Solution Focused Therapy

Solution Focused Therapy challenges the notion that an explanation is both realizable and indispensable if a problem is to be resolved.

Date:   6/15/2006 5:24:27 AM   ( 18 y ) ... viewed 5345 times

There are times when I mention, though often in somewhat veiled terms, that my place of fulltime employment offers traditional allopathic inpatient and outpatient therapeutic services. Every now and then a new and exciting therapy actually makes a noticeable difference in our clients' lives, and Solution Focused Therapy is truly the leader of the pack in that regard! I've seen some absolutely amazing changes in clients AND in other staff members that can easily be attributed to Solution Focused Therapy. I found an article from Counselor Magazine by Teri Pichot, a local therapist and author of one of the best available books on Solution Focused Therapy.

Here's the article by Teri Pichot:

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By Teri Pichot, LCSW, MAC, CACIII


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Solution Focused Therapy challenges the notion that an explanation is both realizable and indispensable if a problem is to be resolved.


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The concept of focusing on solutions became popular in the 1990s. Advertisers often include the word "solution" in an attempt to assist the purchaser to choose their product to solve some identified problem. There is even a Web site, www. SolutionsCatalog.com. It seems that the public has been learning that exploring a problem in depth is not always the quickest way to find resolution.

How often have you been in a situation that starts to get heated, when someone states, "So, what is the solution?" It is a quick and effective way to stop conflict and redirect the attention of those involved. It is most often used as a jumping-off point for problem solving. This trend has also affected the world of psychotherapy, and Solution Focused Therapy (de Shazer, 1985) has benefited from increased recognition from therapists. So, is it any surprise that Solution Focused Therapy is often confused with this type of problem solving approach?

Many well-intentioned therapists firmly believe that they are well versed in using Solution Focused Therapy, yet they are really borrowing some Solution Focused techniques and incorporating them into a Strength Based/Problem Focused approach. So, what is the big deal? So what if therapists are using the term incorrectly? When clients are helped by a therapist's intervention, it is not important what theoretical approach was employed.

Solution Focused Therapy is not in competition with traditional or motivational approaches (Taleff, 1997, p. 71). However, Solution Focused Therapy is often diluted by this misrepresentation. Solution Focused Therapy is a unique approach that has a marked impact on therapists and clients who are exposed to it. We invite you to take a few minutes and gain a brief introduction to what Solution Focused Therapy is all about.

Current trends in substance-abuse treatment
While many of today's counselors have mastered the application of some "new" motivational techniques (Miller & Rollnick, 1991), the basic tenets of the disease model (Fingarette, 1988; Peele, 1989) permeate the current treatment modalities. Addiction continues to be viewed by many as a lifelong problem, and attendance of support groups is often strongly recommended to prevent relapse. In the majority of motivational and traditional approaches, the "counselor typically has a clear goal (e.g., to change drinking and reduce alcohol-related problems) and pursues systematic strategies to achieve that goal" (Miller & Rollnick, 1991, p. 54). The therapist's task is to influence client behavior and to help the clients "recognize something about their present or potential problems" (Miller & Rollnick, 1991, p. 52). Miller and Rollnick (1991) clearly state that their approach, called Motivational Interviewing, is a problem solving approach (p. 54). The therapist remains the expert in identifying the client issues and resultant treatment plans. This and similar methods assume that the solution is found through some degree of exploration of the problem.

Steve de Shazer (1988) states that "people often find it difficult to stop trying to solve a problem because 'down deep' they (we) stick to thinking that an explanation is both realizable and indispensable if a problem is to be really resolved" (p. 10). Solution Focused Therapy challenges this notion.

Solution Focused Therapy
Philosophy

Solution Focused Therapy (de Shazer, 1985) is consistent with and values the four factors, that research indicates cause change: extratherapeutic factors (the client's view of the world); therapeutic relationship (the client's perception of the relationship); therapeutic technique; and expectancy, hope, and placebo factors (Miller, Duncan, & Hubble, 1997, pp. 24-31).

The simple definition of this approach is that it focuses on solutions rather than problems (Miller & Berg, 1995, p. 15). This approach does not challenge the existence or etiology of problems. It proposes that "problems are best understood in relation to their solutions" (de Shazer, 1985, p. 7). Solution Focused Therapy assists the client in exploring life without the problem, and it asserts the premise that "what you expect to happen influences what you do" (de Shazer, 1985, p. 45). By discovering what future the client sees as worth striving for, the present becomes salient to that future. Otherwise, there is no sense in the client's doing something different or in seeing something differently" (de Shazer, 1988, p. 190).

Although the ideas behind this approach are quite simple, therapists who employ this method often state that this is the most difficult theory to successfully implement that they have ever encountered, for it requires that the therapist set his or her own agenda aside and truly listen to what the client wants. This model trusts in the expertise of the clients to determine what is important to them and in turn, what they want to achieve. This results in partnership with the client and often results in change that is more rapid since the client sees relevance of the treatment to his or her goals. By focusing on how life will be once the problem is resolved, clients often experience renewed hope that change is possible and that life without the problematic behaviors is desirable. In addition, it is proposed that these changes will be more lasting since the change is internally motivated.

Solution Focused Therapy proposes that "expertise lies in the manner in which the conversation is conducted, not in the ability to convey a venerated body of information" (Bobele, Gardner, & Biever, 1995, p. 16). Therapists are trained to identify, diagnose and treat problems. This model asserts that "therapists are the experts in the process of change, not in what is best for other human beings" (Pichot, in press). There is no question that professionals are often placed in the role of ensuring public safety. The majority of substance abuse clients are referred by external sources (e.g., Social Services, Probation, Diversion, parents or family members, schools), and a change in client behavior is necessary. Protecting other peoples' rights and community safety is paramount.

Solution focused therapists are able to assist these professionals while remaining therapeutic by focusing on what the referral source and the client both want (and assisting them in negotiating a common goal if needed). It is only by staying neutral that therapists are able to avoid taking sides and are able to be effective (Berg & Reuss, 1998, p. 134). This stance is called a "not knowing" position (Anderson & Goolishian, 1992), and learning to effectively take and maintain this stance has been described as a "life-long process" (De Jong & Berg, 1998, p. 21).

Techniques
Solution Focused Therapy utilizes many techniques such as the miracle question, scaling, exceptions, noticing difference, and compliments (de Shazer, 1985, 1988, 1994; Berg & Miller, 1992; Berg, 1994; Berg & Reuss, 1998; De Jong & Berg, 1998). All are powerful tools that assist the therapist in exploring the client's goals and to measure progress. However, when these techniques are used outside of the theoretical approach, the techniques often become mechanical and devoid of their original potential. Due to the introductory nature of this article, only one of the most well-known techniques of Solution Focused Therapy, the Miracle Question (de Shazer, 1988, 1994; Berg & Miller, 1992; Berg, 1994; Berg & Reuss, 1998), is described. This question helps the client envision life without the problem. "Answering these miracle questions will provide him [the client] with clues on what first steps he needs to take to find solutions and will show him how his life will change, thus giving him hope that his life can change" (Berg, 1994, p. 100). For a client who is referred by the legal system and whose only stated goal is to get off of probation, the question might be asked like this: "Suppose that a miracle happened while you are asleep tonight. And the miracle is that you have gained the ability to get out and stay out of the legal system. But, since you were asleep, you don't know that the miracle has happened. What will you notice when you wake up that lets you know this miracle has happened?" This question focuses the client and therapist on a "problem that is solved rather than a problem that needs to be solved" (Berg, 1994, p. 98). For a solution focused therapist, a thorough exploration of this question is often the central point of the entire therapy process. As one client stated, "The miracle question makes you think beyond how you normally think. You have to be honest, and then you have to do it!"

Outcome
Solution Focused Therapy is often questioned due to its lack of focus on the identified problem. However, this model has impressive results when applied to substance abusing clients. Miller and Berg (1995) state that "our clinical experience suggest that clients want to and do recover from alcohol problems rather rapidly" (pp. 22-23). Steve de Shazer (1994) reports an 80.4 percent success rate with an average 4.6 sessions. This success rate increased to 86 percent when recontacted at 18 months (p. 161). Insoo Berg stated that Steve de Shazer and Dr. Luc Isebaert have experienced good success in their work with substance abuse clients in Belgium. Berg reports that "in a five year follow-up study, 86 percent of clients and their families report that over-all life is better for them. When asked how they felt most of the time, 88 percent reported doing well, feeling good, or feeling very good. In addition, 69 percent reported that their family relationships had improved since hospitalization. Seventy-nine percent reported that they had received no further treatment for alcohol-related problems since discharge" (personal communication, 1999).

Lastly, Solution Focused Therapy has been demonstrated to be effective with mental-health clients (Beyebach, Morejon, Palenzuela, & Rodriguez-Arias, 1996), clients with chronic schizophrenia (Eakes, Walsh, Markowski, Cain, & Swanson, 1997) and clients in the prison system (Lindforss & Magnusson, 1997).

Conclusion
The term "solution" has become almost commonplace in the business, advertising, and helping professions. It is often used in conjunction with problem solving or in marketing an "expert's" answer to an identified problem. Is it any wonder that this type of problem-solving approach is often confused with Solution Focused Therapy? So, what is the big deal about Solution Focused Therapy? Solution Focused Therapy is a powerful and unique approach to working with clients that is desperately needed in the field of substance abuse and psychotherapy. It is a way to assist the client to get to a place in which the problem does not exist. Solution Focused Therapy is not the only answer to client difficulties and it is not in competition with the more traditional or motivational approaches. It is a valuable alternative for clients who are struggling to see life without the problem. This approach instills hope that change is possible in the most impossible-looking situations. For those of us who have experienced this approach, we know . . . miracles can come true!


Teri Pichot, LCSW, MAC, CAC III, has worked with individuals, couples and families distressed by substance abuse and/or domestic violence. She has designed and implemented innovative programs that use solution-focused therapy with both adults and adolescents. Pichot is program director of a substance abuse treatment program and is in private practice in the Denver, Colorado area.

References:
Anderson, H., & Goolishian, H. (1992). The client is the expert: A not-knowing approach to therapy. In S. McNamee & K. J. Gergen (Eds.), Therapy as social construction (pp. 25-39). London: Sage.
Berg, I. K. (1994). Family based services: A solution-focused approach. New York: Norton.
Berg, I. K., & Miller, S. D. (1992). Working with the problem drinker: A solution-focused approach. New York: Norton.
Berg, I. K., & Reuss, N. H. (1998). Solutions step by step: A substance abuse treatment manual. New York: Norton.
Beyebach, M., Morejon, A. R., Palenzuela, D. L., & Rodriguez-Arias, J. L. (1996). Research on the process of solution-focused brief therapy. In Miller, S. D., Hubble, M. A., Duncan, B. L. (Eds.), Handbook of solution-focused brief therapy. (pp. 299-334). San Francisco: Jossey-Bass.
Bobele, M., Gardner, G., & Biever, J. (1995). Supervision as social construction. Journal of Systemic Therapies, 14(2), 14-25.
De Jong, P., & Berg, I. K. (1998). Interviewing for solutions. Pacific Grove, CA: Brooks/Cole.
de Shazer, S. (1985). Keys to solution in brief therapy. New York: Norton.
de Shazer, S. (1988). Clues: Investigating solutions in brief therapy. New York: Norton.
de Shazer, S. (1994). Words were originally magic. New York: Norton.
Eakes, G., Walsh, S., Markowski, M., Cain, H., & Swanson, M. (1997). Family-centered brief solution-focused therapy with chronic schizophrenia: A pilot study. Journal of Family Therapy, 19,145-158.
Fingarette, H. (1988). Heavy drinking. Berkeley: University of California Press.
Lindforss, L. & Magnusson, D. (1997). Solution-focused therapy in prison. Contemporary Family Therapy, 19, 89-104.
Miller, S. D., & Berg, I. K. (1995). The miracle method: A radically new approach to problem drinking. New York: Norton.
Miller, S. D., Duncan, B. L., & Hubble, M. A. (1997). Escape from Babel: Toward a unifying language for psychotherapy practice. New York: Norton.
Miller, W. R., & Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behavior. New York: Guilford.
Peele, S. (1989). The diseasing of America: Addiction treatment out of control. Lexington, MA: Lexington Books.
Pichot, T. (in press). Discovering the true expert of the therapeutic process. The Counselor.
Taleff, M. J. (1997). Solution-oriented and traditional approaches to alcohol and other drug treatment: Similarities and differences. Alcoholism Treatment Quarterly, 15(1), 65-73.

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http://www.counselormagazine.com/pfv.asp?aid=solution_focused_therapy.asp

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