The Method of Solution Focused Therapy - Essay Example

?Running Head: SOLUTION FOCUSED THERAPY Solution Focused Therapy Solution Focused Therapy Introduction Solution focused therapy, orbrief therapy, is a method that engages the client for a specific problem or set of problems. While most therapy is concerned with the past and in working through problems on a comprehensive level, solution focused therapy is accomplished over a short period of time with a goal at its core. Solution focused therapy is not as interested in the past as it is in the future. The solutions focused therapy model is established through the first meeting where the goal is established and the steps towards that goal are explored. The point of this therapy is to be a short period of time in which goals are reached with the hope that through solving one major problem, smaller problems can be resolved. The following paper will explore the method of solution focused therapy through first presenting an overview of its history and basic concepts, and then going through the principles of the model and how it is related to the theory of change. The method will be contextualized through family therapy and through examples that are given so that the model can be understood in relationship to real world applications. The intention is to create a comprehensive look at the solutions focused therapy model and to examine what benefits clients and therapists can gain from using this method. Solution Focused Therapy Solutions focused therapy was first defined by Steve de Shazer and Insoo Kim Berg at the Brief Family Therapy Centre which is located in Milwaukee, Wisconsin in the United States (MacDonald, 2011). The therapy was developed in order to address more specific problems that were not always the focus of general psychotherapy sessions. The long term therapies were often not focusing on the immediate problems that needed to be attended and changed rather than being worked on in long termed therapy that was leaving clients lingering in the state at which they had arrived into therapy for much longer than necessary. Solutions focused therapy is very different than most models of traditional psychotherapy. Gurman (2008) writes that “solutions focused therapy is a ‘post-structural revision...it is an antipathologizing, utilitarian view that emphasizes the use of language (or conversation) in the social construction of reality” (p. 282). It is not about talking about philosophy or technique, but about being proactive and creating meaningful solutions through active participation in life. Through resources that are available and not theoretical, the client finds their solutions usable and productive. Cochran and Pillai (2009) describe solution focused therapy as “a strengths-based approach, emphasizing the resources people invariably possess and how these can be applied to the change process” (p. 234). A solutions focused therapy is concerned with taking the truth of what exists and looking at it through the perspective of the tools that a person possesses and how they can create change or accept what cannot be changed. The purpose of the therapy is to focus on specific problems that can be addressed in order to create a better situation on the whole. Solution focused therapy, or solution focused brief therapy is often simply referred to as brief therapy. This type of therapy is designed to have goals that are attainable, the solutions to problems being a resolution concept. Brief therapy came into fashion in the 1980s and although some models appear to be part of other forms of therapy, such as cognitive or psychodynamic, brief therapy is really not a shortened form of a longer model of therapy. The success of brief therapy has been reported, especially when the client is motivated to change. The desire to change is at the core of creating solutions based therapeutic change. Without motivation, it is difficult for any therapy to work, but the motivation to put solutions into practice is essential in creating change in this model of therapy (O’Connell, 2012, p. 1). There is some fear among therapists from many of the different schools of thought that any quick solution to a problem is not a genuine solution. The dynamic work that is done through solutions focused therapy often requires daily interventions over a brief time then some follow-up weekly visits. O’Connell (2012) suggests that in some instances, weekly visits are enough as long as the work done at home is honed at each weekly visit. The benefits of brief therapy are that it focuses in on a specific area of problems and then systematically removes the obstacles that are creating the problems. This can mean that resolutions to the problems can come very quickly. Sharry (2011) presents the use of brief therapy as a group model in which groups are gathered through which shared problems are focused on with solutions presented. Sharry (2011) writes “solutions focused group work aims to establish collective and mutually beneficial goals and to harness the group’s resources and strengths towards empowering members to make realistic steps towards these goals in the short term” (p. 3). Through this sense of collaboration, shared problems became shared goals, providing insight from a number of different perspectives. However, it is often that a single solution will fit the various problems that are all shared by the group which can then be used to gain change. There is a story told by Sharry (2011) in which God comes to a Rabbi and asks him if he wants to see Hell. He opens a door and in the room is a cauldron full of food in the center with a group of people in a circle around the cauldron. The spoons they have are long enough to reach the food, but too long to be retracted in order to eat the food so they starve. God shuts that door and asks if the Rabbi would now like to see Heaven. In the next room the same set up is seen, but the people are all happy and fed. They have all learned how to feed one another. This is symbolic of how group based brief therapy can work. The differences that exist between solutions focused therapy and traditional psychotherapy are that the history of the client is not necessarily relevant, clients have presented a problem and have resources for implementing change and the will to make changes. Traditional therapy tends to take a wide view of the problems and create comprehensive improvements over a long period of time while solutions focused therapy is looking to create very precise changes in order to get the client to a more productive or peaceful state. Through examining solutions that are aimed at solving problems, the hope is that change will begin to roll through the other problems that the client experiences. Model of Therapy in Clinical Work There are certain assumptions that are made in order to develop the relationship between the therapist and the client. The first basic assumption is that the client is motivated to change and has the means for change. The second set of assumptions will be developed through descriptions. Descriptions are small steps that assume there is a problem and that there is a solution available to solve the problem. They also assume that something new will begin rather than there will be efforts to stop something. The goal is to be transformative rather than to try to end some form of behaviour. What is avoided is blame and talk about motives for the poor behaviour and the purposes behind the behaviour are avoided. Rather than focusing on the negative, the talk between the therapist and the client is based on the future and how behaviour will change in the future. The basic model of solutions focused therapy is the following: the use of the ‘miracle question’, scaling questions, and then compliments with the addition of homework tasks after these basic concepts have come to defining a goal. The miracle question is the centre of how to start to envision solutions. The miracle question poses the idea of a miraculous solution and asks the client to describe that solution. The question might sound something like ‘if the problem were solved miraculously overnight, what would it look like?’ The miracle question poses the end of the problem so that the task will be to fill in the steps that would get to the solution to the problem without the miracle (Rasheed, Rasheed, & Marley, 2010). There are two approaches that are essential in solutions focused therapy. The first is the technical aspect in which the tools of the therapy are used. The second is the human element in which the questions are weaved into the conversations between the client and the therapist, the questions forming a structure through which to find success. The miracle question and the scaling questions form a mould in which to create the therapeutic experience. The first step of the therapeutic model is the interview. During this interview basic questions are asked in which the problem is defined as well as the goals. These are brought into the session by the client. One of the main differences between brief therapy and other models is that the client presents the problem and the focus of the sessions is on the problem that has been presented by the client. The first session can be joined in by family and friends, but all of the family does not need to be present. This is different than the normal family sessions that are undertaken in psychotherapy which usually involves all family members whether they choose to be there or are forced by family based authority, such as a teenage child attending because a parent has demanded it. Another point to make is to ask during the first session what changes have been made before beginning therapy (MacDoncald, 2011). One of the key ways in which to form a bond with the client is to repeat what they say back to them in order to both validate an understanding of what they are saying and to create empathy with their situation. Strategic therapy concepts suggest that it is far more useful to use the name a client uses for a problem than to correct them with a name that is professional for the problem. The point is to not alienate the client. Language, both verbal and non-verbal are the keys to establishing a working rapport with the client in order to create solutions for the problems they have brought (Olavi Lindfors, Knekt, Virtala, & Laaksonen, 2012). Key problem questions are helpful in defining when, where, who, and how the problem occurs. The point of the therapy is to zero in on a definable problem and in order to define the problem; there must be key defining moments that are revealed. Once the client has been made comfortable with the therapist the motivation that they brought with them for change will lead them to answer these questions. The incident in which the problem occurs is as important as being able to describe the behaviour and the behaviours around the incidents while it is occurring. It is possible that the description will not be clear the first time it is described. Questions that suggest ‘watching’ it in the mind’s eye like a video and describing it are useful in creating a proper picture and description of the problem (MacDonald, 2011). One of the most common problems with beginning this type of therapy is that clients will say they have a great many problems and they do not know where to start. Brief therapy needs to be focused on one problem at a time. The great benefit that occurs is that when one problem is solved, the rest of the problems seem to become solved as they cascade from the solution from that one major problem as it is fixed. Clarifying the first problem is the way in which to find out which problem takes the priority. When that first problem is solved, it is likely that the other problems stem from it and will resolve themselves (MacDonald, 2011). The centre of the therapy is to find a goal. The goal needs to be reasonable and achievable through solutions that will provide for ways in which to address the problem. A specific goal, however, may not be the description of the goal. As an example, if a couple is arguing all of the time, then the questions that will be asked of them will be whether or not they believe that they will really never argue with one another again. The truth is that the goal of never arguing again cannot be a reasonable goal to attain (Sharry, 2011. The non-specific goal of finding away to manage arguing or lessoning the arguing can be used to define what the end result will be. The desired result may be to find peace within the situation so that the upset is not prolonged. The question that may be more relevant to setting the goal is to ask what will be the difference when the work is done (MacDonald, 2011). Another part of the model is to ask scaling questions. Scaling questions, MacDonald (2011) writes “help the client move from all-or-nothing goals towards less daunting steps” (p. 18). Scaling takes what seems like unattainable goals and creates more narrowed ideas through which to succeed at creating solutions. Part of what this model of therapy accomplishes is to make what seems overwhelming and undoable scaled down to what can be accomplished. Through exploring the questions and goals with the client, the therapist has the opportunity to help the client create a manageable plan for accomplishing workable goals (Gingerich & Eisengart, 2000). One of the aspects of the model that can be utilized for professional use is that it has the capacity to provide for deeper trust between clients and therapists. While clients who need longer based therapy should still be approached through traditional methods, creating short term successes can create a bond that will promote deeper therapy with the client sooner than other methods might provide. These methods have been shown to support more creative relationships between clients and therapists. Through developing solution focused brief therapy skills, professionals in not only the field of therapy, but in many medical fields, can create a method of creating bonding and relationships with patients and clients (Smith, 2010). Theory of Change What must first be understood is that solutions focused therapy does not include an explanation of how change occurs (Gurman, 2008). What does occur during solutions focused therapy is that clients find that they have a new understanding of the resources that they have available to them and how they can be utilized to find solutions for their problems. The awareness is not the same as insights. Clients do not find revelations from the past that inform them on the future. What they find is that they become aware of their present and the many ways in which their lives are developed through what they have to use for solutions to their problems (Ryan, Lynch, Vansteenkiste, & Deci, 2011). The theory of change that emerges is that through focusing on the one problem, life becomes more manageable and change becomes a consequence of the work. The client and the therapist go on a journey to change the one thing that is at the highest risk of defining life in a direction that is not conducive to the best possible life that the client can lead. There are a number of ways in which this type of focused short term therapy can make great changes in life. Through finding that one problem that is at the core of all of the other problems, or a manageable problem that leads to reducing that main problem, lives can see meaningful change. The role of the therapist is uniquely affected in solutions focused therapy. The first way in which ti is affected is through the communications process. The communication process and the importance of language in this form of therapy creates an opportunity for the professional to create a way in which to relate to their client on a level that retains the professional barrier, but allows the professional to be a part of the experience. The struggles, hardships, and joys of success are all a part of the professional experience when they are collaborating on creating change for the client. As Smith (2010) suggests, it is essential for the relationship of the professional go the client for solutions focused therapy to be shared with mutual goals that have been taken on by the client. Marriage and Family Therapy Marriage and family therapy can see great benefits from brief therapy. Through using the solutions focused model, problems within the family can be addressed through forward motion, the members of the family looking towards solutions that are defined by the most basic problems that can be resolved. Through finding the one change that the family would like to see, through constructive and meaningful dialogue, the family can come together to use their resources to see that problem resolved. Solution focused therapy is highly useful for family therapy in that mutual problems can be resolved through the development of bonds that are created by using resources together in order to solve the problem. As stated previously, it requires that there is also mutual motivation otherwise the resistance of other members will result in diminishing the rate of progress. The use of solutions focus therapy allows for the therapist to engage in productive forward motion rather than concentrating on revisiting past transgressions and rehashing all of the resentments and histories that are impeding progress forward. The point is to find a way forward (Wampler, 2010). One of the biggest problems within a family is that the past is ever present in the developments that occur contemporarily. The complexity of a family is based on its history so it can be difficult to move past those problems and into solutions. If the family can be moved into solutions then most of the problems of the past can be reconstructed for the present so that they can be used productively rather than in a cycle of reactionary results that keep problems stagnant. Productivity in the brief therapy process means living in the present and letting go of the past or using it for the benefit of the future. In the case of a couple, the two people will work on their problems through examining what triggers change their sense of contentment into frustration and working on not setting off those triggers. Often it is the language with which they communicate that is the problem. Gingerich and Eisenrich (2000) discuss how couples are given tasks through tools and games through which they can begin to change their behaviours towards one another. One example of this comes from a couple who was fighting all of the time. Through the initial interview, the therapist was able to determine that they were not really getting upset about issues, but about the way in which they talked to one another about the issues. Most of the time, they agreed on their decisions but did not realize they were doing so. In order to work with the couple, they were given the task to use a jar in which to put money whenever either one of them used words or phrases that they considered to trigger anger. While the jar became fairly full, eventually they learned to laugh about the use of those terms and used them less frequently. Gingerich and Eisenrich (2000) found that empirical research on the outcomes of family sessions using the solutions focused approach were positive and provided for shorter durations of periods of therapy with more tangible results that could be measured by the accomplishment of goals. Gingerich and Peterson (2013) undertook an examination of a variety of empirical studies on the topic of solution focused brief therapy. Through looking at forty-three studies on the topic 74% of the studies showed positive benefits from the use of solution focused brief therapy. Of the studies reported by Gingerich and Peterson (2013) 23% positive trends and the strongest evidence was or depressed adult clients. Four of the studies found that solutions focused therapy was a solid alternative to well-established treatments. Solution focused therapy was shown to take less time in treatment and that it had strong potential for having better results than many traditional therapies where both behavioural and psychological outcomes were concerned. Gingerich and Peterson (2013) suggest that because of the lower number of sessions required, the solutions focused therapy model will also cost less than will traditional models. Summary of Research The development of solutions based research is defined by the use of language as a means of creating a relationship between the client and the professional so that they can work on mutual goals towards solutions to problems. The use of the miracle question provides a vision of the end result. By using scaling questions, the practitioner is able to help form the problem into a manageable situation in which a solution can be accomplished. The use of compliments provides the practitioner with a way in which to get to the resources that can be used by the client to solve the problem. Through dialogue and task assignment, the theory of solutions focused therapy shows a way in which to solve the issues that the client has presented to the therapist. The empirical research supports solutions focused therapy. Smith (2010) found that practitioners of various types were better able to build bonds with clients or patients when using a solution focused approach. Gingerich and Eisengart (2000) found that in family practice the use of solutions focus therapy had higher levels of measurable outcomes while in a review of empirical literature, Gingerich and Peterson (2013) found that positive benefits and trends were measurable and proven to be accomplished through solutions focused therapy. The issues that may be present in relationship to solution focused therapy are that because the past is not a part of the therapeutic process, the causes of some behaviour may not be fully addressed. This could lead to falling back into old habits. The issues that are addressed are in context with the present, but they are also in context with the history of the client. It may be necessary to discuss relevant history and to look at problems that it causes in order to set up manageable goals. Without placing the issues in context, the goals cannot be reached independently without revising how those goals will eventually be processed into the life skills and established habits of the individual. Examples Lichik (2011) presents an example of how the solutions focused therapy model can be used for a family. The family in question consists of a mother and a father with sons, age 14 and 12. One of the sons, the fourteen year old, has been having some problems with defiant behaviour and truancy. The mother instigated the desire to do whole family therapy. There have also been some problems with the boy and his friends breaking into school mailboxes. It turns out that the boys have been sending for porn materials and picking them up in the mailboxes of the neighbors. The biggest conflict between the way in which the parents viewed the situation and the way in which the child viewed is that the parents believed that the child had given up on himself and the child believed that the parents had given up on him. When the child spoke, he indicated he was still doing well in class and that he was looking forward to doing well so that he could go to college. He did not believe, however, that his parents saw this in him. The way in which to use solutions focused therapy was to see the primary problem that was causing disharmony in the family and to focus on that problem. While the boy had already stopped with the mailbox scheme and was going to school more often, the real problem was that the mother and father no longer had trust and that caused the mother to constantly check up on him. The problem to focus on was not the progress of the boy as it might seem because he was already working on changes, but to rebuild the trust in the family and particularly the over worry of the mother. In this case, a specific goal could not be named, but the generalized feeling of the goals could be addressed. Tools are often used in creating solutions. An example that is provided by Nelson (2010) shows something that is called Respect Bingo helped another family in finding how the problems in the family manifested. Nelson (2010) writes that “Playing Respect Bingo proved a productive way of holding solution-focused conversations with this family about the key behaviors that needed to be developed as part of a family safe-care plan” (p. 130). The family members all took on a goal of respect to work on during the week. The children took on the goal of doing what they were told without reminders. They competed between them which made it a game. The father in the family was tasked with listening more. He had been accused of interrupting when others spoke, not listening to the full conversation before making his judgments. Individual problems can benefit from solutions focused therapy as well. People with anxiety can set goals about those things that make them anxious and work on them through tasks and assignments from their therapist. An example of working with an individual who has anxieties in life might be to work with them on scales of anxiety. In order to understand why an anxious situation goes from a level 3 to a level 4, as an example, the therapist will ask what action occurs that changes the level of anxiety. Through focusing on that change and trying to find solutions so that the anxiety level does not change and go up, the therapist and the client are working towards real life solutions to the problem of the anxiety. The goal would be to take that change in circumstances and work towards discovering why it has an impact and how to lessen or eliminate that impact. Conclusion The solutions focused therapy model is a way of working towards solution for the future rather than dwelling on a past that is unchangeable. While there is not a specific attached theory of change, the goal is change through looking at issues as manageable problems that can be modified through tasks that lead to an ultimate goal. Empirical evidence supports the success of the use of solutions focused therapy and while there is some criticism from those who support traditional long term therapy, the results of brief therapy has far more tangible and measurable outcomes. Not all problems can be solved through solution focused therapy, however, the influence that it has had on people with depression and on families supports its use when possible. Resources Connie, E., & Metcalf, L. (2009). The art of solution focused therapy. New York: Springer. Corcoran, J., & Pillai, V. (2009). A review of the research on solution-focused therapy. British Journal of Social Work, 39(2), 234-242. Gingerich, W. J., & Eisengart, S. (2000). Solution?Focused Brief Therapy: A Review of the Outcome Research. Family process, 39(4), 477-498. Gingerich, W. J., & Peterson, L. T. (2013). Effectiveness of Solution-Focused Brief Therapy: A Systematic Qualitative Review of Controlled Outcome Studies. Research on Social Work Practice. 10, 31-41. Gurman, A. S. (2008). Clinical handbook of couple therapy. New York: Guilford Press. Lipchik, E. (2011). Beyond Technique in Solution-Focused Therapy: Working with Emotions and the Therapeutic Relationship. 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