The Centre for Solution Focused Practice

Managing Problem Focused Environments

 

Nearly all Solution Focused practitioners work in jobs that require them to be more than a therapist. Among other things they need to diagnose, assess, safeguard, advise, mentor, make plans, set goals, gate-keep resources, teach, heal, assume parental or pastoral responsibilities and provide care. They might also have to work alongside colleagues using different models of therapy and somehow blend the differences to create some form of coherence. It is these practitioners who have made up the bulk of the 75,000 or so participants who have attended BRIEF trainings and they have found so many creative ways of developing their practice in what can sometimes feel like hostile environments.

Here are a few of the things participants have told us about what they do.

•Most health, education and social care professionals have among their many roles and responsibilities the task of talking to their patients, students and clients with the aim of helping these people have healthier, more successful and more satisfying lives. The Solution Focused approach provides a framework for these conversations whether they occur in set-piece sessions or fragmentarily in classrooms, corridors or on street corners. A scaling question, for instance, can be spread over days and weeks in a school, a GP practice or in a homeless shelter, offering a simple and fruitful structure for exploring anything from performance, to well-being, self-care, progress or coping.
•DIALOG and DIALOG+ (Priebe, 2015) research has shown that spending two or three minutes asking clients to rate themselves on simple well-being scales – just providing a number, nothing more – leads to increased well-being and adding five more minutes asking what puts you there rather than lower increases the sense of well-being even further. If 5-7 minutes of very simple structured questions has this effect it can easily be added to most meetings whatever their purpose.
•So many assessments create a distorted picture which then becomes a reality as the client is treated as if they were the version produced by the assessment. Assessments cannot be avoided but we have to view them rather like those photographs we want to delete. Under the glare of professional gaze we are rarely at our best. Solution Focused practice provides an alternative dynamic form of assessment that is inherently fairer and more ‘reality-founded’: the client is enabled to describe their own way forward (e.g. the Miracle or Tomorrow Question), credit is given for their achievements so far (e.g. scaling questions) and follow-up sessions give a chance for people to demonstrate improvement (e.g. What’s better?) The capacity to change is a big element in any fair assessment and with a Solution Focused approach the client is given a chance to show this capacity on their own terms. 
•In safeguarding the key ‘witness’ has always been the client, either as the person who needs safeguarding or the person who might be the aggressor. They are not the only witnesses of course and where possible corroboration must be sought from other sources but most social professionals have found themselves asking questions like: “If we arrange to meet next week will you still be alive to keep the appointment?” A safety scaling question not only gives the client’s view of the level of safety/risk but can also enhance the level of safety with questions like “What are five things you know about yourself that give you this level of safety?”. Merely inviting people to outline the evidence is likely to promote the safety that is the subject of the enquiry.
•In some services protocols require the specification of plans, targets and goals and staff can be in trouble for not recording them for each client even though it is pretty well established that such practices are more likely to hinder than promote improvement. Evan George has written about ‘signs’ rather than ‘steps’ in relation to progress. Rather than setting out the steps that need to be taken, a process which can feel impositional and not infrequently can become merely the basis for the documentation of failure, asking people to describe possible signs of progress is gentler and reduces the sense of failure ‘If you were to move just a little bit further towards your desired future what might you start to notice different - perhaps?’. On a case record a list of possible signs of progress will look much the same as a set of targets but the process will allow people to find their own way forward in the way that best suits them. This is what is sometimes called in the business world “emergent planning” or ‘in the moment planning’.

Here are just a few examples of the ways in which people have embedded their Solution Focused learnings into their everyday non-therapeutic tasks and roles. The creativity of the practitioners attending our training programmes remains a constant course of pleasure and inspiration.

Stefan Priebe, Lauren Kelley, Serif Omer, Eoin Golden, Sophie Walsh, Husnara Khanom, David Kingdon, Clare Rutterford, Paul McCrone, Rosemarie McCabe (2015) The Effectiveness of a Patient-Centred Assessment with a Solution-Focused Approach (DIALOG+) for Patients with Psychosis: A Pragmatic Cluster-Randomised Controlled Trial in Community Care Psychotherapy and Psychosomatics 2015; 84: 304–313

Chis Iveson
09 June 2019
London