Using solution focused questions
Brief therapy is often (but not always) associated with the employment of solution focused questions. Which are designed to draw attention away from the problem state and towards desirable changes.
For example, a client with anxious thoughts might be asked if she is aware of a time when she was able to defuse from them.
A depressed client might be asked about days when his depressed mood was less noticeable than on other days.
Clients complaining of stress might be asked about moments when they managed it effectively.
The answers received can then be used to explore new ways to react to the problem when it appears. Promising clues can be worked up into a plan the client can follow in between sessions. Uncovering more solutions as progress is made with each success.
Understanding solution focused questions
A common misunderstanding is that solution focused therapy ignores clients’ problems and demands instead that they look at the answers. Sometimes Brief therapists can fall into this trap. Which risks trivialising the client’s suffering.
Before deploying solution focused questions the therapist first acknowledges the client’s distress and then carries out a detailed investigation of where, when, how and with whom the problem is experienced. For example:
A client worried about her alcohol consumption related that her drinking typically got out of control on evenings after work when she was with co-workers in a nearby bar. These drinks sessions were commonly viewed as a winding-down period in which people would relate their problems at work and exchange jokes about tough customers they had to deal with. As mutual bonding proceeded more and more rounds would be offered and accepted and the hours rolled by.
While the client was relating this scenario the therapist noted that, on evenings when she had something else to do, she would either refuse the invitation or cut short the session and leave early. Typically, having dinner with her partner, going to a meditation class, or meeting a friend. This led, later on, to an exploration of solutions that involved planning her evenings differently.
Solution focused questions are effective only when clients feel that their problems have been sufficiently understood. And they are ready to investigate how and in what way they can create changes that match their specified goals in therapy (the client above did not wish to stop drinking altogether; her goal was to to reduce her intake to safe limits and enjoy more alcohol-free evenings).
‘Solution focused questions’ might in fact be a misleading label for what is going on here. A better description might be:
Questions that draw attention to previously un-noticed experiences that indicate possibilities for improvement or change.
The solution focused questions below point to different ways of uncovering these possibilities.
Improvement questions
A favourite solution focused question of mine is to ask clients during their first session about changes they noticed before coming to see me. One version of this question is:
Have you experienced any improvements to X in between making this appointment and coming here today?
This question is based on research that indicates that attention to pre-treatment changes leads to better therapeutic outcomes. Just to ask this question implies that changes in experience happen every day. If the client is able to describe a beneficial change that creates the momentum for more change in therapy.
As therapy unfolds a slightly different question can be repeated over again for hopeful changes that occur between sessions, and that provide further clues to solution.
What changes have you seen over the past week that you would like to see more of?
Exception questions
This type of solution focused question examines experiences in which the problem was not present, or less frequent, or was not as bad as expected.
Typically, the mind over-estimates the frequency of the problem, or else over-generalises it. For example, a client could report that they experience panicky thoughts ‘all the time’, when they really mean it happens twice a day. Meaning that for most of each twenty-four hours panicky thoughts are either replaced by other thoughts, or the client is engaged in activities in which anxious thoughts do not appear. It is those thoughts and activities that contain clues to solution.
Sample questions include:
Are there ever times in which X does not appear as expected?
Can you recall a day when X was less frequent?
Have there been any days recently in which X was not as bad as you expected it to be?
(Follow up question)
What was different about you in those moments?
A client with long-standing depression who had been off work for five months, and who spent most of his time in bed, was asked about days when his depression was less worse than on other days. He recalled that on Tuesdays he had to get up earlier to let the cleaner in. Not wanting to go back to bed while the cleaner was in the house he usually took a walk to a cafe and read the newspaper. He recalled that he seemed to have more energy after that.
Noticing that this was an example of behavioural activation which broke up the depressed mood, his therapist suggested he try getting up 30 minutes earlier every morning to take a walk. This intervention proved successful in getting him to be more active, which led to further improvements as therapy continued.
Coping questions
These questions relate to unacknowledged strengths and resources that enable clients to cope with, or even overcome, difficult situations. They elicit information about what works, rather than what doesn’t work when dealing with life’s challenges.
They are most often employed with clients who are struggling with very stressful situations on a day to day basis for which there are no obvious ‘solutions’. Instead, the therapist will look for hidden strengths that prevent them going under. Coping questions work well if (and only if) the therapist first acknowledges clients suffering, and compliments them on their resilience.
Sample questions:
What enables you to keep going when things are tough?
What coping strategies do you use while X is going on?
What stops you from going under?
A client struggling to care for a mother with Alzheimers’ and a partner with severe disabilities, while working full time to pay the bills, described moments of exhaustion and despair on a recurring basis. At such times she had the thought that she was heading for a breakdown of sorts, and would often cry over it.
After first normalising her distress the therapist asked the third question given above.
Interestingly, her first response was that crying helped a bit. She was then asked the follow up question:
“How does that help you?”
Her response was that sadness kept things in perspective. That she could have some compassion for herself, and acknowledge that she was doing the best she could. Following on from that she would have the automatic thought ‘One day at a time…’ and she would then take a little time out for herself. She would often feel a lot calmer after this ritual.
Scaling questions
Solution focused questions of this type assist the client to consider how they can improve their performance when managing their problems, or expanding their capability.
Instead of asking, “Are you better?” the therapist asks,
On a scale from 0 to 10, where 0 is the problem at its worst, and 10 your perfect outcome where are you today?”
The number itself is not the point. What matters is the conversation it opens. A client who says “4” has already admitted the situation is not a 0. Therefore some solutions are already present. The next question invites investigation of what is working.
“What makes it a 4 and not a 3?
A client struggling with anger at home rated himself at 4. Asked why the score was not lower he related that he (eventually) walked away from an argument the day before with his teenage son, because he realised that continuing would only lead to escalation. Thus one solution lay in foreseeing the outcome of ventilating his anger.
Asked what a ‘5’ rating would look like he said that maybe pausing before saying anything about his son’s behaviour would help. Trying this became one of his assignments before his next session.
In this step-wise way therapy proceeds by experimenting with small changes that make a difference. Keeping those that worked, and discarding those that make little difference.
Evidence questions
This solution focused question focuses on what other people will notice when the client is doing well. For example:
What will your partner/friend/colleague notice about you when you are less X, or more Y?
When one client with stress-related problems was asked this question he did not have any answers but undertook to ask his wife. She told him later that she thought he would be “smiling more”. This got him thinking about periods when he did smile more, and he recalled that this usually happened after he finished tasks he had been putting off. On his next session he reported he had been more disciplined at work and his wife had complimented him on his smiles. This led, in turn, to more attention to his to-do list and improvements to his mental state.
This question works because it draws attention to small clues to solution which lie outside the client’s frame of reference. Most clients focus almost exclusively on the their experience of the problem. By asking clients to focus on what other people might be noticing about them when changes are made fresh possibilities are uncovered.
The Miracle Question
I have written about this solution focused question in another article here.
The Miracle Question is both theatrical and precise. The therapist asks:
Suppose tonight, while you are asleep, a miracle happens and the problem that brought you here is solved. Because you were asleep, you don’t know the miracle has happened. What will be the first small signs tomorrow that tell you something is different?
On the surface the question sounds fanciful. The reason it works is that it bypasses the client’s belief that change is difficult, complex, or blocked by others. By placing the transformation outside conscious effort, it removes the struggle with the problem state. The client is not asked how the change occurs, only how it would be recognised. That shift in attention moves from explanation to description; from pathology to observable behaviour; from frustration to change. Along the way a sense of agency can reappear.
A senior manager with potential burnout syndrome described relentless conflict with her team during meetings. Complaining that they contradicted her, argued between themselves and undermined her efforts to keep the peace, leaving her feeling exhausted. As a result she felt anxious before weekly meetings. When invited into the miracle frame, she reflected that she wouldn’t be bothered about conflicts and would feel a lot more light-hearted.
Pressed gently for further information on this miraculous state she said “I’d walk into next week’s meeting without rehearsing my counter arguments.” And what would others notice about her? “I’d listen longer. I wouldn’t cut people off. I’d be a lot more chilled out.”
Based on these small, specific, observable changes the rest of the session focused on preparing her for the next meeting. At the next session she reported that the meeting had, indeed, gone well in a way that surprised her.