I OVERVIEW, DESCRIPTION, AND RATIONALE
A General Description of Approach
Solution Focused Brief Counseling [SFBC] was developed by Steve de Shazer and Insoo Kim Berg. After spending many years studying problem behavior and trying to change it, they switched to studying ‘solution behavior’ and how to promote it! Two simple ideas lie at the heart of solution focused brief counseling.
Nobody is perfect and this applies to our problems as well as everything else.
If no-one can ‘do’ their problem perfectly there must always be times when they don’t do them so well. These times de Shazer and Berg called exceptions. Whatever the person is doing differently at these ‘exceptional’ times can be the basis of a potential solution. Part of the solution focused brief counselor’s task is therefore to discover whatever a person is already thinking and doing that might contribute to the resolution of the problem.
Knowing where you want to get to makes the getting there much more likely.
One of the common consequences of a serious problem is that it clouds our future. We know that we don’t want the problem but we have lost sight of what it is we do want. Solution focused brief counselors ask lots of questions about what life might be like if the problem was solved. As the answers to these questions gradually unfolds both counselor and client begin to get a picture of where they should be heading. The clearer this becomes the greater the possibility of it beginning to happen.
The diagnostic and therapeutic focus on the individual must be supplemented with a focus on the interaction between individuals. Above all there is need for good models of intervention with the individual and his/her network of important persons.
Solution Focused Counseling is:
- a model that has evolved over years of thought, research and experience.
- a model that places the highest emphasis on respect for clients and their competence, strengths and resources.
- a model in which building a collaborative relationship with the client is key.
- a systems-based model of counseling.
- a model of counseling that recognizes that change is inevitable and ongoing.
- a goal-directed model of counseling.
- a model that focuses on working collaboratively ‘with’ the client to build solutions.
- a model that challenges the assumption that learning all about the etiology of the problem is the only way to find the solution to that problem.
- a model holds that there is no one single ‘correct’ or ‘valid’ way to live one’s life; and because this is so, it is the client’s goals, not the counselor’s that should be identified and accomplished.
Solution-Focused Brief Counseling (SFBC) is a short-term goal-focused therapeutic approach that helps clients change by constructing solutions rather than dwelling on problems. Elements of the desired solution are often already present in the client’s life, and become the basis for ongoing change. The ability to articulate what the changes will be like is often more important than understanding what led to the problem.
SFBC is based on the idea that, if our aim is to help clients CHANGE, we ought to focus on things related to how change happens rather than concentrating on how problems develop. Understanding the details and ’cause’ of the problem is often not necessary to finding a solution. The important issues are how does the client want things to be different and what will it take to make it happen. Envisioning a clear and detailed picture of how things will be when things are better creates hope and expectation and makes solution possible. SFBC focuses on the future (and how it will be better when things change) and on the establishment and elaboration of clear goals. Goals direct the counseling process and help it remain focused and brief (if we don’t know where we’re going, we don’t know when we’ve got there!). SFBC also focuses on client strengths and resources, as a way of helping clients recognize how to use their resources to bring about changes.
Primarily, the model is designed to help clients engage their own unique resources and strengths in solving the problems that bring them into counseling.
B Goals and Objectives of Approach
Goals are the entire focus of the SFBC approach. The model uses a specialized interviewing procedure to negotiate outcome goals whose qualities facilitate efficient and effective intervention. The goals must be:
- Salient to the client rather than the counselor or clinical program.
- Small rather than large.
- Described in specific, concrete, and behavioral terms.
- Described in situational and contextual rather than global and psychological terms.
- Stated in interactive and interpersonal rather than individual and intrapsychic terms.
- Described as the start of something rather than the end of something.
- Described as the presence of something rather than the absence of something.
- Realistic and immediately achievable within the context of the client’s life.
After a goal is negotiated, the model specifies how to use a client’s own unique resources and strengths to accomplish the goal. Two such resources and strengths are known as exceptions and instances. Exceptions are periods of time when the client does not experience the problem or complaint for which s/he is seeking treatment. Instances, however, are periods of time when the client experiences his or her problems either in whole or in part. Interviewing methods are used to elicit information about the occurrence of exception and instance periods so that they may be repeated in the future.
C. Theoretical Rationale
Solutions Focused Brief Counseling is a cognitive behavior management strategy and relies on this theoretical foundation. At the risk of oversimplifying a complex issue, much of the learning which enables psychological change can be defined within the parameters of one or other of the three broad theoretical approaches of Behaviorism, Cognitive Theory, and Constructivism.
Behaviorism argues that learning takes place through the mechanism of stimulus and response – a convenient approach since both are manifest and therefore measurable, and offer an empirical legitimacy to the ‘soft’ science of psychology. The operant conditioning of Skinner, with its focus on unpleasant and pleasant consequences (reinforcement) as a means of shaping behavior is perhaps the best known application, and has led to the development of tangible guidelines for behavioral change through various behavior modification strategies. Behaviorism appears to be limited, however, in the types of change it supports and its decline as the major tool for change was not that classical conditioning, operant conditioning and imitation do not exist but that behaviorists made the mistake of thinking that these three learning processes could explain all learning and change.
Behaviorist theories have fallen from grace in favor of those that acknowledge the role of the individual thought process in learning. Cognitive theory focuses recognition of the complex processes that mediate between the classical ‘stimuli’ and ‘responses’ which behaviorists had so clearly defined. Thus, the process might be better charted as stimulus, thought:emotion , response. This allows for a difference between how individuals perceive and respond to the same event in different ways.
The theoretical basis developed by Baar, is more analogous to constructivist approaches than to the academic conception that knowledge is a mere mental representation.
Constructivism as well as cognitive theory stems from a long and respected tradition in cognitive psychology, especially in the writings of Dewey, Vygotski and Piaget. Constructivism holds that people’s understanding of any concept depends entirely on their mental construction of that concept – that is, their experiences in deriving that concept for themselves. The existence of these mental structures: schema or contexts, and the manner in which they affect learning has since been demonstrated rather effectively by cognitive scientists. Clinicians can guide the process, but the individual must undertake and manage the process of developing an understanding for themselves. Different individuals, depending on their experiences, knowledge and their cognitive structures at the time will understand a given presentation differently. Thus, the inner logic of each individual is based upon his/her own reality and it is this inner logic which supports and maintains relevant responses.
Research indicates that people remember an experience based on what their pre-existing knowledge and cognitive structures allow them to absorb – regardless of the other’s intentions or the quality of the explanation. Cognitive reconstruction fits nicely into this concept. In fact, Constructivism seems to be a compatible orientation with Cognitive Theory.
Baar has indicated that “Every conscious event is shaped by a number of enduring unconscious systems which we shall call ‘contexts’”. He suggests that these contexts are relatively enduring systems, structures or schemata that shape conscious experience, access and control, without themselves becoming conscious. Contexts are coalitions of nonconscious specialized processors that are ‘already committed’ to a certain way of processing information, thus the mental construct of the person’s understanding of a concept is reliant on the mental contexts they already possess.
Contexts can be thought of as information that the nervous system has already adapted to; it is the ground against which new events are defined. Consciousness always seems to favor novel and informative messages. But recognizing novelty requires an implicit comparison to the ‘status quo’; the old knowledge that is represented contextually. The fact that people become unconscious of a repetitive or predictable stimulus does not mean that the stimulus has disappeared. On the contrary, the stimulus continues to be processed in the appropriate input system
Any highly practiced and automatic skill tends to become ‘modular’ – unconscious, separate from other skills, and free from voluntary control and this nonconscious context helps to shape the novel, conscious information. Our ability to learn any new information is, therefore, critically dependent on prior, largely nonconscious knowledge.
Mental contexts, then are organized knowledge structures. This implies that they are internally consistent; they tend to resist change when it is inconsistent with context, and resist more strongly the deeper the inconsistency; there is a tendency to complete partial input; and when one component changes, another may have to compensate. But such mental contexts are not totally stable. They adapt to informative input whenever possible. Thus, from a cognitive constructivist point of view, the learner and the learned may be compatible or incompatible. The incoming information may be accepted, rejected or considered and potentially adapted to fit the context or the context adapted to fit the novel information. This is why the construction of solutions or new narratives must closely resemble the old narrative history of what has and is occurring.
Such contemplation occurs when the person experiences situations that cannot be explained by their present conception. This novelty will tend to bring the conflict to conscious appraisal, and consciousness is often used to ‘debug’ the context. A clinical instructor’s responsibility in cognitive behavioral approaches becomes one of arranging for the misconceptions to be confronted by conflicting evidence and through dispute. The clinical instructor must engage the client in understanding in their own way and primarily in their own time the primary mental constructs, and to determine for themselves whether these flawed constructs can be improved.
Thus, SFBC offers an opportunity for the client to express his/her personal constructs of ‘inner logic’ and the counselor uses these personal constructs to help the client define solutions. Each step of the way the clinician draws out the client’s own construction of solutions, e.g., as demonstrated in exceptions, and helps the client enhance such constructs in order to reach new levels of competence.
The approach proposes that the solution(s) to the problems that a client brings may have little or nothing to do with those problems. This is particularly true in the treatment of problem drinking, where any of a variety of life experiences or actions on the client’s part, which have little to do with his or her use of alcohol, may result in a resolution of the problem. While the number of potential solutions is limitless, one example is a problem drinker who stops using problematically when s/he:
- Obtains employment.
- Ends or begins a relationship.
- Makes new friends.
Intervention, therefore, need not make alcohol the primary focus to resolve the drinking problem. Rather, the focus returns to helping the client achieve the personal goals s/he sets. This gets more complex in the case of a child who is referred by the family or the school because of a disruption. Nonetheless, the negotiation of goals which are meaningful to the child are an important part of helping the child construct a solution to the disruption problem.
D. Agent of Change
In SFBC, there is no one agent of change primarily responsible for positive outcome. Indeed, in the solution-focused approach, the question as to the agent of change may be viewed as one that obscures rather than clarifies the nature of most successful contacts. The solution-focused counselor assumes that change is constant and inevitable and would suggest that the successful counselor need only tap into and utilize that existing change rather than create or cause change.
E. Contrast To Other Counseling Approaches
Some of the motivational enhancement counseling interviewing components by Hester and Miller are similar to this model, as are some interviewing procedures of the cognitive and cognitive-behavioral management programs.
Although the various procedures of the Solution Focused Model can be incorporated into many existing approaches, the model is likely to be most different in terms of assumptions from the more traditional biomedical and psychodynamic approaches which are of an entirely different order since they identify pathology rather than social learning as the fundamental assumption of the methodology.
One shortcoming of this approach is that it makes it impossible to diagnose people and human systems outside the counseling arena. Counselors working this way do not gather information concerning symptoms, pathology or family structure in a systematic way. This may lead to problems for counselors in their contact with systems where information about pathology and diagnosis are important, like managed care organizations contracting with public mental health agencies, courts, mental hospitals, etc.
Standard forms for insurance and State certification requirements are completed by the client. These forms contain a list of complaints, client history in clinical involvement, client history of alcohol and other drug problems, and so forth. In solution-focused counseling, no formal assessment is completed aside from the specialized interviewing questions that are the hallmark of the model. After completion of the State certifications and insurance forms, the clinical process begins. This is because all questions are considered interventions. It is, therefore, not possible to do an assessment without impacting the client.
Outcome is assessed via scaling questions during the clinical process and after intervention in follow-up interviews conducted at 6, 12, and 18 months.
III TARGET POPULATIONS
Available research suggests that the approach may be helpful across a broad range of clients.
The model was originally developed as a family counseling approach. Later it has been utilized for low-income clients with serious alcohol or other drug problems. Many of clients served are minorities, unemployed and may be homeless at the time treatment is initiated. As the model has evolved it has been applied across a variety of settings and clinical populations. The approach has also been used with clients who use a variety of drugs. Because the model stresses that the problem and solution are not necessarily related, the type of drug is not seen as a critical factor in determining differential treatment.
SFBC has been effectively used with a wide variety of presenting problems and client populations, including depression, eating disorders, drug and alcohol problems, difficulties related to sexual abuse, relationship difficulties and so on. Since it focuses on the process of change rather than the murky details of the problem, more major problems do not necessarily require different intervention. The task of a solution focused counselor is to help clients translate seemingly major problems into clearly defined and achievable goals.
Solution-focused counselors work with clients who are ‘forced’ into service by maintaining a delicate balance between acknowledging that the client doesn’t want to be there and trying to find a goal the client would be motivated to work on. The counselor would talk to them pragmatically about what they need to do to achieve the goal of staying out of jail, of getting people off their back, or whatever is something meaningful and motivating for them, including what the challenges will be and what they will have to do to demonstrate that the change is lasting. If the counselor can build a goal that is meaningful, they have a place to start and a destination to reach.
A Modalities of Intervention
The model was developed as a family counseling approach, but it is now being used in a variety of formats including individual, couple, family, and group. In each of these formats, the approach remains largely the same. The only major difference is that specialized interviewing techniques have been developed to encourage and incorporate the participation of multiple participants when the model is applied in couple, family, and group formats.
Being a ‘brief’ intervention model, the average number of counselor-client contacts is 4.7, with a range of between 1 and 12 sessions. Typically, these clinical contacts occur in a 3- to 4-month period. The process is open ended, however, with clients being made aware that they may return in the future for any reason.
Solution Focused Brief Counselors don’t set out to limit artificially the number of sessions. A good brief counselor will not focus on limiting sessions or time, but rather helping clients set goals and develop strategies to reach those goals.
Nonetheless, focusing on goals and how pragmatically to achieve them and not getting caught up with digging around in the past tends to make counseling briefer. The counselor intervenes only to the extent necessary, with involvement usually lasting for fewer than six sessions. Solution-focused counselors ascribe to the ethical value of providing clients with the most effective interventions in the most time efficient manner possible so that clients can get on with living their lives.
V COUNSELOR CHARACTERISTICS AND TRAINING
A Counseling Style
It is understood in SFBC that the problem is the problem, not the person. So problems don’t indicate pathology here; they are accepted as occurring within the context of human interactions, often just happening. The question ‘Why?’ is also left out of the process; questions like that which solidify problem-perspectives are not allowed.
SFBC counselors don’t search for other damage – they are not seeking to delineate all of the behaviors with which they or someone else may disagree. Positive thoughts are enjoyed, and counselors like to understand what this means for the client. So this is a very personalized process, where the solution stories of each client are the basis for planning itineraries about where that person wants to go (goals). Most counselors with a solutions focus never cease to be amazed at the wealth of resources that clients have. Client stories are respected and valued as the sources of great wisdom about how solutions have occurred in the past (exceptions), and how the client wants, hypothetically, things to be different in the future. Thus, the counselor and the client are working together even though the client has not sought out the help.
The basic concept to SFBC is that everyone creates/recreates identity and life moment by moment, using among other feed back that which comes from the persons surrounding them. This concept seems self-evident and incontrovertible, even if concepts from influential people in the world could incite to contemplation.
The same is true for the idea that we create meaning in our life by choosing to remember actions/experiences into a fitting own ‘life-story’, integrated in us with the aid of feed back from important other people. That a redefined ‘life-story’ creates the possibilities for new actions/experiences follows logically from these concepts. Focusing the content of interaction that facilitate solutions in the present and the future is purposeful.
It is when clinicians start understanding the basic difference in perspective between working with problems, and constructing solutions that they can realize the possibilities inherent in this different perspective.
The approach is easy to learn but difficult to apply and it demands a lot of self-discipline.
B Clinical Role And Responsibility
The counselor’s responsibility and basic attitude involve enabling the client to discover his/her own personal constructs concerning the solution and enhancing the client’s ability to implement these previously ignored methods.
Clients come to counselors and tell them about their lives and situations and we assume that what is told, at least in some ways, mirrors what goes on in their life. We must also assume an effect in the opposite direction. It is not enough that ‘reality’ affects what goes on in counseling. We also believe that what goes on in counseling has effects on people’s reality outside the counseling arena. Such an understanding should be self evident to people in the helping professions, for if you don’t believe this, you don’t believe that counselors can influence the reality of clients and you have probably chosen the wrong profession.
SFBC posits that there are many different ways to describe a situation. It is possible to view and describe behaviors and sequences of behavior from many possible perspectives, and clinicians, actively or passively, choose to pay attention to certain things and ignore other. The choices made by the counselor/listener are important in that these choices determine the description of ‘reality’ that is made.
It is these choices that make clinician responsible for the ‘reality’ created in the counseling arena, and therefore also partly responsible for the reality that clients live outside of the counseling arena. SFBC counselors ‘co-create’ reality together with the client in counseling and what we together construct is important because it can determine when and if the client will develop a resolution to what is interfering with living.
You, as a counselor have a responsibility for what you talk about and how you participate in creating the client’s description of his/her reality, and whether it becomes a description that makes it possible to do something about it or if the client is to continue in the same way as before s/he came to you – or, unfortunately, deteriorate into a counselor created ‘reality’ based on pathologies of which the client before contact was never aware.
From a constructionist standpoint, our languages for describing and explaining the world (and ourselves) are not derived from or demanded by whatever is the case in a given situation. Rather, our languages of description and explanation are produced, sustained, and/or abandoned within the processes of human interaction. Further, our languages are constituent features of a cultural pattern. They are embedded within relationships in such a way that to change the language would be to alter the relationship. It follows, therefore, that as we generate new languages in our professions, and disseminate them within the culture, so do we insinuate ourselves into daily relations – for good or ill. (Gergen, Hoffman & Anderson)
As these terminologies are disseminated to the public, and become available for understanding ourselves and others. They are, after all, the ‘terms of the experts’, and if one wishes to do the right thing, they become languages of choice for understanding or labeling people (including the self) in daily life. Terms such as depression, paranoia, attention deficit disorder, sociopathic, and schizophrenia have become essential entries in our vocabulary. And, when the terms are applied in daily life they have substantial effects – in narrowing the explanation to the level of the individual, stigmatizing, and obscuring the contribution of other factors (including the demands of economic life, media images, and traditions of individual evaluation) to the actions in question. (Gergen, Hoffman & Anderson)
We carry with us ideas about what we are like and what other people are like and we carry ideas about how our life is developing (or not de-ve¬loping) and we try to behave in accordance with these ideas. At the same time these ideas about ourselves are influenced by our ex¬pe¬rien-ce. Hence we exist in a circular context where our ideas about oursel-ves and about others are both influenced by and influence our reality.
In the story that we tell, we continually create through telling, retelling, adding and subtracting. Every new experience transforms experience in the present, expectations for the future and colors and modifies our memories. However, the difference are most often too small to be noticed as a difference.
Thus, these stories told in the present contain a past history, a present and a future. A typical story told by a person with problems in living is: I am not good at anything. I have never been good at anything and I will never be good at anything. Problematic stories often have these features: “I’ve always been – depressed – different – too kind – too good-hearted – too dumb – etc., and I will always be that way, and as I am what I am, which is what I’ve always been, I cannot change.”
In interactions with others the person continuously sees and hears others confirm his/her self-image (a story in itself). When people are friendly s/he may have difficulty understanding it. Maybe s/he doesn’t even ‘see’ it or s/he gets suspicious and awkward.
Steve de Shazer describes what he calls the binocular theory of change. When we look at something with our eyes, each eye sees one image. The left and the right eye do not see exactly the same image as the angle of the eye to the object is not identical. The difference between the images convey another type of information than the images in themselves, which is depth. If the images were identical it wouldn’t be of any importance that we had two eyes, and if the difference between the two images were too great we wouldn’t be able to create meaning out of the merging of the images. It is only when the images are sufficiently alike and sufficiently different that the requirements are met for the difference to yield more information; depth.
In the encounter between client and counselor a narrative is created that takes its origin in the client’s experience of his problematic existence. The client doesn’t come with a finished story. He has an experience of the problem but the description, the narrative around his problems and solution, is shaped in interaction with the counselor. This description created in the conversation can be extremely similar to the client’s experience and can, thus, deeply confirm to the client that s/he has an insoluble problem and this will eventually make him/her feel deeply understood. No new information is brought forward and without new information the client will not be able to find any tools to start doing something about his problem.
Requisites for change are at hand when the narrative is sufficiently similar to the client’s experience to be accepted, but at the same time sufficiently different to bring forth a new and different perspective. If the difference is too small the requisites for change are not met and if the difference is too big there may not even be a new meeting. The client says: “That counselor didn’t understand anything, there was no use in continuing”, or s/he thinks “that was the most stupid thing I ever heard” and stops coming.
Useful feed back for the client is when the story is sufficiently similar to be accepted as a valid description of the client’s experience, and sufficiently different to open up new perspectives, possibilities and hope.
Even positive, hopeful and future oriented narratives can be too different. In this case, the story may be seen as an attempt to embarrass or make fun of the client and the relationship can be impaired or destroyed.
“The difference that makes a difference” is one of the favorite sayings of Gregory Bateson, who meant that without knowledge of death, there could be no knowledge of life. To know what heat is, we must know what cold is, etc. All concepts contain differences as a prerequisite for their existence as concepts, either as opposites or as levels on a scale. If there were no differences we would only see light or dark, feel smooth surfaces that never started or ended, hear nothing or a no-sense murmur, and we would not be able to describe any of it.
But the difference highlighted by the counselor must have meaning to the client. It must be large enough to matter, but not too large to be offensive.
For something to be defined as a problem a possible solution must exist. Without a possible solution the problem is not a problem but a fact of life. It may be painful, but will never the less be a fact of life.
A problem is thus a difference that makes a difference, but a difference in relation to what? For the client, the problem is evidently in regard to his or her idea about what ‘not-a-problem’ looks like or how it is experienced – no matter how vague or incomplete.
Stories that are built on exceptions have the advantage of being built upon what the client actually did. They can, therefore, be similar enough to be accepted as part of the client’s history and world, but at the same time different enough to make a difference that will open up the possi¬bi¬li¬ty for new stories about oneself. These new stories can suggest different ways to see oneself, and, thus, a possibility opens for clients to do different things than those existing in their dominant story.
C Basic axioms about SFBC
- a firm belief that clients and families do their utmost to co-operate with us with the purpose to get help in changing what they do in their lives. Our job is therefore to do our utmost to find ways of co-operation considering each family’s unique way, conditions and life situation.
- we as clinicians have difficulties co-operating with people who come to get help and that we therefore must work very hard to understand what they are telling us about their goals and solutions. We must try to adjust ourselves and our model to our clients.
- no matter how bad it seems clients and families do a lot of things that are good for them and it is our job to find out what those things are.
- change is inevitable. When working like this nothing is ever the same. It is always possible to find differences in the present, the past or in ideas about how the future can be different. With time we have become almost incurably optimistic.
- change happens through developing resources rather than treating defects. This is expressed through a relative non-interest in problems and an insatiable interest in what people are good at.
- laughter liberates and that efficient therapy is often fun. Laughter has a tendency to lure out resources instead of deficiencies. What you can’t laugh about you can’t take seriously.
- the step from the told (expected) problem-free story to actually living it is smaller than usually believed and it pays off for clients to experiment.
- it is important for clients to own their change.
- credit for change should be shared among those who deserve it. This particularly means that the counselor must affirm the behaviors of the client and/or his support personnel.
- blame for failure lies with the counselor. Like the quarterback with a football team, the counselor will tend to get all the credit and all of the blame. The credit must be passed to the others, and the blame accepted as one’s own.
- the briefer the therapy the better. The counselor should not intend or pretend that s/he is dealing with all of the aspects of the client’s life that someone may disagree with.
D Ideal Personal Characteristics of Counselor
Certainly, the characteristics of a successful counselor would be seen as adding to the efficacy of SFBC. However, personal characteristics of the counselor are not viewed as central to the clinical process if the appropriate methodologies are employed. If one characteristic does stand out, it would probably be flexibility.
E Counselor’s Behaviors Prescribed/Proscribed
The majority of the solution focused process consists of carefully crafted questions designed to elicit client strengths and resources and to help the client decide how to best use those strengths and resources to achieve the desired treatment objectives.
It is difficult to say which if any specific behaviors on the part of the counselor are generally proscribed although advice giving, education about the effects of alcohol or other drugs, confrontation, indoctrination into a specific model or view of problems, labeling with psychiatric or other diagnoses, focusing on abstinence, and so forth are generally not helpful.
V CLIENT-COUNSELOR RELATIONSHIP
In the solution-focused approach, the counselor is seen as a collaborator/consultant hired by the client to achieve the client’s goals. This differs from the more traditional approach in two primary ways. First, in traditional intervention the counselor is viewed as the expert. Second, the goals and objectives of traditional intervention are frequently determined by the counselor or clinical model to which s/he adheres.
In the majority of cases, the client does the most talking. Furthermore, because of the collaborative nature of the relationship, what the client says is considered essential to the resolution of his or her complaints.
How Directive Is the Counselor?
In the majority of client-counselor contacts, the counselor is indirectly influencing the client through the use of specialized questions. However, the counselor would be more likely to be directive in the Solution-Focused Model if previous directive therapies had been helpful to the client or the client’s frame of reference about the helping relationship.
VI SESSION FORMAT AND CONTENT
A Format for a Typical Session
First sessions are considered the most important interview in the clinical process. These generally begin with questions that are designed to negotiate outcome goals and orient the client toward the strengths and resources that will be used to accomplish those goals. This may be followed by a team break, when the counselor meets with fellow professionals who have observed the session from behind a one-way mirror. Team members are usually made up of trainees and staff at the clinical center. Together, the team and the counselor construct a summary message and homework task that match the goals and motivational level of the client. There are three general types of homework tasks.
- Those that help the client change actions.
- Those that help the client change personal views or thinking.
- Those that encourage the client to return for subsequent sessions.
Second and subsequent interviews use interview questions to elicit, amplify, and reinforce the changes the client is making or to renegotiate goals if progress is not forthcoming. These sessions also utilize the team break and message components of the first session. Cases may or may not be seen with a team during subsequent sessions depending on the availability of other team members and the status of the case.
B. Typical Session Topics or Themes
Typical themes in solution-focused counseling include:
- The outcome that the client desires from the intervention process.
- Strengths and resources of the client that can be used to achieve the desired outcome.
- Discussion of previous successes of the client.
- Discussion of exception and instance periods.
- Discussion of changes in the client’s life from session to session.
- Exploration of what the client does to achieve those changes.
Session themes are believed to result from the interaction between the client and the counselor.
C. Session Structure
The session content is largely structured by the client. However, as noted, there is a loose structure inherent in the model and in the series of interviewing techniques that guide the individual interview.
D. Strategies for Dealing With Common Clinical Problems
All client behaviors are interpreted as efforts to aid the counselor in learning the best way to help each individual client. Therefore, the counselor must decide how to best incorporate and utilize whatever behavior is exhibited by the client. This attitude fosters a cooperation between the counselor and client that is not likely to occur when client behaviors are viewed as problems that must be dealt with to ensure the integrity of the clinical process. A common-sense attitude prevails. For example, if a client is chronically late to a session, this would be interpreted as a message to the counselor that too many appointments are being scheduled. After communicating this to the client, a suggestion might be made that the client call on the day that s/he would like an appointment. If an appointment is available, then the client would be seen. If, however, no appointment were available, the client would be instructed to call on another day. The same attitude prevails with regard to other common clinical problems.
1. Dealing With Denial, Resistance, or Poor Motivation
In the solution focused model, all of these terms are seen as evidence of the counselor’s difficulty (failure) in cooperating with the client’s frame of reference or level of motivation. For example, the word ‘poor’ in reference to the client’s level of motivation is an indication that the counselor has made a judgment that the client is not at the level that the counselor would like. Therefore, in this model, there are no poorly motivated clients, only counselors who poorly match their client’s frame of reference or level of motivation.
2. Dealing With Crises
A variety of specialized interviewing techniques are utilized in the solution focused model that help the client quickly reorient to strengths and resources when experiencing a crisis. One example of these interviewing techniques is known as the coping sequence. When a client calls in a crisis, questions are used that focus attention on how the client is or how to cope with the situation rather than on what is causing the crisis or how bad the client feels.
3. Response to Slips and Relapses
As change is inevitable and constant, there can technically be no relapses back to a previous level but only to different, new experiences. Therefore, in the SFBC, such occurrences are considered new experiences and challenges or even signs of success. After all, a client cannot have a slip or relapse without first having been successful. In these instances, the choice of the solution focused counselor is to focus on exactly what the client was doing when s/he was feeling more successful and to encourage the client to begin doing more of that again. This is a perfect example of the resource, competency-based perspective of the model.
Cooperation is defined in SFBC as any effort that the client is making to reach his/her goals and help the counseling process. This is sometimes interpreted in contrary ways [e.g., a client who misses sessions is trying to tell the counselor that s/he does not need to meet as often]. Even in this contrary interpretation the client is thanked for his/her efforts and praised, where appropriate – “Thanks for letting me know that you do not need all of the counseling time – that is very helpful”.
Other ways to develop affirmations come out of the questioning.
The easiest way to find out is to ask: “What are you good at?” Sometimes the client wonders if he got the question right: “What am I?… good at???”
Very often you get a nuanced and multifaceted description even from people who are not used to thinking about such things. In almost every case such discussions lead to a friendly and relaxed atmosphere develops that facilitates cooperation.
Be thorough with this question. Don’t worry if the client has difficulties answering. Ask what mother, father, lover, child and wife would have answered if they were present. Ask about these people’s attitude even if – and maybe even particularly if – the client has no difficulties talking about his own resources and competence. The earlier you start talking about the family in a positive way, the easier it will be for you and the client to use their help in counseling.
During the sessions, counselors should focus on clients’ goals, exceptions, pre-counseling changes and, in general, clients’ resources. They should do that by asking the Miracle Question [see below], discussing exceptions and pretreatment changes, by using coping questions and scales. Counselors should do this using their clients’ language, and at the same time promote descriptions in specific, small, positive (presence of solutions rather that absence of problems; start of something new rather than stopping something) and interactive terms. Counselors should adopt a respectful, non-blaming and cooperative stance, working towards their clients’ goals from within their clients’ frame of reference.
After some 45 minutes of conversation with their clients, the counselor may take a break. After this break (or, if no break was taken, simply at the end of the sessions) the counselor should compliment and affirm the client(s) and is likely to give some suggestions, following the rules described by de Shazer. Closing the session, the counselor will consult with the client(s) on whether and when to schedule another session.
SFBC should include all of or most of the features described above, but have to meet at least all of the following minimal requirements:
1. … asks what the client is good at.
2. …asks and follows up on the Miracle Question.
3. …asks and follows up on the Progress Scale Question.
4. …compliments the client(s) at the end of the session.
SECOND AND FOLLOWING SESSIONS
5. …asks “What is better?” at the beginning of the session and follows up on it.
6. …asks and follows up on the Progress Scale Question.
7. …compliments the client(s) at the end of the session.
Counselors will have to adjust to the exact wording and (where applicable) timing of these elements, as described in the following sections of this clinical protocol.
Counseling where one or more of these elements are missing in one or more of the session can not be considered to be SFBC.
1. The counselors asks and follows-up on the Miracle Question.
The Miracle Question has to be asked in the following way:
“I’d like to ask you a strange question…Suppose…that you go home tonight…and go to bed…and fall asleep as usual…and while you are sleeping, a miracle happens…and the miracle is that the problems that brought you in here are gone…and you don’t know because you are sleeping… What will you notice different tomorrow…that will tell you that there has been a miracle?”
Follow up questions serve the purpose of getting a description in specific, small, positive and interactive terms. They should focus on who will be doing what, where, when and with whom, and may be asked both from the client’s or from somebody else’s perspective, for instance:
– How will that be different?
– What will you be doing instead when you are not…?
– When you stop….. what will you do then?
– When you are feeling…… what will you be doing?
– How will s/he notice that you are feeling …?
– Who else will notice your being more…?
– What will they do when you…..?
– What will you do when s/he…?
– What would be the first sign that s/he…?
The counselor may also ask “what else…?” (will the client notice, will the father be doing, etc.), how the client (or his wife, her friends…) will do that, or what needs to happen so that the client (his wife, her friends…) can see that happening. For instance:
– How will you do that?
– In what way will that be helpful?
– What needs to happen so that s/he…?
2. The counselor asks and follows up on the Progress Scale.
The Progress Scale has to be asked in the following way:
“On a scale, where 10 stands for the day after the miracle and 0 stands for when the problems that brought you in were at their worst, where would you put yourself right now?
Follow up questions serve the purpose of getting a description in specific, small, positive and interactive terms. They should focus on who is or will be doing what, where, when and with whom, and may be asked both from the client’s or from someone else’s perspective.
Follow up questions of the Progress Scales may be used to:
Amplify exceptions and/or improvements. For instance, the counselor may ask:
– Now that you are at a…(point on a scale), how have things changed?
– What are you doing different now that you are at a …?
– How did s/he notice that you were at a….?
– Who else may have noticed your being at a…?
– What do they do when you…..?
– What do you do when s/he…?
– What was the first sign for them that you got up to a…?
The counselor may also ask “what else…?” (comes into that….., is different now that you are at a… ), how the client (or his wife, her friends…) did go up to that point in the scale, or what happened so that the client (his wife, her friends…) could go up to that point in the scale. For instance:
– How did it happen that you went from … to ….?
– How did you go from … to….?
– How did you know that was the right thing to do in order to go up to a ….?
– How did he decide to do that?
– How did that help?
– In what way was that helpful to you?
– How do you know you can do more of it?
– What needs to happen so that you can do more of it?
The counselor may also ask how come things are not further down on the scale, how the client has been able to keep at that point, what is the highest s/he has ever been on the scale, etc.
Discuss next steps toward goals, for instance:
– How will you notice that you are at a… (one point more on the scale)?
– What will s/he be doing different when you are at a…?
– What will be going on between him/her and you once you are at a…?
– At a … how often will you be doing….?
– What needs to happen so that you can go up to a….?
Negotiate intermediate goals, for instance:
– How much on the scale would be “good enough” for you?
– At what point on the scale do you think you could stop coming in here?
– If that happened, how much higher on the scale would you be?
3. The counselor compliments the client(s) at the end of the session.
During the session the counselor may compliment the client(s) by making remarks using the client’s language and quoting their statements (e.g., goals, exceptions, resources) on what they have done, are doing, or plan to do that is helpful, positive or valuable.
Compliments should be given at the end of the session, within the last five minutes of the session. They may be followed by homework assignments or suggestions.
Examples of compliments:
– The team and I are impressed with how well you described your picture of this day after the miracle and…
– We think that it takes a lot of courage to come here and ….
– We are struck by how committed you are about your daughter.
– I am impressed with how many things you are doing now that seem to work for you.
– The team and I are impressed with how far you have come in …
4. Return visits. The counselor asks `what is better?’ at the beginning of the session and follows up on it.
The counselor asks “what is better (since the last time you were here)?”.
This question should be the opening of the session, and therefore should be asked within the first two minutes of the session.
Follow up questions serve the purpose of getting a description in specific, small, positive and interactive terms. They should focus on who has been doing what, where, when and with whom, and might be asked both from the client’s or from somebody else’s perspective, for instance:
– How has that changed?
– What have you been doing instead, when you’ve not…?
– When you stopped….. what did you do then?
– When you are feeling…… what do you do?
– How did s/he notice that you were feeling …?
– Who else noticed your being more…?
– What did they do when you…..?
– What did you do when s/he…?
– What was the first sign that s/he…?
The counselor may also ask “what else…?” ( is better, did the client notice, was the father doing, etc.), how the client (or his wife, her friends…) did that, or what happened so that the client (his wife, her friends…) could see that happening:
– How did you do that?
– How did you know that was the right thing to do?
– How did s/he decide to do that?
– How did that help?
– In what way was that helpful to you?
– How do you know you can do more of it?
– What needs to happen so that you can do more of it?
Ask and follow up on Progress Scale questions (as paragraph 2).
The counselor compliments the client(s) in relation to this session (as paragraph 3).
Exceptions to the problem
It is important to differentiate between exceptions and resources. Resources are, briefly, everything that keeps the client alive despite his condition, while exceptions are when things happen that are in line with what the client wants (goals). It is, thus, important that when you inquire about exceptions, think both about what the client is complaining about and what it is he wants help with.
Deliberate exceptions are exceptions the client can do whenever he wants to. Donald sniffs gas in a compulsory manner and wants to stop. He never sniffs when he is with his girlfriend “she would beat the crap out of me”. When Donald doesn’t want to sniff he stays with his girlfriend, which he does 2 or 3 evenings a week. He can also abstain from sniffing when he is with his mother, and he is 100% sure that he can abstain tomorrow if he decides to (by being with his mother or with his girlfriend).
These are exceptions that occur out of the blue. What makes them happen, when they happen, and why they happen where they happen is a mystery. They just happen. Sometimes an aspect of what is going on is obvious but the description does not have the same character as with deliberate exceptions.
Resources and competence
Cecile is good at cooking and likes reading. She is interested in art and she is extremely well versed when it comes to Impressionism. In school she received very high grades in drawing, and she shyly discloses that she paints a little (badly she thinks, and she doesn’t understand why her teacher appreciated her so much). Cecile’s mother tells the counselor that she has always been very impressed with Cecile’s talent in this area. Cecile gets very upset with her mother who hasn’t told her this before, but her mother harshly makes it clear that she has shown her appreciation many times.
VII ROLE OF SIGNIFICANT OTHERS IN THE PROCESS
SFBC, as indicated earlier, began as a family counseling approach. Over time, it has been discovered that the model can affect family systems – and the individuals within that system – when only a few members of the system enter services. Sometimes this means that the identified client may not even come to the clinical sessions but will still be helped by the process. Therefore, when any potential client calls for an appointment, s/he is told to bring anyone that might be useful in solving this problem. If a certain member – even the identified client – is not willing to come to counseling, the willing members are instructed to come.
There are now over 32 published research studies On solution focused brief counseling which show successful outcomes in 65-83% of cases. The highest satisfaction ratings come from clients themselves. Some of the research studies relate to very serious mental health problems, drug and alcohol use, criminal behavior and domestic violence. The most common follow-up studies are when clients are asked their opinion. Some of these have been continued for several years and show that in more than 75% of cases the client is satisfied and the problem if not completely resolved is no longer a dominant influence.
At the moment, researchers have found no significant outcome difference between the different problems or people who come for solution focused brief counseling. All that can honestly be said to anyone who comes through the door is that there is a 65-83% chance of the problems the person has come with being resolved or significantly reduced in an average of 4 to 5 sessions.
Solutions Focused Brief Counseling could have as its motto – “That which gets attention becomes important!”. This is so because it spends a great deal of energy asking questions about:
a. What is good?
b. What is changing?
c. How did you do that?
and the like. These questions focus the client’s attention on these items and they become important to him/her. By noticing, they may not even have an answer to the question, but they are prompted to draw an answer out of their intuitive ‘right brain’ which, may not be correct, but can be construed as correct. Thus, a client who has never noticed when or why s/he was able to not ‘do’ non-medical drugs, may for the first time believe that s/he is capable of not ‘doing’ them. From this s/he is able to create a reality in which other things may happen. Again, by asking what is good and changing, and how you notice that it is changing, the client is asked to draw out of his/her nonconscious experiences a relevant answer. Since it is his/her answer, it is automatically accessible and acceptable. The counselor is not providing answers, although s/he may comment on the answer all the while giving the client compliments and affirmations on his/her strength, wisdom and resources.
The messages being sent are consistently positive and relevant, and the client is able to use those messages to redefine him/herself into a new, but acceptable reality.
Because we tend to get what we notice, so we need to notice what we want to get! [Cottrell]
One of the primary principles reflected in Solution Focused Brief Counseling is more time spent focusing on solutions, less time focusing on problem talk.
SFBC places emphasis on the individual’s personal story. Values are alternative, not normative. There is no notion of resistance. If it doesn’t work, do something different. If the client is doing better, keep doing whatever it is you are doing.
Don’t push for change. SFBC is a co-operative therapy, it is neither ‘expert’ led, nor diagnostic, the emphasis is on co-constructing solutions. SFBC may be long term, but is rarely frequent. Frequency of consultations are perhaps fortnightly, perhaps six weekly.