Solution-Focused Counseling:

An Integrative Approach

Jeffrey T. Guterman, Ph.D.Friday, November 12, 2010

8:45 a.m. – 4:15 p.m.

Responsibility House, Inc.Celebration ChurchMetairie, Louisiana

Copyright © 2010 Jeffrey T. Guterman

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Workshop Description

Solution-focused counseling is a strength-based integrative model that emphasizes clients’ existing and potential problem-solving skills. This workshop offers an opportunity for clinicians of diverse orientations, roles, and settings to learn the theory and techniques of solution-focused counseling. Workshop participants are introduced to the clinical stages of the model. Case examples and research illustrate the solution-focused approach to a variety of clinical issues and populations, including clients with co-occurring disorders. The workshop includes exercises to help attendees quickly learn and apply the material.

About the Presenter

Jeffrey T. Guterman, Ph.D. joined the Counseling Program in the Adrian Dominican School of Education at Barry University in 2004. He currently holds the position of Associate Professor. Guterman is a Licensed Mental Health Counselor in Florida. He is a Qualified Supervisor for Marriage and Family Therapists and Mental Health Counselors for the Florida Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling. In the 1980s, Guterman was influenced by rational emotive behavior therapy (REBT) and received training and supervision in the model from its founder Albert Ellis. In the 1990s, Dr. Guterman shifted to a solution-focused approach. Solution-focused therapy is a strength-based model pioneered by Steve de Shazer and his colleagues at the Brief Family Therapy Center in Milwaukee, Wisconsin. Guterman subsequently developed a unique model called solution-focused counseling. His 1994 article, “A Social Constructionist Position for Mental Health Counseling” was published in the Journal of Mental Health Counseling and instigated a debate in both print and at workshops held at the American Counseling Association’s (ACA) annual conferences in the 1990s. In 2006, Guterman’s book, Mastering the Art of Solution-Focused Counseling was published by the ACA. Guterman has published over 100 articles and has served on various editorial and advisory boards, including the Journal of Counseling & Development, Journal of Mental Health Counseling, and The Family Journal: Counseling and Therapy for Couples and Families.

Contact information

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Jeffrey Guterman, Ph.D., Barry University, 11300 NE 2nd Avenue, Powers Building, Room 277, Miami Shores, FL, 33161

Email: jguterman@mail.barry.edu

Phone: 305-899-3862 / 800-756-6000 x 3862

Web: http://JeffreyGuterman.com

Workshop Schedule

8:45 a.m. Introduction to Solution-Focused Counseling

Overview and introduction to solution-focused counseling Key concepts and principles for solution-focused counseling

Solution-Focused Counseling Theory

Theory of problem formation Theory of change Strategic approach for integrative treatment

10:30 a.m. Break

10:45 a.m. Clinical Stages in Solution-Focused Counseling

Co-constructing a problem and goal Identifying and amplifying exceptions Co-constructing tasks Identifying and amplifying exceptions derived from tasks Re-evaluating the problem and goal Workshop exercise

12:00 p.m. Lunch

1:00 p.m. Solution-Focused Counseling Techniques

More of the same

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Mapping the influences of the problem Scaling techniques Journaling

2:30 p.m. Break

2:45 a.m. Solution-Focused Counseling Applications

Co-occurring disorders Workshop exercise Group discussion

4:15 p.m. End of Workshop

Learning Objectives

1. Understand key concepts and principles that inform solution-focused counseling.

2. Understand the theory of problem formation and change corresponding to solution-focused counseling.

3. Understand the clinical theory of solution-focused counseling’s strategic approach for integrative treatment.

4. Understand the clinical stages in solution-focused counseling, including (a) co-constructing a problem and goal, (b) identifying and amplifying exceptions, (c) co-constructing tasks, (d) identifying and amplifying exceptions derived from tasks, and (e) re-evaluating the problem and goal.

5. Develop knowledge and skills for practicing various solution-focused techniques, including (a) solution-focused questions, (b) mapping influences of the problem, and (c) scaling techniques.

6. Develop knowledge and skills for the application of solution-focused counseling to a variety of clinical issues and populations, including clients with co-occurring disorders.

Formula First Session Task

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Between now and next time we meet, I want you to observe so that you can tell me next time what happens in your life that you want to continue to have happen (Molnar & de Shazer, 1987).

Principles of Solution-Focused Counseling

Collaborative approach

Solution-focus

Small changes can lead to big results

Emphasis on process

Strategic approach

Brief by design, but not always

Responsiveness to diversity

What is an Exception?

Solution-focused theory holds that for every “problem” there is an exception. An exception refers to “times when the . . . problem does not happen even though the client has reason to expect it to happen” (de Shazer, 1991, p. 83).

Problem Formation

Problems are seen to maintain themselves simply because they maintain themselves and because clients depict the problem as always happening. Therefore, times when the complaint is absent are dismissed as trivial by the client or even remain completely hidden from the client’s view. Nothing is actually hidden, but although these exceptions are open to view, they are not seen by the client as differences that make a difference. For the client, the problem is seen as primary (and the exceptions, if seen at all, are seen as secondary), while for therapists the exceptions are seen as primary; interventions are meant to help clients make a similar inversion, which will lead to the development of a solution. (de Shazer, 1991, p. 58)

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Theory of Change

Problem / Exception

Strategic Approach

Process and Content

Process refers to what counselors and clients do (i.e., interventions, methods, and techniques) to facilitate change.

Content refers to the object of change in any given clinical theory.

Formal Content and Informal Content

Formal content refers to the counselor’s assumptions about the predetermined cause of problems that is addressed across cases.

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Informal content refers to the client's subjective, idiosyncratic assumptions about the cause of a problem. (Guterman, 2006, Held, 1991)

The formal content in solution-focused counseling is Problem / Exception. The client's informal content (e.g., Ineffective coping skills for depression) is subsumed within the formal content of solution-focused counseling:

Ineffective coping skills for depression / Effective coping skills for depression

Using Formal Content as Informal Content in Solution-Focused Counseling

The strategic approach involves using formal content from another clinical model as informal content within the formal content of solution-focused counseling. Formal content may be used as informal client if the client is a previous consumer of another model and/or if the clinician assesses the formal client fits with the client's worldview. For example, if a previous consumer of rational emotive behavior therapy (REBT) presented for solution-focused counseling, the formal content of REBT (i.e., irrational beliefs) would be conceptualized as informal content within the formal content of solution-focused counseling (i.e., problem/exception). Such a conceptualization might take the form of:

Irrational beliefs / Rational beliefs

Co-constructing a Goal

Goal is stated in positive languageo Develop goals in positive language (i.e., as an increase of

something) rather than negative language (i.e., as a decrease of something).

Goal is measurable, observable, and specific

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o Ask clients to provide a video description of when the goal is happening.

o In some cases it might be preferable to generalize the goal due to its rigid specificity.

Goal is small and limitedo In some cases, the goal might be too large in scope.

Goal is relevant to the problem and cliento It is important for the goal to fit with the client’s problem and

worldview.

Identifying Exceptions

Questions aimed at identifying exceptionso “When has there been a time when the problem has been

improved? When the goal has been reached?” (presuppositional questions)

Identify small exceptionso If the client says there are no exceptions, then attempt to

identify small exceptions.o “When has there been a time when the problem has been

slightly improved? When the goal has been partly reached?” (presuppositional questions)

Identify potential exceptionso If the client is unable to identify small exceptions, identify

potential exceptions.o “How will things be when the problem has been improved? How

will it be when the goal has been reached?” (presuppositional questions)

Miracle Question

“Suppose that one night there is a miracle and while you are sleeping the problem that brought you into therapy is solved: How would you know? What would be different?” (de Shazer, 1988, p. 5)

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Questions for Amplifying Exceptions

How did you make it happen?

How is that different from how you have dealt with the problem in the past?

How did it make your day go differently?

Who else noticed?

What did you tell yourself to make it happen?

What does this say about you and your ability to deal with the problem?

What are the possibilities?

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Solution-Focused Tasks

Task # 1

The client is told and asked, “Between now and the next time, I would like you to observe, so that you can tell me next time, about those times when you are able to make it (the goal) happen.”

Rationale: This task is given if the client is able to construct a problem and goal, and identify and amplify exceptions.

Task # 2

The client is told and asked, “Between now and the next time, I would like you to pay attention to and make note of what you do when you are able to effectively cope with or deal with the problem.”

Rationale: This task is given if the client is able to construct a problem and goal and identify exceptions, but is unable to amplify exceptions.

Task #3

The client is told and asked, “Between now and the next time, I would like you to observe, so that you can tell me next time, what happens in your life (relationship, family, work situation) that you want to continue to have happen.”

Rationale: This task is given if the client is able to construct a problem and goal, and potential exceptions, but is unable to identify exceptions.

Task # 4

The client is told and asked, “Try to avoid making any drastic changes. If anything, think about what you will be doing differently when things are improved.”

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Rationale: This task is given if the client is able to construct a problem, but is unable to construct a goal.

Task # 5

The client is told and asked, “The situation is very volatile. Between now and the next time, attempt to think about why the situation is not worse.”

Rationale: This task is given if the client is in severe crisis.

(cf., Guterman, 2006; Molnar & de Shazer, 1987)

Solution-Focused Checklist

Did you carefully and patiently help the client identify exceptions?

Small exceptions?

Potential exceptions?

Did you try asking your questions differently?

Did you persist in your efforts?

Did you negotiate a small, simple, and relevant goal that the client knows how to accomplish?

Did you amplify the exceptions?

Maybe the client identified a small or potential exception during the session but he or she—and you!—considered it to be irrelevant or unremarkable.

Did you try a strategic approach to eclecticism?

Did you try doing something different?

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Solution-Focused Techniques

Mapping the influences of the problem

Help the client identify how the problem has influenced his or her life across various domains (e.g., work, relationships, health, recreation).

Later, use these influences as signposts for identifying exceptions (small exceptions, potential exceptions) in relation to the influences.

When clients are very problem-focused, mapping the influences of the problem provides an opportunity for clients to “talk about the problem,” address its influences, and not have the problem “stolen away from them.”

(cf. White & Epston, 1990)

Scaling

Many clients understand the problem as an on/off experience. Scaling techniques help clients identify exceptions.

Clients rate their subjective experiences in relation to how they feel, how they cope, how they deal with their problems, on a scale from 0 to 10.

Clients are asked to keep a written record of their ratings.

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The counselor reviews the record and identifies and amplifies exceptions in relation to the best ratings.

(cf. Molnar & de Shazer, 1987)

Journaling

Ask the client to keep track of times when the problem does not happen or when the goal happens.

Ask the client to describe in detail what they did, how they coped, and what was different when the problem did not happen.

Ask the client to make note of any small, positive changes.

Workshop Exercise #1

Practice identifying and amplifying exceptions

Break into pairs and take turns role playing. First, one of you will be the counselor and the other will be the client. Then, you will reverse roles.

Practice identifying and amplifying exceptions in keeping with the solution-focused counseling model.

For purposes of this exercise, consider that the problem and goal has already been co-constructed as follows: The problem is ineffective coping with stress at the workplace. The problem is conceptualized within solution-focused counseling’s problem/exception theory as

Ineffective coping skills at the workplace / Effective coping skills at the workplace

The goal is: Increase effective coping skills for stress at the workplace

In your role as counselor, spend 5 minutes in a conversation with your partner who is in the role of client in an attempt to identify and amplify exceptions to the problem. Then, switch roles.

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Document below all exceptions and amplifications that are identified.

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Workshop Exercise #2

When has there been a time when you have been particularly effective at helping clients identify and build upon their own resources, strengths, and problem-solving capabilities and thereby develop solutions to their problems.

– What did you do to make it happen?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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____________________________________________________________________________________________________________________________________________________________

– What did you do differently in this situation? What did the client do differently?

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

– What else was different? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

References

de Shazer, S. (1988). Clues: Investigating solutions in brief therapy. New York: Norton.

de Shazer, S. (1991). Putting difference to work. New York: Norton.

Guterman, J.T. (2006). Mastering the art of solution-focused counseling. Alexandria, VA: American Counseling Association.

Held, B.S. (1991). The process/content distinction in psychotherapy revisited. Psychotherapy, 28, 207- 217.

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Molnar A., & de Shazer, S. (1987). Solution-focused therapy: Toward the identification of therapeutic tasks. Journal of Marital and Family Therapy, 13, 349-358.

White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New

York: Norton.

Suggested Readings

Berg, I.K., & Miller, S.D. (1992). Working with the problem drinker: A solution-focused approach. New York: Norton.

de Shazer, S. (1985). Keys to solution in brief therapy. New York: Norton.

de Shazer, S. (1988). Clues: Investigating solutions in brief therapy. New York: Norton.

de Shazer, S. (1991). Putting difference to work. New York: Norton.

de Shazer, S. (1994). Words were originally magic. New York: Norton.

de Shazer, S., Berg, I. K., Lipchik, E., Nunnally, E., Molnar E., Gingerich, K., & Weiner-Davis, M. (1986). Brief therapy: Focused solution development. Family Process, 25, 207-222.

de Shazer, S., & Dolan, Y. (2007). More than miracles: The state of the art of solution-focused brief therapy. Binghamton, NY: Haworth Press.

Guterman, J.T. (2006). Mastering the art of solution-focused counseling. Alexandria, VA: American Counseling Association.

Guterman, J.T., & Leite, N. (2006). Solution-focused counseling for clients with religious and spiritual concerns. Counseling and Values, 51, 39-52.

Lipchik, E. (2002). Beyond technique in solution-focused therapy: Working with emotions and the therapeutic relationship. New York: Guilford.

Molnar A., & de Shazer, S. (1987). Solution-focused therapy: Toward the identification of therapeutic tasks. Journal of Marital and Family Therapy, 13, 349-358.

Recent Publications: Jeffrey T. Guterman

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Buter, S., Guterman, J.T., & Rudes, J. (2009). Using puppets with children in narrative therapy to externalize the problem. Journal of Mental Health Counseling, 31, 225-233.

de Castro, S., & Guterman, J.T. (2008). Solution-focused therapy for families coping with suicide. Journal of Marital and Family Therapy, 34, 93-106.

Guterman, J.T., & Rudes, J. (2008). Social constructionism and ethics: Implications for counseling. Counseling and Values, 52, 136-144.

da Costa, D., Nelson, T., Rudes, J., & Guterman, J.T. (2007). A narrative approach to body dysmorphic disorder. Journal of Mental Health Counseling, 29, 67-80.

Rudes, J., & Guterman, J.T. (2007). The value of social constructionism for the counseling profession: A reply to Hansen. Journal of Counseling & Development, 85, 387-392.

Guterman, J.T. (2006). Mastering the art of solution-focused counseling. Alexandria, VA: American Counseling Association.

Guterman, J.T., & Leite, N. (2006). Solution-focused counseling for clients with religious and spiritual concerns. Counseling and Values, 51, 39-52.

Guterman, J.T., & Rudes, J. (2005). A solution-focused approach to rational emotive behavior therapy: Toward a theoretical integration. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 23(3), 223-244.

Guterman, J.T., Mecias, A., Ainbinder, D.L. (2005). Solution-focused treatment of migraine headache. The Family Journal: Counseling and Therapy for Couples and Families, 13, 195-198.

Guterman, J.T., & Rudes, J. (2005). A narrative approach to strategic eclecticism. Journal of Mental Health Counseling, 27, 1-12.