950s, to study interaction patterns in families, and their approach borrowed heavily from anthropological and sociological ideas as opposed to a psychiatric perspective. De Shazer acquired from his exposure to the ideas of the Palo Alto group a number of core therapeutic principles found in systemic family therapy: a belief that intervention can be brief and ‘strategic’; appreciation of the use of questioning to invite clients to consider alternative courses of action; and the use of an ‘observing team’, which advises the therapist during ‘time out’ interludes. Like many other family therapists (including members of the Palo Alto group), de Shazer became fascinated by the unique approach to therapy developed by Milton H. Erickson. The case studies published by Erickson convinced de Shazer that it was possible to work strategically and briefly with individual clients, not just with families, and that for each client there could exist a unique ‘solution’ to their own unique difficulties.
In a series of classic texts, de Shazer (1985, 1988, 1994) developed a distinctive approach to therapy that emphasised the role of language in constructing personal reality. In working out the implications of placing language (‘words’, ‘talk’) at the heart of therapy, de Shazer made use of the ideas of philosophers such as Wittgenstein and Lyotard, and the French psychoanalytic thinker Jacques Lacan. The essence of de Shazer’s approach to therapy concentrates on the idea that ‘problem talk’ perpetuates the ‘problem’, maintains the centrality of the problem in the life and relationships of the person and distracts attention from any ‘solutions’ or ‘exceptions’ to the problem that the person might generate. The task of the therapist, therefore, is to invite the client to engage in ‘solution’ talk, while respectfully accepting (but not encouraging) the client’s wish to talk about their distress and hopelessness, or the general awfulness of their problem. From de Shazer’s point of view, therefore, solution-focused sessions are best thought of as conversations involving language games that are focused on three interrelated activities: namely, producing exceptions to the problem, imagining and describing new lives for clients and ‘confirming’ that change is occurring in their lives.
| Bos 14.4: The contribution of Milton Erickson |
|---|
| Milton H. Erickson MD (1902–80) was an intriguing figure who played a significant role in the history of psychotherapy. Although originally best known for his use of hypnosis, it became clear to Erickson that the effectiveness of his approach to therapy did not rely on the use of suggestions made to patients while in trance states, but to his sensitive and creative use of language, metaphor, and stories, his capacity to observe the fine detail of the client’s behaviour and his ability to form a collaborative relationship with his clients. Erickson’s methods were popularized by the family therapist Jay Haley (1973), and have influenced many constructivist therapists (Hoyt 1994), as well as the solution-focused approach of Steve de Shazer. |
The solution- focused approach to therapy is built on a number of strategies designed to enable the client to articulate and act on the widest possible range of solutions to their problems. These strategies include the following:
Focusing on Change
The idea that change is happening all the time is an important concept in solution- focused therapy. Solution- focused therapists assume therefore that change is not only possible but inevitable. In practice, this means that therapists will usually ask new clients about changes in relation to their presenting concerns prior to their first session – often referred to as ‘pre- session change’. During therapy the therapist will usually begin each session by asking the client about changes since the last session: for example, ‘What’s better even in small ways since last time?’ If the client describes any changes, even apparently minor ones, then the therapist will use a range of follow-up questions to amplify the change and resourcefulness of the client: for instance, ‘How did you do that?’; ‘How did you know that was the right thing to do/best way to handle the situation?’ Should the client not be able to identify any change, the therapist might use ‘coping questions’ to invite the client to talk about how they are managing to survive or cope despite the problem.
Problem-Free Talk
At the beginning of a session, a counsellor might engage the client in talk about everyday activities, as a means of gaining some appreciation of the client’s competencies and positive qualities.
Exception Finding
Fundamental to the solution-focused approach is a belief that no matter how severe or all- pervasive a person’s problem may appear there will be times when it does not occur, is less debilitating or intrusive in their lives. Such instances again point to clients’ strengths and self-healing abilities, which when harnessed allow clients to construct their own unique solutions to their difficulties and concerns. Practitioners will therefore deliberately seek out exceptions by asking clients questions like: ‘When was the last time you felt happy/relaxed/loved/confident, etc.?’ ‘What have you found that helps, even a little?’ Exception finding questions help to deconstruct the client’s view of the problem and at the same time to highlight and build on the client’s success in redefining themselves and their lives.
Use of Pithy Slogans
There are a number of short, memorable statements that help to communicate to clients (and trainee therapists) the basic principles of a solution-focused approach. Typical solution-focused messages include: ‘If it isn’t broken, don’t fix it’, ‘If it’s not working stop doing it’, ‘If it’s working, keep doing it’, ‘Therapy need not take a long time’, ‘Small changes can lead to bigger changes’.
The ‘Miracle Question’
Typically, in a first session, a solution-focused counsellor will ask the client to imagine a future in which their problem has been resolved: ‘Imagine when you go to sleep one night a miracle happens and the problem we’ve been talking about disappears. As you were asleep, you did not know that a miracle had happened. When you woke up, what would be the first signs for you that a miracle had happened?’ (de Shazer 1988). This catalytic question allows the person to consider the problem as a whole, to step into a future that does not include the problem and to explore, with the therapist, how they would know that the problem had gone, how other people would know and how such changes had been brought about. The image of a ‘miracle’ is also a potent cultural metaphor that helps the client to remember what they learned from this discussion that follows the asking of the question.
Scaling
Scaling questions are designed to facilitate discussion about - and measure - change, and are used to consider a multitude of issues in client’s lives. For instance, to assess a client’s readiness or motivation to change, their coping abilities, self-esteem, progress in therapy and so on. Typically, the client is asked to rate their problem (e.g., depression) on a scale of 0–10, where 0 is as bad as it can be (‘rock bottom’) and 10 is ideal. Once the client has rated their problem (a 2, for example), the therapist will first of all enquire about what has helped to get them to a 2 or what the client is doing to prevent slipping back to ‘rock bottom’. Subsequently the therapist will work with the client to negotiate further small goals by inviting them to consider what will be different when they are at 3 on the scale and so on in subsequent sessions until the client reaches a point where they are ready to end therapy.
Homework Tasks – Exploring Resources
Towards the end of each session, the therapist will either leave the room to consult with co-workers who have been observing the session, or (if working alone) take a few minutes to reflect in silence. In the final segment of the session, the therapist restates his or her admiration for positive achievements that the client has made, and then prescribes a task to be carried out before the next session. The homework task is designed to enable the person to remain focused on solutions. An example of a homework task that might be used following the first session of therapy is: ‘Until the next time we meet, I’d like you just to observe what things are happening in your life/family/work that you’d like to see continue, then come back and tell me about it’.
The preceding list covers only some of the many ways in which a solution-focused therapist will structure the therapeutic conversation to allow the client to identify and apply their own personal strengths and competencies. The key points of contrast between a problem- focused and a solution- focused approach to therapy are highlighted in Table 14.1.
| Problem-Focused | Solution-Focused |
|---|---|
| How can I help you? | How will you know when therapy has been helpful? |
| Could you tell me about the problem? | What would you like to change? |
| Is the problem a symptom of something deeper? | Have we clarified the central issue on which you want to concentrate? |
| Can you tell me more about the problem? | Can we discover exceptions to the problem? |
| How are we to understand the problem in the light of the past? | What will the future look like without the problem? |
| How many sessions will be needed? | Have we achieved enough to end? |
Source: O’Connell (2005:21)
The solution-focused approach represents a radical perspective in relation to a number of the key issues that have dominated debates within counselling and psychotherapy during the past 50 years. In psychoanalysis, much of the effectiveness of therapy is attributed to the achievement of suitable levels of insight and understanding of the origins of the presenting problem: for example, its roots in childhood experience. The next generation of therapies that emerged in the mid-twentieth century – humanistic and cognitive–behavioural – retained an interest in understanding the roots of the person’s problem, but, compared to psychoanalysis, paid much more attention to what the person might be seeking to be able to do in the future. Solution-focused therapy represents a radical further movement in this direction. In solution-focused therapy, the ‘problem’ is not particularly interesting. What is important is to focus on the solutions and strengths that the person already possesses, or is able to devise, in relation to living the kind of life they want to live.
The radical shift in solution-focused therapy (and, to some extent, all of the therapy approaches discussed in the present chapter) is a rejection of the notion of the person as being structured in terms of a set of internal mechanisms (mind, unconscious, self, schemas) that have ‘gone wrong’ and need to be fixed. De Shazer did not – and other solution-focused therapists do not – view people in these terms. For them, the person exists within the way they talk, within the stories that they tell themselves and other people. From this perspective, any attempt to explore and understand the ‘problem’ is merely encouraging ‘problem talk’, the maintenance of relationships characterized by a story- line of the ‘I have a problem’ type, and the suppression of stories that offer an account of the person as resourceful, capable, in control and so on. In addition, one of the by-products of an extended exploration of a ‘problem’ with a therapist is that the person begins to apply the language of psychology and psychotherapy not only as a means of accounting for this specific problem, but as a way of talking about other aspects of their life: the person becomes socialized into a ‘problem-sensitive’ way of talking about themselves. Moreover, solution-focused therapists reject any assumption that there is a necessary cause-and-effect relationship between studying a problem and arriving at its solution: a solution is a kind of unpredictable ‘creative leap’. This way of looking at therapy seriously challenges any notion of the ‘scientific’ knowability of what happens in therapy. If clients get ‘better’ by following their own, idiosyncratic solutions, then what role is left for scientific models of dysfunction and change?
A solution-focused approach can be seen as a rigorous attempt to conduct therapy from a postmodern standpoint. The idea that there exist internal psychological structures that determine behaviour is an essentially ‘modern’ way of making sense of the world. A postmodern sensitivity argues that these theories/structures are no more than another kind of story. They are stories that are associated with the power that professions and institutions have to defi ne individuals as ‘cases’, as exhibiting ‘deficits’ (Gergen 1990). Like other postmodern writers, de Shazer adopts a role of challenging and questioning established ideas, with the aim of opening up possibilities for individuals to create their own personal or ‘local’ truths, rather than become assimilated into any theoretical framework that claims universal truth. A considerable amount of research has been conducted that confirms the effectiveness of solution-focused therapy for a range of presenting issues (Gingerich and Peterson 2013; Kim et al. 2018).
