CHAPTER 10: Solution-Focused
Therapy in the Treatment of
Substance Abuse and Addiction
Substance Abuse and Addiction Treatment:
Practical Application of Counseling Theory
First Edition
Todd F. Lewis
Developed by Katie A. Wachtel, University of North
Carolina at Greensboro
Introduction
•A
postmodern approach that aims to understand
client’s constructions about a problem and then coconstruct ways to view it so that solutions emerge
naturally
•Brief,
strength-based, goal-focused
•This
chapter discusses the major tenets of SolutionFocused Therapy (SFT), identify application strategies
for individuals with addiction, and discuss how SFT
can be implemented in group counseling
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
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The Major Tenets of SolutionFocused Therapy
•Many
substance abuse clients present as if they
“are” their problems
•SFT
promotes the notion that clients are separate
from their problems (externalization)
•Developing
solutions can occur outside of talking
about problems
•Solution-talk
•Focus
can promote change
on solutions rather than problems
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
10-3
The Major Tenets of SolutionFocused Therapy Continued
•Look
for solutions by asking questions about when
the problem is NOT happening (exceptions)
•Pay
attention to what works rather than what does
not work
•Actions
are circular
•Use
verbs to highlight problems as changeable and
temporary
•Change
is constant
•Promotes
the client as the expert
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
10-4
The Major Tenets of Solution-Focused
Therapy Continued
Role of the Solution-Focused Clinician
Find out what the client wants
Look for more of what is working and do it more
Clarify and define goals
Focus on present and future
Theory of change
Clients become more flexible in their thinking and behaving
Clients become aware of exceptions to the problem
Criteria for Effective Counseling Outcomes
Co-construction and realization of an ACTIVE solution/goal
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
10-5
Application of Solution-Focused
Therapy with Substance Abuse
Problems
•Focus
on what is going right for the client, rather
than what is going wrong
•Help
clients realize resources they possess to reach
their goals
•What
does the client want?
•What
has the client done to get what he wants?
•What
does the client have to do to get more of what
he wants?
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
10-6
Application of Solution-Focused
Therapy with Substance Abuse
Problems Continued
Step one: Establish a cooperative clinician-client relationship
Step two: Develop treatment goals. Make them:
Relevant
Small
Concrete
Focused on the presence of something rather than the absence
Start at the beginning
Reasonable to client abilities
Perceived by the client as involving hard work
Step
three: Orient the client toward a solution to substance use
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
10-7
Solution-Focused Based
Techniques
Miracle question
Scaling questions
Exception questions
Presupposition questions (future oriented questions)
Relationship oriented questions
Taking in the good (TIG)
Exploration of goals
Taking a break
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
10-8
Solution-Focused Group Therapy
•SFT
has been incorporated into group therapy
(SFGT)
•Goals
can be different for different members
•Exploring
exceptions is effective (talk in terms of
periods of sobriety)
•Miracle
format
question can be processed in a group
•Note:
Outcome research on SFT and SFGT is
building, but more is needed
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
10-9
Solution-Focused Therapy in the
Treatment of Diverse Populations
•SFT
is useful with diverse populations because of its
belief in honoring what the client wants and client
strengths
•Studies
have shown SFT to be effective with AfricanAmerican, Latino, and Asian clients
•Clinicians
must be aware that solutions can look
different for different cultures
•There
is argument that by focusing on the self, SFT
ignores cultural and racial issues that impact clients;
SFT does not promote collectivism
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
10-10
Running Case Study: Michael
•Clinician
uses SFT to help Michael begin to think about
solutions rather than problems
•Clinician
helps develop concrete, behavioral goals,
reframes goals to focus on the presence of something
rather than the absence of something, emphasizes the
work necessary to obtain goals, uses the miracle question,
helps Michael identify exceptions, reinforces successes to
focus on strengths, and uses scaling questions,
presupposition and relationship oriented questions
•Michael
is able to set small, obtainable goals and begins
to focus on strengths and solutions, rather than problems
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
10-11
Strengths, Limitations, and Ethical
Issues Related to SFT
Strengths
SFT can be used independently or along with other
treatments
Respectful, strength-based, focuses on client
wants/needs
Little incompatibility for other treatment models
Flexible and economical
Emphasis on strengths, resources and abilities
Helps build confidence and self-esteem
Well-suited for group therapy
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
10-12
Strengths, Limitations, and Ethical
Issues Related to SFT Continued
Limitations
Some may see as too simplistic
Can be difficult to know where to go after the first few
sessions
Limited empirical support
Does not sufficiently address the physiological aspects of
addiction
Unfamiliar referral sources may question the
effectiveness
Ethical Issues
Requires sufficient training to be used ethically
Fails to take physiological aspects into account
Lewis. Substance Abuse and Addiction Treatment: Practical Application of
Counseling Theory, First Edition. © 2014 by Pearson Education, Inc. All Rights
Reserved
10-13