Paradigm Shift in the Therapeutic Approach: an Overview of Solution-Focused Brief Therapy

Beatrice Popescu
BA Psychology, University of Bucharest
MA Cognitive Behavioral Therapy, Titu Maiorescu University, Bucharest

http://www.brief-therapy.org

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I was from the beginning impressed by this new orientation in psychotherapy: Solution Focused Brief Therapy. SFBT land is an unusual destination which remained unknown for many years. In more recent years, it has become a very popular destination, with more and more people reaching there, both therapists and clients. As I immediately learned while browsing specialized electronic journals and attending seminars, the trend was new only in our country, quite recently introduced by young psychotherapists Bogdan Cezar Ion, PhD and Andreea Ion, PhD under the supervision of experienced psychotherapist Irina Holdevici, PhD. Worldwide and especially in Milwaukee, where Steve de Shazer and Insoo Kim Berg at Brief Therapy Center used this approach since early ’80s, SFBT helped many individuals in crisis and most of them managed to change their lives and make break-through discoveries about their own psychological resources. De Shazer and Kim Berg’s approach originally developed to work in brief marriage and family therapy, has been used since early ’80s in a variety of situations for a variety of problems.

Solution, exceptions, resources and goals, key-terms in SFBT

Solution-focused brief therapy is an approach to psychotherapy based on solution-building rather than problem-solving. It takes a major departure from the problem-focused orientation in psychotherapy begun by Freud and perpetuated by the most fields of therapy. The deepest roots of SFT can be traced back to Gregory Bateson, Milton Erickson and Ludwig Wittgenstein. "It explores current resources and future hopes rather than present problems and past causes " (Iveson, 2002). This therapeutic approach may involve from three to twenty sessions. Developed at the Brief Family Therapy Center, Milwaukee, by Steve de Shazer and Insoo Kim Berg, it originated in an interest in the inconsistencies found in problem behaviour. "From this came the central notion of ‘exceptions’: however serious, fixed or chronic the problem, there are always exceptions and these exceptions contain the seeds of the client’s own solution" (Iveson, 2002). SFBT claims that all clients have resources and one of the therapist’s tasks is to help the client to discover them. Enabling the client to discover his own resources is a rather difficult task since guidance has to be made with subtlety by asking skilful questions. The founders of the Milwaukee team were also interested in determining the goals of therapy so that they and their clients would know when it was time to end. They noticed that the clearer a client was about his or her goals the more likely it was that they were achieved. A strong point of solution-focused approach became finding ways to elicit and describe future goals.

An efficient therapy across a wide range of problems

Since its origins in the early 1980′s, solution-focused brief therapy has proved to be an effective intervention across the whole range of problems. Some of the early studies show similar results regardless of the presenting problem. The Solution Focused Brief Therapy claims to be efficient with all age groups and problems, including behavioural problems at school, child abuse and family breakdown, homelessness, drug use, relationship problems and the more difficult psychiatric problems. There is no claim being made though that the cure for schizophrenia or any other psychiatric condition has been found, but if a man with schizophrenia wants to get back to work or a woman with depression wants to enjoy life then there is a good chance that these goals will be realized (Iveson, 2002). In brief, it is a simple all-purpose approach with a growing evidence base to its claim to efficacy.

The therapeutic process

"As the practice of solution-focused brief therapy has developed, the ‘problem’ began to play a less important part in the therapeutic process, to the extent that it might not even be known" (Iveson, 2002). All attention is given instead to developing a picture of the ‘solution’ and discovering the resources to achieve it. A typical first session involves four areas of exploration. The therapist’s task in the first session are: 1. To find out what the person is hoping to achieve from the meeting or the work together, 2. To find out what the small, everyday details of the person’s life would be like if these hopes were realized, 3. To find out what the person is already doing or has done in the past that might contribute to these hopes being realized, 4. To find out what might be different if the person made one very small step towards realizing these hopes. The first session is always the one that allows exploration of hopes of the person seeking help.

Complimenting

The idea of complimenting is not new. It has been used as a reinforcing means in the past in almost all behaviourally-related approaches. It even works in everyday life; it also works in psychological counselling. Complimenting the client is not a superfluous gesture; it pinpoints every little success the client is achieving towards the final goal of therapy. It supports the idea of change and allows the client to receive a positive feedback on what he/she has been achieved so far.

Miracle question or hypothetical solution

This is definitely a highly original idea in psychotherapy. "Imagine that tonight while you are sleeping something like a miracle occurs. The miracle is that the difficulties and problems that have brought you to therapy today have somehow been resolved. It isn’t until you wake up, that you are aware that the miracle has happened. What is the first thing that tells you that this miracle has happened? What would you be doing, what would you notice that is different, that tells you that the miracle has occurred?" The miracle question has the role of projecting the client into the future, shortcutting the current maladaptive state. By asking the miracle question at the proper time, the therapist tries to suggest the client the idea that the goal may be closer than he expects and most of all, it is achievable. He motivates the client towards the CHANGE, making him curious about the future and what might happen next. It is also a powerful means to encourage creative thinking and opens the client’s appetite to explore the preferred future.

Scaling

As in cognitive behaviour therapy, solution focused approach uses scaling in order to identify what is the actual state at the beginning of the therapy, at the same time monitoring the achieved results during the therapy and at the end of it. On a 0 to 10 scale, where 10 equals the achievement of all goals and zero represents the worst possible scenario, the client is invited to identify his or her current position. Using this framework, the client and the therapist will be able to define ultimate objectives and the therapist will know what the client is already doing to achieve them and what the next step might be.

"If this doesn’t work, try something else!"

The therapeutic schema "do something different" was perfected by Steve de Shazer in 1978 and is effective when a person complains permanently about other person’s behaviour, he/she has done everything possible to solve the situation but still remains trapped in the vicious circle of the negative interaction sentence that seems to be replicated over and over again. (Holdevici, 2000). An intervention message addressed to a teenage girl’s parents (de Shazer, 1985) could be formulated in these terms: "Starting now and up to our next meeting, each of you should behave differently when you see your daughter watching television instead of doing her task, regardless of how strange or inappropriate you find this behaviour". This therapeutic task is non-specific; it may be transferred to a wide variety of situations. Its role is to cut the pattern of behaviours that proved to be ineffective up to the present moment and to create new behaviours who may work due to the element of surprise and novelty.

Research on the effectiveness of the SFBT

There was useful research addressing the needs of clinicians, educators, clients, students, theorists, health organizations. Mc Keel states that research of solution-focused brief therapy concludes that the model is effective and many techniques of the model accomplish their intended purpose. Research suggests that SFBT is an effective treatment for a broad range of client problems. De Jong and Berg (1998) report SFBT accomplished 70% or better success rates for many clinical problems, including depression, suicidal thoughts, sleep problems, eating disorders, parent-child conflict, marital/relationship problems, sexual problems, sexual abuse, family violence, and self-esteem problems. Steve de Shazer & Isebaert (1997) report a 74% success rate for 250 inpatient clients and a 73.5% success rate for 72 outpatient clients with alcohol problems. A study by Eakes, Walsh, Markowski, Cain, & Swanson (1997) found SFBT successful in treating five clients with a diagnosis of schizophrenia. Three research studies have examined whether SFBT is effective in group therapy. These studies conclude that SFBT group therapy successfully addresses couples issues, parenting issues and anger reduction. Other research studies have found that SFBT is effective in an Occupation Therapy setting (Cockburn, Thomas, & Cockburn, 1997), in schools (Lafountain, Garner, & Eliason, 1996; Littrell, Malia, & Vanderwood, 1995), in Social Work Agencies (Sudman, 1997), and in prisons (Lindforss & Magnusson, 1997).

An interesting pathway for the future

Solution focused approach is not an universal remedy, neither it claims to be THE perfect "solution" for all types of problems, all the time, at every stage in the human development or suitable to everybody. However, what it really claims is a clear focus on the development of a goal and the pursuit in achieving it. It may be successfully used in psychological counselling or therapy, in life coaching and also as a complementary therapy to psychiatric treatment, providing a set of tools useful in supplementing and enhancing therapeutic work. It appears that its elegant simplicity has seduced practitioners worldwide. In UK are now being made efforts to evaluate SFBT in the national health system. There are also established MA programs in Counselling Psychology worldwide teaching solution focused way among other therapeutic approaches. Beyond its limitations, solution focused approach can be used by therapists of all orientations, provided that they have the ability to integrate the psychotherapeutic approaches, in their dedication of helping the client to create a painless and more productive life. More than a crisis intervention, but highly efficient in crisis situations, SFBT looks like an interesting choice in this fast paced era, more and more restrictive in terms of time resources. For persons not willing to spend lengthy periods of their life in therapy but wishing steady results, it may be an inspired choice.

Biographical Note

Beatrice Popescu, BA in Psychology, University of Bucharest, MA in Cognitive Behavioral Therapy at “Titu Maiorescu” University, Faculty of Psychology, Romania. Member of "Brief Therapies, Study and Promotion of Change" Section of Romanian Psychological Association, also a member of "Romanian Association of CBT", she is trained in Solution Focused Brief Therapy and attended advanced training in REBT psychological counselling with supervision from Albert Ellis Institute, NY http://www.rebt.org/ and Babes Bolyai University www.psychology.ro. Her eclectic academic interests, passion for essay writing and empathetic abilities together with an early interest in consumer psychology compete in picturing her professional profile.
beatrice.popescu@ejop.org

References

De Shazer, S. (1985) Keys to Solution in Brief Therapy. New York: Norton
DeJong, P. & Berg, I. K. (2001, 2e). Interviewing for solutions. Pacific Grove, CA: Brooks/Cole.
Holdevici, I. (2000) Brief therapies, Ed. Ceres, Bucharest, 159.
Ion B.C., Ion A. (2004) Basis of brief collaborative solution-oriented therapies, Bucharest.
Iveson, C. (2002) Solution-focused brief therapy. Advances in Psychiatric Treatment, 8, 149-156
McKeel, J. A. (2000), A selected review of research of solution-focused brief therapy.
Perkins, J.E. (1999) The Solution Frame: The Genius of Solution-Focused Therapy.
Todd, T. C., & Stanton, M. D. (1983). Research on marital and family therapy, Handbook of family and marital therapy (pp. 91-115). New York: Plenum.