In Heidelberg in 1999, Steve de Shazer began a talk by taking issue with the title that the organisers had given his presentation, namely ‘solution oriented therapy’. He said that solution oriented therapy was like being oriented ‘to the north’, whereas, he said, in solution focused therapy, ‘you are determined to get to Bremen from here’.
I am used to explaining to people that the client’s answer to the Best Hopes Question or BHQ (‘what are your best hopes from our work together’) constitutes a ‘contract’ between us, and that a vague contract such as ‘to be happy’ is ok – the broader the contract, the more possibilities that can become available to the client when they start to answer the Tomorrow Question (TQ) or Miracle Question (MQ), questions that develop the client’s ‘preferred future’ (‘if tomorrow you had achieved your best hopes from coming here, what would you be doing then?’). What this means is that to ‘go north’ is in fact a viable answer. The client might then say, in their answers to the TQ, that going north is arriving at Bremen, but we see that as merely an indicator of what might be different in future. We are not seeking to set goals with the client, and so we are interested in the outcome of getting to Bremen. We do, of course, hope they get there, but we see it as a by-product of this preferred future exploration.
So what happens when someone, a researcher say, or a manager monitoring case-loads, wants to know the follow up later on? They would do well to ask the practitioner whether the client has achieved their best hopes from the work, the contract. But if the client had said they wanted to be happy, then surely the chances that they would be positive later about the outcome would be very slight. Accepting ‘happy’ as the contract is surely what the team at the Brief Therapy Center at the Mental Research Institute in the 1970s warned was a ‘utopian’ expectation on the part of clients, and they had counselled against therapists accepting such goals. This raises the question of what, then, comprises a useful, measurable outcome in SF work. If it’s ‘to go north to Bremen’ that’s an easy measure.
An obvious objection to de Shazer’s view is that it makes sense that if someone stops you in the street and says they’re lost and you say ‘where do you want to get to?’, then an answer like ‘north’ would not be very useful. A question of destination is a practical everyday thing. But with the ‘softer’ outcomes that people want from coaching and therapy, such as to be happier or to be more confident or have a calmer family life or have a better work-life balance, it makes sense to explore what ‘going north’ means and not to tie it down to a single destination.
de Shazer was, of course, wise to this. In an article he wrote with Gale Miller, they described ‘solution-focused therapists’ preference for open-ended stories. These stories are always in process and, therefore, subject to reinterpretation and revision’ (Miller & de Shazer 1998).
But that takes us back again to what are measurable outcomes and I can see no way out of this except via that trusty old SF measuring workhorse, the scale*. When we put a scale before the client, we call their preferred future ‘10’ and ask the client to rate where they reckon they are now. I have seen practitioners describe ‘10’ as ‘the client’s best hopes from the work’ which seems to me to dismiss the richness of their preferred future descriptions: the outcome goes back to ‘being happy’. We can, if we choose - and this would be particularly sensible if the client’s preferred future was multifactorial and maybe over-ideal – ask them where on the scale would be ‘good enough’ for them to get to. Most clients say ‘7 or 8’ and the researcher could, presumably, ask the client 6 or 12 months after their last session, ‘where are you now on the scale?’
In an early presentation that Insoo Kim Berg and Steve de Shazer gave for BRIEF in London, Insoo stated that there wasn’t much point to asking a client the MQ if it wasn’t clear that the client wanted anything from therapy. In those days they would ask clients ‘what brings you in here?’ so that the client’s ticket to therapy, so to speak, was having a problem they wanted solved. For us, today, it’s having an aim, a sense of direction. Insoo and Steve said that answers to the MQ tell us what the client’s goals are; for us, it’s their preferred future, and any progress the client makes towards that shows that they have benefitted from the work.
So I propose that we dispense with the word ‘contract’ (sorry, Part 4 of SFBT: 100 Key Points and Techniques). ‘Sense of direction’ is one idea I have for a replacement, but I wonder about some other possibilities, such as ‘direction of the work’, ‘aspirations from the work’ or even ‘where we are heading’. I’d be interested in what people think. My hunch is that ‘contract’ is useful for those concerned about what managers and researchers have to say, and would be sorry to see it go.
*Interesting and not so trivial fact: John Walter and Jane Peller, in their challenging take on Solution Focused Practice, dispensed with scale questions altogether. I’m not sure I understand exactly why, but I think they saw scales as too close to problem-solving and pressurising clients to ‘do’ something about their situation. Matter for another blog, I imagine.
Harvey Ratner December 2017
Miller, G. & de Shazer, S. (1998) Have you heard the latest rumor about…? Solution-focused therapy as a rumor. Family Process 37:3, 363-377.
Walter, J.L. & Peller, J.E. (2000) Recreating Brief Therapy: Preferences and Possibilities. New York: Norton.