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Brief Solution Models in Family Therapy Major Concepts in Solution-Oriented Therapy
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Brief Solution Models in Family Therapy Major Concepts in Solution-Oriented Therapy 1. Clients have within them or their social systems the resources to make the changes they need to make. The therapist’s job is to access these resources and help clients put them to use in appropriate areas of their lives. 2. The role of positive expectations: Having positive expectations of client’s success is more conducive to tasks of exploration, discovery, and healing than a psychopathological perspective. 3. Indirect communication: Stresses the importance of the therapist’s communication in his/her role as a passive inquirer who asks questions solely to receive an answer regardless of its content.
Clients have resources and strengths to resolve complaints — It is therapist’s task to access these abilities and help clients put them to use. • Change is constant — Therapists can do a great deal to influence client’s perceptions regarding the inevitability of change and what is supposed to happen during the therapy session. • The therapist’s job is to identify and amplify change — He/She accomplishes this through choice of questions, topics focused on or ignored. “Focus on what seems to be working however small, to label it as worthwhile, and to work toward amplifying it.” If [the change] is in a crucial area, it can change the whole system.
It is usually unnecessary to know a great deal about the complaint in order to resolve it — What is significant is what the clients are doing that is working. Learn from clients’ identifying when the problem is not troublesome. Clients can learn to function that way again to solve the problem. • It is not necessary to know the cause or function of a complaint to resolve it — Even the most creative hypotheses about the possible function of a symptom will not offer therapists a clue about how people can change. It simply suggests how people’s lives have become static. Ask those who want to know why they have a symptom: “Would it be enough if the problem were to disappear and you never understood why had it?” • A small change is all that is necessary: A change in one part of the system can affect change in another part of the system — “We have the sense that positive changes will at least continue and may expand and have beneficial effects in other areas of the person’s life.
Clients define the goal — Do not assume that therapists are better equipped to decide how their clients should live their lives; ask people to establish their own goals for treatment. • Rapid change or resolution of problems is possible — “We believe that, as a result of our interaction during the first session, our clients will gain a more productive and optimistic view of their situations.” Therapists expect them to go home and do what is necessary to make their lives more satisfying (p. 45). Average length of treatment is less than 10 sessions, usually 4 to 5, occasionally only 1.
There is no one “right” way to view things; Different views may be just as valid and may fit the facts just as well — Views that keep people stuck are simply not useful. Sometimes all that is necessary to initiate significant change is a shift in the person’s perception of the situation.” • Focus on what is possible and changeable rather than what is impossible and intractable — Focus on aspects of a person’s situation that seem most changeable. This imparts a sense of hope and power.
INTRODUCING UNCERTAINTY The therapist can introduce some uncertainty into the problem definition by asking “What gives you the impression that things seem difficult to handle?” Or he/she can imply that there are days when the problem is nonexistent by asking “What is different about the days when things seem manageable?”
FRAMING QUESTIONSQuestions asked can elicit information about strengths, abilities, and resources. Perceptions of problems then change significantly in this context.
1. The Miracle Question: 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?This type of question seems to make a problem-free future more real and therefore more likely to occur.The therapist is given guidelines and information to help the client go directly to a more satisfactory future.
2. The Exception Question: Asks the client to focus on times when problem does not occur or has not occurred when they expected it would. They may discover solutions they had forgotten or not noticed. The therapist might find clues on which to build future solutions. Example: “What is different about those times when things are working?”
REFRAMING PROBLEM DEFINITIONS Therapists offer new, more workable problem definitions that are within the power of the client and therapist to solve. They usually help the client reframe the problem definition to a more positive one or listen for a hint of something in the client’s complaint that can be solved. This co-creates the experience that the problem is solvable and the client has some ability to solve it.
PROBLEM SOLVING TECHNIQUES • 1. Dissolve the idea that there is a problem: Help people see their situations in new ways. • 2. Negotiate a solvable problem: Reduce the size of the problem in the client’s eyes. (Get specific about the problem; focus on when it is not so serious a problem). • 3. Frame towards the idea that clients have all the abilities and resources to solve the problem: • Create an atmosphere that facilitates the realization of strengths and abilities.
MATCHING THE CLIENT’S LANGUAGE • Example: Use the exact words the client uses to describe the problem in asking questions about what they have done before, when it is not so serious a problem, etc. • Also, attend to client’s metaphors and utilize them also to extend observations, learn about their interests or hobbies to use metaphors that involve them.
MATCHING SENSORY MODALITIESUse words pertaining to “seeing” or “hearing” how things are and use words in the same vein.
CHANNELING THE CLIENT’S LANGUAGE Channel away from jargon into action descriptions used in every day language. This has the effect of depathologizing or normalizing clients’ situations. Gradually change your terminology to less serious, more positive words. (Example: Use the words “transitional period” as this give the client the opportunity to take solace in hearing that a problem is temporary, helps shape their expectations for the future).
Use of verb forms: Create a reality where the problem is in the past and possibilities exist for the present and in the future. “When you had this problem before, you used to . . . you were having difficulty . . . how did the old you . . .”
Help clients make distinctions that are helpful (feeling like or thinking about . . . rather than doing it).
NORMALIZING AND DEPATHOLOGIZING Tell clients that their problems are “understandable” and put the situation in an everyday frame of reference. Say such things as “naturally,” “of course,” “welcome to the club,” “so what else is new,” “that sounds familiar,” or “yeah, me too.”
GOAL SETTING Start small — “What will be the first sign that things are moving in the right direction?” Goals must be concrete.
FAST-FORWARDING QUESTIONS For use when clients can’t identify exceptions or past solutions. Clients are asked to envision a future without the problem and describe what that looks like. (The miracle question or a magic wand question). “What will not would be different?”
FIRST SESSION PROTOCOL The Consultation Break: After 30-40 minutes, therapist excuses himself to consult with a team, or when working alone to think about things. Talk focuses on: things the clients are doing that are good for them; any exception to the complaint pattern; and what the team imagines the clients will be like once the complaint is part of the past. • Compliments are then given based on what the client is already doing that is useful or good or right in some way, regardless of the specific content and context. Compliments are designed to help the client “see through” their frame of the situation in such a way that a more flexible view of the situation is possible. The purpose is to support the orientation toward solution while continuing the development of a “yes set” begun during the interview but now will be pursued in a more intense and focused manner. It is designed to let clients know that the therapist sees things their way and agrees with them . . . Then the clients are in a proper frame of mind to accept clues about solutions. • Clues are focused therapeutic suggestions, tasks, or directives about other sorts of things that the clients might do that will likely be good for them and will lead in the direction of solution. • Message Delivery: After intermission of 10 minutes or less, therapist returns and gives the formal intervention. This takes 5 minutes or less, a new appointment is set, and the session ends.
Solution-Based Psychotherapy Techniques • Strong belief that client possesses solution to the problem. Never ending search for exceptions to the problem. Use of positive lines of questioning, stories, and expansion of client’s possessed solutions.
1. Clients present 3 options: a. Want to stop doing something b. Want to start doing something c. Want to do something differently
3. Emphasis is on strengths and solutions NOT problem or pathology.
Assessment as Intervention • Pay attention to the client’s: • 1. language • 2. interests/motivations • 3. frames of reference • 4. behavior • 5. symptoms • 6. beliefs
1. Pay close attention to their theories/beliefs/explanations • — Where do they come from? • 2. Create fit of realities regarding therapy • — what do clients believe therapy is about? • — ethnographic interview
3. Introduce: • — confusion • — disbelief • — doubt • — normalization
4. Give close examination to their language and yours. • A. Vague statements • B. Unspecified verbs • “He ruined the relationship” (how, what way?). “I am scared” (of what) • C. Specify comparison • “He is lazy” (compared to whom) • D. Empty nouns • respect, love, anger, depression • E. Generalization (all, non) • F. Cannot/will not vs. does/did not • G. Characterizations (lazy, aggressive) • H. Challenge claims • “How do you know you feel depressed”
5. What are your presuppositions — try to examine from another theory
6. Reformulate the problem — do at end of session
Pretherapy Assessment 1. What makes you think your family needs our services? 2. What do you expect to happen here that will be helpful to your family? 3. What will convince you that your family does not need to come here? 4. How many days per week does the problem occur? (please circle) 1 2 3 4 5 6 7 5. How many hours per day in the problem present? 6. Please place an X indicating the severity of the problem. 1<----------------------------------5---------------------------------->10 very mild very severe 7. Who will be the first person to notice an improvement in the problem? 8. What is one of the first things your family will be doing differently when they notice improvement? 9. When does your family NOT have the problem? 10. How do you explain when the problem does not happen? 11. How will you know when the problem is really solved? 12. What are you doing to keep things from getting worse? 13. What would tell you that things are getting a little better? Todd, T. Pretherapy assessment. Unpublished measure. The Brief Therapy Institute of Denver, 8120 Sheridan Blvd., Ste. C-112, Westminster, CO, 80030.
1) FINDING OUT ABOUT THE CLIENT’S LIFE with a special attention to interests, motivations, competencies, and beliefs. This is accomplished in a social, conversational manner by “chatting” with the client about their work, hobbies, vocations, interests, and commitments. Special attention is given to metaphors and the use of language for the purpose of using such processes of communication to access the client’s beliefs and to assist the client in changing existing beliefs and behaviors. This sequence is on-going in that the therapist is always learning about the client, but a short time, usually 5-10 minutes, in given in the first session to get the sequence started. At the end of this sequence the therapist should be able to answer questions such as: • a) What does the client like to do? Such as what subjects in school do they do like. • b) What are some major hobbies or interests of the client? • c) How do they use language to describe themselves and others? • d) Are there any important key words or metaphors that can be used to communicate to the client? • e) What is known so far about their worldview or beliefs?
2) GATHERING A BRIEF DESCRIPTION OF THE PROBLEM BEHAVIORS. After the solution-focused therapist is acquainted with the client he or she proceeds to gather a problem description from the client by asking questions such as “What would have to happen for you to know that it was worth your time to come and see me today may be asked? Or, “If we were successful in making progress in solving the problem that brought you here today, what would need to be different?” The client will usually begin to volunteer information about the presenting problem. The therapist asks follow-up questions to gain a sense of the problem and context of the problem. However, the questions may be phrased in different ways to accommodate to individual clients.
The therapist should come out of this sequence having asked and been provided answers to the following questions. • a) What is the problem? • b) How long is the problem been going on? • c) How often does the problem occur? • d) Where or in what situations does the problem occur? • e) Who is there when the problem happens or who is involved in the problem? • f) What does each person do in a sequence (What does your teacher do?, Your classmates? When the principle comes what does he do? etc.)? • g) Whose idea was it for you to come for help with the problem? • h) Why did you come or get sent for help now and not before? • i) What is your explanation for why this problem is happening? • j) What have you tried so far to solve the problem?
3) ASKING RELATIONSHIP QUESTIONS TO HELP THE CLIENT DEFINE THE SOCIALLY CONSTRUCTED NATURE OF THE PROBLEM. The therapist asks relationship questions such as What would your teacher say about your grades? What would your mother say? If you were to do something that made your teacher very happy what would that be? Who would be most surprised that you did really well on the test? What would that person say about the fact that you are doing so well ? Relationship questions are used throughout the sessions at different points to help the client gain a meta-perspective about the problem, and to assess the individual cognitive constructions and social constructions concerning the problem definition and resolution. Relationship questions can be used to help clients discuss their problems from a third person’s perspective, making the problems less threatening to discuss.
After asking relationship sequence questions a therapist should know the following: a) How the client perceives the problem as well as their perceptions about others’ perspectives about the problem or problem resolution. b) How the problem is being socially constructed and who and how they are involved with those social constructions. c) Who from the client’s perspective makes the problem worse and who makes it better? d) What social supports and resources are available to the client and how these resources may be used to solve the problem.
4) TRACKING SOLUTION BEHAVIORS OR EXCEPTIONS TO THE PROBLEM. The therapist proceeds to identify times when the problem does not occur, effective coping responses, and the contexts for the absence of the problem. The therapist says something such as, “Even though this is a very bad problem, in my experience people’s lives do not always stay the same. I bet that there are times when the problem of being sent to the principal’s office is not happening or at least it is better. Describe those times. What is different? How did you get that to happen?” The therapist gathers as many exceptions to the problem pattern as possible by repeatedly asking the client what else... what other times...? The therapist must be patient and give the client time to construct the exceptions from episodic memory. Since the client is often focused on the problem situations the exceptions may not be on the “tip of their tongue”. Once an exception has been identified by the client, the therapist uses “prompts,” such as “tell me more about that,” to help the client describe in detail the exceptions. The therapist also uses his or her own affects, tone and intense attention to the client’s story to communicate to the client that they are very interested in those exceptions. Such non-verbal gestures as nodding, smiling, leaning forward, looking surprised are used. They also may say something such as “how about that,” “I am amazed,” “Wow!” as social reinforcement to the client. This encourages the client to talk on and to develop in more detail the exceptions story.
The therapist should come out of this sequence knowing the following: • a) What exceptions to the problem exist? • b) How often have exceptions occurred? • b) When was the last time an exception happened? • c) What was different in the situation where the exception occurred than in situations where the problem happens? • d) Who was involved in making the exception happen?
5) SCALING THE PROBLEM. Using Scaling questions to anchor the problem and to track progress toward problem resolutions. The therapist says, using the prior descriptions of the client concerning the problem descriptions and exceptions, “On a scale of 1-10 with 1 being that you are getting in trouble everyday in the class, picking on Johnny and Susi, getting out of your seat and being scolded by your teacher, and 10 being that instead of fighting with Johnny and Susi you are doing your work, and that you ask permission to get out of your seat, and your teacher says something nice to you, where would you be on that scale now?” With children, often smiley and sad faces are also used to anchor the two ends of the scale.
Several other uses of the scaling technique in the therapy process include the following: 1) asking questions about where the client is on the scale in relationship to solving the problem; 2) using the scaling experience to find exceptions to the problems, such as saying “How did you get to the 3?” “What are you doing so you are not a 1?” 3) employing scales to construct “miracles” or to identify solution behaviors. For example, the therapist inquires as to where on the scale (with 1 representing low and 10 representing high) the client is, and proceeds to ask the client how that they will get from 1 to a 3. Or, the therapist inquires as to how clients managed to move from 4 rating to 5 a rating. How did they get that to happen? What new behaviors did they implement or what was different in their lives that made the changes? Solution-focused therapists may also express surprise that the problem is not worse on the scale as a way of complimenting the client’s coping behavior or as a way to use language to change the client’s perception of the intractable nature of their problem. Or, the therapist may use the scale, along with the “miracle question”(described below), by asking the client, “If there was an overnight miracle and you could get to a 9 or 10 on the scale, what would be the first thing that you would notice that is different?” Solution behaviors described by the client, through the use of the scaling technique, are often used in constructing specific tasks or homework assignments that are prescribed and discussed in future sessions.
The therapist should finish the scaling sequence having accomplished the following: • a) Developing a scale from 1-10 with the client which can be referred back to in future sessions. • b) Having developed two concrete behavioral descriptions or self- anchors that describe the problem and its solutions. One (1) should be anchored as the problem behaviors and ten (10) the presence of solution behaviors. Therapist uses the client’s own words, descriptions, and images to develop the anchors. • c) Having obtained a rating from the client on where they perceive they are on the scale today.
6) USING COPING AND MOTIVATION QUESTIONS TO ASSESS HOW THE CLIENT PERCEIVES THEY ARE COPING AND TO DETERMINE THEIR MOTIVATION FOR CHANGE. This is a variation on the scaling question that helps the therapist assess the client’s motivation for solving the problem as well as how well the client perceives that they are coping with the problem. The therapist says something like: “On a scale of 1-10 with 10 being you would do anything to solve this problem and 1 being that you do not care so much for solving it, where would you say you are right now?” Or the therapist may say: “On a scale of 1-10 with 1 being that you are ready to throw in the towel, and give up ever doing well in school and 10 being that you are ready to keep on trying, where would you rate yourself right now”?
