Solution Focused Techniques

[David Baxter PhD]

Solution Focused Techniques
Counselling Connection
March 30, 2009

Solution focused therapies are founded on the rationale that there are exceptions to every problem and through examining these exceptions and having a clear vision of a preferred future, client and counsellor, together, can generate ides for solutions.

Solution focused therapists are competency and future focused. They highlight and utilise client strengths to enable a more effective future. In this article, we will look at commonly utilised solution focused techniques.

Basic Assumptions
The following assumptions provide the framework on which solution focused therapy is founded:

1. There are significant advantages in focusing on the positive and on solutions for the future. Focusing on strengths and solution-talk will increase the likelihood that therapy will be brief.
2. Individuals who come to therapy do have the capacity to act effectively. This capacity, however, is temporarily blocked by negative cognitions.
3. There are exceptions to every problem.
4. Clients tend to present one side of the problem. Solution focused therapists invite clients to view their problems from a different side.
5. Small change fosters bigger change.
6. Clients want to change, they have the capacity to change and they are doing their best to make change happen.
7. As each individual is unique, so too is every solution.

Source: Corey, G. (2005). Theory and practice of counseling and psychotherapy. (7th ed.). Belmont, CA: Wadsworth.

The Miracle Question
The miracle question is a technique that counsellors can use to assist clients to think ‘outside the square’ in regard to new possibilities and outcomes for the future.

“The miracle question has been asked thousands of times throughout the world. It has been refined as practitioners have experimented with different ways of asking it. The question is best asked deliberately and dramatically.

Now, I want to ask you a strange question. Suppose that while you are sleeping tonight and the entire house is quiet, a miracle happens. The miracle is that the problem which brought you here is solved. However because you are sleeping, you don’t know that the miracle has happened. So, when you wake up tomorrow morning, what will be different that will tell you that a miracle has happened and the problem which brought you here is solved?” (de Shazer, 1988, p. 5.)​

Asked this way, the miracle question requests clients to make a leap of faith and imagine how their life will be changed when the problem is solved. This is not easy for clients. It requires them to make a dramatic shift from problem saturated thinking to a focus on solutions. Most clients need time and assistance to make that shift. (De Jong & Kim Berg, 2002)

Exception Questions
Having created a detailed miracle picture, the counsellor has started to gain some understanding of what the client hopes to achieve and the counsellor and client can begin to work towards these solutions. This is achieved through highlighting exceptions in a client’s life that are counter to the problem. This helps empower clients to seek solutions.

Exception questions provide clients with the opportunity to identify times when things have been different for them.

Examples of exception questions include:

1. Tell me about times when you don’t get angry.
2. Tell me about times you felt the happiest.
3. When was the last time that you feel you had a better day?
4. Was there ever a time when you felt happy in your relationship?
5. What was it about that day that made it a better day?
6. Can you think of a time when the problem was not present in your life?

When exploring for exceptions, be aware that such questions can be phrased to ask for the client’s perception of exceptions (individual questions) and the client’s perception of what significant others may notice (relationship questions).

Examples of each follow.

Elicit - So when the miracle happens, you and your husband will be talking more about what your day was like and hugging more. Are there times already which are like the miracle - even a little bit? If your husband was here and I were to ask him the same question, what do you think he would say?

Amplify - When was the last time you and your husband talked more and hugged more? Tell me more about that time. What was it like? What did you talk about? What did you say? When he said that, what did you do? What did he do then? How was that for you? Was else was different about that time? If he were here, what else might he say about that time?

Reinforce - Nonverbally: Lean forward raise eyebrows, take notes. Do what you naturally do when someone tells you something important. Verbally: Show interest. (Was this new for you and him? Did it surprise you that this happened?) And compliment. (Seems like that might have been difficult for you to do, given everything that’s happened in the relationship. Was it difficult?)

Explore how the exception happened - What do you suppose you did to make that happen? If your husband was here and I asked him, what do you suppose he would say you did that helped him to tell you more about his day?

Use compliments - Where did you get the idea to do it that way? That seems to make a lot of sense. Have you always been able to come up with ideas about what to do in difficult situations like this?

Project exceptions into the future - On a scale of 1 to 10, where 1 means every chance, what are the chances that a time like that (the exception) will happen again in the next week (month, sometime in the future)? What will take for that to happen?)

What will it take for that to happen more often in the future? Who has to do what to make it happen again? What is the most important thing for you to remember to do to make sure that _________________ (the exception) has the best chance of happening again? What’s the next most important thing to remember?

What do you think your husband would say the chances are that this (the exception) will happen again? What would he say you could do to increase the chances of that happening again? Suppose you decide to do that, what do you think he would do? Suppose he did that, how would things be different for you…around your house… in your relationship with him?”

(De Jong & Kim Berg, 2002, pp. 302-303)

Scaling Questions
Scaling questions invite clients to perceive their problem on a continuum. Scaling questions ask clients to consider their position on a scale (usually from 1 to 10, with one being the least desirable situation and 10 being the most desirable). Scaling questions can be a helpful way to track coachees’ progress toward goals and monitor incremental change.

To use these types of questions, the therapist begins by describing a scale from one to ten where each number represents a rating of the client’s complaint(s). The therapist might say, “On a scale of one to ten, with one being the worst this problem has ever been, and ten being the best things could be, where would you rate things today?

Once a therapist is given a number, he or she explores how that rating translates into action-talk. For example, if the client rates his or her situation at a three, the therapist asks, “What specifically is happening to indicate to you that it is a three?” The next step is to determine the goals and preferred outcomes. To do this the therapist asks the client where things would need to be for him or her to feel that the goals of treatment have been met or that therapy has been successful.

We aim for small changes that will represent progress in the direction of goals and preferred outcomes.” (Bertolino & O’Hanlon, 2002, pg. 4)

Examples of scaling questions include:

• You said that things are between a 5 and a 6. What would need to happen so that you could say things were between a 6 and a 7?
  
• How confident are you that you could have a good day like you did last week, on a scale of zero to ten, where zero equals no confidence and ten means you have every confidence?

Presupposing Change
When clients are focused on changing the negative aspects (or problems) in their lives, positive changes can often be overlooked, minimized or discounted due to the ongoing presence of the problem.

The solution focused approach challenges counsellors to be attentive to positive changes (however small) that occur in their clients’ lives. Questions that presuppose change can be useful in assisting clients to recognise such changes. Questions such as, “What’s different, or better since I saw you last time?” This question invites clients to consider the possibility that change (perhaps positive change) has recently occurred in their lives.

If evidence of positive change is unavailable, counsellors can pursue a line of questioning that relates to the client’s ability to cope.

Questions such as:

1. How come things aren’t worse for you?
2. What stopped total disaster from occurring?
3. How did you avoid falling apart?

These questions can be followed up by the counsellor positively affirming the client with regard to any action they took to cope.” (Geldard & Geldard, 2005)

References

1. Bertolino, B., & O’Hanlon, B. (2002). Collaborative, competency-based counseling and therapy. Needham Heights, MA: Allyn & Bacon.
2. Corey, G. (2005). Theory and practice of counselling and psychotherapy. (7th ed.). Belmont, CA: Brooks/Cole.
3. De Jong, P., & Kim Berg, I. (2002). Interviewing for solutions. (2nd ed). Pacific Grove, CA: Wadsworth.
4. de Shazer, S. (1988). Clues: investigating solutions in brief therapy. New York: Norton.

 

[Daniel E.]

Cool Intervention #10: The Miracle Question | Psychology Today

 

[Daniel E.]

New Counseling Methods | Psychology Today
by Steven Reiss, Ph.D.

...Counseling is challenging because many people change slowly if at all, while others change but over time go back to old habits. Sigmund Freud took notice of this very common resistance to change and put forth a theory of unconscious defenses to explain it. I think it undeniable that people resist changing; I think that is because true personality change often requires a change in values, and people resist changes in their values.

My colleagues and I have been working on a new strategy for counseling people. Instead trying to change people to adjust to current life situations, we teach them to find new life situations in which they can thrive. As we like to say, "Better to marry the right person to begin with than need to a counselor to teach you to get along with somebody else."

We are not the only ones who have tried to match people to partners, careers, and life situations so they will thrive and not need to change. Others have attempted the same strategy. What is new with our group, however, is we have field tested with tens of thousands of people scientifically validated, seemingly superior matching technologies. Our work is published in 17 articles and five books.

Our research shows that 16 needs and life goals are universal to human nature. These motives include everything from a need for acceptance to needs for sex , order, and status. Although everybody embraces all 16 life goals, individuals prioritize them differently. By objectively assessing an individual's unique needs hierarchy, we can match people to mates, careers, and life situations...

 

[Daniel E.]

Solutions do not necessarily have anything to do with the problem.

For example, a man or woman who is bored on the job may become increasingly lethargic and ineffective. An unexpected stimulus outside work, such as a hobby, sport, or new relationship, may result in a general change of attitude that affects his or her perception of and performance on the job as well. Searching for solutions only in relation to the problem can seriously constrain progress.

Source: Beyond technique in solution-focused therapy - Google Books

 

[Daniel E.]

We discovered that problems do not happen all the time. Even the most chronic problems have periods or times when the difficulties do not occur or are less intense. By studying these times when problems are less severe or even absent, we discovered that people do many positive things that they are not fully aware of. By bringing these small successes into their awareness and repeating the successful things they do when the problem is less severe, people improve their lives and become more confident about themselves.

And, of course, there is nothing like experiencing small successes to help a person become more hopeful about themselves and their life. When they are more hopeful, they become more interested in creating a better life for themselves and their families. They become more hopeful about their future and want to achieve more.

Because these solutions appear occasionally and are already within the person, repeating these successful behaviors is easier than learning a whole new set of solutions that may have worked for someone else. Thus, the brief part was born. Since it takes less effort, people can readily become more eager to repeat the successful behaviors and make further changes.

Solution-Focused Brief Therapy has taken almost 30 years to develop into what it is today. It is simple to learn, but difficult to practice because our old learning gets in the way. The model continues to evolve and change. It is increasingly taken out of the therapy or counseling room and applied in a wide variety of settings where people want to get along or work together.

~Insoo Kim Berg
What is Solution-Focused Brief Therapy :: sfbta.org

 

[JennyS]

But why is it called this?
Isn't therapy in general "solution based"?
The reason I ask this is that to me it implies that other therapies are problem based.
That does not make sense to me.

 

[Daniel E.]

Well, one example of where they are coming from in regards to what problem-focused means:




Solution-focused therapy - Bill O'Connell - Google Books

 

[Daniel E.]

Isn't therapy in general "solution based"?

At least according to one psychologist, solution-focused therapy can be seen as a form of CBT:

This chapter describes how solution-focused brief therapy can be viewed as form of cognitive behavior therapy (CBT)...It turns out they apply the same theoretical learning principles and that they follow the same behavioral therapeutic process...

CBT and solution-focused brief therapy also have the same goal: to help clients make desired changes in their lives...CBT and solution-focused therapy are concerned with changing both cognitions and behavior...In addition, CBT and solution-focused brief therapy both make frequent use of homework and evaluation of the treatment provided.

1001 Solution-Focused Questions: Handbook for Solution-Focused Interviewing by Fredrike Bannink

More generally:

HOW SFBT IS CONTRASTED WITH OTHER TREATMENTS

SFBT is most similar to competency-based, resiliency-oriented models, such as some of the components of motivational enhancement interviewing (Miller & Rollnick, 2002; Miller, Zweben, DiClemente, & Rychtarik, 1994). There are also some similarities between SFBT and cognitive-behavioral therapy, although the latter model has the therapist assigning changes and tasks while SFBT therapists encourage clients to do more of their own previous exception behavior and/or test behaviors that are part of the client’s description of their goal. SFBT also has some similarities to Narrative Therapy (e.g., Freedman & Combs, 1996) in that both take a non-pathology stance, are client-focused, and work to create new realities as part of the approach. SFBT is most dissimilar in terms of underlying philosophy and assumptions with any approach which requires “working through” or intensive focus on a problem to resolve it, or any approach which is primarily focused on the past rather than the present or future.

http://www.sfbta.org/Research.pdf

 

[Daniel E.]

de Shazer outlined the following characteristics of well-formed goals:

1. they are small;
2. they are salient;
3. they are described in specific behavioral terms;
4. they are achievable in the practical context of clients' lives;
5. they are perceived by the client as involving "hard work";
6. they are described as the "start of something" and not as the "end of something"; and
7. they involve the initiation of new behaviors rather than the absence or cessation of existing behaviors.

excerpted from Doing what works in brief therapy: a strategic solution focused approach

 

[Daniel E.]

In the context of treating eating disorders:

SFBT And Eating Distresses

...These are some of the aspects my clients find particularly helpful:

• The element of surprise. Many of my clients say that they start therapy feeling anxious and worried, expecting to start digging into the problem and excavate their past. They are pleased to learn that instead I like to find out what it is they wish to achieve, and rather than dwelling on their problem, we start building solutions.
• Miracle Question. Most clients know exactly what they want to STOP doing, but have not formulated what they would rather do instead. When asked: "What will be the first thing that tells you a miracle has happened?" they commonly reply: "I won't be thinking about food". My next question is: "Ok, so what will you think about instead?" The MQ [miracle question] helps to draw them away from the problem and towards their preferred future. A helpful 'task' is to invite clients to look out for tiny parts of the miracle and report those when we next meet.
• Exceptions. A black-and-white viewpoint is common among my client group and looking for Exceptions helps to challenge these. If they say: "I'm always vomiting" I wonder: "What? Always? Even while you take a shower? Even when drive your car?" "I can never stop eating" gets challenged by: "How come you're not eating at this moment?" These questions are empowering. They give evidence that something positive is already happening, and this forms the basis for further change.
• Externalizing the problem. This is an intervention borrowed from Narrative Therapy. I invite clients to buy into the idea that they are not the problem, in fact they are perfectly lovely and precious human beings which have been unfortunate in that a slimy monster (the eating disorder) has attached itself to their shoulder, and now it is brainwashing them with eating disordered thoughts and behaviour. Once clients get used to this idea they can stop fighting themselves ('I'm useless, I'm disgusting, I should be able to snap out of this') and fight against the eating disorder (slimy monster) instead. They become assertive and are able to make constructive choices. Instead of listening to their monster which tries to persuade them to eat/not eat/vomit etc, they say: "No, I don't want to do that, so instead I will do something that does my body justice, such as phone a friend, have a bath, read a book etc.
• Teaching. It is useful to raise awareness of related problems such as tooth decay, osteoporosis and infertility. Many clients are simply not aware of the ravaging and far reaching effects of an eating disorder. I appreciate that some therapists never get involved in educating/advice giving but as my clients clearly identify this to be helpful I continue to do this when it appears appropriate.
• Turning negatives into positives. Clients are often stuck in negative thought patterns. With little or no self-esteem, their metabolism is disrupted and they feel a physical wreck living in isolation and often shame, with a sense of loss of control. Characteristically, recovery follows a pattern of peaks and troughs. Some people say they feel like they've taken one step forward and then several back! This is normalized in therapy. The larger picture generally reveals that they have slipped, but either they have not gone as low down as they were before or they have not dwelled in the pit as long as they did previously. We are not interested in the whys and wherefores of a dip. Instead we look at how they managed to dust themselves down and decided to climb up again. In other words, we prioritize the ups rather than the downs.
• Breaking rigid routines. Eating disorders of the restricting kind tend to seduce people into the 'safety' of rigid routines. We challenge what is offered by the eating disorder and begin to move towards being able to move towards being more spontaneous around food. The therapist leads from behind and is guided by the client in this process. Small achievable goals are set and these are expanded as the client feels ready. In cases of extreme low weight the input from a nutritionist is sought.

 

[Daniel E.]

21 Solution-Focused Techniques

 

[Daniel E.]

Perspective Change

A useful and simple way to help people (including yourself) is the technique of the perspective change. You visualize how the situation will be different and better when the goal has been achieved. With this technique you ask in essence: ”How will other people notice things will have become better?" A few examples:

- How would the customer notice our service orientation will have improved?
- How will other colleagues notice the conflict has been resolved?
- How will your manager notice this coaching will no longer be necessary?
- How will our competitor notice our company has become more competitive?

The perspective change helps people to get a broader perspective on themselves and their situation so that they can develop clearer goals.

 

[Daniel E.]

A softer, humbler version of the miracle question:

 

[Daniel E.]

 

[Daniel E.]

Example of the miracle question concerning social anxiety: