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Solution Focused Therapy

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Katie Witcher

on 5 March 2014

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Transcript of Solution Focused Therapy

Personal Background
Born on June 25, 1940 in Milwaukee, WI
Earned his Master's Degree in Social Work from the University of Wisconsin - Milwaukee
Established the Brief Family Therapy Center in Milwaukee in 1978 with his wife, Insoo Kim Berg
Died on September 11, 2005 in Vienna
De Shazer is a post-modernist
Solution Focused Brief Therapy
This form of therapy targets the solution rather than the situation
Focuses on the present and future, not the past
Emphasizes constant change and tries to use this constant state of change to enable clients to take positive steps toward improving their lives
Key Tenets of SFBT
If it isn't broken, don't fix it

Intervention is irrelevant, or should be, if the family has solved its problem

If something is working, do more of it
The two main jobs of the therapist are to uncover things that the family does that are working to make things better, and then encourage them to do more of that

Key Tenets Cont'd
If it's not working, do something different

- if a homework assignment is not completed by the family, the assignment is merely dropped and the therapist continues exploring with the family things they did that worked

Small steps can lead to large change
- Focus is always on small change, made incrementally rather than in big movements
Solution Focused Therapy
Steve de Shazer

Key Tenets Cont'd
The solution is not directly related to the problem
- the path to making things better, to find the solution, does not require continued scrutiny and emphasis on the problem itself.

The language requirements for solution development are different than those needed to describe a problem
- the language of solutions tends to be positive, is present or future oriented.

Therapist Role
Collaborator and consultant there to help clients achieve their goals.
The therapist always operates from the assumption that the client is the expert.
The therapist assumes a one-down or a “leading from behind” position by asking clients how they can help them to change their situation.
The therapist places him/herself in the position of needing to be informed by the client, rather than having an assumption of what the client should do.
The therapist use more indirect methods such as the use of extensive questioning about previous solutions and exceptions.
Three Therapist/Client Relationships
Visitors
do not bring a specific problem to therapy and do not have a commitment to participating productively in treatment. The therapist engages in solution-focused conversations, gives compliments, and hopes that the relationship will move the therapy forward.
Three Therapist/Client Relationships Cont'd
Complainer
brings a specific problem, but is currently unwilling to focus on a solution. As with the ‘visitor’ the therapist engages in solution focused conversation, gives compliments, but in addition gives an assignment, asking the client to observe when exceptions to the problem occur.
Three Client/Therapist Relationships Cont'd
Customers
bring a problem and willingness to work toward its resolution. Here the therapist can progress beyond solution-focused conversation, compliments, and assignments to amplifying those behaviors that move the clients towards his/her goals.
Steps of Solution Focused Therapy
Step 1:

Joining and Building Rapport:
Introduce yourself and greet everyone in the room.

Step 2:

Understanding the Presenting Issue:
Inquire about what brought the client/family to therapy.

Step 3:

Assessment of Family Dynamics:
The solution-focused therapist does not assess the presenting issue, as many other therapeutic models do, to learn why the issue exists. The therapist does listen for exceptions, within the family system, that provide possibilities to solutions.
Steps of Solution Focused Therapy Cont'd
Step 4:

Goals:
The solution-focused therapist works with the client to set specific goal(s) that will be meaningful and relevant to the client.

Step 5:

Amplifying Change:
Support the client, look for change, and realize that change is constant. Emphasize the clients’ successes and improvements toward the goal.

Step 6:
Termination:
Each week, ask the client whether they wish to come back, and, if so, when. This puts them in charge of therapy.
Miracle Question
The miracle question asks for the client's goal(s) in a way that communicates respect for the immensity of the problem.
At the same time it leads the client to come up with smaller more manageable goals.


"I am going to ask you a rather strange question. The strange question is this: After we talk, you will go back to your (home, work, school) and you will do whatever you need to do the rest of the day, it will come time for bed. Everyone in your household is quiet, and you are sleeping in peace. In the middle of the night a miracle happens and the problem that prompted you to talk to me today is solved! But because this happens while you are sleeping, you have no way of knowing that there was an overnight miracle that solved the problem. So, when you wake up the next morning, what might be a small change the will make you say to yourself: "Wow, something must have happened, the problem is gone!"
Exceptions
As a solution focused therapist you are always listening for talk about points of previous solutions and exceptions, as well as goals.

When a client points out an exception, or time where the issue could have occurred but didn't, your job is to highlight that instance and encourage with enthusiasm and support.

The main focus is to keep solution-talk in the center of the conversation.


Steve De Shazer & Insoo Kim Berg
Miracle Question Cont'd
The miracle question is one of the most well known techniques in solution focused therapy.

This technique actually came about by accident during a session in which a client continuously responded: "Nothing will help!" Insoo Kim Berg actually responded (in frustration) "Maybe only a miracle will help!"

Once Insoo Kim Berg had asked that "miracle question" the client was then able to articulate what it would be like if that miracle was to occur. Since the client had described that situation, they were able to set a solution focused goal.
Example Wording of "Miracle Question"

Keys to Highlighting Exceptions

1. Listen carefully for exceptions to the problem

2. Punctuate the exception by repeating it, emphasizing, and asking for more details

3. Connect the exception to their goal, or "miracle" by asking: " If this exception were to occur more often, would your goal be reached?"
Scaling
The most important intervention in solution focused therapy.

The therapist asks the family or client to scale, from 1-10 what a 10 (10 being the greatest level of satisfaction) would be if the problem were to be solved.

This intervention also acts as a measure of the progress during therapy.

The scale is most often introduced in the first session.
"Take me back to a time when you and your wife got along slightly better"

"Tell me about a time when things went slightly better for you in school"

"Please tell me how up until now you have been able to cope with this situation"

"Between your last session and today, did you notice any times when the problem was less severe, or frequent?"
Solution Focused Therapy Video

Examples of Exception-Finding Questions
Example of Scaling
The therapist will let the client know that they would like them to scale the problem and the goal. For example, " Lets say a
1

is as bad as the problem could ever be, you never talk, only fight, or avoid each other. Lets say a
10
is where you talk all the time, with perfect communication and never have a fight ever....."
Once the paramaters for scaling have been set, the therapist and client(s) discuss where they feel they fall on the scale currently, and set goals for where they would like to end up once therapy has concluded.
Scaling Concluded
Three major components:

It acts as an assessment tool

It makes it clear to the client that their own evaluation of the issue is more important than the therapists

It acts as an intervention in itself, because it centers the conversation around previous solutions and exceptions. Also, highlights new changes as they occur.
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