b. Solution Focused Brief Therapy(SFBT)-Key Concepts, therapeutic process.

techniques and
procedure. - Shreya

Intro
Growing out of the strategic therapy orientation at the Mental Research Institute, solution-focused brief therapy
(SFBT) shifts the focus from problem solving to a complete focus on solutions. Steve de Shazer and Insoo Kim Berg
initiated this shift at the Brief Therapy Center in Milwaukee in the late 1970s. ’Hanlon and Weiner-Davis were
influenced by de Shazer and Berg’s original work, yet they expanded upon this foundation and created what they
called solution-oriented therapy.

Key Concepts
Focus is on the Solution not origin of problem:
Solution-focused brief therapy (SFBT) differs from traditional therapies as the therapists focus on what is possible
and have little or no interest in understanding the problem. De Shazer (1988, 1991) suggests that it is not necessary
to know the cause of a problem to solve it and that there is no necessary relationship between the causes of problems
and their solutions. Gathering information about a problem is not necessary for change to occur. In solution-focused
brief therapy, clients choose the goals they wish to accomplish, and little attention is given to diagnosis, history
taking, or exploring the problem.

Positive orientation:
Solution-focused brief therapy is grounded on the optimistic assumption that people are healthy and competent and
have the ability to construct solutions that can enhance their lives. An underlying assumption of SFBT is that we
have the ability to resolve the challenges life brings us. Berg believes clients are competent and that the therapist's
role is to help clients recognize their competencies
.
SFBT is a nonpathological approach that emphasizes competencies rather than deficits, and strengths rather than
weaknesses (Metcalf, 2001). The solution-focused model requires a philosophical stance of accepting people where
they are and assisting them in creating solutions.

Emphasis on what works:

The emphasis of SFBT is to focus on what is working in clients’ lives. SFBT focuses on finding out what people are
doing that is working and then helps them apply this knowledge to eliminate problems in the shortest amount of time
possible. De Shazer (1991) prefers to engage clients in conversations that lead to progressive narratives whereby
people create situations in which they can make steady gains toward their goals.

Basic Assumptions as given by Walter and Peller

Walter and Peller (2000) have moved away from the term therapy and refer to what they do as personal
consultation.

• Individuals who come to therapy do have the capability of behaving effectively, even though this effectiveness
may be temporarily blocked by negative cognitions. Problem-focused thinking prevents people from recognizing
effective ways they have dealt with problems.

• There are advantages to a positive focus on solutions and on the future. If clients can reorient themselves in the
direction of their strengths using solution-talk, there is a good chance therapy can be brief.

• There are exceptions to every problem. By talking about these exceptions, clients can get control over what had
seemed to be an insurmountable problem. The climate of these exceptions allows for the possibility of creating
solutions. Rapid changes are possible when clients identify exceptions to their problems.

• Clients often present only one side of themselves. Solution-focused therapists invite clients to examine another
side of the story they are presenting.

• Small changes pave the way for larger changes. Oftentimes, small changes are all that are needed to resolve
problems that clients bring to therapy.
• Clients want to change, have the capacity to change, and are doing their best to make change happen. Therapists
should adopt a cooperative stance with clients rather than devising strategies to control resistive patterns. When
therapists find ways to cooperate with people, resistance does not occur.

• Clients can be trusted in their intention to solve their problems. There are no “right” solutions to specific problems
that can be applied to all people. Each individual is unique and so, too, is each solution.

Therapeutic Process

Goals
Goals are unique to each client and are constructed by the client to create a richer future. Solution-focused therapists
concentrate on small, realistic, achievable changes that can lead to additional positive outcomes. Solution-oriented
therapy offers several forms of goals: changing the viewing of a situation or a frame of reference, changing the
doing of the problematic situation, and tapping client strengths and resources.

As soon as individuals learn to speak in terms of what they are able to do competently, what resources and strengths
they have, and what they have already done that has worked, they have accomplished the main aim of therapy

Walter and Peller (1992) emphasize the importance of assisting clients in creating well-defined goals that are (1)
stated positively in the client’s language, (2) are process- or action-oriented, (3) are structured in the here and now,
(4) are attainable, concrete, and specific, and (5) are controlled by the client.

Role of Therapist
Solution-focused brief therapists adopt a not-knowing position to put clients in the position of being the experts
about their own lives. Therapists do not assume that because they are experts, they know the significance of the
client’s actions and experiences. Therapists have expertise in the process of change, but clients are the experts on
what they want changed. The therapist’s task is to point clients in the direction of change without dictating what to
change. Therapists create a climate of mutual respect, dialogue, inquiry, and affirmation in which clients are free to
create, explore, and co-author their evolving stories.

Therapeutic relationship
De Shazer (1988) has described three kinds of relationships that may develop between therapists and their clients:
1. Customer: the client and therapist jointly identify a problem and a solution to work toward. The client realizes
that to attain his or her goals, personal effort will be required.
2. Complainant: the client describes a problem but is not able or willing to assume a role in constructing a solution,
believing that a solution is dependent on someone else’s actions. In this situation, the client generally expects the
therapist to change the other person to whom the client attributes the problem.

3. Visitor: the client comes to therapy because someone else (a spouse, parent, teacher, or probation officer) thinks
the client has a problem. This client may not agree that he or she has a problem and may be unable to identify
anything to explore in therapy.

Rather than categorizing clients, therapists can reflect on the kinds of relationships that are developing between their
clients and themselves. How the therapist responds to different behaviors of clients has a lot to do with bringing
about a shift in the relationship. In short, both complainants and visitors have the capacity to become customers.

Length of Therapy
Because SFBT emphasizes present-oriented efficient treatment that seeks solutions to specific concerns, treatment
usually requires fewer than 10 sessions with an average treatment length of between 3 and 5 sessions. Clinicians do
not hesitate to extend treatment as long as positive change and forward movement are evident.

Steps:
Walter and Peller (1992) describe four steps that characterize the process of SFBT: (1) Find out what clients want
rather than searching for what they do not want. (2) Do not look for pathology, instead look for what clients are
doing that is already working and encourage them to continue in that direction. (3) If what clients are doing is not
working, encourage them to experiment with doing something different. (4) Keep therapy brief by approaching each
session as if it were the last and only session.

SFBT typically proceeds according to seven stages (de Shazer, 1985):

1. Identifying a solvable complaint: Clients are given an opportunity to describe their problems. The therapist listens
respectfully and carefully as clients answer the therapist’s questions. Clinicians might ask, “What led you to make
an appointment now?” Or “What do you want to change?”. Like other behaviorally oriented clinicians, solution-
focused therapists often use scaling questions to establish a baseline and facilitate identification of possibilities and
progress

2. Establishing Goals: The therapist works with clients in developing well-formed goals as soon as possible. The
question is posed, “What will be different in your life when your problems are solved?” Clinicians collaborate with
clients to determine goals that are specific, observable, measurable, and concrete. Goals typically take one of three
forms: changing the doing of the problematic situation; changing the viewing of the situation or the frame of
reference; and accessing resources, solutions, and strengths. One of the most useful ways for solution-focused
clinicians to establish treatment goals is to use the miracle question which is explained later.

3. designing an intervention: clinicians draw on both their understanding of their clients and their creative use of
treatment strategies to encourage change, no matter how small. The therapist asks clients about those times when
their problems were not present or when the problems were less severe. Clients are assisted in exploring these
exceptions, with special emphasis on what they did to make these events happen.

4. Strategic tasks then promote change. These are generally written down so that clients can understand and agree to
them. Tasks are carefully planned to maximize client cooperation and success. People are praised for their efforts
and successes and for the strengths they draw on in completing tasks.

5. Positive new behaviors and changes are identified and emphasized when clients return after they have been given
a task. At the end of each solution-building conversation, the therapist offers clients summary feedback, provides
encouragement, and suggests what clients might observe or do before the next session to further solve their
problems.

5. The therapist and clients evaluate the progress being made in reaching satisfactory solutions by using a rating
scale. Clients are asked what needs to be done before they see their problem as being solved and also what their next
step will be.

6. Stabilization is essential in helping people consolidate their gains and gradually shift their perspectives in more
effective and hopeful directions. During this stage, clinicians might actually restrain progress and predict some
backsliding. This gives people time to adjust to their changes, promotes further success, and prevents them from
becoming discouraged if change does not happen as rapidly as they would like.

7. Finally, termination of treatment occurs, often initiated by the clients who have now accomplished their goals.

Techniques and Procedures

ESTABLISHING A COLLABORATIVE RELATIONSHIP: It is important that therapists actually

believe that their clients are the true experts on their own lives. All of the techniques must be implemented from the
foundation of a collaborative working relationship. Clinicians create an environment that is conducive to change.
Tone of voice, metaphorical stories, and suggestions embedded in discussions promote such a state. This enables
people to become more open to new possibilities and interpretations, more creative, more amenable.

PRETHERAPY CHANGE Simply scheduling an appointment often sets positive change in motion. During the
initial therapy session, it is common for solution-focused therapists to ask, “What have you done since you called for
the appointment that has made a difference in your problem?” (de Shazer, 1985, 1988). By asking about such
changes, the therapist can elicit, evoke, and amplify what clients have already done by way of making positive
change.
EXCEPTION QUESTIONS SFBT is based on the notion that there were times in clients’ lives when the
problems they identified were not problematic. These times are called exceptions and represent news of difference
(Bateson, 1972). Solution-focused therapists ask exception questions to direct clients to times when the problem did
not exist, or when the problem was not as intense. Exceptions are those past experiences in a client’s life when it
would be reasonable to have expected the problem to occur, but somehow it did not. This exploration reminds
clients that problems are not all-powerful and have not existed forever.

THE MIRACLE QUESTION Therapy goals are developed by using the miracle question, which is a main
SFBT technique. The therapist asks, “If a miracle happened and the problem you have was solved overnight, how
would you know it was solved, and what would be different?”

This process of considering hypothetical solutions is based on the belief that changing the doing and viewing of the
perceived problem changes the problem. Clients are encouraged to allow themselves to dream as a way of
identifying the kinds of changes they most want to see. This question has a future focus in that clients can begin to
consider a different kind of life that is not dominated by a particular problem.

SCALING QUESTIONS Solution-focused therapists also use scaling questions when change in human
experiences are not easily observed, such as feelings, moods, or communication. with zero being how you felt when
you first came to therapy and 10 being how you feel the day after your miracle occurs and your problem is gone,
how would you rate your anxiety right now?

FORMULA FIRST SESSION TASK The formula first session task (FFST) is a form of homework a
therapist might give clients to complete between their first and second sessions. The therapist might say: “Between
now and the next time we meet, I would like you to observe, so that you can describe to me next time, what happens
in your (family, life, marriage, relationship) that you want to continue to have happen”. This kind of assignment
offers clients hope that change is inevitable. It is not a matter of if change will occur, but when it will happen.

SOLUTION TALK is an important tool in SFBT. Clinicians choose their words carefully so that they increase
clients’ hope and optimism, their sense of control, and their openness to possibilities and change. The focus is on
solutions, not problems. Some examples of how language can be used to enhance treatment follow:
Solution Talk
• Emphasize open questions.
• Use presuppositional language that assumes that problems are temporary and that positive change will occur.
• Externalize the problem. For example, clinicians might ask “How long has that problem been
controlling your life?
• Normalizing people’s problems provides reassurance and can reduce feelings of inadequacy.
• Focus on coping behavior via questions such as “What has kept you from harming yourself?”
• Reinforce and notice strengths and successes. Congratulate and compliment people for their improvements and
efforts
• Use inclusive language such as “and” that allows potentially incompatible outcomes to coexist. Eg. “You might
feel like you can’t do it, and you can do it”
• Create hypothetical solutions such as “If you weren’t feeling afraid, what might you be feeling and doing instead?”
This expands possibilities and encourages change.
• Concentrate on describing and changing behaviors rather than thoughts or emotions.
• Use rituals, metaphors, stories, and symbols to convey indirect messages that can promote change.
• Use reframing and relabeling to offer different perspectives.
• Match clients’ vocabulary or style of talking to promote a collaborative therapeutic alliance.

VIDEOTALK INVOLVES encouraging people to describe their concerns in action terms, as though they are viewing
themselves in a film. They might even imagine themselves in a theater, watching the action related to their problem
on the screen, and holding a remote control that can change the volume, stop the action, modify the size and
intensity of the picture, and even shut off the film. Once the action has been described, clinicians can suggest
alterations in the action that are likely to effect positive change. Videotalk gives people a new perspective on
their problems, helps them distance themselves from their problems, and allows them to view
the problems more objectively

Complaint pattern intervention.

• O’Hanlon and Weiner-Davis (1989) suggest many approaches to helping people get “unstuck,” modify unhelpful
patterns, and move forward, including changing the frequency or rate of an undesired behavior, changing its
duration, changing the timing, changing the location, changing the sequence, and adding or subtracting at least one
element in a sequence of behaviors. Eg. One might cry for 1 hour and then take a walk before crying for the second
hour.

THERAPIST FEEDBACK TO CLIENTS Solution-focused practitioners generally take a break of 5 to 10

minutes toward the end of each session to compose a summary message for clients. There are three basic parts to the
structure of the summary feedback: compliments, a bridge, and suggesting a task.

Compliments are genuine affirmations of what clients are already doing that is leading toward effective solutions. a
bridge links the initial compliments to the suggested tasks that will be given. The bridge provides the rationale for
the suggestions. suggesting tasks to clients, which can be considered as homework. Observational tasks ask clients
to simply pay attention to some aspect of their lives. This self-monitoring process helps clients note the differences
when things are better, especially what was different about the way they thought, felt, or behaved.

• Solution prescriptions, a common form of suggestion in SFBT, are tasks designed to help people discover ways to
resolve their concerns. These may be designed to fit a particular person or situation or may be a standard
prescription in the clinician’s repertoire. Commonly used prescriptions include “Do one thing different,”

TERMINATING From the very first solution-focused interview, the therapist is mindful of working toward
termination. Once clients are able to construct a satisfactory solution, the therapeutic relationship can be terminated.
Prior to ending therapy, therapists assist clients in identifying things they can do to continue the changes they have
already made into the future (Bertolino & O’Hanlon, 2002). Clients can also be helped to identify hurdles or
perceived barriers that could get in the way of maintaining the changes they have made. Guterman (2006) maintains
that the ultimate goal of solution-focused counseling is to end treatment.

Limitations
Unless clients and clinicians carefully co-create problem definitions, the approach can cause clinicians to focus
prematurely on a presenting problem and thereby miss an issue of greater importance.

Solution-focused treatment is not usually appropriate as the primary or only treatment for severe or urgent emotional
difficulties or when clients do not have the skill or internal resources to cope with their problems. If it’s the only
treatment given, people may fail to receive the intensive treatment they need.

In addition, its implementation appears easier than it is. In reality, this approach requires well-trained clinicians who
are skilled and experienced in assessment, goal setting, treatment planning, and effective use of a range of creative
and powerful interventions.

Strengths
It is effective and efficient with a broad range of problems, is generally well received by clients, is encouraging and
empowering, and offers new ways of thinking about helping people.

It addresses immediate problems while enabling people to make better use of their strengths and resources in
addressing future difficulties.

Many clinicians and clients now believe that treatment need not be prolonged and costly to be effective. SFBT also
has provided clinicians with powerful new interventions. Its use of the miracle question, its emphasis on exceptions
and possibilities, its use of presuppositional and other solution-focused language, and its emphasis on small
behavioral changes are innovative concepts that are changing the way many clinicians think about and provide
treatment.