Care & Recovery Coordination
2015
Solution Focused Therapy
A Strengths-based Approach
What do we mean by a strengths-based
approach?
Solution Focused Therapy (SFT)
• Has roots in the work of Milton Erikson
• Erikson believed that problems experienced by
individuals and families are not reflective of
neurotic or pathological traits
• Problems are best conceived as ineffective
solutions
• Erickson suggested that people inherently know
the correct answers to their problems
• Solution Focused therapists see clients as coming
to therapy seeking expression, not help
Solution-Focused Therapy
A competency-based therapy whereby the
counsellor takes the view that a focus on
problems tends to obscure client resources and
solutions and whereby clients are valued and
respected for their skills, capacities, potential,
hopes and dreams.
Solution focused therapy is described as
useful because…
• It is practical and simple
• It is a brief therapy making it attractive
especially in services where episodes of care
are limited e.g. CRC
• It has a cognitive emphasis
Solution focused therapy is…
• Usually brief and focuses on
• What is the positive outcome the client is
wanting?
• What specifically will be different when the
outcome is achieved?
• What are examples of either current or past
behaviours that indicate achieving of goals
The key assumptions is…
• The client is not experiencing
problematic AOD use 24 hours a day, 7
days a week and 365 days per year
Solution focused therapy
Key assumptions (1)
• Clients have resources and strengths to resolve
complaints.
• This asserts that clients have inherent strengths and
abilities that can be used to to address their complaints
• Clients may be using strengths and not be aware of this
• Focusing on desired outcomes is of greater use
• There are always exceptions to the problem and this is
where solutions will be identified
• SFT makes the assumption that, even if only rarely, clients
do experience times where they are not experiencing the
problem
Solution focused therapy
Key assumptions (2)
• Clients are separate from their complaints
• It is important for workers to be clear that the
client is not the problem. A client is not an addict
but someone who is experiencing difficulties,
however severe.
• It is imperative that the worker assist the client to
define that they are much more than someone
with and AOD related problem
Solution focused therapy
Key assumptions (3)
• Clients know what is right for them
• The client is the expert on himself
• Clients are much more aware of goals that are
realistic and strategies that best suit them
• The emphasis is on support of the clients goals
Solution focused therapy
Key assumptions (4)
• Small changes can lead to bigger changes
• The goal is not to address all problems at once . A
small change is all that is necessary. Small changes
lead to larger changes
• Address one or two smaller goals
• Change occurs when people experience
themselves as competent and successful
• Change is possible when people tap into the
possibility that their situation can be different
Solution focused therapy
Key assumptions (5)
• The worker’s task is to identify and amplify
change
• The key to supporting change is for the worker to
illuminate where change might already be starting
to take place
• Having an extensive history is not a prerequisite
for assisting the client in developing effective
solutions
• Effective solutions do not always have a logical
connexion to the aetiology of the problem
Solution focused therapy
Key assumptions (6)
• Solution focused therapy is theoretical and
client determined
• Little time is devoted to figuring out or explaining
why problems exist
• The client's view is simply accepted at face value
Solution focused therapy
Key assumptions (7)
• Parsimony
• Accepting the clients complaint at face value and
then choosing the simplest, least invasive
treatment option and keeping it simple
• The term simple permeates this style of therapy
• Striving for economy, conducting treatment from
the bottom up
Solution focused therapy
Key assumptions (8)
• Change is inevitable
• The assumption that change is much part of living
that clients cannot prevent themselves from
changing
• Therapy identifies change, and utilises it to bring
about a solution
• The worker searches for those times when a
problem is not a problem
Solution focused therapy
Key assumptions (9)
• Present and future orientation
• This approach has a strong orientation toward the present
and the future
• This process orientates clients away from the past problem
and toward the future solution
• The use of the miracle question
‘Suppose that one night, while asleep there is a miracle and the problem that
brought you here is solved. However, because you are asleep you don’t know
that the miracle has already happened. When you wake up in the morning,
what will be different that will tell you that the miracle has taken place? And,
what else?’
Solution focused therapy
Key assumptions (9)
• Cooperation
• An overall attitude of cooperation permeates the
solution focused approach
• Not only must the client cooperate, but also so
must the worker
• Solution focused workers are described as very
rarely having difficult or resistant clients
Solution focused therapy for AOD use
problems
• SFT considered similar to motivational interviewing
in that there is very clear set of techniques and
strategies recommended
• The strategies are the same for clients with AOD
issues as for other health concerns
• The worker emphasises finding solutions, not on
discovering the cause or origins of the problem
Solution focused therapy for AOD use
problems
• Berg and Miller’s rules:
• If it ain’t broke don’t fix it
• Once you know what works, do more of it
• If it doesn’t work, then don’t do it again – do
something different
Client Suitability
Certain client groups may not be considered suited:
 Clients in immediate need of medical attention as a result
of their current drug use (e.g., overdose or severe
withdrawal)
 Clients who have marked cognitive deficits, particularly in
the areas of concentration, attention and short-term
memory impairment
 Clients experiencing acute psychological distress
 Clients with an intellectual disability whereby SFT may be
too cognitively demanding
 People invested in maintaining their problems
Worker Stance
• Collaborative
• “Not Knowing”
•
“… rather than seeing oneself as having expert
knowledge about the nature of someone’s problem, and
therefore able to diagnose it and/or solve it, the
practitioner must relinquish this role and, instead, start
from a very different place – the place of skilled
unknowing.”
Weick, Kreider & Chamberlain (2006, p. 125) .
Questions as useful tools
• Key questions guide the counsellor and provide direction
• Sequence
– not bound by a rigid set of rules or procedures. Counsellor
works according to the principle - find out what works and do
more of it. If a particular question is not working, the
counsellor should move to another one that might be more
productive
• Language
• the words that are used aim to help the client move
forward in the desired direction
The Words We Use
• Steve de Shazer emphasised that what we say does
make a difference
Examples:
• Instead of “what’s been happening?” ask:
“How may I be of help to you?”
• Instead of “how’s things?”, ask:
“What’s better?”
• Instead of “what will be different?, ask:
“What will you be doing differently?”
Getting Started:
The Counsellor’s Tasks
• Adopt a not-knowing position – view the client as the
expert in his/her life
• Create a collaborative relationship and assume the client
wants to cooperate
• Ask for the client’s understanding of the situation
• Listen for who and what are important to the client
• Listen for what the client might want to be different in
his/her life
• Accept what the client wants as valid and reasonable
• Help the client to explore signs that indicate that changes
are already happening
Pre-session Change Questions
• Change happens all the time and has already occurred by
the time the client has his/her first counselling session
• Aim to identify what useful actions the client has taken
before the session. The act of making an appointment
means the person is already thinking about how
counselling will help achieve a better future
• “Between the time you first thought about making an
appointment at this service and now, what have you
noticed that’s different for you or better?”
From Problem Talk to Solution Talk
Problem Talk
Solution Talk
• What they don’t want
• What they do want
• When things go wrong
• When things go right
• Forces beyond their control
• Forces within their control
• Being stuck
• Making progress
• Expecting more troubles
• Expecting positive
possibilities
Key Solution Focused Interventions
•
Exceptions
•
Miracle Question
•
Scaling
•
Compliments
•
End of Session Tasks
Exceptions Questions
There are always exceptions - times and circumstances
in the past when the problem did not exist or when
things were better
The aim is to locate as many exceptions to the problem
as possible and then build upon these exceptions
“When was this not a problem for you?”
End of Session Tasks
• “Homework” - assignments given to clients to help re-orient
clients from focusing on negatives and focusing on the future
• Behavioural Tasks (think about, do)
• “Between now and the next time we meet, think about ….”
• Observational Tasks (notice)
• “Pay attention to what’s different when you resist having a
drink. “
Why Ask The Miracle Question?
• 1. Is a way of setting treatment goals
• 2. Has an experiential component – emotion/body
• 3. Provides an opportunity to ask about exceptions
(what is already working – the bits of the miracle
that are already happening)
• 4. Creates an opportunity to talk about possibilities
Therapist stance in asking the miracle
question
• A not-knowing approach
• Respect the client’s answer (not pushing; not making
interpretations)
• Believe in the client’s capacity to create meaningful
descriptions about what they want in their lives
• Accept the “dream” answer (e.g,. “I’d win lotto”) –
Respond by saying something like “Yes, that would be
nice”. Then wait.
How to Ask the Miracle Question
• Step 1.
“Is it okay if I ask you a strange question?”
Wait until the client nods or says “yes” before
continuing
Asking the Miracle Question
• Step 2.
“ Let’s suppose that after we talk here today you leave
and you go to do whatever you usually do on a day like
this. Then you come home, you have dinner, perhaps
watch TV, do whatever you would normally do as the
evening goes on”
Then pause. Wait for the nod or some other indicator
that the client is processing what you have said.
Asking the Miracle Question
• Step 3.
“Then it gets late, you get tired, you go to bed, and
you fall asleep.”
Wait for a confirmatory nod and you know the
client is following you.
Asking the Miracle Question
• Step 4:
“Then during the night … while you’re sleeping... a
miracle happens.”
Then pause for a short while, just long enough to
elicit some kind of reaction.
Asking the Miracle Question
• Step 5:
“And not just any miracle. It’s a miracle that makes
the problems that brought you here today go away…
just like that”
Asking the Miracle Question
• Step 6:
“But since the miracle happens while you are
sleeping you won’t know it happened”.
Asking the Miracle Question
• Step 7:
“So … you wake up in the morning. During the night a
miracle happened. The problems that brought you here
are gone, just like that … How do you discover that things
are different? What is the very first thing you notice after
you wake up?”
Relax, take a deep breath and wait for the answers.
Listening for Answers and Responding
• Asking about awareness that the problem has gone:
“What is the first thing that you notice that is different?”
“What are you doing that is different as a first sign that the
problem has gone?”
How do other people notice that something is different?
Dealing with Responses to the Miracle
Question
• I don’t know (or silence)
Important to remain silent for a few seconds to give the
client time to think.
Dealing with Responses to the Miracle
Question
• The “will not” answer
Usually descriptions of what the client will not
feel, will not do, will not think or what other
people will not …… etc.
Dealing with Responses to the Miracle
Question
• The thinking/feeling answer
e.g., “I’d wake up and think this is great. I can look
forward to a nice day”
Dealing with Responses to the Miracle
Question
• The behaviour answer
• When it is concrete and detailed, it acts as a
rehearsal for everyday experience
• The more detail that can be evoked and described,
the more vivid the imagined situation and the more
likely this is to be translated into in real life
experience
Unrealistic Answers to the Miracle Question
Examples:
• “Others will be different”, “I’ll win tattslotto”
• Can be the result of errors in asking the Miracle
Question – e.g., wording, timing, unclear goal
• Important to be flexible – e.g., might need to vary the
question to suit the client
Detailing the Miracle Question
• What do other people notice?
• How will other people react?
Scaling Questions
• Scales expand on exceptions and future visions
• Scales for change, confidence, motivation, coping,
effort
• Allows therapist and client to recognise and nurture
small changes toward the goal
 “On a scale of one to ten, one being how you felt
when you decided to seek counselling and ten being
‘this problem is fixed’, where are you now?”
Scaling Example
Compliments
A. Direct Compliments
Emotional support that comes across through via words
such as “That’s Great”, “Wow”, “You’ve done really well”
B. Indirect Compliments
Highlighting recent change
“How did you manage to do that?”
“What do you suppose your friends have noticed about you?”
C. Self-Compliments
Client-generated compliments
“I went 3 days without …”
Activity
DVD – counselling session
Solution focused strategies
•
•
•
•
Ask the miracle question
Ask about exceptions
Explore differences
Using a scaling system to determine how well things
are going
• Try taking time out
• Affirm the clients competencies
• Suggest tasks
THANKS
Sharon Patterson
Senior Education Officer
T: 03 8413 8457