'Disadvantages' of Solution Focused Therapy?

What are the disadvantages of Solution Focused Therapy?

Ups and downs, in and outs, strengths and weaknesses . . .pros and cons. It is hardly surprising that on solution focused courses participants are lead to ask about the disadvantages of using solution focused brief therapy.

As is often the case disadvantages tend to be the converse of and closely related to advantages. Some of the disadvantages of using solution focused brief therapy can be summarised as follows:

• The worker has to listen to the client and has to take what the client says seriously. What the client says is what the client means. The worker cannot take the position that the client really means something else or that if the client were well she would be saying something else. The potential disadvantages of this are clear and varied. For example the worker has to accept the client’s goals for the piece of work, even if the worker feels that the goals are not the right goals. A client may for example describe her wish to improve her relationship with her partner. The worker in such an instance would need to put away her thought that the client should work on her experience of childhood sexual abuse. For the worker who has developed professionally in a culture dominated by the idea of underlying causation, this change might be hard to make and the worker will tend to be constantly assailed with a worry that her work is superficial and failing to get to the root of the problem.
• Listening to the client also means that when the client says that the work is done – the work is done. The disadvantages of this, particularly to the worker in private practice, are clear and obvious. However beyond this, listening to the client can mean having to tackle and get to grips with the worker’s natural ambition for the client, her natural desire that the client make the most of her undoubted skills, strengths, resources and abilities. Accepting that the client could do more and yet is deciding, for the moment at least, that she is happy to accept life the way it is, requires huge self-discipline on the part of the worker.
• The worker who uses solution focused brief therapy can never take the credit. If the work goes well it is always the client who has made the changes and who will be credited. For example the client who says to the worker “What’s helped me to make changes is coming here and talking with you” is likely to respond by saying “many people come here and do not make changes. What is it about you that means that you have made good use of our talking together?” Some therapy has at the heart of its self-description the image of the heroic worker struggling with the client’s pathology – getting down into the bear-pit and fighting for the client’s health. Other therapies have the idea of the clever therapist, outwitting the client’s resistance, tricking the client into giving up his symptoms. At the heart of solution focused brief therapy is the image of the heroic client. The worker disappears. One of Chris Iveson’s clients (George et al 1999) commented that “when you ask the right questions you disappear”. The client at the end of the therapeutic process may remain puzzled about the part that the therapy has played in the client making changes. The skill of solution focused brief therapy is to work close to the client’s position, close to the client’s reality and yet sufficiently distant to make a difference. Such a skill tends to be invisible.
• The solution focused worker cannot be clever. If the worker is being clever it is likely that the work is not solution focused. The early history of strategic family therapy was marked by clever, intricate, even at times somewhat abstruse interventions. The tasks that the workers developed seemed creative, extraordinary almost as if they had come from nowhere. This of course was in fact because the task had come out of the world of the worker‘s theory, out of the worker’s head. In solution focused brief therapy the best suggestions are born logically out of the talking that has gone on during the sessions and will have been co-created by the worker and the client. Yet again the client will have to be given much of the credit and the worker’s contribution may appear mundane to the outsider.
• Using solution focused brief therapy will not even impress your colleagues. Case conferences can be an arena within which the professional ‘pecking order’ or hierarchy of esteem can be negotiated. The worker whose approach allows for the possibility of hypothesising can develop an impressive formulation which will, in all likelihood, relate the presenting problems to underlying issues of causation developing a strikingly consistent new ‘narrative’ of explanation from the often limited facts available. Examples of this are commonplace, the client’s case history being presented to the conference and one of the group responding with “I wonder if this client’s father wasn’t a sailor?” or “I wonder whether (the client) wasn’t separated from her parents in her early life?” or “I wonder whether (the client) hasn’t been abused?” Solution focused brief therapy of course allows no space for hypothesising and thus little scope for impressing colleagues, except with the rather more mundane matter of good outcomes.
• Using solution focused brief therapy even prevents the worker from being helpful. Many of us came into this sort of work precisely because we were motivated by the desire to be helpful to others – it certainly was not for the social esteem or the financial rewards. In solution focused brief therapy the worker has to guard against this tendency trying to be useful rather than helpful. Helpfulness might lead the worker hearing the client describe a problem to suggest ‘what about trying to . . . ‘ or ‘have you ever thought of . . . ‘ In solution focused brief therapy the worker, in attempting to be useful, will limit herself to asking useful questions, questions which orient the client towards solutions. Indeed the worker will have to develop the discipline of leaving her ‘good ideas’ at the door of the consulting room, since if the worker begins to say to herself ‘I know what this client should do to resolve this problem, then it becomes almost impossible not to try to get the client to do what the worker thinks the obvious solution is. And this, of course, is the best recipe for building what can be thought of as resistance in the client worker relationship, trying to get clients to do things that they have not yet decided to do.
• Solution focused brief therapy is inconvenient for the worker. What works for workers is regular scheduling – seeing clients weekly at the same time which means that the worker’s diary can be managed in a neat and orderly way with the worker having some ability to predict what might be happening on any one day. Since in solution focused brief therapy it will be the worker and the client together who will decide on the scheduling of the next appointment and since weekly appointments are unusual and since the gap between sessions is likely to get longer as the client changes and since regular appointment times are frowned upon for changing therapy into a question of habit rather than a purposeful activity it is clear that solution focused diaries tend to be chaotic. The worker has to be able to cope with this.
• The worker also has to be able to deal with lots of new clients. Since the average number of sessions is likely to be around four, no client is likely to be seen for very long and the worker will have to get used to working with lots of new clients. Working with new clients is hard work, since there is never the time to slip into a routine.
• What’s more the worker is not even likely to enjoy sitting with the client as the client recounts the benefits of the changes that she has made to her life. As soon as the client is confident enough of being able to made the changes she requires, before even achieving them therefore the therapy is likely to end. No time at all to bask in the satisfaction of a job well done.
• And if the work does not go well the solution focused worker cannot even blame the client by suggesting that there is something wrong with the client. There is no way that the worker can argue that the client is lacking in insight or insufficiently psychologically minded, or unmotivated or in any way other deficient. The worker has to face up to the lack of change and acknowledge that however hard she has tried she has not managed to find a way of being useful to the client. So if the work does go well it is the client who is to be credited and if it does not then that is the responsibility of the worker.

Workers should think hard before espousing this approach. It is tough and demanding and just like a virus, once in the system it will never go away again. In fact for anyone reading this it might already be too late.

With thanks to Jay Haley for his article’ Why a mental health clinic should not use family therapy’.

Evan George
July 2010