Solution-focused Family Therapy

Solution-Focused Family Therapy Running head: SF FAMILY THERAPY

Solution-Focused Family Therapy Carolyn Frances Argosy University

PC 6700 J. Persing April 2008

1

Solution-Focused Family Therapy Solution-Focused Family Therapy History Steve de Shazer, Insoo Kim Berg, and a group of their associates developed solution-focused therapy (SFT) in the early 1980s at the Brief Family Therapy Center in Milwaukee (de Shazer et al., 2007; Kiser & Piercy, 2001; Goldenberg & Goldenberg, 2008).

It grew out of the postmodern movement and is a social

constructionist view.

In accordance with this Lee (1997)

observed, Solution-focused brief family therapy views problems as being developed and maintained within the context of human interactions.

The task of therapy, therefore, is to help

clients do something different by changing their interactive behaviors or their interpretations of behaviors and situations so that a solution can be achieved (de Shazer et al., 1986). The founders were influenced by the work at the Mental Research Institute in Palo Alto, Milton H. Erikson, Wittgensteinian philosophy, and Buddhist thought (de Shazer et al., 2007).

The

approach was developed by viewing sessions to discover what worked and why it worked (de Shazer et al., 2007; Kiser & Piercy, 2001).

It is considered brief therapy because it is a

focused approach on specific complaints that leads to an outcome in 10 sessions or less 99.9% of the time (Kiser & Piercy, 2001).

2

Solution-Focused Family Therapy Developed during the time that the DSM III had been released, the solution-focused approach was a reaction against the focus on problems, diagnosis, and the pathologizing of behaviors and people (Kiser & Piercy, 2001; Gingerich & Eisengart, 2000). It is not either a person has a symptom or he does not. That a certain behavior is labeled a symptom is arbitrary: In some other setting or with a different meaning attached, the same behavior would be both appropriate and normal (de Shazer, 1985, p. 14). Philosophy The first evidence of the emerging solution-focused therapy was an article written in 1978 by Don Norum titled “Brief Therapy: The Family Has The Solution” (Kiser & Piercy, 2001). The title of this article suggests the beginning philosophy of taking a positive view of the client. on client strengths.

SFT seeks to capitalize

Therapists who practice SFT believe that

the family already has all the resources they need to solve their problem.

The therapist’s job is to help the family see

things differently (Campbell, Elder, Gallagher, Simon & Taylor, 1999). The therapist aims to expand a family’s options by helping the family shift their perceptions from a stance of either/or to one of both/and (de Shazer et al., 2007).

“Through

interaction and language, people enter into relationships where they create certain meanings to situations.

Part of the

3

Solution-Focused Family Therapy therapist’s position is, through language, change the meanings that people have for events, behaviors, feelings, and thoughts (Reiter, 2004).”

This therapy style is minimalistic,

transparent and egalitarian in nature, emphasizing a collaborative relationship with the client (Kiser & Piercy, 2001).

The therapist takes an attitude of “not knowing” when

working with the clients. solutions and not problems.

The focus of the session is on The therapist will not ask

questions or attempt to flesh out the problem, its history, or causes.

The view is that clients will speak about their

problems as much as they need to and when they need to in the session naturally without the therapist delving into them.

The

therapist will follow the client’s lead, but takes an optimistic viewpoint, guiding the session away from rehashing the problem over and over again (de Shazer et al., 2007). The idea is to direct your curiosity to where clients want to go rather than where they have been, to what they do right rather than what they do wrong, and to encourage them to become the expert in their own life (Sharry, Madden & Darmody, 2003, p. 95). When working with a family, the SFT practitioner will see whoever comes for the session and does not hold that all members of the family are required for progress to be made (Lee, 1997; de Shazer, 1985).

They believe that any change in a part of the

4

Solution-Focused Family Therapy system will affect the rest of the system and cause a change in the whole.

They see clients as being of three types: visitors,

complainants, and customers.

Usually, a family system has

members who are at different levels.

Visitors are not looking

for change and may not see anything as being wrong. Complainants are complaining about a problem and expecting others to change.

Customers are ready and motivated to make

changes themselves.

These levels of motivation affect how the

therapist will interact with the client and what interventions will be used (de Shazer, 1988). The basic tenets of SFT are:

if it’s not broken, don’t fix

it; if it works, do more of it; if it’s not working, do something different; small changes lead to big changes; solutions are not necessarily directly related to the problem; solution language is different than problem language; there are always exceptions to a problem; and the future is negotiable (de Shazer et al., 2007).

In accordance with these tenets are

several standard interventions and techniques: therapist use of language, questions, compliments, homework, and exception finding.

Each session is looked at as if it could be the last

and in every session, the therapist inquires about and enlivens progress (Hackett, 2006). Techniques Solution language is important for SFT.

The therapist’s

5

Solution-Focused Family Therapy language and questions presuppose that change is happening and that things will improve (Lee, 1997).

In the course of the

session, the therapist will guide and model a shift in language from problem talk to solution talk.

Changing language

influences a change in thinking and in action (Taylor, 2005). Language changes in five areas.

Instead of talking about

what the client does not want, the talk is centered on what they do want.

Instead of focusing on what is going wrong, the focus

is on what is going right.

Therapists seek to help the client

move from a place of feeling that things are beyond their control to realizing what is within their control.

Clients

start speaking about progressing instead of being stuck.

The

view of the future is filled with possibilities instead of more trouble (Taylor, 2005).

These shifts in language are evident in

the structure of the session. TEAM approach.

Taylor (2005) refers to it as a

First, the therapist uncovers the client’s goal

which he calls finding a title, T. client does want.

This is focusing on what the

Then the session moves on to events, E, or

what is going right in their lives at this moment. pieces of the goal already apparent in their lives.

These are After

discovering what is going right, the client becomes aware of being able to do more of what is going right which is agency, A. The session then moves on to the results of these actions or movement, M.

From there the therapist can ask about what the

6

Solution-Focused Family Therapy next step is which takes the process back to goals, T.

Sessions

generally follow a pattern of eliciting information about what is better, what is working, or what is wanted; amplifying the positive; reflecting; and starting over with eliciting more information (Hackett, 2006). All of this discovery and change in language is guided by careful questions.

There are several standard questions that

SFT is known for: the miracle question, relationship questions, scaling questions, coping questions, and questions about presession change (de Shazer et al., 2007; Taylor, 2005; Goldenberg & Goldenberg, 2008; Gingerich & Eisengart, 2000; Lee, 1997). The first question the therapist may ask is, “What kind of changes have occurred between the time when the appointment was made and the appointment itself?”

This is a positive assumption

that progress is already being made.

The therapist will also

ask the family how they will know that therapy has been successful and what needs to happen in the session for it to have been helpful. goal.

This is the beginning of searching for a

To further define the goal, or discover it, the miracle

question is asked.

The therapist begins the miracle question by

drawing a scene for the client in which they do their usual routines and go to bed and during the night, a miracle happens that solves their problem.

However, the miracle happened while

they were asleep so no one knows about it.

The question is, how

7

Solution-Focused Family Therapy would they recognize that the miracle had taken place? would be different in their lives?

What

The therapist explores

behaviors and reactions of everyone in the life of the client. These are the relationship questions. of everyone present in the session.

The questions are asked The therapist asks for

details and may continue to ask, “What else?” many times (de Shazer et al., 2007; Goldenberg & Goldenberg, 2008; Gingerich & Eisengart, 2000).

Following the miracle question and at various

junctures during the interview, the therapist will ask clients to rate their motivation or confidence on a scale of 1 to 10 and then use that scale to help the clients talk about small steps and recognize progress.

If the client is doing poorly or worse,

coping questions are used to reframe the experience in a more positive light.

This exposes the client’s strengths in asking

how they were able to cope and keep things from getting worse. Another distinctive aspect of SFT is compliments.

This

theory does not believe in resistance and uses compliments to counteract them.

What others call resistance, SFT views as the

client communicating to the therapist that the suggestions being made are not a fit for them (de Shazer, 1985).

There are three

types of compliments employed by SFT: direct, indirect, and self-compliments (Berg & DeJong, 2005).

Direct compliments are

sincere statements or interpretation of positive observations about what the client is doing.

Clients do not always accept

8

Solution-Focused Family Therapy these types of compliments.

Indirect compliments are obtained

by asking clients what positive things other people might say about them.

Because these compliments come from those who know

the client well, they are more readily accepted over those given by a therapist who does not know them.

Self-compliments are

solicited from the client by asking questions that require them to talk about their successes and abilities.

Self-compliments

are the most powerful because they come from the client themselves and are more accepted and internalized (Berg & DeJong, 2005). Compliments serve various purposes. restructure, and affirm. suggestions.

They normalize,

They also act as a bridge to

“Compliments serve to normalize the client’s

experience, restructure the meaning of the problem, and highlight the client’s own solution-building competencies (de Shazer, 1988).” Compliments also suggest next steps in the process of solution development (Campbell, Elder, Gallagher, Simon & Taylor, 1999).

Normalizing helps the client to know

that their situation is not uncommon and is understandable. This can help the client shift their understanding of the situation or problem.

Restructuring helps to open the

possibilities for the clients and counteracts the limits they have set for themselves.

Affirmations draw the client’s

attention to their strengths and resources.

When making

9

Solution-Focused Family Therapy

10

compliments, therapists use the family’s language by echoing their phrases and metaphors.

“The compliments usually include

validation of concerns, recognition of competencies, and a suggestion for something to do between sessions (Campbell, Elder, Gallagher, Simon & Taylor, 1999).” The compliment leads the way to the homework suggestion outside of the session. bridging statement.

These suggestions are prefaced by a

“The bridging statement can frame

suggestions as research, experiments, crazy ideas, curiosities, or anything else that will have meaning for the client (Campbell, Elder, Gallagher, Simon & Taylor, 1999).”

The

guidelines for suggestions are: “keep it simple, emphasize possibilities, and design according to the client’s degree of customership (de Shazer, 1985) (Campbell, Elder, Gallagher, Simon & Taylor, 1999).”

Some examples of common suggestions are

asking families to notice when things are better or notice what allows you to cope.

Another example is to ask the family to do

more of what they already know works.

Sometimes the family is

asked to do something different, perhaps wild and crazy, than what they have been doing in connection with a misbehaving child.

There is also a predictive task where the family is

asked to predict each night what kind of day the next day will be and then watch for evidence of that prediction coming true. In cases where a child is viewed negatively, the therapist might

Solution-Focused Family Therapy

11

assign the child a surprise task where they are to do something that will pleasantly surprise their parents between sessions. The child is told privately not to make it too easy and not to do something too outlandish and not immediately after the session so as to keep the parents guessing.

The parents are

told to try and figure out what the surprise is. session they make their guesses.

In the next

In all these cases, most of

the task is left up to the client to create.

The therapist

avoids being specific to allow more possibilities and a better fit. Tasks are based on what the client is already doing or inclined to do. family.

In this way, the task is more likely to fit the

Campbell, Elder, Gallagher, Simon & Taylor (1999)

further state that, “When working with families, we try to offer suggestions that encourage them to discover each other’s competencies.”

Although common tasks have been mentioned,

therapists will borrow from other modalities if they fit the family.

For example, Selekman (1997) uses a stuffed animal team

with children where they bring in their favorite animals.

The

therapist and child have a conference with the stuffed animals about possible solutions and ideas.

The child then has the

stuffed animal team on their side when they go home. The nature of the intervention matches the level of client motivation or customership.

If someone is only a visitor, the

Solution-Focused Family Therapy therapist will compliment him or her, but give no tasks.

12

If

someone is a complainant, he or she may be given a task that involves only observing what is going on.

If he or she is a

customer, then action tasks that change behavior are given (Sharry, Madden & Darmody, 2003). Research This approach has been used in many venues including family services, mental health, public social services, child welfare, prisons, residential treatment centers, schools, and hospitals (Gingerich & Eisengart, 2000).

It has also been used with a

wide range of families of diverse backgrounds. show preliminary support for the method.

Initial studies

SFT has been shown to

be better than no treatment and equivalent to some established methods.

Studies also support the SFT view of working with

whatever family members come for therapy instead of insisting on seeing the whole family.

Success rates as reported by clients

range from 64.9% to 80% (Lee, 1997).

The approach is better

suited to concrete issues such as child behavior problems versus family relationships.

62.5% of clients interviewed after

therapy was complete stated that the most helpful aspect of the therapy was the approach and one-third said that the supportive environment was the next most helpful aspect (Simon & Nelson, 2004).

Solution-Focused Family Therapy

13

References Berg, I. K., & DeJong, P. (2005). Engagement through complimenting. Journal of Family Psychotherapy, 16(1-2), 51-56. Campbell, J., Elder, J., Gallagher, D., Simon, J., & Taylor, A. (1999, March 1). Crafting the "tap on the shoulder:" a compliment template for solution-focused therapy. The American Journal of Family Therapy, 27(1), 35-47. de Shazer, S. (1985). Keys to solution brief therapy. New York, NY: W.W. Norton & Company. de Shazer, S. (1988). Clues: Investigating solutions in brief therapy. New York, NY: W.W. Norton & Company. de Shazer, S., Berg, I. K., Lipchik, E., Nunnally, E., Molnar, A., Gingerich, W. et al. (1986). Brief therapy: Focused soltuion development. Family Process, 25, 207-222. de Shazer, S., Dolan, Y., Korman, H., Trepper, T., McCollum, E., & Berg, I. k. (2007). More than miracles: The state of the art of solution-focused brief therapy. New York: The Haworth Press, Inc. Gingerich, W. J., & Eisengart, S. (2000, December 1). Solution focused brief therapy: A review of the outcome research. Family Process, 39(4), 477-498. Goldenberg, H., & Goldenberg, I. (2008). Family therapy: An overview (Seventh edition, pp. 341-355). Belmont, CA:

Solution-Focused Family Therapy

14

Thomson Brooks/Cole. Hackett, P. (2006). What happens between the E.A.R.S? Journal of Family Psychotherapy, 17(2), 81-88. Jordan, K., & Quinn, W. H. (1994, Spring). Session two outcome of the formula first session task in problem- and solutionfocused approaches. The American Journal of Family Therapy, 22(1), 3-16. Kiser, D. J., & Piercy, F. P. (2001). Creativity and family therapy theory development: Lessons from the founders of solution-focused therapy. Journal of Family Psychotherapy, 12(3), 1-30. Lee, M.-Y. (1997, Spring). A study of solution-focused brief family therapy: Outcomes and issues. The American Journal of Family Therapy, 25(1), 3-17. Reiter, M. D. (2004). The surprise task: A solution-focused formula task for families. Journal of Family Psychotherapy, 13(3), 37-45. Selekman, M. D. (1997). Solution-focused therapy with children: Harnessing family strengths for systemic change. New York, NY: The Guilford Press. Sharry, J., Madden, B., & Darmody, M. (2003). Becoming a solution detective: Identifying your clients' strengths in practical brief therapy. New York: The Haworth Clinical Practice Press.

Solution-Focused Family Therapy Taylor, L. (2005). A thumbnail map for solution-focused brief therapy. Journal of Family Psychotherapy, 16(1-2), 27-33.

15