by Rob Cumming
Solution focused brief therapy (SFBT)
is at first sight a rather minimal set of skills and assumptions about helping
It seems to defy many of the conventions of psychotherapy from the last
hundred years – about the need for long-term work for example - yet it
seems to be giving good results in many fields, from mental health through to
SFBT was developed through the
research programmes of the Brief Family Therapy Centre, Milwaukee, USA. It was
named in 19861 in a paper whose title gave homage to an earlier paper2
by John Weakland and his team from the Mental Research Institute at Palo Alto.
That earlier paper had outlined a practice of strategic brief psychotherapy;
both papers refer to the work of pioneers such as Milton Erickson and Jay
Haley3. These are the “usual suspects” who show up in the history
of many major threads of the strategic and brief psychotherapies and they are
very much present in the genealogy of SFBT. If a more profound understanding of
SFBT’s origins is what you desire, then the literature of family therapy,
particularly Milton Erickson and the Strategic branch of the subject, will
reward your study.
SFBT also bears
a family resemblance to other contemporary collaborative and narrative
therapies, such as the work of Bill O’Hanlon4; Michael White and
David Epston5; John Walter and Jane Peller6; Harlene
Anderson and Harry Goolishian7.
The upsurge in interest in all
these variants of brief therapy has coincided with moves towards cost-effective,
accountable psychological interventions in healthcare in the USA and elsewhere.
But that is not where these therapies are from, or necessarily what they are
for. Yvonne Dolan has written8 that brief therapy means doing only
what is necessary for healing; a standard which can be applied in any context.
It can be very tough to achieve this in work-contexts where time is strictly
SFBT runs on questions.
Approaching it as a set of skills, there are specific questions which
must learn to ask. The questions the therapist has to answer may
give a simpler idea of what happens in SFBT.
What does my client want to get
as a result of coming along to see me? This involves questioning (such as the
Miracle Question) and as far as possible, literal acceptance of the client’s
answers. Plenty of detail is always sought; and the outcome desired for the
therapy should be richly described, and include differences which therapist and
client will notice, and which will make a difference!
The Miracle Question goes
something like this: Suppose… we finish up our meeting today, and you go home
and eventually you go to bed and go to sleep… and while you are sleeping a
miracle happens, and this miracle has the effect of solving the problem which
brought you along to see me today. But you’re asleep, so you don’t know this
miracle has happened. What will you notice when you wake up, that shows you that
the miracle has happened? This can lead to a very detailed description of the
preferred future which your client want to move towards. More generically,
it’s that word ‘suppose’ which I think is significant. The therapist has
to be able to invite the client in to an imagined place where their problems
don’t hold sway. Suppose your problem is gone, what specifically would happen
then? This can work as a self-help exercise – remembering always to tarry a
while in the imagined future and to fully explore what it looks, sounds and
feels like, and what other people make of it.
The next question the therapist
has to answer is, what is my
client already doing and what have they done recently which might help
them to attain their preferred future? This means looking for exceptions
to the rule of their problems. Here the principle is that there are exceptions
to every rule. And another principle which guides these conversations is: that
if the therapist chooses to talk about, and seek detail of every exceptional
thing which the client tells her about, the salience and relevance of these
‘anomalies’ in the client’s story will be greatly increased. Clients can
rapidly, visibly change as this becomes real to them, and marginalised successes
become central threads of their stories.
Notice that so far we have two
activities in therapy - finding out what the client wants, and finding out about
times when they have attained at least a little of what they want. That’s two
thirds of the approach. The last bit is to find out what bridges the client can
build between where they are now and their desired future. You may
seek descriptions of the next small steps towards their goals which the
client feels able to take. These can be very small indeed. Maybe some clients
will first want to know how they can avoid getting worse! Scaling
questions can come in to this bridge-building process – for example, On
a scale of zero to ten where zero is where you first called me, and ten is after
the miracle, where are you now? With questions like this you and your client can
mark progress, talk about small steps as well as end-points or goals, and talk
about what part of the process they want you to help them with.
What else is involved in
solution-focused work? The emphasis on recognising and building on strengths
which underpins it, works best when you are also able to truly acknowledge your
client’s humanity and their suffering or difficulties.
This is surely an ingredient of all effective therapy – and it is
essential in SFBT also. Jingoistic positive thinking does not come in to it.
So, in SFBT we are cultivating a way of thinking which is constructive. Empathy is also essential. ‘Constructive’ means that you seek out competence and capability – however small – and build on that. Nowadays this way of thinking is being incorporated in everything from social work to dog training, so SFBT is in a sense participating in the spirit of the age. Empathy means that you are doing your very best to understand the world from your client’s point of view. When you are doing this, being curious from this perspective, your questions are far more likely to come out well and your client will be ready to work towards solutions.
Let’s end with a bit of
homework. This utilises a scale in a slightly unorthodox way:
Imagine a scale from 0
to 10. And immediately place yourself on that scale.
Now – what does the 10 mean on your scale? What is your scale called? Give yourself a little time to notice these things.
References and Notes
1. Brief Therapy: Focused Solution
Development Steve De Shazer, Insoo Kim Berg, Eve Lipchik, Elam Nunnally, Alex
Molnar, Wallace Gingerich, Michele Weiner-Davis. Family Process, 25, pp. 207-222
2. Brief Therapy: Focused Problem
Resolution. John H Weakland, Richard Fisch, Paul Watzlawick, Arthur M Bodin.
Family Process, 13, pp. 141-168
papers cite Haley, J., Uncommon Therapy: The Psychiatric Techniques of Milton H.
Erickson, M.D. Norton, 1973, and Haley, J. (Ed.) Advanced Techniques of Hypnosis
and Therapy: Selected Papers of Milton H. Erickson, M.D. Grune and Stratton,
Bill and Bertolino, Bob: Even From A Broken Web: brief, respectful
solution-oriented therapy for sexual abuse and trauma. Wiley, 1998.
5. White, Michael and Epston, David:
Narrative Means to Therapeutic Ends. W W Norton, 1990.
6. Walter, John L. and Peller, Jane
E. Recreating Brief Therapy: preferences and possibilities. W W Norton, 2000.
7. Anderson, Harlene and Goolishian,
Harold. The Client is the Expert: a Not-Knowing Approach to Therapy. In McNamee,
Sheila and Gergen, Kenneth J., Therapy as Social Construction, pp. 25-39.
8. Dolan, Yvonne M., Resolving Sexual Abuse: solution-focused therapy and Ericksonian Hypnosis for adult survivors. W W Norton, 1991.
Rob Cumming is a therapist, supervisor and trainer working from, and continuing to work on, an integration of brief therapy and other therapeutic models. He loves working in process models of therapy and consultation; although his clients and students frequently frustrate and delight him by sorting things out with novelty beyond his comprehension. His website is at www.gethelp.co.uk. Links to many resources in Solution Focus and related approaches, as well as Rob’s training work, can be made there.