What is solution-focused therapy?
In solution-focused change we move from problems to possibilities and solutions. First establishing the goals for change, then exploring existing solutions, before looking at possibilities for improvement. While problems are taken seriously, the focus is not on problem analysis but on creating new directions.
The whole approach is based on the premise that most clients already have the skills, resources, opportunities and solutions required to overcome their problems. All that is required is to bring these to their conscious attention.
Solution-focused change revolves around open-ended, solution-oriented questions. In what follows, each intervention is based on a specific question.
Solution-focused goals
On first meeting my client I like to use an open-ended question: What would you like to achieve in these sessions?
I encourage my client to answer in terms of what could be thought, seen, heard and activated when the desired changes are accomplished, building up a complete picture of what success might look like.
If (as frequently happens) the client answers the question by detailing what they don’t want – e.g. ‘I want to stop feeling anxious’ I follow up with another goal-related question:
“What will you be doing/thinking/feeling when you are no longer anxious?”
Example: A client seeking help with social phobia related how he would feel relaxed when meeting people, courageous when engaging in conversation, and focused on other people rather than on his worries. This formed the basis of a plan that included relaxation methods, developing ‘courage’, and thought defusion.
Distinguishing between goals people can influence, and those they can’t
Sometimes expressed goals relate to matters that are beyond the client’s influence. Where realistic goals can be identified the focus turns towards things the client can do to achieve them. Where the problem is beyond the client’s control, the focus turns towards problem acceptance and the search for coping mechanisms.
For example, one client complained that her elderly father was often cantankerous and unreasonable when she visited. Since her father had always been irritable as long as she could remember, and had recently been diagnosed with dementia change here seemed unlikely. She was asked:
“What would help you the most around your father when he is this way?”
She replied that in the past it had helped her when she reminded herself that he had always cared for her, that she loved him, and that he was now an old and sick man. Moreover, that he might not have long to live.
The follow up question was:
“When you have those thoughts, what is the difference in you?”
To that she replied she was more patient and, sooner or later, he would either calm down or she would take the next opportunity to change the subject.
Exploring personal resources
Prior success questions
These relate to improvements already noticed, or prior success in managing the problem. Bearing in mind that many clients show improvement in between making their first appointment and attending for it.
“Have you noticed any signs of improvement before coming to see me today?”
Or:
“What’s already working? What helps you when the problem appears?”
Example: A client suffering from stress reported that, after making an appointment to see me she read some articles on this website and listened to some mindfulness tapes. As a result she felt noticeably calmer over the three days prior to her first session. This led to a discussion on how regular mindfulness practice would counteract her agitated state.
Exception questions
These questions are also useful when the client is pre-occupied with the problem state.
“Has there ever been a time when you were able to get out of that state?” Or:
“Have there been any times when things were better than you expected them to be?“
With a follow up question if the answer is in the affirmative: “What were you doing differently then?”
Example: A depressed client related how she felt less depressed on Tuesday and Friday mornings, when she worked in a food bank charity. This led to a discussion on how she might expand her activities (in the food bank and elsewhere) to other mornings and afternoons.
Skills-based questions
All clients have skills, resources, habits, possibilities and existing solutions which can be mobilised in the service of solution-focused change. Some of these resources may not be apparent to the client, for they may exist in other areas of life which are not connected directly to the problem.
For example, one client with troublesome children complained that they rarely did what she asked them to do. When asked:
“Have you ever found that you could get other people to do what they didn’t want to do?”
She recalled that in her hair-dressing salon she could persuade her clients to take a more expensive service if she clearly explained the benefits (as well as the real cost-savings) for doing so. This insight led to a plan in which the tasks she set her children came with a careful description of the rewards that might follow. She later reported that her children had been surprised at the change in her delivery, and listened with more care as a result. Although she wasn’t always successful with this tactic, their bedrooms were tidier than they had been for some time.