Solution focused brief therapy

What is Solution focused brief therapy?

Solution focused brief therapy (SFBT) is a goal-oriented form of therapy developed in the 1970s. It focuses on utilising (or developing) strengths, resources and possibilities available to the client in making improvements to mental health and life-problems. It is a collaborative approach, in which clients and therapists work together on promoting change, rather than getting stuck in problem analysis. SFBT typically works over 3-10 sessions and research shows that the approach was significantly effective in nine out of ten controlled trials.

Solution focused brief therapy is an accessible, affordable alternative to expensive long-term therapy.

Origins of Brief therapy

In the 1950s behavioural psychologists like Joseph Wolpe developed a form of treatment known as behavioural modification still in use today. The emphasis was on changing what people did rather than what they imagined, thought or felt. For example, some types of anxiety can be resolved through exposure therapy: teaching people to tolerate discomfort while gradually increasing the length of time they spend in anxious situations.

In the 1960s cognitive psychologists like Joseph Beck added thought change techniques to the repertoire of tools, thus developing Cognitive-Behavioural therapy. Originally developed for the treatment of depression the average number of sessions in CBT is 9 sessions. Thus making CBT a type of brief therapy.

In the 1940s Milton Erickson, an American psychiatrist, developed a form of brief therapy utilising hypnotic suggestion, behavioural modification, reframing and changes to self-image that were effective for a wide range of psychiatric disorders. It was Erickson who first emphasised that therapy should focus on finding solutions rather than analysing the history of the problem. Thus making therapy briefer and  more efficient.

Origins of Solution focused brief therapy

Bill O’Hanlon, a student of Erickson’s, developed a non-hypnotic approach to Brief therapy that focused on solution-focused change, utilising the client’s existing resources, opportunities and possibilities.

The Mental Research Institute in Palo Alto, California developed a model of Solution-focused change based partly on the work of Erickson and others. This model contained four guiding principles:

  1. Define the problem in observable terms (i.e. locations, interactions, behaviours, communications, etc).
  2. Set specific goals for change
  3. Identify old ‘solutions’ that haven’t worked
  4. Discard the old solutions and experiment with new approaches

Working in social work settings in the 1970s Insoo Kim Berg and Steve de Shazer developed a minimalist approach to therapy based on a core set of simple questions addressed to clients.

Goal questions: How would you like things to be different?

Exception questions: Has there ever been a time when you didn’t have the problem?

Difference questions: Has there ever been a time when things turned out better than you expected?

Miracle questions: If you woke up tomorrow and the problem had vanished, what would be different about you?

Scaling questions: On a scale of 0-10 where are you now on the scale of improvement? What will be different when you move one point up the scale?

Principles of Solution focused brief therapy

Solution focused brief therapy is based on the recognition that the majority of people resolve their problems without therapy, and that people are constantly changing throughout life. Solution-focused therapists look for ways in which their clients have already changed, and utilise that learning in the service of further change. For example, many people have resolved some conflicts with other people; their experiences in the past can be applied to their relationships in the present.

Related to this last point is the recognition that the majority of mental health problems are triggered (or made worse) by adverse life events: work-place stress, family conflicts, bereavement, financial problems and relationship breakdown to name a few. Helping people to adapt to, and overcome, adversity is key to the solution-focused approach. In that way it helps clients develop resilience.

Most (although not all) clients are quick to learn, and research shows that most of the benefits they accrue from therapy will take place in 8-10 sessions, with many needing fewer than that. This points, also, to the advantage of setting clear-cut goals at the start of treatment, as that gives more point to the sessions that follow.

Solution focused brief therapists argue that, beyond certain limits, analysing the history of the problem can be a barrier to improvement, as clients get stuck in painful experiences from the past rather than improving their position in the present. Long-winded analysis also makes therapy more expensive, thereby reducing access to all but the wealthy.

Key principles of work include:

  1. Focusing on goals and solutions rather than the past and its problems,
  2. The client is the ‘expert’ on change, not the therapist.
  3. The first task of the therapist is to assist clients to see the problem from a different point of view
  4. The second task is to mobilise the client’s available resources.
  5. Resources include: personal strengths, values, thought processes, experiences, relationships, skills and motivations.
  6. Where skills are missing, these can be acquired in therapy.
  7. Solution focused brief therapy is wary of psychiatric labels that stigmatise clients.
  8. Most therapeutic issues are grounded in adverse life events; addressing these improves resilience.
  9. Solutions don’t have to be perfect or permanent; learning is a life-long process.
  10. Clients can have as many, or as few, sessions as they need.

Solution focused brief therapy techniques

Here is a partial list of ideas and techniques used in SFBT:

Reframing problems from a more hopeful perspective.

Defusing from unhelpful thoughts.

Connecting to values and emotions that drive change.

Accepting what can’t be changed, and influencing situations that can.

Solution focused questions.

Utilising existing strengths.

Building resilience.

Finding new ways to solve old problems.

Behavioural activation.

Reinforcing success.

A Solution focused brief therapy process

Here is a self-help guide to therapy using solution-focused techniques:

First identify any recurring event you would rather not have in your life. For example: losing your temper, social anxiety, avoiding challenging situations, stressing out, drinking to excess, people-pleasing, negative thinking, etc.

Next define how you would like to be instead. For example: staying calm, confident, self-controlled, assertive, positive, etc. Be clear and specific about new ways you would be thinking, feeling, speaking and behaving. Imagine yourself doing all these things in a specific situation at work, at home, or in your community.

Use solution-focused questions to identify potential resources. Write your answers down.

Past success. Has there ever been a time when you were successful in doing X?

Exceptions. Has there ever been a time when things were better than you expected them to be?

‘Good enough’. Has there ever been a time when things were relatively Ok? (Not perfect, just better).

Analogous situations. Has there ever been a situation in which you achieved something like X? How could that be adapted to the problematic situation?

Modelling. Think of a person who has the qualities you would like to have yourself. What would this person think, feel, say or do in your (problematic) position?

Motivation. What is your most important reason for change? Improving a relationship? Building confidence? Health? Career advancement? Making new friends? Self-respect? Stress reduction? Think of the ways in which change could make you a better person.

Thought change. If there is a thought that gets in the way of change, then defuse from the old thought and replace it with a more realistic thought. For example: ‘I am hopeless‘ could change to ‘My best is good enough.’

Imagining the solution. Imagine looking back at a successful moment. What was different about you?

Build an action plan. Based on your findings, map out the series of steps you will take towards your goal.

First step. What is the smallest step you could take to get started? For example, if you are anxious about meeting new people, then going into a crowded bar for ten minutes with a friend could be your initial move.

Scaling. If you have taken your first step, how would you rate your performance on a scale of 0-10? What will be different when you go one point higher on the scale next time?

Continuous improvement. Keep moving towards your goal: adapting to circumstances and discoveries, bringing in new resources, getting help from friends, and revising your performance.

 

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