Working with a group in North Wales, another lovely group naturally, we were discussing how we might respond when a client answers the ‘best hopes’ question (George et al, 1999) by saying ‘well my GP suggested that I should come’ or ‘my social worker told me to come’. The easiest way to respond in such situations is of course just to assume that the client has not yet answered the question and to ask again ‘great – so how will you know that your decision to come has turned out to be useful?’. Typically at this point, at this second time of asking, the question will become clearer (perhaps) and the client will answer. Of course sometimes it is not quite this straightforward and the client may respond with something on the lines of ‘I really don’t know – my (year head) told me that I had to come’. Now we have a choice, we can either persist along the lines of ‘so how come you decided to go along with (her/him/them) . . . ?’, or persistence might take the form of something like ‘OK – and if coming ends up being good for you in some way how could you know?’ or alternatively we can loop back and get nearer to the answer given. If we take this route we ask ‘so what do you think your (GP/Social Worker/Year-head/Boss’s) best hopes are?’ and when the client answers, which more often or not they will, then we can just check out ‘and if you were to be (getting on better at school and getting into less trouble) would that be good for you too?’. If the client responds with a ‘yes’ we have a starting point for our conversation and we can ask a preferred future question, inviting the client to begin describing the version of their life as transformed by the presence of their ‘best hopes’.
However when we were discussing possible ways of responding to the ‘my GP suggested that I should come’ response, one of the group, drawing on his knowledge of, and familiarity with Motivational Interviewing (MI), suggested in essence that we should take the client’s response as evidence of ambivalence and explore with the client possible good reasons for not attending, or perhaps more broadly, good reasons for not changing. As so often this completely sensible and reasonable response, from a MI stand-point, just highlighted for me the distinctiveness of our SFBT way of listening to our clients. The MI way of responding, as characterised by our course attender, hears the client’s words but then hears something else beneath those words. Clients, if we listen this way, do not necessarily say what they mean, they say one thing but may well mean another. Clients words thus require expert de-coding by the therapist to see what lies beneath those words.
SFBT is different. We assume that the client means what they say. When clients say that they want to change we choose to take them at their word. When they say that they have come because someone else told them to come we accept this response , absolutely, and merely look for the next good question to ask, rather than hypothesising about the significance of the response, and then responding in line with our own hypothesis. And listening to this possible Motivational Interviewing response I found myself clearer about the characteristics of the way that we talk, of the way that we work. In SFBT we would never introduce to our client, indeed perhaps you could say impose upon our client, an idea of ambivalence. Indeed we would in effect do the exact opposite. In inviting the client to describe in minute detail the preferred future, the life that contains the ‘best hopes’ we would be inviting the client to specify, to describe, all the good things that would flow from the change, thereby potentially enhancing the client’s commitment to change. Why would we complicate the change process by suggesting to the client that they may have reasons for not wanting to change. Rather we would take what the client offers us and asks questions that build on it.
Isn’t it strange how differently different approaches respond, different approaches being utilised by different practitioners all equally committed to their client’s successful outcome! And then I recalled one small way in which this MI idea of ‘ambivalence’ does find an echo, a reflection in our work. Who remembers the way that Insoo Kim Berg would talk about the question ‘and what good reasons might you have for keeping things the same, for not changing?’? Many of you might. However as you will also recall Insoo would only use this question in later sessions if the client was not changing. Her rooted belief in her clients’ absolute good sense and their capacity would lead her to the idea that if a client is not changing that client must have a good reason for not doing so. There we are – a small connection perhaps.
In Clues (1988) Steve de Shazer wrote ‘Traditionally, therapists have thought they had to penetrate the clinical situation, to see beneath or beyond the appearances. This is based on the assumption that the essence is hidden away (in the psyche or in the system?). However, other assumptions are possible. Perhaps nothing is hidden away and everything lies in plain sight.’ (p70) Thank-you Steve.
Have a good February everyone.
de Shazer, Steve (1988) Clues: Investigating Solutions in Brief Therapy. New York: Norton.
George, Evan, Iveson, Chris, and Ratner, Harvey (2nd edition, 1999) Problem to Solution: brief therapy with individuals and families. London: BT Press.
31st January 2021