The Centre for Solution Focused Practice

Turning ‘tough referrals’ into ‘easy cases’.

On Friday Chris and Harvey and I were having lunch together. Amongst many other things we found ourselves discussing the pros and cons around demonstrating the Solution Focused approach, whether live sessions with real clients or recorded sessions, either with real clients or with actors or demonstration role plays worked best. And one of us was found to say ‘well even when you show real therapy sessions recorded with real clients very often people respond by saying we don’t have easy cases like that, our cases are much tougher. My initial thought was that we should respond by taking this as a compliment and then asking ‘so what would I have had to have done in order to have turned this into a difficult piece of work’ – and indeed on occasions I have said this, although I have wondered how well received this thought is. However this is in my view a key feature that is central to the Solution Focused approach, the capacity to turn ‘tough referrals’ into ‘easy cases’. So what is it that we do that makes this likely? Here are a few ideas.

1. Assume that every client is motivated (for something). Some workers immediately make work difficult for themselves by having the idea that their clients are not motivated. As Solution Focused practitioners we choose to assume that our clients are not daft and that everyone who agrees to meet with us must want something. Meeting clients with this assumption firmly in mind is the first step towards ‘easy cases’.

2. Focus on what the client wants. Many (many) years ago I remember meeting a client who even before I had asked a question, I had barely said hello, thought it right to reassure me that he definitely did not have a problem with alcohol. I responded by saying that I was glad to hear that and so what were his ‘best hopes from our talking together’ (George et al. 1999). The client explained that his partner had required him to come for therapy arguing that there was no future to their relationship if he did not stop drinking. I commiserated with him in his tricky situation and said that given that he had come to see me even though he was confident that he had no problem with alcohol that the future of his relationship with his partner must be really important to him, and I asked whether that would be true. He agreed and I wondered whether, if we could do some talking and he could become more confident in the future of his relationship could that make our talking useful to him. The client concurred and we set off on a ‘easy case’ piece of ‘consolidating the future of marriage’ work. If I had tried to engage the client in a piece of alcohol work no doubt it would have been very clear that this was a ‘tough referral’ since he is likely to have responded by arguing that he had no problem with alcohol. However interestingly in the course of this piece of ‘future of relationship’ work the client significantly changed his drinking.

3. Try not to know anything about ‘solutions’. Meeting clients and choosing to know nothing of the solutions to their problems can be scary and unnerving and yet is a key part of moving from tough referrals to easy clients. When we think that we know what the client should do to solve their problem it is terribly hard to resist the urge to ‘get’ the client to do it, but unfortunately clients do not like us telling them what to do . As a client of Chris’s very memorably said to him many years ago ‘when it’s forced upon you then you don’t want to do it even more’. In this case the ‘it’ was cuddling her child and no doubt she had been repeatedly ‘told’ that she ought to ‘cuddle’ her child if she wanted to improve their relationship. Letting go of knowing the right solution allows us to explore ‘exceptions’ and ‘instances’ and these open up conversational pathways towards the client finding their own best way forward, the way forward that fits the client, the way forward that the client can ‘own’. Assuming that the client’s best way is the best way is another step towards ‘easy cases’.

4. Not requiring clients to talk directly about the problems that are bothering them. Solution Focus does not require clients to talk directly about their problems. For many people talking about problems directly is hard, is often upsetting and people can find it hard to do. Indeed in order to do so people need to ‘trust’ the worker since exposing painful experiences requires significant self-disclosure and many clients have been repeatedly let down, often by professionals, and so it seems reasonable for them to doubt whether the latest professional is trust-worthy. A client who does not trust and so does not engage can look like a ‘tough referral’. However in Solution Focus rather than asking clients to tell us about the problem we merely invite them to tell us about what they want ‘I want to be more confident and to like myself more’. We might then ask ‘so if we did some talking together and you ended up being more confident and liking yourself more would that mean that our talking together had been useful?’ and the client will typically say ‘yes’. We will then ask the client to describe their everyday life transformed by the presence of their ‘best hopes’, the version of their life in which confidence and liking self are present. Describing this is hardly likely to be hard, indeed most clients find it easy to talk about and relatively easy to describe – ‘easy cases’. However if we were to ask the client how come they did not like themselves and what might have led to this not-liking many clients will be reluctant and many will struggle, again possible signs of the ‘tough referral’. Clients even seem more articulate when describing the future that they want compared with talking about the painful past – ‘easy clients’!

The list of things that Solution Focus does that are associated with the emergence of collaboration and engagement, sure signs of ‘easy client’ cases, is long:

never asking questions which require clients to condemn themselves,

asking clients questions which invite self-complimentary responses,

avoiding ‘action planning’ and going with the client’s energy between sessions,

assuming that there are no ‘resistant clients’, just inflexible therapists

and so on and so on and so on.

When Steve de Shazer was asked to explain how come he got such good outcomes in so few sessions, Steve would respond ‘it’s because I get such great clients’; but of course Steve’s clients were very similar to my clients and your clients and everyone else’s clients. ‘Great clients’ do not arrive in our offices ready-made, they are co-constructed in the therapeutic process. And it is the same with ‘easy cases’. An interesting exercise that we might all devote some time to is listing 30 things that we do to turn ‘tough referrals’ into ‘easy cases’. Good luck.

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

With thanks to Chris and Harvey not only for our enjoyable lunch on Friday but also for the discussion that was the basis for these thoughts.

Evan George


06th November 2022


Featured Video

What is SF - a 2020 version of the approach


July 9, 2020