Evan George thinks about the key question 'how can brief therapy lead to sustainable change?'.
If by “integrate” it is intended that the sf approach can be combined with and melded with a problem focused approach, then the answer is ‘no’.
If one is asking if sf can be used alongside a problem focused approach, then the answer would be “of course”.
Suppose a client announces to her therapist, “I’ve been having a rotten week”. As Harry Korman has noted, there are, after we have said something like “I’m sorry to hear that” or “that’s tough”, basically two ways we can proceed with the meeting. On the one hand, we can ask “What’s been happening?” This is the traditional “problem focused” approach. It invites the client into telling the story of their trouble. In most approaches, this would pave the way for a problem-solving enquiry about why things have got this way, and what can be done about it.
On the other hand, we can (again, after acknowledging we have heard their distress) see the statement of trouble as the client’s plea for things to be different. We can therefore move very quickly into solution focused questions. Which questions we choose will be influenced by whether this is a first session or a follow up. If it were a first meeting we would most likely ask “so, given how tough things have been lately, what are your best hopes from our work together?” If it were a later session, we could ask “so what would be a sign to you that things were getting better?” or “when this has happened to you before, what did you do to deal with it?” If the client continues to talk about their problems, we could ask them “how have you been coping with this?”
We agree with Harry that there is fundamentally a choice to be made in response to clients mentioning a problem. We can either ask about the problem…or move into a solution focused conversation.
This means that solution focus cannot, in our opinion, be integrated with problem focused approaches.
Suppose, in the example just given, the therapist does decide to ask the client to talk about their problems, and then moves into the sort of sf questions suggested. We would argue that what they have done is adopt a problem focused approach and then moved into a solution focused approach. As Michael Hoyt has said, they have been eclectic rather than integrative. Solution and problem focused conversations are radically different. A practitioner can move as often as they like between the two, but they still remain separate discourses. From a solution focused perspective, there is really no need therefore to spend time on discussing the problem with the client, and it can also be very difficult to shift perspective. This is because asking clients to talk about problems is usually associated with a theory about why this is a useful thing to do. For example, that the problem “means” something and by discussing it that meaning (and function in the client’s life) will be uncovered. Or, that the client “needs” to talk about things before they can do solution work.
2. What if the client needs to tell their story?
Maybe we need to think about this word “needs”! Of course clients want to talk about their problems. That’s why they are seeing us and they probably assume, like most people, that the therapist “needs” to know about the problem before they can help them solve it. Some models will say that the client needs to talk about their problem as a way of discharging their strong feelings about what has happened, and if they are stopped from doing that they will be unable to engage in solution talk.
The solution focus approach argues that when clients are enabled to talk about their hopes for the future and their successes in dealing with things in the past, their apparent “need” to talk about their problems and to discharge their emotions simply disappears. If, however, they wish to talk more about their troubles, then the therapist will need to listen some more until the client is ready to engage in solution talk. The simplest way to assess their readiness is by giving the client a brief acknowledgement of what they are going through and then asking a solution focused question. As Bill O’Hanlon advises therapists, “keep one foot in acknowledgement and one foot in possibility”. For example, the therapist might say “so you’ve been having this terrible time lately and I’m wondering how you’ve managed to survive it and still get to this meeting?” If the client can respond constructively to this question, the two can proceed with a solution focused dialogue, otherwise the therapist might need to persevere with some more acknowledgement.
In other words, acknowledging the client’s trouble will be important to the relationship the practitioner is developing. They don’t need to know the client’s problem but they do want the client to feel heard.
There is no assessment in solution focused work, so there would be no attempt to assess the client’s readiness or motivation to do change work. We assume that every client is a customer for change. And a little acknowledgement can go a long way!
Assessments are usually about problems. Someone wants to know what is happening in the client’s life and why, usually as a way to arrive at a diagnosis or formulation of the problem. On the basis of the information gathered, decisions are then taken about what can be offered to the client to help them. The obvious example here is a medical assessment, where the diagnosis will lead to a prescription of treatment.
Looked at in those terms it is difficult to see a place for a solution focused approach. However, it has been argued that as assessments should include a focus on the client’s strengths as well as the problems, then there can be a solution focused part of the assessment.
For example, an assessment can include discussion of when a client has not been drinking, or when a parent has managed to nurture their children without neglect or abuse. In the field of child protection work, Andrew Turnell has developed a model called Signs of Safety to enable practitioners to develop a balanced view between signs of risk as well as safety.
Just as in any dialogue with a client it is possible to conduct a problem focused conversation and then a solution focused one (and vice versa) so it can be possible to do the same in an assessment. The question though is whether it is meaningful to speak of a solution focused assessment even if it is part of a problem focused one.
What is important here is the question of the status that is accorded the information gathered. A traditional assessment regards the information as in some way fixed – it is an evaluation of the client. For example, the client drinks x amount units of alcohol and therefore can be diagnosed as a “problem drinker” for which the treatment would be…etc. This is regarded as a kind of “fact”. But suppose the client went 2 months last year without drinking. What does this “fact” mean? It shows that the client has been able to stop drinking, but in an assessment this isn’t very interesting, as virtually all drinkers are able to stop sometimes. However, as part of solution focused therapy, this example of the client’s control is of immense importance.
In solution focused practice, the times clients have been able to achieve their hopes for the future, those instances of success, are regarded less as “facts” and more as useful conversation markers that enable the client to talk in detail about how they are moving towards their preferred future. Solution focus does not evaluate clients. There is therefore no place for attempting, in solution focused practice, an assessment in the sense of establishing the truth about the client.
Since the research gives us no way of knowing for whom sf works and for whom it does not, what is there that the sf practitioner could find out about the client that would affect whether they were going to offer the sf approach?
The obvious exception concerns safety. Where the therapist has reason to be concerned about the safety of the client or others then that will always take precedence over therapy and the practitioner must do what they have to do to prevent harm from happening. The topic of how a sf practitioner might decide that action should be taken, and what they might do, is the subject of another FAQ. At the end of the day a practitioner has to do what their agency expects of them. If they have been required to do a risk assessment anyway, then they would act in accordance with their agency requirements if they receive information that concerns them.
Indeed there are, and there probably shouldn’t be! Since solution focus focuses on solutions and not problems, it makes no sense to talk about how the approach deals with problem drinkers or mental health problems or the problems of young people or whatever else. Solution focused practice simply doesn’t “deal with” problems. It is interesting that Steve de Shazer, one of the founders of the approach, and author of several of the classic texts in the field, only wrote generic books that included examples of work with a range of presenting problems. This demonstrated that while the therapist had to be an expert in asking good questions, the only expert in the room when it came to the client’s problem was the client him or herself.
The obvious value of books focusing on particular contexts is that it might be easier for a beginner to see how the approach applies to their particular area of work. However, if the texts give the idea that solution focus is somehow different with different problems, then they do the approach a disservice.
Evan George thinks about the key question 'how can brief therapy lead to sustainable change?'.