Mastering the Artof Solution-Focused Counseling

Jeffrey T. Guterman, Ph.D.

Copyright © 2016 Jeffrey T. Guterman

Session Objectives1. Participants will learn the main principles of solution-focused counseling.

2. Participants will learn the theory of problems and change in solution-focused counseling.

3. Participants will learn the clinical stages in solution-focused counseling.

4. Participants will learn solution-focused counseling techniques.

5. Participants will learn clinical applications of solution-focused counseling.

Principles ofSolution-Focused Counseling

• Solution-focus• Collaborative approach• Small changes can lead to big results• Emphasis on process• Strategic eclecticism• Brief by design, but not always• Responsive to diversity• Committed to outcome

Theory of Problems inSolution-Focused Counseling

• Problem/Exception

• Exception refers to times when the problem is not happening.

• Depressed/Not Depressed

Theory of Change forSolution-Focused Counseling

Problem / Exception

Common Change Factors

• Client factors (self-help): 40%• Client-counselor relationship factors: 30% • Expectancy factors: 15%• Model factors: 15%

Using client feedback to improve treatment outcome in solution-focused counseling

Stages of Solution-Focused Counseling

• Coconstructing problems and goals• Identifying and amplifying exceptions• Coconstructing tasks• Evaluating the effectiveness of tasks• Reevaluating problems and goals

Coconstructing Problems and Goals

• Coconstruct solvable problems (e.g., ineffective coping skills for depression, rather than merely ‘depression’)

• Develop goals in positive language (an increase in something), rather than negative language (a decrease in something)

• Encourage clients to provide video description of the problem

• Coconstruct a problem and a goal that fits with the client's worldview

S.M.A.R.T. Goals

• Specific– Small– Incremental

• Measurable• Attainable• Relevant• Time-based

Mapping the Influences of the Problem

• Identifying potential exceptions

• Externalizing the problem

Identifying and Amplifying Exceptions

• Presuppositional questions• Identifying small exceptions• Identifying potential exceptions– The miracle question

• Questions for amplifying exceptions

Excerpt from Session

Counselor: You mom says you hit everyone that bothers you. Would you say that’s true?

Eric: Yes. (Pause) Ain’t scared of nobody.

Counselor: Your mom also says you don’t know any other way to solve problems. Is she right about that?

Eric: I don’t need any other ways.

Excerpt from SessionCounselor: Eric, help me understand something. You seem like this session is bothering you a lot. I mean, like I’m bothering you.

Eric: Damn right.

Counselor: So why haven’t you hit me yet?

Eric: What?

Counselor: Yeah, I’m serious.

Excerpt from Session

Eric: Shit, I don’t know. After a day like today, I don’t need any more trouble.

Counselor: So, maybe you are able to solve problems a different way? It sounds like your mom might be wrong about you, Eric. What else do you think people get wrong about you?

Miracle Questions

Suppose that one night there is a miracle and while you are sleeping the problem was solved.

How would you know?

What would be different?

Excerpt from Session

Counselor: Where would you rate your depression?

Vanessa: Nine. Easy. What a waste, we’ve been doing this for four months, and I’m still no better.

Counselor: Are you sure about that? You had to go to the hospital twice in the first two months of counseling. Now, however, you’re facing a bunch of challenges in math and science, so there’s extra pressure.

Excerpt from Session

Vanessa: Right. So things have gotten even worse!

Counselor: Yes, they have gotten harder. But in spite of all of this, you’ve managed to avoid Hospital Time. How have you stopped the ball from rolling up to Hospital Time? You certainly might not have done that in the beginning.

Vanessa: I don’t know.

Excerpt from Session

Counselor: Think about it. Take your time.

Vanessa: I guess I’m not as afraid of life as I used to be.

Counselor: Tell me more about that.

References and Suggested ReadingsBerg, I.K., & Miller, S.D. (1992). Working with the problem drinker: A solution-focused approach. New York: Norton.de Castro, S., & Guterman, J.T. (2008). Solution-focused therapy for families coping with suicide. Journal of Marital and Family Therapy, 34, 93-106.de Shazer, S. (1982). Patterns of brief family therapy. New York: Norton.de Shazer, S. (1984). The death of resistance. Family Process, 23, 11-17. de Shazer, S. (1985). Keys to solution in brief therapy. New York: Norton. de Shazer, S. (1988). Clues: Investigating solutions in brief therapy. New York: Norton. de Shazer, S. (1991). Putting difference to work. New York: Norton. de Shazer, S. (1994). Words were originally magic. New York: Norton. de Shazer, S. (1997). Commentary: Radical acceptance. Families, Systems, & Health, 15, 375-378.de Shazer, S., Berg, I. K., Lipchik, E., Nunnally, E., Molnar E., Gingerich, K., & Weiner-Davis, M. (1986). Brief therapy: Focused solution development. Family Process, 25, 207-222. Duncan, B. (2014). On becoming a better therapist: Evidence based practice one client at a time. (2nd edition). Washington DC: American Psychological AssociationDuncan, B.L., Miller, S., Huggins, A., & Sparks, J. (2003a). Young child outcome rating scale. Chicago: Author. Duncan, B.L., Miller, S., Huggins, A., & Sparks, J. (2003b). Young child session rating scale. Chicago: Author. Duncan. B.L., Miller, S.D., & Sparks, J. (2003). Child outcome rating scale. Chicago: Author.Duncan. B.L., Miller, S.D., & Sparks, J.A. (2004). The heroic client: A revolutionary way to improve effectiveness through client- directed, outcome-informed therapy. San Francisco: Jossey-Bass. Duncan, B.L., Miller, S.D., Sparks, J.A., & Johnson, L.D. (2003). Child session rating scale. Fort Lauderdale, FL: Author.Franklin, C., Trepper, T.S., McCollum, E.E., & Gingerich, W.J. (2011). Solution-focused brief therapy: A handbook of evidence-based practice. New York: Oxford University Press.Gergen, K.J. (2009). An invitation to social construction (2nd ed.). Thousand Oaks, CA: Sage.Guterman, J. T. (1994). A social constructionist position for mental health counseling. Journal of Mental Health Counseling, 16, 226-244.

References and Suggested Readings (continued)

Guterman, J.T. (1996). Doing mental health counseling: A social constructionist re-vision. Journal of Mental Health Counseling, 18, 228-252.Guterman, J.T. (1998). Identifying pretreatment change before the first session. Journal of Mental Health Counseling, 20, 370-374.Guterman, J.T. (2013). Mastering the art of solution-focused counseling (2nd edition) Alexandria, VA: American Counseling Association. Guterman, J.T., & Leite, N. (2006). Solution-focused counseling for clients with religious and spiritual concerns. Counseling and Values, 51, 39-52. Guterman, J.T., Mecias, A., Ainbinder, D.L. (2005). Solution-focused treatment of migraine headache. The Family Journal: Counseling and Therapy for Couples and Families, 13, 195-198. Held, B.S., (1992). The problem of strategy within the systemic therapies. Journal of Marital and Family Therapy, 18, 25-35.Johnson, L.D., Miller, S.D., & Duncan, B.L. (2000). Session rating scale 3.0. Chicago: Author.Lambert, M.J. (1992). Implications of outcome research for psychotherapy. In J.C. Norcross M.R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 94-129). New York: Basic Books. Lambert, M.J., Whipple, J., Smart, D., Vermeersch, D., Nielsen, S., & Hawkins, E. (2001). The effects of providing therapists with feedback on patient progress during psychotherapy: Are outcomes enhanced? Psychotherapy Research, 11, 49-46.Lipchik, E. (2002). Beyond technique in solution-focused therapy: Working with emotions and the therapeutic relationship. New York: Guilford.Martin, C.V., Guterman, J. T., & & Shatz, K. (2012). Solution-focused counseling for eating disorders. VISTAS, 1-11.Miller, S., & Duncan. B.L. (2000). Outcome rating scale. Chicago: Author. Molnar A., & de Shazer, S. (1987). Solution-focused therapy: Toward the identification of therapeutic tasks. Journal of Marital and Family Therapy, 13, 349-358. Murphy, J.J. (2008). Solution-focused counseling in middle and high schools (2nd ed.) Alexandria, VA: American Counseling Association.O'Hanlon, B., & Rowan, T. (2003). Solution oriented therapy for chronic and severe mental illness. New York: Norton.O'Hanlon, W. H., & Weiner-Davis, M. (1989). In search of solutions: A new direction in psychotherapy. New York: Norton. White. M., & Epston, D. (1990). Narrative means to therapeutic ends. New York: Norton.

Suggested Internet ResourcesJeffrey T. Guterman, Ph.D.Homepage: http://JeffreyGuterman.comTwitter: http://twitter.com/JeffreyGutermanFacebook: http://facebook.com/jeffreygutermanpage

International Center for Clinical Excellence (ICCE)http://www.centerforclinicalexcellence.com

Scott D. Miller, Ph.D.http://www.scottdmiller.com

Institute for Solution-Focused Therapyhttp://www.solutionfocused.net

Solution-Focused Brief Therapy Association (SFBTA)http://www.sfbta.org