Solution Focused Therapy

SOLUTION-FOCUSED THERAPY

A short-term approach to intervention in which the social worker and client attend to solutions or exceptions to problems more so than to problems themselves.

It helps clients identify and amplify their strengths and resources toward the goal of finding solutions to presenting problems.

Principles

If it ain’t broke, don’t fix it

If it works, keep doing it

If it’s not working, stop

Small change leads to larger change

Keep intervention as simple (concrete) as possible

UNIQUE ASSUMPTIONS OFSOLUTION FOCUSED THERPY

There is no necessary connection between problems and solutions

Events in a person’s past and present are not necessarily causally connected

One need not understand a problem in order to resolve it

Depth is not synonymous with truth

BASIC APPROACH OFSOLUTION-FOCUSED THERAPY

Two Primary Activities

Development of well-formed goals within the client’s

frame of reference

Development of solutions based on exceptions

The Process

Describe the problem

Develop goals

Explore for exceptions

End of session feedback

Evaluate client progress (each session)

SOLUTION-FOCUSED INTERVENTIONTHROUGH THE HELPING PROCESS

The Social Worker’s General Approach

Give Compliments (Direct and indirect)

Ask Future- Oriented Open-Ended Questions

The worker’s language should always imply the likelihood of change

Emphasis is on the future when the problem no longer exists

“What will you be doing when _____ “

The Pessimistic Stance (gets clients to argue for their own change)

“It sounds like the problem is serious. How come things are not worse?”

“What are you (or your family) doing to keep things from getting worse?

“How has that been helpful? Would _____ agree?”

The Social Worker’s General Approach (Cont.)

Reframe

Introduce clients to new ways of looking at themselves or the problem issue

Externalize

Discuss the problem as something apart from the client, rather than

something that is central to the client’s nature

“You struggle with substance abuse” vs. “You are a substance

abuser”

THE SOCIAL WORKER’S ACTIVITIES

Facilitate:Change talk (seeking differences)

Solution talk (constructing preferred futures)

Strategy talk (for managing the problem) via: Coping questions Present multiple options Scaling (levels of confidence, motivation, and progress)

If the client is comfortable, he or she will disclose all of what is important

GOALS OF THE FIRST SESSION

Build positive feelings and a sense of hope: “Tell me what will be different for you when our time here has been successful.”

Assessment Topics

Client’s perceptions of the problem

Client’s beliefs about the sources of the problem

How the problem affects the client

How the client has coped with the problem thus far

What the client has tried already

What the client’s experiences have been with other helpers

CREATE A CLIMATE FOR CHANGE

Inquire about Pre-Session Change

“Has anything changed relative to the presenting problem since you set up this appointment?”

“Are these the kinds of changes you would like to continue see happen?”

Do not minimize the significance of any efforts the client has made, or any changes that may have occurred prior to the first meeting

CLARIFY THE CLIENT’SGOALS FOR INTERVENTION

Encourage clear problem definition

Prioritize (work on only one problem at a time)

The Miracle Question - “Imagine when you go to sleep one night a miracle happens……. but you don’t know it…… what would be the first signs for you that ……” Perspective of the client Perspective of a significant other

Partialize problems into discreet, measurable units

Scaling questions (for goal setting and assessing motivation)

CHARACTERISTICS OFWELL-FORMULATED GOALS

Realistic

Challenging

Include the possibility of interpersonal interaction

Situational (vs. broad) focus

Concrete, measurable

Focus on the presence of desirable behavior rather than the

absence of a behavior

Enable a focus on “steps” rather than a final result

Client recognizes a role for him or herself

EXPLORING FOR EXCEPTIONS

Exceptions - past experiences in a client’s life when the problem might reasonably have been expected to occur, but somehow did not

Recent exceptions are more useful to intervention

Random versus deliberate exceptions

Also …..

Identify the client’s areas of competence, strengths

Identify protective factors that can be mobilized

EXAMPLES OF EXCEPTIONS QUESTIONS

“What was going on in the past when the problem wasn’t a problem?”

“Tell me about a time recently when the problem did not exist (or was less troublesome)“

“How did you make that (the exception) happen?”

“What were you thinking?”

“Who was there?” “How did they have a part in creating the exception?”

“When did it happen?” “Where did it happen?”

“What did you think and feel as a result of doing that?”

EXPLORE TASK IDEAS

The End-of-Session “Message” Compliments Summary statement of positive strategies Tasks Personal functioning Interactions with others

Interactions with resource systems

The Formula First Session Task “Between now and the next time we talk, notice the things in your life that you would like to continue”

SUBSEQUENT SESSIONS

Ask: “What’s better?”

Client should be encouraged to report positive and negative developments

Clients may be ambivalent about “positive” changes that involve loss

Ask questions about:

Maintenance strategies “What needs to happen for these changes to keep happening? What obstacles may get in your way, and how might you overcome those?”

Learning strategies “What have you learned so far from what you’ve been doing? What have you learned not to do?”

REVIEW TASK PERFORMANCE

All session-to-session tasks should be jointly designed by the social worker and client; the client should take the lead in devising them

Practitioners vary in the importance they place on the specificity of tasks, their accomplishment, and “reporting in”

The client’s lack of or inability to follow through with a task signals the need to renegotiate tasks or goals or to review motivation

Scaling questions regarding progress and confidence. Use of a 0 - 10 scale promotes specificity of focus and concrete indicators of movement

DEVELOP OR REINFORCENEW STRATEGIES FOR CHANGE

Build on what the client is already doing

Don’t focus too much on setbacks, but ask:

Should you be doing something different?

Are your goals realistic? Your timetable?

What did you do to stop it from getting worse?

How did you cope with the problem not improving?

Possibly revisit the miracle question (clients may change their answers)

The Surprise Task - “Between now and the next time we meet, do something that will pleasantly surprise _____ (a significant other person)”

EVALUATE EACH SESSION

Evaluation Questions“Is our work together helpful to you? Are the changes along the lines that you hoped? Have your goals changed? What should we be doing differently?”

During each session ask the client (on a 0 to 10 scale) what number will signify good-enough problem resolution

After a goal is achieved, set additional goals or end the intervention

Remind the client at the end of each session how progress toward goal achievement is being demonstrated

SOLUTION-FOCUSED INTERVENTIONWITH “VISITORS”

Maintain the position of “not knowing”

Agree with the client’s perceptions of the presenting situation

Assume that there are good reasons for the client’s negativity

Ask the client to elaborate on feelings of anger and negativity

Turn client complaints into beginning goals for the intervention

Listen for other people who are important to the client

Ask what previous professional helpers” (if any) could have done

differently to be more helpful

Ask for the client’s perceptions of “best interest” and what he or she

wants

Make sure non-negotiable requirements are clear

Give the client as much control of the intervention process as possible

INTERVENTION WITH CLIENTS IN CRISIS

“How can I help?”

“What have you tried already?”

“What do you want to be different?”

Ask Coping Questions

“How do you get out of bed in the morning?”

“How did you survive long enough to get here today?”

“How have you managed to cope this far?”

“How come things are not worse?”

QUESTIONS TO ASK WHEN ENDING INTERVENTION

“What do you need to remember if things get difficult for you again?”

“What will be the benefits for you that will make the effort worth it?”

“Who is going to be able to help you?

“Who do you think will be more a part of the problem?”

“How long do you think it will take before this is not a big problem

anymore?”

“How will you remind yourself about the things you know are helpful?”

“What do you expect the hardest challenge will be?”

“What do you think the possible obstacles might be, and how will you

overcome them?”

SFT IDEAS THAT ARE “TRANSFERABLE”TO OTHER APPROACHES

Considering the balance of time spent discussing the client’s past, present, and future

Scaling and the miracle-question can be useful when the social worker feels “stuck” with a client

Attention to the client’s coping strategies can correct against a deficits bias

It is not always necessary to look for detailed explanations of client problems

The danger of fostering client dependency on formal intervention

CRITICISMS OF SOLUTION-FOCUSED INTERVENTION

The practice denies clients the opportunity to explore presentingproblems in greater depth

Its encouragement of clients to "think positively" may induce denial or minimization of problems

Clients may feel discouraged from sharing important details or negativefeelings about the presenting issue

SFT may create a false impression on young practitioners thatintervention is relatively “easy” or straightforward