The question of integration is raised in a number of different ways, so let’s start first of all with the ‘toolbox’. I was pleased to notice the other day that our friend and colleague Elliott Connie shares some of my thoughts about the ‘toolbox’, and I may as well be honest at once, I loathe the ‘toolbox’ metaphor. When participants talk about ‘having a toolbox’ or ‘putting SF techniques into their toolbox’ I have to work hard to remain polite. I normally do manage to do so (just) because I know that mainly people have not given the matter a great deal of thought to the word. It is just one of those words that has crept into professional parlance and is a taken-for-granted good idea. However let’s think about it now. I have a clear image of a toolbox. I have one downstairs in the kitchen right now as I write with hammers and spanners and screwdrivers and a small saw and a spirit level and a number of awls and a tape measure and a set of Allen keys, as well as two planes and some pliers and some chisels and then all those other bits and pieces that we throw in when we are half way though a job and never clear out. Toolboxes are really useful and they are really useful specifically when we want to fix something or to mend something. But when we are doing therapy would we want to think about ourselves fixing or mending the client and would we want to think of the client as something - yes as a thing - impassive upon which we operate. Surely not and certainly not if we are working in a solution focused way. Clients aren’t things and it would be a mistake to use language, to use a metaphor, that implies this inappropriate and unhelpful idea. So we can dismiss the ‘toolbox’ metaphor right now, but what about the ideas that are hidden with the ‘toolbox’ metaphor?
So how else is the idea of integration raised? I think that often it is used by people who describe themselves working eclectically, drawing on a range of approaches and using those elements of that range of approaches and techniques that seem appropriate to them in any given situation. But the question that this begs is how do you decide what to do at any one given time? How do you know whether to stick with person-centred or to drop in a bit of CBT or even of SFBT? How do workers decide? And if you ask this question workers most often return to the nature of the problem and we find them saying ‘if the client is struggling in relation to a bereavement then I might draw on person-centred whereas if it is anxiety then I find that CBT works well maybe with a bit of . . . .‘ Alternatively people talk about evaluating where the client is in the cycle of change ‘I start more person-centred when the client needs to get the problem out and then I switch to SF’. So the worker tends to evaluate the problem, or what the client needs at any point, and then to make a decision. But of course in SFBT we wouldn’t do this. Whatever problem brings the client to our office we are going to ask ‘so what are your best hopes from our talking together?‘ and we will be establishing with that client a desired outcome for the work, and the outcome that we will be inviting the client into will be a ‘shape-of-life outcome’. ‘I’ll be living again’, ‘I’ll be more confident and happier’, ‘I’ll be liking myself and getting on better with my partner’. So even though the problems that bring clients to our doors may well, at first blush, look very diverse, the outcomes tend to look rather similar, and they look rather similar whether the client is dealing with a bereavement or alcoholism or anxiety or depression or a relationship issue. So given this similarity on what basis could I decide that CBT rather than SFBT would be appropriate since what the client wants is largely rather pretty much the same?
But integration also turns up in a further guise with people enquiring couldn’t I integrate your SFBT with my Narrative Therapy or my Motivational Interviewing or my CBT? And the answer really, if we are being careful in our thinking, is ‘no you can’t’. All of the therapies highlighted here are problem-focused approaches. All of them are interested in the problem. All of them invite the client, in their very different ways, to reflect upon the problem. They all assume that the problem has meaning which SFBT does not. Problem focused approaches are fundamentally and radically different from the Solution Focused approach. In SFBT we think about the process of change differently, we listen to the client differently, we conceptualise differently. So if we were to work in a problem focused way and were to think about the client in that way, then any ‘solution focusedness’ disappears, indeed even the seeming solution focused techniques that the worker thought that they were using, are transformed and changed by the context within which they are being deployed. Part of the definition of a technique lies in the context of intention within which it is used. If that context of intention is problem focused, then the seeming solution focused technique becomes a problem-focused technique. What we are left with therefore is not an integration but a worker using techniques that are drawn from the solution focused literature in the midst of a problem focused piece of work thereby turning them into problem-related techniques. I remember many years ago a course participant, who had initially been highly sceptical regarding the usefulness of SF, returning for a follow-up session and enthusing. The basis for his new-found enthusiasm was a clinical experience that he had. He was seeing a client who had been, in his words, ‘denying that she was using heroin’. What he reported was that ‘I used one of your scale questions with her and it forced her to admit that she was using. Brilliant!’. Using a scale question to force anyone to admit anything means that the question is no longer a solution focused scale question. It is a ‘forcing to admit question’ which could never be the purpose of any solution focused question. The question is therefore no longer a solution focused scale question. It is something else. Work seems to me to be either problem focused or solution focused and it really can’t be a bit of both.
Adopting a solution focused approach is a radical decision, a radical choice and part of the definition lies in the way that we listen and the ideas that we hold about our client and these ways are antithetical to the sort of listening that is involved in assessing and evaluating the client’s situation in order to make a decision about what sort of technique to use next. So the common sense ideas that people bring about integration, about toolboxes don’t work; they tend to collapse under closer examination.
Evan George
London
June 2018
