At the very beginning of my career I worked for some years in a community social work service in London. As a community social worker working a great deal with children and families, and with children in the care of the Local Authority, it was not unusual for me to meet with distress and difficulty in the families for whom and with whom I worked. Being aware, particularly in my early days, of my own very marked clinical limitations and wanting ‘my families’ to have the very best service available, I referred quite a few of them to our local Children and Families Psychiatric out-patient service. Naturally I would encourage them and support them and facilitate their arrival at the first appointment, often the first of three initial ‘assessment’ sessions. What I discovered was that very often the families I referred did not enjoy the sessions much, after all we were still in the days of ‘no pain no gain’, that they found it really difficult to get the children to go because the children appeared not to enjoy either the idea of the sessions or the fact of them, and yet having made an absolutely heroic effort many of them would attend all three assessment sessions and somehow ‘get’ their children to come with them. And then we waited, and not infrequently we would receive a report turning them down for treatment on the grounds that they were adjudged not to be sufficiently insightful, or that the young person was not deemed to be in a sufficiently stable situation to undergo therapy, or that the family were not psychologically minded, or that they did not accept that they had the problem which the assessors believed to be the case. I remember wondering what I had done. With the best will in the world I had referred and yet following an assessment it seemed as if their problems were even worse. Before the referral they were just unhappy but now they were unhappy and deemed not fit for therapy. Could it be that, in referring, I had made life worse for my clients?
I was reminded last week of this painful experience when reading a chapter called ‘Motivating the unmotivated; Psychopathy, treatment and change’ by Hemphill and Hart (2002). In the chapter they list some of the generally assumed requirements for effective engagement in therapy and I realised that not much had changed between my experiences in the 1970’s and some 25 years later. Hemphill and Hart listed a series of ‘motivational deficits’ in their clinical population including the necessity for the offender to ‘acknowledge personal problems’, the requirement for the offender to be ‘interested in changing’, the need for the offender to ‘view his or her problems as psychologically-based’, the need for the offender to recognise ‘his or her contributions to personal problems’, to be ‘self reflective’ and have ‘psychological insights into his or her behaviours’ and to experience ‘marked emotional distress or shame regarding his or her problems’ (pp 205 - 207).
This way of thinking seems deeply rooted in the unquestioned assumptions embedded in so many approaches to change and in so many professional contexts. I recall working some years ago with a Probation Service. I was delivering a two-day introduction to the Solution Focused approach and at the end of the first day a significant group of attenders expressed doubt, scepticism, indeed frank disbelief in the model because the clients were not being obliged to focus on their ‘offending behaviour patterns’. In fact I recall that some of the group expressed the view that even if hypothetically Solution Focused work were to be effective and to reduce recidivism, and they doubted the likelihood of this, that nonetheless an approach that did not challenge the ‘offender’s’ behaviour directly was somehow wrong. Perhaps the work was seen as insufficiently ‘punitive’ and it was in this context undoubtedly thought to be failing in ‘victim-centredness’. Victims it was seemingly suggested were more interested in the ‘offender’ feeling shame than in the ‘offender’ never offending again.
Therapy has it seems been rather demanding of potential clients, specifying those with whom it is prepared to work and those who are to be rejected, and only those potential clients ticking most of the therapist’s boxes have been taken on. And it was my perception of this so many years ago, and my distress at the consequences of this way of thinking, that created part of the context for my enthusiastic embracing of Solution Focus. In our approach the client does not have to do anything except to ‘turn up’, the client does not have to ‘be anything’ other that that which they are. It is our job to work in a way that co-operates with the client’s capacities, to find a way of working that fits with what the client can do. We do not require the client to ‘shame’ or to ‘humiliate’ or to ‘blame’ themselves. Our clients do not have to put up their hands and own up ‘I am an alcoholic’, ‘I am an offender’. All that we need is for the client to have an answer to the ‘best hopes’ question (George et al., 1999), whatever that answer is. How often have clients who made no mention of drinking in the first two sessions mentioned in passing in session three that they have reduced their drinking? How often have adolescents, referred to BRIEF as a result of concern regarding their drug use, made no mention of it in their best hopes or indeed in the first session and yet on returning to the second session tell us that they have decided to stop smoking in the morning since it makes them lazy. Human beings are complex. Talking about something does not mean that it is being addressed and not talking about it does not mean that it is not. This is what Lee, Sebold and Uken understood in their work with ‘Domestic Violence Offenders’ (2003).
Conveying our belief in our clients, rather than our disbelief, in itself makes a difference, in itself facilitates engagement and once clients are engaged who knows what is possible. Solution Focus is committed to making engagement and indeed change easier and if neither engagement or change occur then in Solution Focus we choose to turn the spotlight on ourselves and to ask what could I have done differently rather than to blame the client. Clients notice the difference.
George, E., Iveson, C. and Ratner, H. (1990; Revised and expanded Edition 1999) Problem to Solution: Brief Therapy with Individuals and Families. London: BT Press
Hemphill, J.E., Hart, S.D. (2002) Motivating the Unmotivated: Psychopathy, Treatment and Change. In McMurran, Mary (Ed.) Motivating Offenders to Change: A Guide to Enhancing Engagement in Therapy. Chichester: Wiley.
Lee, Mo Yee, Sebold, John, Uken, Adriana (2003) Solution-Focused Treatment of Domestic Violence Offenders: accountability for change. Oxford: Oxford University Press.
23 August 2020